Where You Live Determines How Much You Pay For Health Insurance

By Julie Appleby

By Jordan Rau

When buying health insurance, where you live matters. In Pennsylvania and more than a half dozen states, consumers in some cities will pay at least 50 percent more for the same type of coverage than their friends and relatives in other parts of the state.

A 40-year-old in Philadelphia, for instance, will spend $300 a month to buy a mid-level insurance plan in the new Obamacare marketplace -- 77 percent more than a 40-year-old in Pittsburgh, where the same type of coverage will cost a more modest $169 a month.  Lower-income people eligible for federal subsidies will spend less.

Consumers in Georgia, Wisconsin, California, Arizona, Missouri and Florida will also see wide variations, ranging from more than a 100-percent cost spread between high- and low-cost regions of Georgia, to 82 percent in Wisconsin and 52 percent in Florida.

Long a fact of life in the world of insurance brokers, rate variations within a single state have been thrown into sharp relief because for the first time, consumers can compare prices for comparable products by logging into the new online marketplaces. Earlier this week, the Obama administration released average premium prices for the policies that will be sold in the 36 states whose markets are being overseen entirely or in part by the federal government.

“Identical people with identical incomes will face very different choice and cost of plans,” said William Custer, director of the Center for Health Services Research at Georgia State University

For instance, a 40-year-old in rural southwest Georgia would pay $481 a month for a midlevel plan - more than double the cost of someone in the eastern portion of the state, where the premium is $238.

And in California, a 27-year-old buying insurance in Los Angeles will pay $209 a month, 56 percent less than his counterpart in in El Centro, near the Mexican border, who will pay $325. Those premiums are for the second lowest cost plan in the “silver” level of coverage and don’t include subsidies, which will bring down the cost for many consumers.

Insurance, Like Politics, Is Local

An estimated 7 million people in 2014 are expected to buy coverage through the new markets, which open for enrollment on Tuesday. The majority of states, including Pennsylvania, defaulted to the federal government to operate their marketplaces or are partnering with the federal government. 

“They say all politics is local, and insurance and healthcare are local as well,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, a nonpartisan health policy group. (Kaiser Health News is an editorially independent program of the foundation.)

Insurer competition correlates strongly with lower prices, federal data show: Georgia’s highest-price region, for instance, has only one insurer -- Blue Cross Blue Shield of Georgia, Custer said. In other parts of the state, different insurers are offering different prices even for the same type of coverage, he said. 

source : Where You Live Determines How Much You Pay For Health Insurance

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'Krokodil' Drug FAQ

Deadly Drug May Have Entered the U.S.

By Kathleen Doheny
WebMD Health News

Reviewed by Arefa Cassoobhoy, MD, MPH

Sept. 30, 2013 -- A deadly, homemade drug known as krokodil may have made its way from Russia to the U.S.

Two people in Arizona are suspected of using the heroin-like drug, which rots the skin from the inside out, says Frank LoVecchio, DO, MPH. He is the co-medical director at the Banner Good Samaritan Poison & Drug Information Center in Phoenix, Ariz.

In the last week, he and his team have consulted with doctors about the patients, but he can't confirm the injections were krokodil because the drugs have not been tested.

LoVecchio says at least two other U.S. cities have unconfirmed reports of krokodil use. It’s named for the crocodile-like look it gives users’ rotting skin.

So far, there are no confirmed U.S. cases, says Barbara Carreno, a spokeswoman for the Drug Enforcement Administration. "We've been following this drug overseas for several years," she says. "We are very concerned about the possibility of this drug coming to the U.S."

Here, the two address other questions about the drug.

What is krokodil?

Krokodil is a homemade drug. It combines codeine, lighter fluids, gasoline, paint thinner, alcohol, and other ingredients, Carreno and LoVecchio say.

When and where did it become popular?

Krokodil was first used in Russia in 2003, according to the Journal of Addictive Diseases.

LoVecchio suspects krokodil took off in Russia because it was difficult to smuggle in heroin. Its use spread quickly across the country.

How is it used?

Users inject the drug because it delivers a faster high than in tablet form, LoVecchio says. "If the onset [of effects] was an hour or 2 for pill form, it could be within 5 to 10 minutes if you shoot it IV."

What are the effects and side effects?

The drug may be 10 times cheaper than heroin, LoVecchio says. For less money, it is said to give a heroin-like effect of euphoria -- but at a price.

It eats the user from the inside out, he says, rotting the flesh and leaving bone and muscle tissue exposed. The skin takes on a scaly, green appearance, earning its name of krokodil, Russian for "crocodile."

"A common reason for death is the loss of skin," LoVecchio says. He says that users can die of infection and gangrene. The drug also destroys the blood vessels it’s injected into, causing blockages.

Regular users in Russia often die within 2 years of starting krokodil, he says.

How did it get to the U.S.?

LoVecchio says drug users here may have heard of it and looked for information on web sites. "Another explanation would be that addiction, whether opiates or alcohol, is a very terrible disease. People get desperate. Taking a pill wouldn't be enough. They might look for ways to make them higher."

How are side effects treated?

Medications to reverse effects are one way, LoVecchio says. Wound care, skin grafts, and surgery may be needed if the user survives the injections.

source : 'Krokodil' Drug FAQ

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Poll Finds Most Unaware of Tuesday Opening of Health Insurance Marketplaces

By Jordan Rau

A new poll finds a majority of the public - especially those lacking health coverage - is unaware that new insurance marketplaces created by the health law are slated to open this week. The poll also found deep skepticism of media coverage of the law, with more than half the public saying they don’t trust any media source to provide credible information.

Two-thirds of the public were not aware when the new online marketplaces open to allow people without employer coverage to shop and purchase their own health policies, according to the poll by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) These exchanges open Tuesday. Despite outreach efforts by the Obama administration and supporters of the law, the poll found the number of uninsured unaware of the opening date is even greater than the public at large, with three out of every four not knowing the marketplaces are supposed to open in October.

The poll found that 56 percent of those polled believe media coverage has mostly focused on politics and controversies surrounding the law, while only 6 percent thought the coverage concentrated on how the law might impact people. Another 33 percent said coverage balanced both substance and politics.

The poll found that 53 percent of those polled said they did not have a single newspaper, magazine TV or radio show they trusted to provide reliable information about the law.  Those that did have a reliable source of information were mostly likely to cite cable television, particularly Fox News. A total of 19 percent of people said they trust cable TV the most, while only 7 percent said they trust newspapers and 4 percent trusted public radio or TV.

Among specific news outlets, 10 percent said they trust Fox, 5 percent trust CNN, 3 percent trust public radio including NPR, 2 percent trust the New York Times, 2 percent trust MSNBC and 1 percent trust the Wall Street Journal.

Slightly over half of those polled said they do not have enough information about the law to understand it. Of those, 19 percent said they wanted to know how the law was funded and what they would have to pay. Another 18 percent said they wanted someone to explain the law in a simple, concise way. Among the specific questions the pollsters said people told them they wanted answered were: “Will this medical insurance be free or will I have to pay?”, “Can you just put it in plain laymen language so we can understand what you’re doing for us?” and “What happens if we’re unable to afford it? I’ve heard we can go to jail.”

The public view of the law, which KFF has been tracking since it passed in 2010, remains consistently divided, with 43 percent disliking it and 39 percent favoring it. Democratic enthusiasm about the law, which has wavered over the months, has crept up a bit, and now two-thirds of Democrats say they like it.

source : Poll Finds Most Unaware of Tuesday Opening of Health Insurance Marketplaces

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