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Emergency rooms due to buy cipro over the counter fibroids, according to a new study spanning 12 years. Fibroids are common noncancerous growths in the uterus. They don't always cause symptoms, but those that do may result in heavy menstrual bleeding and severe abdominal pain. Fully tens of thousands of women are seen annually in the emergency department for fibroids across the United States, buy cipro over the counter but only 1 in 10 are admitted to the hospital. That suggests that many of these cases could have been successfully treated elsewhere, if women had access to care.

"If you have symptomatic fibroids, it's important for you to establish care with a women's health provider so you can be counseled on all the options for treatment and symptom relief in a relaxed and trusted setting," said study author Dr. Erica Marsh buy cipro over the counter. She is the chief of the division of reproductive endocrinology and infertility at the Center for Reproductive Medicine at Michigan Medicine Von Voigtlander Women's Hospital in Ann Arbor. "The ER can be avoided by not delaying care for your symptoms, even in the midst of a cipro, and working with your health care provider on short-term interventions and long-term interventions if needed," Marsh added. Fibroids can be treated with medications, surgery, and/or interventional radiology procedures such as uterine artery embolization to block blood supply to the buy cipro over the counter fibroid, she said.

To arrive at their findings, the researchers looked at more than 487 million emergency visits by U.S. Women aged 18 to 55 that took place between 2006 and 2017 using a nationwide database. They found that the number of ER visits for fibroids more than doubled during the study period, going from more buy cipro over the counter than 28,700 visits to nearly 65,700 visits. At the same time, hospital admissions for these visits fell from about 24% to 11%, the study found. The study can't say why more women seem to be going to the emergency room to treat fibroids, but it could be that they don't have a primary care doctor or health insurance, and many may delay seeking care until the symptoms become overwhelming.

Emergency department visits for fibroids were buy cipro over the counter most common among women aged 36-45 and those with lower incomes. Women who came to the emergency room for bleeding-related issues were 15 times more likely to be admitted. By contrast, hospital admission was least likely for women without insurance who came to the emergency room with fibroid symptoms, the study showed. There will buy cipro over the counter be times when seeking emergency care is necessary, Marsh said. But "the vast majority of women who present to the ER with fibroids as their primary diagnosis are discharged home," she said.

"We need better infrastructure for women's health in general and for urgent women's health care specifically," Marsh said. "When patients buy cipro over the counter don't get timely care, they often end up needing more expensive and invasive care, and have more limited options for treatment." Fibroid care can be twice as expensive as other emergency room visits among similarly aged women, likely because of pricey imaging scans and other tests needed to assess bleeding. During the study period, the average emergency room visit charge for fibroids more than doubled, costing more than $6,000 per visit and totaling $500 million during 2017. The study appears in the May issue of the journal Obstetrics &. Gynecology.

Getting regular gynecologic exams will likely help identify fibroids before they become an emergency, said Dr. Jennifer Wu, an obstetrician-gynecologist at Lenox Hill Hospital in New York City. "Knowledge is power, and if you know that you have fibroids, you can better recognize the symptoms, such as pain before you get your period, and take steps to treat them." There are times when a fibroid and its symptoms can constitute an emergency, stressed Wu, who was not part of the study. "If you are bleeding so heavily that you feel faint and/or become anemic, you may need a blood transfusion and should seek care immediately." There are more treatments than ever before to address the symptoms of fibroids, she said. Over-the-counter medications including NSAIDs can help relieve pain, and birth control pills can control heavy bleeding and painful periods.

QUESTION What are uterine fibroids?. See Answer Surgeries may involve removal of the fibroids (myomectomy), and sometimes a hysterectomy is still needed if other treatments have not worked or if the fibroids are extremely large, Wu said. More information The Office on Women's Health offers more information on fibroids and their treatments. SOURCES. Erica Marsh, MD, chief, division of reproductive endocrinology and infertility, Center for Reproductive Medicine, Michigan Medicine Von Voigtlander Women's Hospital, Ann Arbor.

Jennifer Wu, MD, obstetrician-gynecologist, Lenox Hill Hospital, New York City. Obstetrics &. Gynecology, May 2021 Copyright © 2021 HealthDay. All rights reserved. From Women's Health Resources Featured Centers Health Solutions From Our Sponsors.

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Black women are Buying levitra online from canada an integral part of the American labor force but cipro and gas have long faced a pay gap due to longstanding inequities in education and the labor market. In addition, they have been disproportionately impacted by the cipro. Black women workers are cipro and gas overrepresented in low-paying service sector jobs, which were among the hardest hit, in terms of job losses. Aug. 3, 2021, marks Black Women’s Equal Pay Day, a cipro and gas symbolic representation of the number of additional days Black women working full-time, year-round, must work, on average, to earn what white, non-Hispanic men earned the year before.

Here are five facts about Black women in the labor force. 1. Black women earn 63 cents for every dollar earned by white, non-Hispanic men Black women’s earnings are 63.0% of white, non-Hispanic men’s earnings cipro and gas – the third-widest gap after Native women (60%) and Hispanic women (55.4%). In comparison, white, non-Hispanic women earn 78.7% of white, non-Hispanic men’s earnings, and Asian women earn 87.1%.2. This wage cipro and gas gap is not just driven by educational differences Even controlling for education, Black women still earn less than their white male counterparts.

Among those with a bachelor’s degree, Black women only earn 65% of what comparable white men do, for instance. And among people with advanced degrees, Black women earn cipro and gas 70% of what white men do. In fact, Black women with advanced degrees have median weekly earnings less than white men with only a bachelor’s degree.3. Black women have the highest labor force participation rate of all women Typically, Black women have higher labor force participation rates than other women, meaning a higher share of Black women are either employed or unemployed and looking for work. For instance, in 2019, Black women's labor force participation rate was 60.5% compared with 56.8% for cipro and gas white women.

Even in 2020, in the midst of the cipro, their labor force participation rate was 58.8%, compared to 56.2% for women overall.4. Black women have also experienced high cipro and gas unemployment, especially in the wake of the cipro In 2020, Black women’s unemployment rate was 10.9%, compared to 7.6% for white women and 8.3% for all women. This is no doubt reflective of the steep job losses and slow job recovery experienced by this group since early 2020, though even prior to the cipro, their unemployment was relatively high (5.6%) compared with white (3.2%), Asian (2.7%) and Hispanic (4.7%) women. 5. Black moms, too, have relatively high labor force participation rates Black mothers – two-thirds of whom are equal, primary or sole earners in their households – have higher labor force participation rates than other moms.

This has historically been the case, and 2020 was no exception. 76.0% were in the labor force, compared with 71.3% of white moms, 62.8% of Hispanic moms and 64.3% of Asian moms.Mathilde Roux is a Presidential Management Fellow in the department's Women's Bureau. Follow the bureau on Twitter @WB_DOL.Photo credit. Paul Chang In the early morning hours of Aug. 2, 1995, federal agents raided an apartment complex in El Monte, California, where 72 Thai workers – mostly women – were found working.

For as long as seven years, they had been held captive in a garment sweatshop and forced to work long hours in inhumane conditions. Surrounded by barbed wire and under the constant surveillance of armed guards, they made clothes for brand-name retailers. The horrifying case sparked a national outcry and led to important labor reforms. I’m proud to have played a role in that process and to have built my work around protecting the rights of workers and holding those who take advantage of them accountable. As a 26-year-old staff attorney at Asian Americans Advancing Justice-Los Angeles (formerly the Asian Pacific American Legal Center), I led a team that sued the captors and the manufacturers and retailers who benefited from the forced labor in El Monte.

We were committed to ensuring that those at the top of the chain were held responsible for these horrendous violations of labor and human rights, and we were successful. We recovered over $4 million in back wages through a groundbreaking lawsuit and California passed legislation that expanded manufacturer and retailer responsibility for wage theft when they contract with sweatshops. We advocated for S visas to protect workers who report crimes so their immigration status could not be weaponized to further their exploitation. A few years later, Congress passed the Victims of Trafficking and Violence Protection Act, which built on our efforts, set up a federal interagency task force on human trafficking, and created the U and T visas for victims of crimes – such as human trafficking and forced labor – who assist law enforcement. But the biggest changes would not be measured in dollars or policy changes.

The most profound changes were personal. The workers stood up, learned they had power, and, against all odds, defied the message they had heard their whole lives – that they should keep their heads down and know their place. These are the changes that shaped me as a young lawyer and that continue to inspire me to fight for workers today. I spent a great deal of time with the workers as they adjusted to their new lives and almost every August since then, we get together to commemorate their freedom. Over the years, they have changed jobs, started or reunited with families, some have become successful business owners or bought homes, each pursuing their own American Dream.

As the daughter of Chinese immigrants who came to this country with limited English skills, I have seen from my family’s experience just how challenging it can be to start over in a new country, and that immigrant workers’ essential contributions to our economy are often undervalued. The resilience of these workers and my experiences working with them left a lasting impression, and I have continued to advocate for vulnerable and marginalized people throughout my career. That’s why I am so honored — and excited — to join the U.S. Department of Labor as the Deputy Secretary of Labor to carry on this important work. And I’ve long been familiar with the critical role the department plays in protecting workers.

The Labor Department is a member of the federal government’s human trafficking task force and its Wage and Hour Division certifies the U and T visas that are a legacy of the Thai workers’ case. The division also enforces the Fair Labor Standards Act’s minimum wage, overtime, and record-keeping provisions. And over the past 26 years, Wage and Hour Division investigators have continued to identify sweatshop conditions in the garment industry, and in other industries with widespread wage and hour violations. Other agencies across the department, such as the Occupational Safety and Health Administration and the Bureau of International Labor Affairs, also work hard every day to make sure the conditions the Thai workers endured are not repeated. Often, garment workers are paid a piece-rate for each item they sew or cut without regard to the minimum wage or overtime requirements.

Some employers falsify time cards and underreport or fail to record actual hours worked by their employees. Though we’ve made important progress, unscrupulous employers are still taking advantage of workers, particularly workers who don’t speak English or who may be reluctant to report violations for fear of retaliation. The anniversary of the El Monte case is both a reminder that we have a long way to go – and that change is possible. I’m proud to work alongside Secretary Marty Walsh to help lead the department responsible for making sure garment workers know their rights and that employers understand their responsibilities. We will enforce the law when we find violations and ensure every worker is protected under the law.

And, just as importantly, the Biden-Harris administration is committed to empowering immigrants and other workers to advocate for better working conditions and wages. The American Jobs Plan invests in programs that would expand pathways to good-paying jobs for immigrant workers, workers of color and all workers. Good jobs, fair wages and strong worker protections are key to an inclusive, equitable recovery. I’m excited to get to work for all working people and help our nation build back better. Editor’s note.

You can contact the Wage and Hour Division to report violations or ask questions about labor law compliance in any language at 866-4US-WAGE (487-9243). You can read about your rights online in English, Chinese, Hmong, Korean, Punjabi, Spanish, Tagalog, Thai, Vietnamese and other languages. Julie Su is the Deputy Secretary of Labor.MDEL Bulletin, June 24 2021, from the Medical Devices Compliance Program On this page Fees for Medical Device Establishment Licences (MDELs) We issue Medical Device Establishment Licences (MDELs) to. class I manufacturers importers or distributors of all device classes for human use in Canada The MDEL fee is a flat fee, regardless of when we receive your initial application. The same fee applies to applications for.

a new MDEL the reinstatement of a suspended MDEL the annual licence review (ALR) of an MDEL If you submit any of these applications, you must pay the MDEL fee when you receive an invoice. See Part 3, Division 2 of the Fees in Respect of Drugs and Medical Devices Order. Normally, we collect the MDEL fee before we review an application. However, to help meet the demand for medical devices during the buy antibiotics cipro, we have been reviewing and processing MDEL applications before collecting the fees. As a result, some MDEL holders still haven't paid the fees for their 2020 initial MDEL application, despite multiple reminders.

Authority to withhold services in case of non-payment As stated in the Food and Drug Act, Health Canada has the authority to withhold services, approvals, rights and/or privileges, if the fee for an MDEL application is not paid. Non-payment of fees 30.64. The Minister may withdraw or withhold a service, the use of a facility, a regulatory process or approval or a product, right or privilege under this Act from any person who fails to pay the fee fixed for it under subsection 30.61(1). For more information, please refer to. Cancellation of existing MDELs We will cancel MDELs for existing MDEL holders with outstanding fees for.

initial applications or annual licence review applications If your establishment licence is cancelled, you are no longer authorized to conduct licensable activities (such as manufacturing, distributing or importing medical devices). You must stop licensable activities as soon as you receive your cancellation notice. Resuming activities after MDEL cancellation To resume licensable activities, you must re-apply for a new establishment licence and pay the MDEL fee. See section 45 of the Medical Device Regulations. To find out how to re-apply for a MDEL, please refer to our Guidance on medical device establishment licensing (GUI-0016).

In line with the Compliance and Enforcement Policy (POL-0001), Health Canada monitors activities for compliance. If your MDEL has been cancelled, you may be subject to compliance and enforcement actions if you conduct non-compliant activities. If you have questions about a MDEL or the application process, please contact the Medical Device Establishment Licensing Unit at hc.mdel.questions.leim.sc@canada.ca. If you have questions about invoicing and fees for an MDEL application, please contact the Cost Recovery Invoicing Unit at hc.criu-ufrc.sc@canada.ca. Related links.

Black women are an integral part of the American labor force http://thecassiechronicles.com/buying-levitra-online-from-canada but have long faced a pay buy cipro over the counter gap due to longstanding inequities in education and the labor market. In addition, they have been disproportionately impacted by the cipro. Black women workers are overrepresented in low-paying service sector jobs, which were buy cipro over the counter among the hardest hit, in terms of job losses.

Aug. 3, 2021, marks Black Women’s Equal Pay Day, a buy cipro over the counter symbolic representation of the number of additional days Black women working full-time, year-round, must work, on average, to earn what white, non-Hispanic men earned the year before. Here are five facts about Black women in the labor force.

1. Black women earn 63 cents for every dollar earned by white, non-Hispanic men Black women’s earnings are 63.0% of white, non-Hispanic men’s earnings – the third-widest gap after Native women (60%) and Hispanic women (55.4%) buy cipro over the counter. In comparison, white, non-Hispanic women earn 78.7% of white, non-Hispanic men’s earnings, and Asian women earn 87.1%.2.

This wage gap is not buy cipro over the counter just driven by educational differences Even controlling for education, Black women still earn less than their white male counterparts. Among those with a bachelor’s degree, Black women only earn 65% of what comparable white men do, for instance. And among buy cipro over the counter people with advanced degrees, Black women earn 70% of what white men do.

In fact, Black women with advanced degrees have median weekly earnings less than white men with only a bachelor’s degree.3. Black women have the highest labor force participation rate of all women Typically, Black women have higher labor force participation rates than other women, meaning a higher share of Black women are either employed or unemployed and looking for work. For instance, in 2019, Black women's labor force participation rate was buy cipro over the counter 60.5% compared with 56.8% for white women.

Even in 2020, in the midst of the cipro, their labor force participation rate was 58.8%, compared to 56.2% for women overall.4. Black women have also experienced high unemployment, especially in the wake of the cipro In 2020, Black women’s unemployment rate was 10.9%, buy cipro over the counter compared to 7.6% for white women and 8.3% for all women. This is no doubt reflective of the steep job losses and slow job recovery experienced by this group since early 2020, though even prior to the cipro, their unemployment was relatively high (5.6%) compared with white (3.2%), Asian (2.7%) and Hispanic (4.7%) women.

5. Black moms, too, have relatively high labor force participation rates Black mothers – two-thirds of whom are equal, primary or sole earners in their households – have higher labor force participation rates than other moms. This has historically been the case, and 2020 was no exception.

76.0% were in the labor force, compared with 71.3% of white moms, 62.8% of Hispanic moms and 64.3% of Asian moms.Mathilde Roux is a Presidential Management Fellow in the department's Women's Bureau. Follow the bureau on Twitter @WB_DOL.Photo credit. Paul Chang In the early morning hours of Aug.

2, 1995, federal agents raided an apartment complex in El Monte, California, where 72 Thai workers – mostly women – were found working. For as long as seven years, they had been held captive in a garment sweatshop and forced to work long hours in inhumane conditions. Surrounded by barbed wire and under the constant surveillance of armed guards, they made clothes for brand-name retailers.

The horrifying case sparked a national outcry and led to important labor reforms. I’m proud to have played a role in that process and to have built my work around protecting the rights of workers and holding those who take advantage of them accountable. As a 26-year-old staff attorney at Asian Americans Advancing Justice-Los Angeles (formerly the Asian Pacific American Legal Center), I led a team that sued the captors and the manufacturers and retailers who benefited from the forced labor in El Monte.

We were committed to ensuring that those at the top of the chain were held responsible for these horrendous violations of labor and human rights, and we were successful. We recovered over $4 million in back wages through a groundbreaking lawsuit and California passed legislation that expanded manufacturer and retailer responsibility for wage theft when they contract with sweatshops. We advocated for S visas to protect workers who report crimes so their immigration status could not be weaponized to further their exploitation.

A few years later, Congress passed the Victims of Trafficking and Violence Protection Act, which built on our efforts, set up a federal interagency task force on human trafficking, and created the U and T visas for victims of crimes – such as human trafficking and forced labor – who assist law enforcement. But the biggest changes would not be measured in dollars or policy changes. The most profound changes were personal.

The workers stood up, learned they had power, and, against all odds, defied the message they had heard their whole lives – that they should keep their heads down and know their place. These are the changes that shaped me as a young lawyer and that continue to inspire me to fight for workers today. I spent a great deal of time with the workers as they adjusted to their new lives and almost every August since then, we get together to commemorate their freedom.

Over the years, they have changed jobs, started or reunited with families, some have become successful business owners or bought homes, each pursuing their own American Dream. As the daughter of Chinese immigrants who came to this country with limited English skills, I have seen from my family’s experience just how challenging it can be to start over in a new country, and that immigrant workers’ essential contributions to our economy are often undervalued. The resilience of these workers and my experiences working with them left a lasting impression, and I have continued to advocate for vulnerable and marginalized people throughout my career.

That’s why I am so honored — and excited — to join the U.S. Department of Labor as the Deputy Secretary of Labor to carry on this important work. And I’ve long been familiar with the critical role the department plays in protecting workers.

The Labor Department is a member of the federal government’s human trafficking task force and its Wage and Hour Division certifies the U and T visas that are a legacy of the Thai workers’ case. The division also enforces the Fair Labor Standards Act’s minimum wage, overtime, and record-keeping provisions. And over the past 26 years, Wage and Hour Division investigators have continued to identify sweatshop conditions in the garment industry, and in other industries with widespread wage and hour violations.

Other agencies across the department, such as the Occupational Safety and Health Administration and the Bureau of International Labor Affairs, also work hard every day to make sure the conditions the Thai workers endured are not repeated. Often, garment workers are paid a piece-rate for each item they sew or cut without regard to the minimum wage or overtime requirements. Some employers falsify time cards and underreport or fail to record actual hours worked by their employees.

Though we’ve made important progress, unscrupulous employers are still taking advantage of workers, particularly workers who don’t speak English or who may be reluctant to report violations for fear of retaliation. The anniversary of the El Monte case is both a reminder that we have a long way to go – and that change is possible. I’m proud to work alongside Secretary Marty Walsh to help lead the department responsible for making sure garment workers know their rights and that employers understand their responsibilities.

We will enforce the law when we find violations and ensure every worker is protected under the law. And, just as importantly, the Biden-Harris administration is committed to empowering immigrants and other workers to advocate for better working conditions and wages. The American Jobs Plan invests in programs that would expand pathways to good-paying jobs for immigrant workers, workers of color and all workers.

Good jobs, fair wages and strong worker protections are key to an inclusive, equitable recovery. I’m excited to get to work for all working people and help our nation build back better. Editor’s note.

You can contact the Wage and Hour Division to report violations or ask questions about labor law compliance in any language at 866-4US-WAGE (487-9243). You can read about your rights online in English, Chinese, Hmong, Korean, Punjabi, Spanish, Tagalog, Thai, Vietnamese and other languages. Julie Su is the Deputy Secretary of Labor.MDEL Bulletin, June 24 2021, from the Medical Devices Compliance Program On this page Fees for Medical Device Establishment Licences (MDELs) We issue Medical Device Establishment Licences (MDELs) to.

class I manufacturers importers or distributors of all device classes for human use in Canada The MDEL fee is a flat fee, regardless of when we receive your initial application. The same fee applies to applications for. a new MDEL the reinstatement of a suspended MDEL the annual licence review (ALR) of an MDEL If you submit any of these applications, you must pay the MDEL fee when you receive an invoice.

See Part 3, Division 2 of the Fees in Respect of Drugs and Medical Devices Order. Normally, we collect the MDEL fee before we review an application. However, to help meet the demand for medical devices during the buy antibiotics cipro, we have been reviewing and processing MDEL applications before collecting the fees.

As a result, some MDEL holders still haven't paid the fees for their 2020 initial MDEL application, despite multiple reminders. Authority to withhold services in case of non-payment As stated in the Food and Drug Act, Health Canada has the authority to withhold services, approvals, rights and/or privileges, if the fee for an MDEL application is not paid. Non-payment of fees 30.64.

The Minister may withdraw or withhold a service, the use of a facility, a regulatory process or approval or a product, right or privilege under this Act from any person who fails to pay the fee fixed for it under subsection 30.61(1). For more information, please refer to. Cancellation of existing MDELs We will cancel MDELs for existing MDEL holders with outstanding fees for.

initial applications or annual licence review applications If your establishment licence is cancelled, you are no longer authorized to conduct licensable activities (such as manufacturing, distributing or importing medical devices). You must stop licensable activities as soon as you receive your cancellation notice. Resuming activities after MDEL cancellation To resume licensable activities, you must re-apply for a new establishment licence and pay the MDEL fee.

See section 45 of the Medical Device Regulations. To find out how to re-apply for a MDEL, please refer to our Guidance on medical device establishment licensing (GUI-0016). In line with the Compliance and Enforcement Policy (POL-0001), Health Canada monitors activities for compliance.

If your MDEL has been cancelled, you may be subject to compliance and enforcement actions if you conduct non-compliant activities. If you have questions about a MDEL or the application process, please contact the Medical Device Establishment Licensing Unit at hc.mdel.questions.leim.sc@canada.ca. If you have questions about invoicing and fees for an MDEL application, please contact the Cost Recovery Invoicing Unit at hc.criu-ufrc.sc@canada.ca.

How should I take Cipro?

Take Cipro by mouth with a glass of water. Take your medicine at regular intervals. Do not take your medicine more often than directed. Take all of your medicine as directed even if you think your are better. Do not skip doses or stop your medicine early.

You can take Cipro with food or on an empty stomach. It can be taken with a meal that contains dairy or calcium, but do not take it alone with a dairy product, like milk or yogurt or calcium-fortified juice.

Talk to your pediatrician regarding the use of Cipro in children. Special care may be needed.

Overdosage: If you think you have taken too much of Cipro contact a poison control center or emergency room at once.

NOTE: Cipro is only for you. Do not share Cipro with others.

Cipro dosage for dental

In 1906, zoologist Herbert Spencer Jennings published Behavior of the Lower cipro dosage for dental Organisms, a book that contained a provocative idea. Microbes can change their minds. His subject cipro dosage for dental was a single cell bristling with beating hairs called Stentor. These trumpet-shaped predators are so large fish can eat them and humans can see them, and so brazen they can catch and eat rotifers—proper animals with hundreds of cells and a simple brain.

In the microbial galaxy, stentors lie somewhere between Star Destroyer and sarlacc pit. Jennings decided to annoy it and see cipro dosage for dental what happened. When confronted with a stream of irritating carmine powder expertly aimed at their mouths by his steady hand, Stentor would first bend away, then reverse the beating of its hairs (called cilia) to expel the powder, then contract and finally detach. He noted that the order of behaviors varied somewhat with different stimuli (he tried other chemicals) and steps were sometimes omitted.

€œBut it remains true,” he wrote, “that under conditions which gradually interfere with the normal activities of the organism, the behavior consists in ‘trying’ successively different reactions, till one is found that affords relief.” In short, cipro dosage for dental stentors could confront a stimulus with one behavior, and then choose a costlier approach if the irritant persisted. At least for a short while (a period that Jennings declared difficult to determine experimentally and still unresolved), it could “remember” that it had tried one solution without success, and opt for another. But in 1967, scientists from a different school of animal behavior repeated his experiment and failed to produce the same result. And with that, Jennings’s findings were consigned to the cipro dosage for dental dustbin.

Then about 10 years ago, Jeremy Gunawardena, an associate professor of systems biology at Harvard Medical School, discovered the experiment and its defenestration and decided that it deserved another look. To his surprise, he discovered the 1967 team had not used the correct species of Stentor (being behaviorists who believed variation flowed from the environment and not genes, they might have felt the species didn’t matter). The one they had chosen, Stentor coeruleus, strongly prefers cipro dosage for dental to swim, unlike Jennings’s Stentor roeselii, which prefers to chill poolside. Gunawardena became fascinated by what replicating the experiment might reveal about what single cells are capable of.

After years of cipro dosage for dental dangling the idea fruitlessly at lab meetings, he found undergrad Joseph Dexter and postdoc Sudhakaran Prabakaran were willing to give it a try at night and on weekends—with no funding. This time, the Harvard team managed to track down the correct species in an English golf course pond, construct their own “Device for Irritating Stentors” (being quantitative biologists, they lacked Jennings’s extreme pipette skills), and discovered something extraordinary. In their setup, Stentor did not respond to carmine powder the way Jennings described. However, when faced with barrages of 21st-century plastic microbeads, individual Stentor roeseli behaved consistent with Jennings’s description—and in one remarkable way that Jennings did not observe in 1906 cipro dosage for dental .

If Stentor really can “decide,” it certainly isn’t the only way the ciliates—the group of shaggy microbes to which Stentor belongs—resemble us. A ciliate operates like an animal at the scale of a single huge cell, and the resemblance can be startling. For example, some glue bundles of their cilia into structures called cirri and can use cipro dosage for dental them as legs, mouths, paddles or teeth. Euplotes skitters nimbly along surfaces atop cirri like some sort of Close Encounters–class water flea.

The cirri are wired by nervelike neurofibrils. If the fibrils are cut, cipro dosage for dental the cirri fall limp. Some ciliates pack tiny tethered darts they can fire to attack prey, deter predators or simply drop anchor. Others sport tentacles that snag food.

Like sea stars, ciliates can regenerate entire bodies within a day or two from shockingly tiny pieces provided cipro dosage for dental those pieces contain both a bit of the cell’s cilia-studded armor and a bit of nucleus, the cell’s genetic heart. Many ciliates divide in the usual way by pinching in two, but some stalked or sessile ciliates push small round larvae into the world through a special birth canal. One ciliate called Diplodinium lives in the rumen of cows and other hoofed animals, a special environment known to harbor all kinds of strange things, about half of which by mass may be ciliates (think about that next time you see a cow placidly chewing its cud). Diplodinium contains cipro dosage for dental neurofibrils, cirri, musclelike striated contractile fibers called myonemes, a “backbone” made of stacked plates, a mouth, an esophagus that contracts with the help of a ring tethered to its exterior, and an anus.

But remember. Single cell cipro dosage for dental . In short, ciliates have taken the biology of the solo cell to its apparent earthly limit. Having something like a noggin in there is less credulity-stretching once you grasp this.

In the new study, published in the journal Current Biology in 2019, the scientists found that cipro dosage for dental Stentor indeed switched behaviors in response to repeated puffs of beads, and the order of operations was generally consistent with Jennings’s description. Detachment was always preceded by contraction, and mathematical analyses revealed cilia alternation or bending were far more likely to appear before contraction than after. There is something else interesting about their data, which I encourage you to examine for yourself. It sure looks like cipro dosage for dental stentors have personalities.

Some repeatedly contracted and relaxed, or bent, contracted, then relaxed, seemingly willing to tolerate irritation—or to live dangerously. These were the optimists. Some contracted cipro dosage for dental once or just a few times, never to relax again. Others contracted and detached, and that was it.

These were the pessimists (or perhaps just the ones with a more recent successful “door dash”). Some stentors always cipro dosage for dental responded with one or two preferred behaviors, and never with others that they were surely just as biologically capable of performing. One indefatigable individual subjected to 13 bead blasts responded persistently with ciliary alternation or contraction, never bending or detachment. Does Stentor possess something cipro dosage for dental like agency—a capacity to make decisions?.

This study and Jennings’ evidence certainly suggest so. There was a final provocative finding. This team's statistical analysis revealed that the choice between contracting or detaching was consistent the probability cipro dosage for dental of a fair coin toss. In other words, it seemed perfectly random.

There’s only one problem. No known cellular mechanism can produce this cipro dosage for dental result. That head scratcher remains both unreplicated and unexplained. Perhaps it is time to let go of our preconceived notions of what cells are capable of because they are only cells, and the cells in our own soviet-style bodies are the equivalent of worker bees.

The capabilities of wily, gunslinging, free-living cells may well exceed our dim primate imaginations.The items below are cipro dosage for dental highlights from the free newsletter, “Smart, useful, science stuff about buy antibiotics.” To receive newsletter issues daily in your inbox, sign up here. Katelyn Jetelina updated her buy antibiotics treatment comparisons table on 5/20/21 at her site Your Local Epidemiologist. Highlights include the latest data on how well various treatments protect against antibiotics variants. The post also includes cipro dosage for dental a helpful discussion of two ways that researchers measure how well a treatment works – efficacy (analyzing the extent of disease protection in experiments) and immunogenicity (analyzing levels of a type of antibodies made in response to a pathogen over time).

A total of 23 U.S. States and Washington, D.C., recently have changed their face-coverings and mask guidance in response to last week's Centers for Disease Control’s update to its guidance for fully vaccinated people, reports Lindsay Kalter for WebMD (5/18/21). The WebMD story’s second page links to various state plans for lifting mask cipro dosage for dental mandates. A growing body of evidence, including a study published 5/15/21 in The Lancet and another published 5/6/21 in JAMA, suggests that the Pfizer-BioNTech treatment not only protects us against moderate or severe buy antibiotics.

It also protects us against getting infected at all with antibiotics and thereby protects against us transmitting cipro dosage for dental s to others. Lower amounts of the cipro persist in the nasal passages of vaccinated people than in those of unvaccinated people, Dr. Anthony Fauci said 5/16/21 on CBS News’ “Face the Nation.” There are very rare “breakthrough s” of antibiotics in vaccinated people, but “almost always the people [with these s] are asymptomatic [feel no symptoms], and the level of cipro is so low, it makes it extremely unlikely, not impossible, but very, very low likelihood that they are going to transmit it,” Fauci said. These findings, along with ongoing evidence that the treatments are safe and effective, even against cipro dosage for dental antibiotics variants, provided the scientific basis for the U.S.

Centers for Disease Control’s guidance (5/13/21) stating that vaccinated people no longer need to wear masks nor socially distance in most indoor and outdoor settings, even crowded ones, reports Apoorva Mandavilli at The New York Times (5/14/21). In a New York Times survey conducted between April 28 and May 10, 85% of more than 700 epidemiologists responded that they think people in the U.S. Will be able to safely gather outdoors on the Fourth cipro dosage for dental of July, as the nation “rounds the bend” (as some writers put it) on the buy antibiotics cipro. Nearly the same percentage of epidemiologists think that U.S.

Schools can safely reopen in the fall, according to the survey results, as reported by the Times. Another notable finding from the cipro dosage for dental survey. The majority (59%) of the surveyed epidemiologists think that vaccination rates are the most important statistic to examine when considering whether to "resume most pre-cipro activities without new buy antibiotics-era precautions.” So, what vaccination rate or level should you look for?. "Half of respondents said at least 80 percent of Americans, including children, would need to be vaccinated before it would be safe to do most activities without precautions," write Claire Cain Miller, Kevin Quealy, and Margo Sanger-Katz (5/15/21).

And where does one find U.S cipro dosage for dental . Federal, state, and county vaccination rates?. Some experts frequently consult The cipro dosage for dental New York Times' various buy antibiotics dashboards, including this U.S. Vaccinations tracker, which allows you to look up the percentage of people in each U.S.

County who are fully vaccinated. Of course, any single statistical measure provides cipro dosage for dental limited information. Additional factors that influence a region’s antibiotics risk include local immunity among people who have recovered from antibiotics s or buy antibiotics in the past 14 months (areas that have recovered from antibiotics surges will have higher rates of this “natural immunity”) as well as public-health measures such as masking and distancing requirements. In freelance journalist Tara Haelle’s 5/13/21 story for Scientific American about the recent U.S.

Authorization for use of the Pfizer-BioNTech treatment in adolescents, I learned cipro dosage for dental about a site called VaxTeen. The site states that it is designed to address “the decline in vaccinations” in the U.S. By directly informing teenagers and young adults about treatment misinformation and encouraging these groups to catch up on any missing shots. One of the site’s main resources is cipro dosage for dental a state-by-state index where teens may look up their legal rights to obtain a vaccination without parental consent.

Each state entry includes a statement on how the local laws pertain to buy antibiotics vaccinations. Accumulating research reveals that buy antibiotics treatments are safe and effective during pregnancy, even against some of the antibiotics variants (e.g. B.1.1.7, first identified cipro dosage for dental in the UK, and B.1.351, first identified in South Africa), reports Emily Anthes for The New York Times (5/13/21). €œVaccinated women can also pass protective antibodies to their fetuses through the bloodstream and to their infants through breast milk,” Anthes writes, describing the results of a study published 5/13/21 in JAMA.

And neither the Pfizer-BioNTech treatment nor the Moderna treatment cipro dosage for dental harms the placenta during pregnancy, Anthes describes a 5/11/21 study as concluding. More research is needed to study these same questions in women at earlier stages of pregnancy, the story states. You might enjoy, “An open letter to sleep. We need to talk,” by Viktoria Shulevich for cipro dosage for dental McSweeney’s (5/20/21).

This is an opinion and analysis article.The following essay is reprinted with permission from The Conversation, an online publication covering the latest research. The Food and Drug Administration expanded emergency use authorization of the Pfizer-BioNTech buy antibiotics treatment to include adolescents 12 to 15 years of age on May 10, 2021. The Centers for Disease Control and Prevention followed with recommendations endorsing use in this cipro dosage for dental age group after their advisory group meeting on May 12. The American Academy of Pediatrics also supports this decision.

Dr. Debbie-Ann Shirley is an associate cipro dosage for dental professor of pediatrics at the University of Virginia specializing in pediatric infectious diseases. Here she addresses some of the concerns parents may have about their teen or preteen getting the buy antibiotics treatment. 1.

Does the cipro dosage for dental treatment work in adolescents?. Yes, recently released data from Pfizer-BioNTech shows that the buy antibiotics treatment seems to work really well in this age group. The buy antibiotics treatment was found to be 100% efficacious in preventing symptomatic buy antibiotics in an ongoing clinical trial of children in the U.S. Aged 12 to cipro dosage for dental 15.

Adolescents made high levels of antibody in response to the treatment, and their immune response was just as strong as what has been seen in older teens and young adults 16-25 years of age. 2. How do I know whether the treatment is safe for my child?. So far, the buy antibiotics treatment appears to be safe and well tolerated in adolescents.

All of the buy antibiotics treatments authorized for use in the U.S. Have undergone rigorous study, but we don’t want to assume that children are little adults. This is why it is so important to study these treatments just as carefully in children before health authorities could recommend use. Ongoing studies will continue to follow vaccinated children closely and robust safety monitoring will help rapidly identify rare or unexpected concerns if they emerge.

3. I thought children were low-risk – do they still need to get the treatment?. Currently, children represent nearly one-quarter of all new reported weekly buy antibiotics cases in the U.S. While serious illness from buy antibiotics is rare in children, it does occur – thousands of children have been hospitalized and at least 351 children have died from buy antibiotics in the U.S.

Some children who get seriously ill from buy antibiotics may have underlying health conditions, but not all do. Vaccination will help protect children from developing serious illness. Additionally, since adolescents can transmit buy antibiotics to others, vaccinating children may prove to be an important part of safely getting back to normal activities of life, including attending school in person, participating in team sports and spending time with friends. A large survey of school-aged children showed that children in full or partial virtual school reported lower levels of physical activity, less in-person time socializing with friends and worse mental or emotional health compared with those receiving full in-person schooling.

Children are experiencing unprecedented increases in indirect adverse health and educational consequences related to the cipro, and we need to find ways to help them get quickly and safely back to normal life. Vaccination is one of them. 4. What side effects might I expect for my child?.

Nonsevere side effects may be experienced following vaccination. The most commonly reported side effects have been pain and swelling at the injection site. Other common side effects include tiredness and headache. Similar to young adults, some adolescents have experienced fever, chills, muscle aches and joint pain, which may be more common after the second dose.

These effects are short-lived, however, and most resolve within one to two days. Some adolescents may faint when receiving an injection. If this is a concern for your child, let your treatment administration site know ahead of time – your child can be given the treatment while they’re seated or lying down to avoid injuries from falling. 5.

Have there been any severe reactions among children?. No serious adverse events related to vaccination were reported in the Pfizer-BioNTech clinical trial. Serious allergic reactions have rarely been reported in older people. Anyone with a known severe or immediate allergy to the treatment or any component of the treatment should not get the treatment.

If your child has a history of any severe allergic reactions or any type of immediate allergic reaction to a treatment or injectable therapy, let the treatment site administrator know so that your child can be monitored for at least 30 minutes after getting the treatment. Parents should talk to a trusted health care provider or allergist if they have specific questions about the possibility of an allergic reaction in their child. 6. When will a buy antibiotics treatment be authorized for children younger than 12 years?.

buy antibiotics treatment makers have begun or are planning to begin testing buy antibiotics treatments in younger children. As more information becomes available, the authorized age recommendations may change. Children ages 2-11 years old could potentially be eligible as early as the end of this year. 7.

If I’ve been vaccinated but my child hasn’t, could I still give the cipro to them?. The buy antibiotics treatments do not contain live buy antibiotics cipro, so they cannot cause buy antibiotics. Rather, getting vaccinated will help protect both you and your children from buy antibiotics. Studies have shown that vaccinated pregnant and lactating mothers can pass protective immunity on to their young infants across the placenta and in breast milk—one more benefit of vaccination.

Though researchers are still learning how well the treatment can help prevent spread, vaccination is still an important way to limit infecting people who are not yet eligible for the treatment, like younger children. This article was originally published on The Conversation. Read the original article..

In 1906, zoologist Herbert Spencer http://www.egarciajr.com/?p=244 Jennings published Behavior of the Lower Organisms, buy cipro over the counter a book that contained a provocative idea. Microbes can change their minds. His subject buy cipro over the counter was a single cell bristling with beating hairs called Stentor.

These trumpet-shaped predators are so large fish can eat them and humans can see them, and so brazen they can catch and eat rotifers—proper animals with hundreds of cells and a simple brain. In the microbial galaxy, stentors lie somewhere between Star Destroyer and sarlacc pit. Jennings decided to annoy it and buy cipro over the counter see what happened.

When confronted with a stream of irritating carmine powder expertly aimed at their mouths by his steady hand, Stentor would first bend away, then reverse the beating of its hairs (called cilia) to expel the powder, then contract and finally detach. He noted that the order of behaviors varied somewhat with different stimuli (he tried other chemicals) and steps were sometimes omitted. €œBut it remains true,” he wrote, “that under conditions which buy cipro over the counter gradually interfere with the normal activities of the organism, the behavior consists in ‘trying’ successively different reactions, till one is found that affords relief.” In short, stentors could confront a stimulus with one behavior, and then choose a costlier approach if the irritant persisted.

At least for a short while (a period that Jennings declared difficult to determine experimentally and still unresolved), it could “remember” that it had tried one solution without success, and opt for another. But in 1967, scientists from a different school of animal behavior repeated his experiment and failed to produce the same result. And with that, Jennings’s findings buy cipro over the counter were consigned to the dustbin.

Then about 10 years ago, Jeremy Gunawardena, an associate professor of systems biology at Harvard Medical School, discovered the experiment and its defenestration and decided that it deserved another look. To his surprise, he discovered the 1967 team had not used the correct species of Stentor (being behaviorists who believed variation flowed from the environment and not genes, they might have felt the species didn’t matter). The one they had chosen, Stentor coeruleus, strongly prefers to swim, unlike Jennings’s Stentor buy cipro over the counter roeselii, which prefers to chill poolside.

Gunawardena became fascinated by what replicating the experiment might reveal about what single cells are capable of. After years of dangling the idea fruitlessly at lab meetings, he found undergrad Joseph Dexter and postdoc Sudhakaran Prabakaran were willing to give it a try at night and buy cipro over the counter on weekends—with no funding. This time, the Harvard team managed to track down the correct species in an English golf course pond, construct their own “Device for Irritating Stentors” (being quantitative biologists, they lacked Jennings’s extreme pipette skills), and discovered something extraordinary.

In their setup, Stentor did not respond to carmine powder the way Jennings described. However, when faced with barrages of 21st-century buy cipro over the counter plastic microbeads, individual Stentor roeseli behaved consistent with Jennings’s description—and in one remarkable way that Jennings did not observe in 1906. If Stentor really can “decide,” it certainly isn’t the only way the ciliates—the group of shaggy microbes to which Stentor belongs—resemble us.

A ciliate operates like an animal at the scale of a single huge cell, and the resemblance can be startling. For example, some glue bundles of their cilia into buy cipro over the counter structures called cirri and can use them as legs, mouths, paddles or teeth. Euplotes skitters nimbly along surfaces atop cirri like some sort of Close Encounters–class water flea.

The cirri are wired by nervelike neurofibrils. If the fibrils are cut, the cirri fall limp buy cipro over the counter. Some ciliates pack tiny tethered darts they can fire to attack prey, deter predators or simply drop anchor.

Others sport tentacles that snag food. Like sea stars, ciliates can regenerate entire bodies within a day or two from shockingly tiny buy cipro over the counter pieces provided those pieces contain both a bit of the cell’s cilia-studded armor and a bit of nucleus, the cell’s genetic heart. Many ciliates divide in the usual way by pinching in two, but some stalked or sessile ciliates push small round larvae into the world through a special birth canal.

One ciliate called Diplodinium lives in the rumen of cows and other hoofed animals, a special environment known to harbor all kinds of strange things, about half of which by mass may be ciliates (think about that next time you see a cow placidly chewing its cud). Diplodinium contains neurofibrils, cirri, buy cipro over the counter musclelike striated contractile fibers called myonemes, a “backbone” made of stacked plates, a mouth, an esophagus that contracts with the help of a ring tethered to its exterior, and an anus. But remember.

Single cell buy cipro over the counter. In short, ciliates have taken the biology of the solo cell to its apparent earthly limit. Having something like a noggin in there is less credulity-stretching once you grasp this.

In the new study, published in the journal Current Biology in 2019, the scientists found that Stentor indeed switched behaviors in response to repeated puffs buy cipro over the counter of beads, and the order of operations was generally consistent with Jennings’s description. Detachment was always preceded by contraction, and mathematical analyses revealed cilia alternation or bending were far more likely to appear before contraction than after. There is something else interesting about their data, which I encourage you to examine for yourself.

It sure looks like stentors buy cipro over the counter have personalities. Some repeatedly contracted and relaxed, or bent, contracted, then relaxed, seemingly willing to tolerate irritation—or to live dangerously. These were the optimists.

Some contracted once or just a few times, never buy cipro over the counter to relax again. Others contracted and detached, and that was it. These were the pessimists (or perhaps just the ones with a more recent successful “door dash”).

Some stentors always responded with one or two preferred behaviors, and never with others that they were surely just as biologically capable of buy cipro over the counter performing. One indefatigable individual subjected to 13 bead blasts responded persistently with ciliary alternation or contraction, never bending or detachment. Does Stentor possess something buy cipro over the counter like agency—a capacity to make decisions?.

This study and Jennings’ evidence certainly suggest so. There was a final provocative finding. This team's statistical analysis revealed that buy cipro over the counter the choice between contracting or detaching was consistent the probability of a fair coin toss.

In other words, it seemed perfectly random. There’s only one problem. No known cellular mechanism can buy cipro over the counter produce this result.

That head scratcher remains both unreplicated and unexplained. Perhaps it is time to let go of our preconceived notions of what cells are capable of because they are only cells, and the cells in our own soviet-style bodies are the equivalent of worker bees. The capabilities of buy cipro over the counter wily, gunslinging, free-living cells may well exceed our dim primate imaginations.The items below are highlights from the free newsletter, “Smart, useful, science stuff about buy antibiotics.” To receive newsletter issues daily in your inbox, sign up here.

Katelyn Jetelina updated her buy antibiotics treatment comparisons table on 5/20/21 at her site Your Local Epidemiologist. Highlights include the latest data on how well various treatments protect against antibiotics variants. The post also includes a helpful discussion of two ways that researchers measure how well a treatment buy cipro over the counter works – efficacy (analyzing the extent of disease protection in experiments) and immunogenicity (analyzing levels of a type of antibodies made in response to a pathogen over time).

A total of 23 U.S. States and Washington, D.C., recently have changed their face-coverings and mask guidance in response to last week's Centers for Disease Control’s update to its guidance for fully vaccinated people, reports Lindsay Kalter for WebMD (5/18/21). The WebMD story’s second page buy cipro over the counter links to various state plans for lifting mask mandates.

A growing body of evidence, including a study published 5/15/21 in The Lancet and another published 5/6/21 in JAMA, suggests that the Pfizer-BioNTech treatment not only protects us against moderate or severe buy antibiotics. It also protects us against getting infected at all with antibiotics and thereby protects against us transmitting s to buy cipro over the counter others. Lower amounts of the cipro persist in the nasal passages of vaccinated people than in those of unvaccinated people, Dr.

Anthony Fauci said 5/16/21 on CBS News’ “Face the Nation.” There are very rare “breakthrough s” of antibiotics in vaccinated people, but “almost always the people [with these s] are asymptomatic [feel no symptoms], and the level of cipro is so low, it makes it extremely unlikely, not impossible, but very, very low likelihood that they are going to transmit it,” Fauci said. These findings, along with ongoing evidence that the treatments are safe and effective, even against buy cipro over the counter antibiotics variants, provided the scientific basis for the U.S. Centers for Disease Control’s guidance (5/13/21) stating that vaccinated people no longer need to wear masks nor socially distance in most indoor and outdoor settings, even crowded ones, reports Apoorva Mandavilli at The New York Times (5/14/21).

In a New York Times survey conducted between April 28 and May 10, 85% of more than 700 epidemiologists responded that they think people in the U.S. Will be able buy cipro over the counter to safely gather outdoors on the Fourth of July, as the nation “rounds the bend” (as some writers put it) on the buy antibiotics cipro. Nearly the same percentage of epidemiologists think that U.S.

Schools can safely reopen in the fall, according to the survey results, as reported by the Times. Another notable finding from the buy cipro over the counter survey. The majority (59%) of the surveyed epidemiologists think that vaccination rates are the most important statistic to examine when considering whether to "resume most pre-cipro activities without new buy antibiotics-era precautions.” So, what vaccination rate or level should you look for?.

"Half of respondents said at least 80 percent of Americans, including children, would need to be vaccinated before it would be safe to do most activities without precautions," write Claire Cain Miller, Kevin Quealy, and Margo Sanger-Katz (5/15/21). And where does one find U.S buy cipro over the counter. Federal, state, and county vaccination rates?.

Some experts frequently buy cipro over the counter consult The New York Times' various buy antibiotics dashboards, including this U.S. Vaccinations tracker, which allows you to look up the percentage of people in each U.S. County who are fully vaccinated.

Of course, any single statistical measure provides buy cipro over the counter limited information. Additional factors that influence a region’s antibiotics risk include local immunity among people who have recovered from antibiotics s or buy antibiotics in the past 14 months (areas that have recovered from antibiotics surges will have higher rates of this “natural immunity”) as well as public-health measures such as masking and distancing requirements. In freelance journalist Tara Haelle’s 5/13/21 story for Scientific American about the recent U.S.

Authorization for use of the Pfizer-BioNTech treatment in adolescents, I learned about a site buy cipro over the counter called VaxTeen. The site states that it is designed to address “the decline in vaccinations” in the U.S. By directly informing teenagers and young adults about treatment misinformation and encouraging these groups to catch up on any missing shots.

One of the site’s main resources is a state-by-state index where teens may look up their legal buy cipro over the counter rights to obtain a vaccination without parental consent. Each state entry includes a statement on how the local laws pertain to buy antibiotics vaccinations. Accumulating research reveals that buy antibiotics treatments are safe and effective during pregnancy, even against some of the antibiotics variants (e.g.

B.1.1.7, first identified in the UK, and B.1.351, first identified buy cipro over the counter in South Africa), reports Emily Anthes for The New York Times (5/13/21). €œVaccinated women can also pass protective antibodies to their fetuses through the bloodstream and to their infants through breast milk,” Anthes writes, describing the results of a study published 5/13/21 in JAMA. And neither the Pfizer-BioNTech treatment nor the Moderna buy cipro over the counter treatment harms the placenta during pregnancy, Anthes describes a 5/11/21 study as concluding.

More research is needed to study these same questions in women at earlier stages of pregnancy, the story states. You might enjoy, “An open letter to sleep. We need to talk,” by Viktoria Shulevich for buy cipro over the counter McSweeney’s (5/20/21).

This is an opinion and analysis article.The following essay is reprinted with permission from The Conversation, an online publication covering the latest research. The Food and Drug Administration expanded emergency use authorization of the Pfizer-BioNTech buy antibiotics treatment to include adolescents 12 to 15 years of age on May 10, 2021. The Centers for Disease Control and Prevention followed with recommendations endorsing buy cipro over the counter use in this age group after their advisory group meeting on May 12.

The American Academy of Pediatrics also supports this decision. Dr. Debbie-Ann Shirley buy cipro over the counter is an associate professor of pediatrics at the University of Virginia specializing in pediatric infectious diseases.

Here she addresses some of the concerns parents may have about their teen or preteen getting the buy antibiotics treatment. 1. Does the treatment work in adolescents? buy cipro over the counter.

Yes, recently released data from Pfizer-BioNTech shows that the buy antibiotics treatment seems to work really well in this age group. The buy antibiotics treatment was found to be 100% efficacious in preventing symptomatic buy antibiotics in an ongoing clinical trial of children in the U.S. Aged 12 buy cipro over the counter to 15.

Adolescents made high levels of antibody in response to the treatment, and their immune response was just as strong as what has been seen in older teens and young adults 16-25 years of age. 2. How do I know whether the treatment is safe for my child?.

So far, the buy antibiotics treatment appears to be safe and well tolerated in adolescents. All of the buy antibiotics treatments authorized for use in the U.S. Have undergone rigorous study, but we don’t want to assume that children are little adults.

This is why it is so important to study these treatments just as carefully in children before health authorities could recommend use. Ongoing studies will continue to follow vaccinated children closely and robust safety monitoring will help rapidly identify rare or unexpected concerns if they emerge. 3.

I thought children were low-risk – do they still need to get the treatment?. Currently, children represent nearly one-quarter of all new reported weekly buy antibiotics cases in the U.S. While serious illness from buy antibiotics is rare in children, it does occur – thousands of children have been hospitalized and at least 351 children have died from buy antibiotics in the U.S.

Some children who get seriously ill from buy antibiotics may have underlying health conditions, but not all do. Vaccination will help protect children from developing serious illness. Additionally, since adolescents can transmit buy antibiotics to others, vaccinating children may prove to be an important part of safely getting back to normal activities of life, including attending school in person, participating in team sports and spending time with friends.

A large survey of school-aged children showed that children in full or partial virtual school reported lower levels of physical activity, less in-person time socializing with friends and worse mental or emotional health compared with those receiving full in-person schooling. Children are experiencing unprecedented increases in indirect adverse health and educational consequences related to the cipro, and we need to find ways to help them get quickly and safely back to normal life. Vaccination is one of them.

4. What side effects might I expect for my child?. Nonsevere side effects may be experienced following vaccination.

The most commonly reported side effects have been pain and swelling at the injection site. Other common side effects include tiredness and headache. Similar to young adults, some adolescents have experienced fever, chills, muscle aches and joint pain, which may be more common after the second dose.

These effects are short-lived, however, and most resolve within one to two days. Some adolescents may faint when receiving an injection. If this is a concern for your child, let your treatment administration site know ahead of time – your child can be given the treatment while they’re seated or lying down to avoid injuries from falling.

5. Have there been any severe reactions among children?. No serious adverse events related to vaccination were reported in the Pfizer-BioNTech clinical trial.

Serious allergic reactions have rarely been reported in older people. Anyone with a known severe or immediate allergy to the treatment or any component of the treatment should not get the treatment. If your child has a history of any severe allergic reactions or any type of immediate allergic reaction to a treatment or injectable therapy, let the treatment site administrator know so that your child can be monitored for at least 30 minutes after getting the treatment.

Parents should talk to a trusted health care provider or allergist if they have specific questions about the possibility of an allergic reaction in their child. 6. When will a buy antibiotics treatment be authorized for children younger than 12 years?.

buy antibiotics treatment makers have begun or are planning to begin testing buy antibiotics treatments in younger children. As more information becomes available, the authorized age recommendations may change. Children ages 2-11 years old could potentially be eligible as early as the end of this year.

7. If I’ve been vaccinated but my child hasn’t, could I still give the cipro to them?. The buy antibiotics treatments do not contain live buy antibiotics cipro, so they cannot cause buy antibiotics.

Rather, getting vaccinated will help protect both you and your children from buy antibiotics. Studies have shown that vaccinated pregnant and lactating mothers can pass protective immunity on to their young infants across the placenta and in breast milk—one more benefit of vaccination. Though researchers are still learning how well the treatment can help prevent spread, vaccination is still an important way to limit infecting people who are not yet eligible for the treatment, like younger children.

This article was originally published on The Conversation. Read the original article..

Cipro discount

1 http://tristangough.com/levitra-price-in-uk/ cipro discount. ACA Marketplace SubsidiesProvision DescriptionUnder the Affordable Care Act, people purchasing Marketplace coverage could only qualify for subsidies if they met other eligibility requirements and had incomes between one and four times the cipro discount federal poverty level. People eligible for subsidies would have to contribute a sliding-scale percentage of their income toward a benchmark premium, ranging from 2.07% to 9.83%.

Once income passed 400% FPL, subsidies stopped and many individuals and families were unable to afford coverage.In 2021, the American Rescue cipro discount Plan Act (ARPA) temporarily expanded eligibility for subsidies by removing the upper income threshold. It also temporarily increased the dollar value of premium subsidies across the board, meaning nearly everyone on the Marketplace paid lower premiums, and the lowest income people pay zero premium for coverage with very low deductibles. The ARPA also made people who received unemployment insurance (UI) benefits during 2021 eligible for zero-premium, low-deductible plans.However, the ARPA provisions removing the upper cipro discount income threshold and increasing tax credit amounts are only in effect for 2021 and 2022.

The unemployment provision is only in effect for 2021.Section 137501 of The Build Back Better Act would make permanent ARPA subsidy changes that eliminate the income eligibility cap and increase the amount of APTC for individuals across the board.Additionally, Section 137507 of The Build Back cipro discount Better Act would extend the special Marketplace subsidy rule for individuals receiving UI benefits for an additional 4 years, through the end of 2025.Finally, Section 237502 modifies the affordability test for employer-sponsored health coverage. The ACA makes people ineligible for marketplace subsidies if they have an offer of affordable coverage from an employer, currently defined as requiring an employee contribution of no more than 9.61% of household income in 2022. The Build Back Better Act would reduce this affordability threshold to 8.5% of income, bringing it in line with the maximum contribution required to enroll in the benchmark marketplace plan.People AffectedCBO projects that, under Section 137051, subsidized ACA Marketplace enrollment would increase by 3.6 million people (relative to the number of people who would be enrolled in cipro discount the absence of these provisions).

CBO expects 1.4 million of these enrollees would otherwise be uninsured, while 600,000 would otherwise be covered by an unsubsidized individual market plan and 1.6 million would otherwise have employer coverage.Additionally, CBO expects the enhanced subsidies for people receiving unemployment insurance (Section 137507) would result in 500,000 people newly enrolling, on average per year during the 2022-2025 period. Most of these new enrollees would otherwise be uninsured.As of August 2021, 12.2 million people were actively enrolled in Marketplace plans – an 8% increase from 11.2 million people enrollees as of the close of Open Enrollment cipro discount for the 2021 plan year. HealthCare.gov and all state Marketplaces reopened for a special enrollment period of at least 6 months in 2021, enrolling 2.8 million people (not all of whom were necessarily previously uninsured).

Of these, 44% selected plans with monthly premiums of $10 or less.The US Department of Health and Human Services (HHS) reports that ARPA reduced Marketplace premiums for the 8 million existing Healthcare.gov enrollees by $67 per cipro discount month, on average. If the ARPA subsidies are allowed to expire, these enrollees will cipro discount likely see their premium payments double.HHS also reports that between July 1 and August 15, more than 280,000 individuals received enhanced subsidies due to the ARPA UI provisions. Individuals eligible for these UI benefits can continue to enroll in 2021 coverage through the end of this year.The ARPA changes made people with income at or below 150% FPL eligible for zero-premium silver plans with comprehensive cost sharing subsidies.

40% of new consumers who signed up during the SEP are in a plan that cipro discount covers 94% of expected costs (with average deductibles below $200). As a result of the ARPA, HHS reports the median deductible for new consumers selecting plan during the buy antibiotics-SEP decreased by more than 90% (from $750 in 2020 to $50 in 2021).With the ARPA and ACA subsidies, as well as Medicaid in states that expanded the program, we estimate that at least 46% of non-elderly uninsured people in the U.S. Are eligible for free or nearly-free health plans, often with low or no cipro discount deductibles.Budgetary ImpactCBO published a score of certain provisions in the House Reconciliation legislation that affect coverage of nonelderly adults.CBO projects that, over the ten year period 2022-2031, the cost of permanently extending ARPA ACA subsidies (Section 137501) would be $209.5 billion.

The cost of Section 137507, which extends additional tax cipro discount credits for people receiving unemployment insurance, would be $10.6 billion over the ten-year period of 2022-2031. Modification of the affordability test for employer-sponsored coverage (Section 137502) would cost $10.8 billion over the ten-year period.2. New Medicare Dental, Hearing, cipro discount and Vision BenefitProvision DescriptionTraditional Medicare currently does not cover dental, vision, or hearing services, except under limited circumstances.

Dental, hearing, and vision services are typically offered by Medicare Advantage plans, which currently enroll more than 26 million Medicare beneficiaries, but according to our analysis, the extent of that coverage and the value of these benefits varies. Some beneficiaries in traditional Medicare may have private coverage or coverage through Medicaid for these services, but many do not – including nearly half of Medicare beneficiaries (24 million people) who did not have dental coverage as of 2019, based on cipro discount our estimates. Our recent analysis found about half of all beneficiaries did not have a dental visit in the past year, with higher rates among Black and Hispanic beneficiaries.Sections 30901, 30902, and 30903 of the Build Back Better Act would add coverage of dental, hearing, and vision services to Medicare Part B.

Coverage of vision would begin in 2022, hearing in 2023, and dental in 2028.Covered dental services would include preventive and screening services such as cipro discount oral exams, cleanings, and x-rays, major treatments such as crowns and root canals, and dentures. Coverage for hearing care would include hearing rehabilitation and treatment services by qualified audiologists, and cipro discount hearing aids. Vision services would include routine eye examinations and contact lens fitting services, eyeglasses and contact lenses.

Cost sharing would apply to cipro discount these services. The legislation specifies that the additional cost of providing dental benefits would not be factored into the determination of Part B premium.People AffectedAdding coverage of dental, hearing, and vision services to traditional Medicare would benefit up to all 62 million people on Medicare, but particularly the roughly 36 million beneficiaries in traditional Medicare who currently either lack coverage for these services or opt to purchase private coverage. A new, defined Medicare Part B benefit could also lead to enhanced dental, vision and hearing benefits for Medicare cipro discount Advantage enrollees.

Because costs are often a barrier to care, adding these benefits to Medicare could increase use these services, and contribute to better health outcomes.Coverage of dental, hearing, and vision services under traditional Medicare also would make these services more affordable relative to what beneficiaries who use these services currently pay out of pocket. Our analysis shows that beneficiaries who use dental, vision, and hearing services can incur cipro discount high out-of-pocket costs. Among beneficiaries who used each type of service in 2019, average spending was $914 for hearing care, $874 for dental care, and $230 for vision care.Budgetary ImpactCBO has not yet published budgetary estimates for these sections of the Build Back Better Act.However, according to a CBO estimate of an cipro discount earlier version of H.R.3 passed by the House of Representatives in 2019, which included these same provisions, adding coverage of dental, vision, and hearing services to Medicare would lead to higher federal spending of $358 billion over 10 years (2020-2029), including $238 billion for dental and oral health care, $89 billion for hearing care, and $30.1 billion for vision care.3.

Controlling Prescription Drug Prices and SpendingProvision DescriptionCurrently, under the Medicare Part D program, which covers retail prescription drugs, Medicare contracts with private plan sponsors to provide a prescription drug benefit. The law that established the Part D benefit includes a provision known as the “noninterference” clause, which stipulates that the HHS Secretary “may not interfere with the negotiations between drug manufacturers and pharmacies and PDP [prescription drug plan] sponsors, and may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.”In addition to the inability to negotiate drug prices under Part D, Medicare lacks the ability to limit annual price increases for drugs covered cipro discount under Part B (which includes those administered by physicians) and Part D. In contrast, Medicaid has an inflationary rebate in place.

Year-to-year drug price increases cipro discount exceeding inflation are not uncommon and affect people with both Medicare and private insurance. Our analysis shows that half of cipro discount all covered Part D drugs had list price increases that exceeded the rate of inflation between 2018 and 2019.Section 139001 of the Build Back Better Act would amend the non-interference clause by adding an exception that would allow the federal government to negotiate prices with drug companies for a relatively small number of high-cost drugs lacking generic or biosimilar competitors. The negotiation process would apply to at least 25 (in 2025) and 50 (in 2026 and subsequent years) single-source brand-name drugs lacking generic or biosimilar competitors, selected from among the 125 drugs with the highest net Medicare Part D spending and the 125 drugs with the highest net spending in the U.S., which could include physician-administered drugs covered under Medicare Part B, along with all insulin products.The proposal to allow the government to negotiate drug prices establishes an upper limit for the negotiated price equal to 120% of the Average International Market (AIM) price paid by at least one of six applicable countries (Australia, Canada, France, Germany, Japan, and the United Kingdom).

The agreed-upon negotiated price would be made available to private plan sponsors in Medicare Part D and cipro discount commercial payers in group and individual markets, and to providers that administer physician-administered drugs. An excise tax would be levied on drug companies that do not comply with the negotiation process, and civil monetary penalties would be imposed on companies that do not offer the agreed-upon negotiated price to any payer.Sections 139101 and 139102 of the Build Back Better Act would require drug manufacturers to pay a rebate to the federal government if their prices for drugs covered under Medicare Part B and Part D increase faster than the rate of inflation (CPI-U). Under these provisions, price changes would be measured based on the average sales price (for Part B drugs) or the average manufacturer price (for Part D drugs) cipro discount.

For price increase higher than inflation, manufacturers would be required to pay the difference in the form of a rebate to Medicare. The rebate amount is equal to the total number of units multiplied by the amount if any by which the manufacturer price exceeds the inflation-adjusted payment amount, including all units sold outside of Medicaid and therefore applying not only to use by Medicare beneficiaries but by privately insured individuals as cipro discount well. Rebate dollars would be deposited in the Medicare Supplementary Medical Insurance (SMI) trust fund,Manufacturers that do not pay the requisite rebate amount within 30 days would be required to pay a penalty equal to 125% cipro discount of the original rebate amount.

The base year for measuring price changes is 2016, and the provisions would take effect in 2023.People AffectedThe number of Medicare beneficiaries and privately insured individuals who would see lower out-of-pocket drug costs in any given year under these provisions would depend on how many and which drugs were subject to the negotiation process, and how many and which drugs had lower price increases, and the magnitude of price reductions relative to current prices under each provision.According to estimates from the CMS Office of the Actuary (OACT) of the drug price negotiation provision included in H.R.3 passed by the House of Representatives in 2019, allowing the federal government to negotiate drug prices would lower cost sharing for Part D enrollees by $102.6 billion in the aggregate (2020-2029) and Part D premiums for Medicare beneficiaries by $14.3 billion. Based on our analysis, premium savings for Medicare beneficiaries are projected to increase from an estimated 9% of the Part D base beneficiary premium in 2023 to 15% cipro discount in 2029.Because the lower negotiated prices would also apply to private health insurers under the BBBA, people with private insurance would also face lower cost sharing for prescription drugs and premiums, according to OACT. Overall, people with private health insurance would save an estimated $54 billion between 2020 and 2029, including $25 billion in lower cost sharing for enrollees who use drugs subject to negotiation and $29 billion in savings due to lower premiums.While it is expected that some people would face lower cost sharing under these provisions, it is also possible that drug manufacturers could respond to the inflation rebate by increasing launch prices for new drugs.

In this case, some individuals could face higher out-of-pocket costs for new drugs that come to market, with potential spillover effects on total costs incurred by payers as well.A recent KFF Tracking Poll finds large majorities support allowing the federal government to negotiate and this support holds steady even after the public is provided the arguments being presented by parties on both sides of the legislative debate (83% total, 95% of Democrats, 82% of independents, and 71% of Republicans).Budgetary ImpactCBO has not yet cipro discount published budgetary estimates for these sections of the Build Back Better Act.However, CBO estimated there would be over $450 billion in 10-year (2020-2029) savings from the Medicare drug price negotiation provision in drug price legislation considered in the 116th Congress (H.R. 3), including $448 billion in savings to Medicare and $12 billion in savings for subsidized plans in the ACA Marketplace and the Federal Employees Health Benefits Program. CBO also estimated an increase in revenues of about $45 cipro discount billion over 10 years resulting from lower drug prices available to employers, which would reduce premiums for employer-sponsored insurance, leading to higher compensation in the form of taxable wages.A separate CBO estimate of the same Medicare drug price negotiation provision included in another House bill in the 116th Congress (H.R.

1425, the Patient Protection and Affordable Care Enhancement Act) estimated higher 10-year (2021-2030) savings of nearly cipro discount $530 billion, mainly because the Secretary would negotiate prices for a somewhat larger set of drugs in year 2 of the negotiation program under H.R. 1425 (this change is incorporated in the current version of the Build Back Better Act).CBO estimated savings from the drug inflation rebate provisions in previous legislation (H.R. 3 and S cipro discount.

2543, Senate Finance Committee legislation considered in the 116th Congress) amounting to $36 billion for H.R. 3 (2020-2029) and $82 billion for cipro discount S. 2543 (2021-2030) cipro discount.

10-year savings were estimated to be lower under H.R. 3 because the inflation provision would not apply to drugs subject to the government cipro discount negotiation process that would be established by that bill. This same exception applies in the Build Back Better Act.

However, because the Build Back Better Act applies the inflation rebate to cipro discount use by private insurers as well as Medicare, it is possible that the savings from the inflation rebate provision would be larger than CBO estimated for either H.R. 3 or S. 2543.4.

Medicare Part D Benefit RedesignProvision DescriptionMedicare Part D currently provides catastrophic coverage for high out-of-pocket drug costs, but there is no limit on the total amount that beneficiaries pay out of pocket each year. Medicare Part D enrollees with drug costs high enough to exceed the catastrophic coverage threshold are required to pay 5% of their total drug costs unless they qualify for Part D Low-Income Subsidies (LIS). Medicare pays 80% of total costs above the catastrophic threshold and plans pay 15%.Under the current structure of Part D, there are multiple phases, including a deductible, an initial coverage phase, a coverage gap phase, and the catastrophic phase.

When enrollees reach the coverage gap benefit phase, they pay 25% of drug costs for both brand-name and generic drugs. Plan sponsors pay 5% for brands and 75% for generics. And drug manufacturers provide a 70% price discount on brands (no discount on generics).

Under the current benefit design, beneficiaries can face different cost-sharing amounts for the same medication depending on which phase of the benefit they are in, and can face significant out-of-pocket costs for high-priced drugs because of coinsurance requirements and no hard out-of-pocket cap.Section 139201 of the Build Back Better Act amends the design of the Part D benefit by adding a hard cap on out-of-pocket spending (set at $2,000 in 2024, and increasing each year based on the rate of increase in per capita Part D costs). It also lowers Medicare’s share of total costs above the catastrophic threshold from 80% to 20%, increases plans’ share of costs from 15% to 50%, and adds a 30% manufacturer price discount on brand-name drugs, instead of providing a 70% price discount for brands in the coverage gap, which would be phased out. Manufacturers would also be required to pay 10% of the costs in the initial coverage phase (prior to catastrophic coverage).People AffectedWhile most Part D enrollees have not had out-of-pocket costs high enough to exceed the catastrophic coverage threshold in a single year, the likelihood of a Medicare beneficiary incurring drug costs above the catastrophic threshold increases over a longer time span.Our analysis shows that in 2019, nearly 1.5 million Medicare Part D enrollees had out-of-pocket spending above the catastrophic coverage threshold.

Looking over a five-year period (2015-2019), the number of Part D enrollees with out-of-pocket spending above the catastrophic threshold in at least one year increases to 2.7 million, and over a 10-year period (2010-2019), the number of enrollees increases to 3.6 million.We also find that in 2019, nearly 1 million more Part D enrollees incurred out-of-pocket costs for their medications above $2,000, the proposed out-of-pocket spending limit in the Build Back Better Act, than above $3,100, the proposed out-of-pocket spending limit in recent GOP drug legislation (H.R. 19) and a 2019 Senate Finance Committee bill (S. 2543).

Overall, 1.2 million Part D enrollees in 2019 incurred annual out-of-pocket costs for their medications above $2,000, while 0.3 million spent more than $3,100 out of pocket.Medicare Part D enrollees with higher-than-average out-of-pocket costs could save substantial amounts with an out-of-pocket spending cap, as our analysis shows. For example, the top 10% of beneficiaries (122,000 enrollees) with average out-of-pocket costs for their medications above $2,000 in 2019 – who spent at least $5,348 – would have saved $3,348 (63%) in out-of-pocket costs with a $2,000 cap and $2,248 (42%) with a $3,100 cap.Budgetary ImpactCBO has not yet published budgetary estimates for this section of the Build Back Better Act.Adding a cap on out-of-pocket drug spending under Part D could add costs to the program, unless combined with other policies to lower Medicare drug spending (such as reducing the among Medicare now pays above the catastrophic threshold). A lower cap would help more beneficiaries and provide more out-of-pocket savings than a higher cap, but could mean higher costs for the federal government, plans, and drug manufacturers, depending on the specific features included in the Part D benefit redesign proposal.5.

Medicaid Coverage GapProvision DescriptionThere are currently 12 states that have not adopted the ACA provision to expand Medicaid to adults with incomes through 138% of poverty. The result is a coverage gap for individuals whose below-poverty-level income is too high to qualify for Medicaid in their state, but too low to be eligible for premium subsidies in the ACA Marketplace.Sections 137504, 137505 and 30701 of the Build Back Better Act would allow people living in states that have not expanded Medicaid to purchase subsidized coverage on the ACA Marketplace for 2022 to 2024. They would also be eligible for cost sharing subsidies that would reduce their out-of-pocket costs.

Beginning in 2025, a Federal Medicaid Program would be established to provide coverage to those with incomes up to 138% FPL. States that had expansion in place in January 2022 and then decide to end expansion coverage would be required make payments estimating the state costs for the expansion group.People AffectedCBO estimates that these provisions would increase the number of adult Medicaid enrollees by an average of 3.8 million people per year over the ten year period of 2022-2031. CBO estimates that about 2.3 million of those enrollees would otherwise be uninsured, 700,000 would otherwise have Marketplace coverage, and 900,000 would otherwise have employer coverage.

For the period in which people in the Medicaid coverage gap would be eligible for marketplace subsidies, enrollment would be somewhat lower.We estimate that 2.2 million uninsured people with incomes under poverty fall in the “coverage gap”. Most in the coverage gap are concentrated in four states (TX, FL, GA and NC) where eligibility levels for parents in Medicaid are low, and there is no coverage pathway for adults without dependent children. Half of those in the coverage gap are working and six in 10 are people of color.

Another 1.8 million uninsured people with incomes between 100% and 138% FPL in non-expansion states are eligible for subsidized marketplace coverage. In non-expansion state, there are also individuals with incomes 100-138% enrolled in marketplace coverage who would be eligible for coverage under the new Federal Medicaid Program in 2025.Budgetary ImpactCBO estimates that the federal cost of these provisions would be $323.1 billion over the 2022-2031 period. The estimate accounts for increased federal Medicaid spending partially offset by decreases in Marketplace subsidies.The total cost to the federal government will depend on the number of people who take up this coverage benefit, the cost per enrollee for coverage in the Marketplace or the new federal option, as well as the behavioral response of states and interaction with Marketplace coverage.6.

Maternity Care and Postpartum CoverageProvision DescriptionMedicaid currently covers almost half of births in the U.S. Federal law requires that pregnancy-related Medicaid coverage last through 60 days postpartum. After that period, some may qualify for Medicaid through another pathway, but others may not qualify, particularly in non-expansion states.

In an effort to improve maternal health and coverage stability and to help address racial disparities in maternal health, a provision in the American Rescue Plan Act (ARPA) of 2021 gives states a new option to extend Medicaid postpartum coverage to 12 months. This new option takes effect on April 1, 2022 and is available to states for five years.Section 30723 of the Build Back Better Act would require states to extend Medicaid postpartum coverage from 60 days to 12 months, ensuring continuity of Medicaid coverage for postpartum individuals in all states.Sections 31041 through 31056 of the Build Back Better Act provide federal grants to bolster other aspects of maternal health care. The funds would be used to address a wide range of issues, such as addressing social determinants of maternal health.

Diversifying the perinatal nursing workforce, expanding care for maternal mental health and substance use, and supporting research and programs that promote maternal health equity.People AffectedLargely in response to the new federal option, at least 25 states have taken steps to extend Medicaid postpartum coverage. Pregnant people in non-expansion states could see the biggest change as they are more likely than those in expansion states to become uninsured after the 60-day postpartum coverage period. For example, in Alabama, the Medicaid eligibility level for pregnant individuals is 146% FPL, but only 18% FPL (approximately $4,000/year for a family of three) for parents.The federal grant provisions related to maternal health could affect care for all persons giving birth, but the focus of these proposals is on reducing racial and ethnic inequities.

There were approximately 3.7 million births in 2019, and nearly half were to women of color. There are approximately 700-800 pregnancy-related deaths annually, with the rate 2-3 times higher among Black and American Indian and Alaska Native women compared to White women. Additionally, there are stark racial and ethnic disparities in other maternal and health outcomes, including preterm birth and infant mortality.Budgetary ImpactCBO has not yet published budgetary estimates for these sections of the Build Back Better Act.However, in June 2020, prior to the enactment of the ARPA option for postpartum coverage, CBO estimated that a proposal to require 12 month postpartum coverage in Medicaid and CHIP would have a net federal cost of $6 billion over 10 years (new costs of $12.3 billion offset by revenues).Total allocations in FY 2022 for the federal grant sections in the Build Back Better Act related to maternal health care outside of the postpartum extension are $1.05 billion.7.

Continuous Coverage for Children in Medicaid / CHIPProvision DescriptionUnder current law, states have the option to provide 12-months of continuous coverage for children. Under this option, states allow a child to remain enrolled for a full year unless the child ages out of coverage, moves out of state, voluntarily withdraws, or does not make premium payments. As such, 12-month continuous eligibility eliminates coverage gaps due to fluctuations in income over the course of the year.Section 30724 of the Build Back Better Act would require states to extend 12-month continuous coverage for children on Medicaid and CHIP.People AffectedAs of April 2021, there were 39 million children enrolled in Medicaid and CHIP (nearly half of all enrollees).

As of January 2020, 31 states provide 12-month continuous eligibility to children in either Medicaid or CHIP. A recent MACPAC report found that the overall mean length of coverage for children in 2018 was 11.7 months, and also that rates of churn (in which children dis-enroll and reenroll within a short period of time) were lower in states that had adopted the 12-month continuous coverage option and in states that did not conduct periodic data checks. Another recent report shows that children with gaps in coverage during a year are more likely to be children of color with lower incomes.Budgetary ImpactCBO has not yet published budgetary estimates for this section of the Build Back Better Act.Given that the length of coverage for children in Medicaid is already high (mean of 11.7 months), more than half of all states already have a continuous coverage policy in place, and costs for children are generally lower compared to other eligibility groups, new federal costs could be moderate.

In addition, reducing churn could modestly reduce Medicaid administrative costs.8. Permanent Extension of the Children’s Health Insurance Program (CHIP)Provision DescriptionUnder current law, Medicaid is the base of coverage for low-income children. CHIP complements Medicaid by covering uninsured children in families with incomes above Medicaid eligibility levels.

Unlike Medicaid, federal funding for CHIP is capped and provided as annual allotments to states. CHIP funding is authorized through September 30,2027. While CHIP generally has bipartisan support, during the last reauthorization funding lapsed before Congress reauthorized funding.Section 30801 of the Build Back Better Act would permanently extend the CHIP program.People AffectedAs of April 2021, there were 6.9 million people (mostly children) enrolled in CHIP.Budgetary ImpactCBO has not yet published budgetary estimates for this section of the Build Back Better Act.Federal CHIP funding in Fiscal Year (FY) 2020 for the states was $17.0 billion.

Since CHIP is authorized through FY 2027, CBO estimates would only account for costs in FY 2028 – FY 2031 (the current ten-year window). When CHIP was reauthorized through FY 2027, CBO estimated that this would result in net fiscal savings to the federal government because without CHIP, other alternatives would have higher federal costs and because of expected changes in the federal match rate back to traditional CHIP match rates.9. Medicaid Home and Community Based Services and the Direct Care WorkforceProvision DescriptionMedicaid is currently the primary payer for long-term services and supports (LTSS), including home and community-based services (HCBS), that help seniors and people with disabilities with daily self-care and independent living needs.

There is currently a great deal of state variation as most HCBS eligibility pathways and benefits are optional for states.Sections 30711-30715 of the Build Back Better Act would create the HCBS Improvement Program, which would provide a permanent 7 percentage point increase in federal Medicaid matching funds for HCBS. To qualify for the enhanced funds, states would have to maintain existing HCBS eligibility, benefits, and payment rates and have an approved plan to expand HCBS access, strengthen the direct care workforce, and monitor HCBS quality. The bill includes some provisions to support family caregivers.

In addition, the Act would include funding ($130 million) for state planning grants and enhanced funding for administrative costs for certain activities (80% instead of 50%).Sections 30721 and 30722 of the Build Back Better Act would make the Money Follows the Person (MFP) program and the ACA HCBS spousal impoverishment protections permanent.People AffectedThe majority of HCBS are provided by waivers, which served over 2.5 million enrollees in 2018. There is substantial unmet need for HCBS, which is expected to increase with the growth in the aging population in the coming years. Nearly 820,000 people in 41 states were on a Medicaid HCBS waiver waiting list in 2018.

Though waiting lists alone are an incomplete measure, they are one proxy for unmet need for HCBS. Additionally, a shortage of direct care workers predated and has been intensified by the buy antibiotics cipro, characterized by low wages and limited opportunities for career advancement. The direct care workforce is disproportionately female and Black.Over 101,000 seniors and people with disabilities across 44 states and DC moved from nursing homes to the community using MFP funds from 2008-2019.

A federal evaluation of MFP showed about 5,000 new participants in each six month period from December 2013 through December 2016, indicating a continuing need for the program.A KFF survey found that, as of 2018, 14 states expected that allowing the ACA provision to expire would affect Medicaid HCBS enrollees, for example by making fewer individuals eligible for waiver services.Budgetary ImpactCBO has not yet published budgetary estimates for these sections of the Build Back Better Act.The House Energy and Commerce Committee markup of the bill described the cost to the federal government as $190 billion. This is less than the $400 billion originally proposed by President Biden. While the program requirements are not the same, CBO previously estimated that the American Rescue Plan Act’s 10 percentage point increase in federal matching funds for Medicaid HCBS for 1 year would increase federal costs by about $12.7 billion.10.

Paid Family and Medical LeaveProvision DescriptionThe U.S. Is the only industrialized nation without a minimum standard of paid family or medical leave. Although six states and DC have paid family and medical leave laws in effect, and some employers voluntarily offer these benefits, this has resulted in a patchwork of policies with varying degrees of generosity and leaves many workers without a financial safety net when they need to take time off work to care for themselves or their families.Section 130001 of the Build Back Better Act would guarantee 12 weeks per year of paid family and medical leave annually to all workers in the U.S.

Who need time off work to welcome a new child, recover from a serious illness, care for a seriously ill family member, or for certain military-related reasons. Also included is three days of paid bereavement leave. The progressive benefits formula means that that the amount of pay replaced while on qualified leave is higher for workers with lower wages, with 85% wage replacement for individuals earning about $15,080/year.

While all workers taking qualified leave would be eligible for at least some wage replacement, earnings above $250,000/year are not included in the benefit formula.People AffectedAccording to the Bureau of Labor Statistics, one in five (21%) workers have access to paid family leave through their employer. It is estimated that 53 million adults are caregivers for a dependent child or adult and 61% of them are women. Sixty percent (60%) of caregivers reported having to take a leave of absence leave from work or cut their hours in order to care for a family member.

Workers who take leave do so for different reasons. Half (51%) reported taking leave due to their own serious illness, one-quarter (25%) for reasons related to pregnancy, childbirth, or bonding with a new child, and one-fifth (19%) to care for a seriously ill family member. In total, four in ten (42%) reported receiving their full pay while on leave, one-quarter (24%) received partial pay, and one-third (34%) received no pay.Budgetary ImpactCBO has not yet published budgetary estimates for this section of the Build Back Better Act.However, unofficial estimates reportedly put the cost at $494 billion over ten years.

A 2019 CBO estimate of the proposed Democratic-led FAMILY Act, which is similar to the current proposal, estimated that program would cost $547 billion over ten years.SOURCE. KFFKey FindingsThe October KFF Health Tracking Poll finds one in five adults in the U.S. Report receiving ongoing support for daily activities such as bathing, dressing, or remembering medications, and a similar share say they are providing those type of services for a close friend or family member.

About one in five adults (18%) also say they or a family member need either new or additional support from paid nurses or aides beyond what they are currently getting. The most common reason why people haven’t gotten the support they need is cost. More than three-fourths of those who say they need more help (14% of all adults) say “not being able to afford the cost of the care” is a reason why they or their family member has not received the additional support from paid nurses or aides.Many unpaid caregivers say providing support to friends or family members has caused them to worry or stress (77%), experience worsening of their own mental health (50%), financial strain due to inability to work (42%), or worsening of their own physical health (38%).

Unpaid caregivers are more likely to be racial and ethnic minorities, those with lower education, and report lower levels of household income.Significant shares of older adults in the U.S. Report difficulty paying for various aspects of health care, especially services not generally covered by Medicare. Four in ten older adults (41%) report difficulty paying for dental care while three in ten report difficulty affording hearing or vision care (30%).

Dental, vision, and hearing coverage are three benefits not generally covered by Medicare but are part of Democratic lawmakers’ proposals as part of the reconciliation spending package.Many older adults who are eligible for Medicare also report putting off or foregoing medical care due to costs. While Medicare helps older adults pay for routine doctor visits and hospital stays, substantial shares of lower income older adults report putting off or foregoing services not covered by Medicare. Overall, more than four in ten older adults in households earning less than $40,000 annually report delaying or going without some form of medical care over the past year due to costs (compared to 24% of older adults with household incomes over $40,000), including dental care (34%), vision care (20%), and hearing services including hearing aids (16%).With substantial shares of the public reporting financial strains associated with help with everyday activities for themselves or family members, and seniors reporting difficulty paying for some health care expenses, the latest KFF poll finds broad support for many of the proposals in the reconciliation package being currently discussed in Congress.Home And Community Based ServicesOne in five adults, including 27% of adults 65 and older, say they are currently receiving ongoing support with everyday activities from either a family member (19%), a friend (11%), or paid nurses or aides (5%).

Additionally, nearly four in ten (38%) adults say a family member gets ongoing help from at least one of these sources including another family member (30%), paid nurses or aides (16%) or friends (12%). About one in five adults (18%) say they or a family member need either new or additional support from paid nurses or aides beyond what they are currently getting. The most common reason why people haven’t gotten the support they need is cost.

More than three-fourths of those who say they need more help (14% of all adults) say “not being able to afford the cost of the care” is a reason why they or their family member has not received the additional support from paid nurses or aides. Other reasons include not being able to find someone to provide the services (47%, or 8% of all adults), being worried about being exposed to antibiotics (40%, 7% of all adults), being afraid or embarrassed to get help (32%, 6%), or being too busy or unable to find the time to get help (20%, 4%). With many reporting difficulty paying for cost of home and community based care, the poll also gauged support for Democratic proposals to increase funding to Medicaid to pay workers and expand home and community-based services (HCBS).

Medicaid is the primary payer for long-term services and supports (LTSS), including home and community-based services (HCBS), that help seniors and people with disabilities with daily self-care and independent living needs. Majorities across partisans (79% total, 95% of Democrats, 76% of independents, 67% of Republicans) support increased funding to Medicaid to pay workers and expand home and community-based services (HCBS).The toll On Unpaid CaregiversWith Congress discussing possible new tax credits to help with home and community based care, one in five adults (21%) say they are currently providing unpaid support with everyday activities to either a friend or family member, excluding the type of care young children need. Majorities across partisans also favor new tax credit to help people pay for such care (82% total, 94% of Democrats, 80% of independents, 73% of Republicans).The KFF October Tracking Poll finds unpaid caregivers are more likely to be Black or Hispanic (14% and 21%) compared to those who are not unpaid caregivers (10% and 15%).

About eight in ten unpaid caregivers to family and friends do not have a college degree, and about half have household incomes under $40,000. Consistent with recent focus groups conducted by KFF, the poll finds most unpaid caregivers (85%, 18% of all adults) report experiencing at least one of several negative outcomes due to their caregiving responsibilities. Over three-fourths of unpaid caregivers (16% of all adults) say they have experienced stress or worry related to the care of the individual they are caring for, with an additional half (11% of all adults) say they have experienced a worsening of their own mental health as a result of providing this ongoing support.

About four in ten (9% of total) say they have experienced financial strain, such as losing a job or having to work reduced hours. A similar share (38% and 8% of total) also say they have experienced a worsening of their own physical health. Expanding Medicare BenefitsWith Congress debating changes to the current Medicare program, eight in ten adults—and nearly all older adults—say Medicare is important to them and their family members.

This includes at least seven in ten adults across partisanship, income groups, and racial and ethnic identity. Significant shares of older adults in the U.S. Report difficulty paying for various aspects of health care, especially services not generally covered by Medicare.

Four in ten older adults (41%) report difficulty paying for dental care while three in ten report difficulty affording hearing or vision care (30%). Two in ten report difficulty affording their prescription drugs. Additionally, one-third report difficulty affording their out-of-pocket health care costs and one in five report the same about their monthly health insurance costs – shares comparable to those who report difficulty affording other household expenses such as rent or mortgage, gasoline, monthly utilities, or food and groceries.

Dental services are the most common type of medical care that people have delayed or gone without with about with about one in four (23%) of adults ages 65 and older saying they have put off dental care in the past year due to cost. This is followed by vision services or eyeglasses (15%) and hearing aids (13%). Dental, vision, and hearing coverage are three benefits not generally covered by Medicare.Few older adults report delaying or going without a doctor’s office visit (6%), hospital services (5%) or mental health care (2%) due to cost.

Overall, three in ten adults 65 and older report delaying or going without certain medical care during the past year due to cost (32%). Even among older adults who are eligible for Medicare, those with lower incomes report delaying or going without care at higher rates. More than four in ten older adults in households earning less than $40,000 annually report delaying or going without some form of medical care over the past year due to costs (compared to 24% of older adults with household incomes over $40,000).

While Medicare helps older adults pay for routine doctor visits and hospital stays, substantial shares of lower income older adults report putting off or foregoing dental care (34%), vision care (20%), and hearing services including hearing aids (16%) that are not generally covered by Medicare. A large majority of the public (90%) favor expanding Medicare coverage to include dental, vision, and hearing coverage, including 97% of Democrats, 90% of independents, and 85% of Republicans. This proposal is also largely favored by adults 65 and older, including 96% of those in that age group who identify as Democrats or Democratic-leaning and 82% of their Republican counterparts.

Proposals aimed at curbing the price individuals have to pay for their prescription drugs are favored by majorities of the public with at least eight in ten overall and at least three-fourths across partisans saying they favor each of the proposals asked about. Eighty-eight percent of adults favor limiting how much drug companies can increase the price for prescription drugs each year to not outpace the rate of inflation (including 93% of Democrats, 86% of independents, 89% of Republicans) and a similar share (85%) favor placing an annual limit on out-of-pocket prescription drug costs for people on Medicare (favored by 88% of Democrats, 85% of independents, 84% of Republicans). The proposed changes to Medicare drug negotiations as part of the reconciliation package poll findings were released earlier this week.The Affordable Care ActViews of the 2010 Affordable Care Act are still largely driven by party identification with nearly nine in ten Democrats saying they view the law favorably, while three-fourths of Republicans say they hold an unfavorable view.

Independents are slightly more favorable than unfavorable with more than half saying they hold a positive opinion of the ACA. KFF has been polling on the ACA since its passage and since 2017 views have been more favorable than unfavorable but still sharply divided on party lines. The buy antibiotics relief bill passed in early March 2021 providing additional financial help for people who buy their own health insurance coverage.

Previous KFF polling found that a small minority of those likely eligible for additional financial help or coverage reporting going online to see if they qualify for a different or cheaper health insurance plan.Among those under 65 years old, nine percent of those who are either uninsured or buy their own coverage reported going online in the in the two months before mid-May 2021 to see if they qualify for a different or cheaper health insurance plan or Medicaid as part of the buy antibiotics relief package. Four months later, the latest KFF polling finds that about one in four (23%) of those likely eligible for this assistance have gone online to see if they qualify, though majorities (75%) still have not. In addition, changes to health insurance coverage provided under the Affordable Care Act continue to be seen through a partisan lens, with overwhelming majorities of Democrats and smaller majorities of Republicans expressing support.

Overall, eight in ten adults favor making permanent the financial help to low- and moderate- income Americans who buy their own health insurance coverage (94% of Democrats, 79% of independents, 63% of Republicans). Three in four favor the federal government stepping in to provide insurance options for lower income people living in states that haven’t expanded their Medicaid programs (94% of Democrats, 76% of independents) but this is supported by a small majority (54%) of Republicans.While the poll finds broad support for many of the Democratic proposed changes to the country’s health care system including the ACA, Medicaid, and Medicare, the poll did not ask about the potential costs and savings associated with each provision, or the size and scope of Democrats’ broader legislative plan, which includes many provisions unrelated to health care. Methodology.

1 http://tristangough.com/levitra-price-in-uk/ buy cipro over the counter. ACA Marketplace SubsidiesProvision DescriptionUnder the Affordable Care Act, people purchasing Marketplace coverage could only qualify for subsidies if they met other eligibility requirements and buy cipro over the counter had incomes between one and four times the federal poverty level. People eligible for subsidies would have to contribute a sliding-scale percentage of their income toward a benchmark premium, ranging from 2.07% to 9.83%.

Once income passed 400% FPL, subsidies stopped and many individuals and families were unable to afford coverage.In 2021, the American buy cipro over the counter Rescue Plan Act (ARPA) temporarily expanded eligibility for subsidies by removing the upper income threshold. It also temporarily increased the dollar value of premium subsidies across the board, meaning nearly everyone on the Marketplace paid lower premiums, and the lowest income people pay zero premium for coverage with very low deductibles. The ARPA also made people who received unemployment insurance (UI) benefits during 2021 eligible for zero-premium, low-deductible plans.However, the ARPA provisions removing the upper income threshold and increasing tax credit amounts buy cipro over the counter are only in effect for 2021 and 2022.

The unemployment provision is only in effect for 2021.Section 137501 of The Build Back Better Act would make permanent ARPA subsidy changes that eliminate the income eligibility cap and increase the amount of APTC for individuals across the board.Additionally, Section 137507 of The Build Back Better Act would extend the special Marketplace subsidy rule for individuals receiving UI benefits for an additional 4 years, through the end of buy cipro over the counter 2025.Finally, Section 237502 modifies the affordability test for employer-sponsored health coverage. The ACA makes people ineligible for marketplace subsidies if they have an offer of affordable coverage from an employer, currently defined as requiring an employee contribution of no more than 9.61% of household income in 2022. The Build Back Better Act would reduce this affordability threshold to 8.5% of income, bringing it in line with the maximum contribution required to buy cipro over the counter enroll in the benchmark marketplace plan.People AffectedCBO projects that, under Section 137051, subsidized ACA Marketplace enrollment would increase by 3.6 million people (relative to the number of people who would be enrolled in the absence of these provisions).

CBO expects 1.4 million of these enrollees would otherwise be uninsured, while 600,000 would otherwise be covered by an unsubsidized individual market plan and 1.6 million would otherwise have employer coverage.Additionally, CBO expects the enhanced subsidies for people receiving unemployment insurance (Section 137507) would result in 500,000 people newly enrolling, on average per year during the 2022-2025 period. Most of these new enrollees would otherwise be uninsured.As of August 2021, 12.2 million people were actively enrolled in Marketplace plans – an 8% increase from 11.2 million people enrollees as of the close of Open Enrollment for the 2021 buy cipro over the counter plan year. HealthCare.gov and all state Marketplaces reopened for a special enrollment period of at least 6 months in 2021, enrolling 2.8 million people (not all of whom were necessarily previously uninsured).

Of these, buy cipro over the counter 44% selected plans with monthly premiums of $10 or less.The US Department of Health and Human Services (HHS) reports that ARPA reduced Marketplace premiums for the 8 million existing Healthcare.gov enrollees by $67 per month, on average. If the ARPA subsidies are allowed to expire, these enrollees will buy cipro over the counter likely see their premium payments double.HHS also reports that between July 1 and August 15, more than 280,000 individuals received enhanced subsidies due to the ARPA UI provisions. Individuals eligible for these UI benefits can continue to enroll in 2021 coverage through the end of this year.The ARPA changes made people with income at or below 150% FPL eligible for zero-premium silver plans with comprehensive cost sharing subsidies.

40% of new consumers who signed up during the SEP are in buy cipro over the counter a plan that covers 94% of expected costs (with average deductibles below $200). As a result of the ARPA, HHS reports the median deductible for new consumers selecting plan during the buy antibiotics-SEP decreased by more than 90% (from $750 in 2020 to $50 in 2021).With the ARPA and ACA subsidies, as well as Medicaid in states that expanded the program, we estimate that at least 46% of non-elderly uninsured people in the U.S. Are eligible for free or nearly-free health plans, often with buy cipro over the counter low or no deductibles.Budgetary ImpactCBO published a score of certain provisions in the House Reconciliation legislation that affect coverage of nonelderly adults.CBO projects that, over the ten year period 2022-2031, the cost of permanently extending ARPA ACA subsidies (Section 137501) would be $209.5 billion.

The cost of Section 137507, which extends additional buy cipro over the counter tax credits for people receiving unemployment insurance, would be $10.6 billion over the ten-year period of 2022-2031. Modification of the affordability test for employer-sponsored coverage (Section 137502) would cost $10.8 billion over the ten-year period.2. New Medicare Dental, Hearing, and Vision BenefitProvision DescriptionTraditional Medicare currently does not cover dental, vision, or hearing services, except under buy cipro over the counter limited circumstances.

Dental, hearing, and vision services are typically offered by Medicare Advantage plans, which currently enroll more than 26 million Medicare beneficiaries, but according to our analysis, the extent of that coverage and the value of these benefits varies. Some beneficiaries in traditional Medicare may have private coverage or coverage through Medicaid for these services, but many do not – including nearly half of Medicare beneficiaries (24 million people) who did not have dental coverage as of 2019, based on our buy cipro over the counter estimates. Our recent analysis found about half of all beneficiaries did not have a dental visit in the past year, with higher rates among Black and Hispanic beneficiaries.Sections 30901, 30902, and 30903 of the Build Back Better Act would add coverage of dental, hearing, and vision services to Medicare Part B.

Coverage of vision would begin in 2022, hearing in buy cipro over the counter 2023, and dental in 2028.Covered dental services would include preventive and screening services such as oral exams, cleanings, and x-rays, major treatments such as crowns and root canals, and dentures. Coverage for hearing care would include hearing rehabilitation and treatment services by qualified audiologists, and hearing aids buy cipro over the counter. Vision services would include routine eye examinations and contact lens fitting services, eyeglasses and contact lenses.

Cost sharing would apply to these buy cipro over the counter services. The legislation specifies that the additional cost of providing dental benefits would not be factored into the determination of Part B premium.People AffectedAdding coverage of dental, hearing, and vision services to traditional Medicare would benefit up to all 62 million people on Medicare, but particularly the roughly 36 million beneficiaries in traditional Medicare who currently either lack coverage for these services or opt to purchase private coverage. A new, defined Medicare Part B benefit could also lead to enhanced dental, buy cipro over the counter vision and hearing benefits for Medicare Advantage enrollees.

Because costs are often a barrier to care, adding these benefits to Medicare could increase use these services, and contribute to better health outcomes.Coverage of dental, hearing, and vision services under traditional Medicare also would make these services more affordable relative to what beneficiaries who use these services currently pay out of pocket. Our analysis shows that beneficiaries who use dental, vision, and hearing services can incur high out-of-pocket costs buy cipro over the counter. Among beneficiaries who used each type of service in 2019, average spending was $914 for hearing care, $874 for dental care, and $230 for vision care.Budgetary ImpactCBO has not yet published budgetary estimates for these sections of the Build Back Better Act.However, according to a CBO estimate of an earlier version of H.R.3 passed by the House of Representatives in 2019, which included these same provisions, adding coverage of dental, vision, and hearing services to Medicare would lead to higher federal spending of $358 billion over 10 years (2020-2029), including $238 billion for dental and oral health care, $89 billion for hearing care, and $30.1 buy cipro over the counter billion for vision care.3.

Controlling Prescription Drug Prices and SpendingProvision DescriptionCurrently, under the Medicare Part D program, which covers retail prescription drugs, Medicare contracts with private plan sponsors to provide a prescription drug benefit. The law that established the Part D benefit includes a provision known as the “noninterference” clause, which stipulates that the HHS Secretary “may not interfere with the negotiations between drug manufacturers and pharmacies and PDP [prescription drug plan] sponsors, and may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.”In addition to the inability to negotiate drug prices under Part D, Medicare lacks the ability to limit annual price increases for drugs covered under Part B (which includes those administered by physicians) and Part D buy cipro over the counter. In contrast, Medicaid has an inflationary rebate in place.

Year-to-year drug price increases exceeding inflation are not uncommon and affect people buy cipro over the counter with both Medicare and private insurance. Our analysis shows that half of all buy cipro over the counter covered Part D drugs had list price increases that exceeded the rate of inflation between 2018 and 2019.Section 139001 of the Build Back Better Act would amend the non-interference clause by adding an exception that would allow the federal government to negotiate prices with drug companies for a relatively small number of high-cost drugs lacking generic or biosimilar competitors. The negotiation process would apply to at least 25 (in 2025) and 50 (in 2026 and subsequent years) single-source brand-name drugs lacking generic or biosimilar competitors, selected from among the 125 drugs with the highest net Medicare Part D spending and the 125 drugs with the highest net spending in the U.S., which could include physician-administered drugs covered under Medicare Part B, along with all insulin products.The proposal to allow the government to negotiate drug prices establishes an upper limit for the negotiated price equal to 120% of the Average International Market (AIM) price paid by at least one of six applicable countries (Australia, Canada, France, Germany, Japan, and the United Kingdom).

The agreed-upon negotiated price would be made available to buy cipro over the counter private plan sponsors in Medicare Part D and commercial payers in group and individual markets, and to providers that administer physician-administered drugs. An excise tax would be levied on drug companies that do not comply with the negotiation process, and civil monetary penalties would be imposed on companies that do not offer the agreed-upon negotiated price to any payer.Sections 139101 and 139102 of the Build Back Better Act would require drug manufacturers to pay a rebate to the federal government if their prices for drugs covered under Medicare Part B and Part D increase faster than the rate of inflation (CPI-U). Under these provisions, price changes would be measured based on the average sales price (for Part B drugs) or the average buy cipro over the counter manufacturer price (for Part D drugs).

For price increase higher than inflation, manufacturers would be required to pay the difference in the form of a rebate to Medicare. The rebate amount is equal to the total number of units multiplied by the amount if any by which the manufacturer price exceeds the inflation-adjusted payment amount, including all units sold outside of Medicaid buy cipro over the counter and therefore applying not only to use by Medicare beneficiaries but by privately insured individuals as well. Rebate dollars would be deposited in the Medicare Supplementary Medical Insurance (SMI) trust fund,Manufacturers that do not pay the requisite rebate amount within 30 days buy cipro over the counter would be required to pay a penalty equal to 125% of the original rebate amount.

The base year for measuring price changes is 2016, and the provisions would take effect in 2023.People AffectedThe number of Medicare beneficiaries and privately insured individuals who would see lower out-of-pocket drug costs in any given year under these provisions would depend on how many and which drugs were subject to the negotiation process, and how many and which drugs had lower price increases, and the magnitude of price reductions relative to current prices under each provision.According to estimates from the CMS Office of the Actuary (OACT) of the drug price negotiation provision included in H.R.3 passed by the House of Representatives in 2019, allowing the federal government to negotiate drug prices would lower cost sharing for Part D enrollees by $102.6 billion in the aggregate (2020-2029) and Part D premiums for Medicare beneficiaries by $14.3 billion. Based on our analysis, premium savings for Medicare beneficiaries are projected to increase from an estimated 9% of the Part D base beneficiary premium in 2023 to 15% in 2029.Because the lower negotiated prices would also apply to private health buy cipro over the counter insurers under the BBBA, people with private insurance would also face lower cost sharing for prescription drugs and premiums, according to OACT. Overall, people with private health insurance would save an estimated $54 billion between 2020 and 2029, including $25 billion in lower cost sharing for enrollees who use drugs subject to negotiation and $29 billion in savings due to lower premiums.While it is expected that some people would face lower cost sharing under these provisions, it is also possible that drug manufacturers could respond to the inflation rebate by increasing launch prices for new drugs.

In this case, some individuals could face higher out-of-pocket costs for new drugs that come to market, with potential spillover effects on total costs incurred by payers as well.A recent KFF Tracking Poll finds large majorities support allowing the federal government to negotiate and this support holds steady even after the public is provided the arguments being presented by parties on both sides of the legislative debate (83% total, 95% of Democrats, buy cipro over the counter 82% of independents, and 71% of Republicans).Budgetary ImpactCBO has not yet published budgetary estimates for these sections of the Build Back Better Act.However, CBO estimated there would be over $450 billion in 10-year (2020-2029) savings from the Medicare drug price negotiation provision in drug price legislation considered in the 116th Congress (H.R. 3), including $448 billion in savings to Medicare and $12 billion in savings for subsidized plans in the ACA Marketplace and the Federal Employees Health Benefits Program. CBO also estimated an increase in revenues of about $45 billion over 10 years resulting from lower drug prices available buy cipro over the counter to employers, which would reduce premiums for employer-sponsored insurance, leading to higher compensation in the form of taxable wages.A separate CBO estimate of the same Medicare drug price negotiation provision included in another House bill in the 116th Congress (H.R.

1425, the Patient Protection and Affordable Care Enhancement Act) estimated higher 10-year (2021-2030) savings of nearly $530 billion, mainly because the Secretary would negotiate prices for a somewhat larger set of drugs in year buy cipro over the counter 2 of the negotiation program under H.R. 1425 (this change is incorporated in the current version of the Build Back Better Act).CBO estimated savings from the drug inflation rebate provisions in previous legislation (H.R. 3 and S buy cipro over the counter.

2543, Senate Finance Committee legislation considered in the 116th Congress) amounting to $36 billion for H.R. 3 (2020-2029) and $82 billion for buy cipro over the counter S. 2543 (2021-2030) buy cipro over the counter.

10-year savings were estimated to be lower under H.R. 3 because the inflation provision would not buy cipro over the counter apply to drugs subject to the government negotiation process that would be established by that bill. This same exception applies in the Build Back Better Act.

However, because the Build Back Better Act applies the inflation rebate to use by private insurers buy cipro over the counter as well as Medicare, it is possible that the savings from the inflation rebate provision would be larger than CBO estimated for either H.R. 3 or S. 2543.4.

Medicare Part D Benefit RedesignProvision DescriptionMedicare Part D currently provides catastrophic coverage for high out-of-pocket drug costs, but there is no limit on the total amount that beneficiaries pay out of pocket each year. Medicare Part D enrollees with drug costs high enough to exceed the catastrophic coverage threshold are required to pay 5% of their total drug costs unless they qualify for Part D Low-Income Subsidies (LIS). Medicare pays 80% of total costs above the catastrophic threshold and plans pay 15%.Under the current structure of Part D, there are multiple phases, including a deductible, an initial coverage phase, a coverage gap phase, and the catastrophic phase.

When enrollees reach the coverage gap benefit phase, they pay 25% of drug costs for both brand-name and generic drugs. Plan sponsors pay 5% for brands and 75% for generics. And drug manufacturers provide a 70% price discount on brands (no discount on generics).

Under the current benefit design, beneficiaries can face different cost-sharing amounts for the same medication depending on which phase of the benefit they are in, and can face significant out-of-pocket costs for high-priced drugs because of coinsurance requirements and no hard out-of-pocket cap.Section 139201 of the Build Back Better Act amends the design of the Part D benefit by adding a hard cap on out-of-pocket spending (set at $2,000 in 2024, and increasing each year based on the rate of increase in per capita Part D costs). It also lowers Medicare’s share of total costs above the catastrophic threshold from 80% to 20%, increases plans’ share of costs from 15% to 50%, and adds a 30% manufacturer price discount on brand-name drugs, instead of providing a 70% price discount for brands in the coverage gap, which would be phased out. Manufacturers would also be required to pay 10% of the costs in the initial coverage phase (prior to catastrophic coverage).People AffectedWhile most Part D enrollees have not had out-of-pocket costs high enough to exceed the catastrophic coverage threshold in a single year, the likelihood of a Medicare beneficiary incurring drug costs above the catastrophic threshold increases over a longer time span.Our analysis shows that in 2019, nearly 1.5 million Medicare Part D enrollees had out-of-pocket spending above the catastrophic coverage threshold.

Looking over a five-year period (2015-2019), the number of Part D enrollees with out-of-pocket spending above the catastrophic threshold in at least one year increases to 2.7 million, and over a 10-year period (2010-2019), the number of enrollees increases to 3.6 million.We also find that in 2019, nearly 1 million more Part D enrollees incurred out-of-pocket costs for their medications above $2,000, the proposed out-of-pocket spending limit in the Build Back Better Act, than above $3,100, the proposed out-of-pocket spending limit in recent GOP drug legislation (H.R. 19) and a 2019 Senate Finance Committee bill (S. 2543).

Overall, 1.2 million Part D enrollees in 2019 incurred annual out-of-pocket costs for their medications above $2,000, while 0.3 million spent more than $3,100 out of pocket.Medicare Part D enrollees with higher-than-average out-of-pocket costs could save substantial amounts with an out-of-pocket spending cap, as our analysis shows. For example, the top 10% of beneficiaries (122,000 enrollees) with average out-of-pocket costs for their medications above $2,000 in 2019 – who spent at least $5,348 – would have saved $3,348 (63%) in out-of-pocket costs with a $2,000 cap and $2,248 (42%) with a $3,100 cap.Budgetary ImpactCBO has not yet published budgetary estimates for this section of the Build Back Better Act.Adding a cap on out-of-pocket drug spending under Part D could add costs to the program, unless combined with other policies to lower Medicare drug spending (such as reducing the among Medicare now pays above the catastrophic threshold). A lower cap would help more beneficiaries and provide more out-of-pocket savings than a higher cap, but could mean higher costs for the federal government, plans, and drug manufacturers, depending on the specific features included in the Part D benefit redesign proposal.5.

Medicaid Coverage GapProvision DescriptionThere are currently 12 states that have not adopted the ACA provision to expand Medicaid to adults with incomes through 138% of poverty. The result is a coverage gap for individuals whose below-poverty-level income is too high to qualify for Medicaid in their state, but too low to be eligible for premium subsidies in the ACA Marketplace.Sections 137504, 137505 and 30701 of the Build Back Better Act would allow people living in states that have not expanded Medicaid to purchase subsidized coverage on the ACA Marketplace for 2022 to 2024. They would also be eligible for cost sharing subsidies that would reduce their out-of-pocket costs.

Beginning in 2025, a Federal Medicaid Program would be established to provide coverage to those with incomes up to 138% FPL. States that had expansion in place in January 2022 and then decide to end expansion coverage would be required make payments estimating the state costs for the expansion group.People AffectedCBO estimates that these provisions would increase the number of adult Medicaid enrollees by an average of 3.8 million people per year over the ten year period of 2022-2031. CBO estimates that about 2.3 million of those enrollees would otherwise be uninsured, 700,000 would otherwise have Marketplace coverage, and 900,000 would otherwise have employer coverage.

For the period in which people in the Medicaid coverage gap would be eligible for marketplace subsidies, enrollment would be somewhat lower.We estimate that 2.2 million uninsured people with incomes under poverty fall in the “coverage gap”. Most in the coverage gap are concentrated in four states (TX, FL, GA and NC) where eligibility levels for parents in Medicaid are low, and there is no coverage pathway for adults without dependent children. Half of those in the coverage gap are working and six in 10 are people of color.

Another 1.8 million uninsured people with incomes between 100% and 138% FPL in non-expansion states are eligible for subsidized marketplace coverage. In non-expansion state, there are also individuals with incomes 100-138% enrolled in marketplace coverage who would be eligible for coverage under the new Federal Medicaid Program in 2025.Budgetary ImpactCBO estimates that the federal cost of these provisions would be $323.1 billion over the 2022-2031 period. The estimate accounts for increased federal Medicaid spending partially offset by decreases in Marketplace subsidies.The total cost to the federal government will depend on the number of people who take up this coverage benefit, the cost per enrollee for coverage in the Marketplace or the new federal option, as well as the behavioral response of states and interaction with Marketplace coverage.6.

Maternity Care and Postpartum CoverageProvision DescriptionMedicaid currently covers almost half of births in the U.S. Federal law requires that pregnancy-related Medicaid coverage last through 60 days postpartum. After that period, some may qualify for Medicaid through another pathway, but others may not qualify, particularly in non-expansion states.

In an effort to improve maternal health and coverage stability and to help address racial disparities in maternal health, a provision in the American Rescue Plan Act (ARPA) of 2021 gives states a new option to extend Medicaid postpartum coverage to 12 months. This new option takes effect on April 1, 2022 and is available to states for five years.Section 30723 of the Build Back Better Act would require states to extend Medicaid postpartum coverage from 60 days to 12 months, ensuring continuity of Medicaid coverage for postpartum individuals in all states.Sections 31041 through 31056 of the Build Back Better Act provide federal grants to bolster other aspects of maternal health care. The funds would be used to address a wide range of issues, such as addressing social determinants of maternal health.

Diversifying the perinatal nursing workforce, expanding care for maternal mental health and substance use, and supporting research and programs that promote maternal health equity.People AffectedLargely in response to the new federal option, at least 25 states have taken steps to extend Medicaid postpartum coverage. Pregnant people in non-expansion states could see the biggest change as they are more likely than those in expansion states to become uninsured after the 60-day postpartum coverage period. For example, in Alabama, the Medicaid eligibility level for pregnant individuals is 146% FPL, but only 18% FPL (approximately $4,000/year for a family of three) for parents.The federal grant provisions related to maternal health could affect care for all persons giving birth, but the focus of these proposals is on reducing racial and ethnic inequities.

There were approximately 3.7 million births in 2019, and nearly half were to women of color. There are approximately 700-800 pregnancy-related deaths annually, with the rate 2-3 times higher among Black and American Indian and Alaska Native women compared to White women. Additionally, there are stark racial and ethnic disparities in other maternal and health outcomes, including preterm birth and infant mortality.Budgetary ImpactCBO has not yet published budgetary estimates for these sections of the Build Back Better Act.However, in June 2020, prior to the enactment of the ARPA option for postpartum coverage, CBO estimated that a proposal to require 12 month postpartum coverage in Medicaid and CHIP would have a net federal cost of $6 billion over 10 years (new costs of $12.3 billion offset by revenues).Total allocations in FY 2022 for the federal grant sections in the Build Back Better Act related to maternal health care outside of the postpartum extension are $1.05 billion.7.

Continuous Coverage for Children in Medicaid / CHIPProvision DescriptionUnder current law, states have the option to provide 12-months of continuous coverage for children. Under this option, states allow a child to remain enrolled for a full year unless the child ages out of coverage, moves out of state, voluntarily withdraws, or does not make premium payments. As such, 12-month continuous eligibility eliminates coverage gaps due to fluctuations in income over the course of the year.Section 30724 of the Build Back Better Act would require states to extend 12-month continuous coverage for children on Medicaid and CHIP.People AffectedAs of April 2021, there were 39 million children enrolled in Medicaid and CHIP (nearly half of all enrollees).

As of January 2020, 31 states provide 12-month continuous eligibility to children in either Medicaid or CHIP. A recent MACPAC report found that the overall mean length of coverage for children in 2018 was 11.7 months, and also that rates of churn (in which children dis-enroll and reenroll within a short period of time) were lower in states that had adopted the 12-month continuous coverage option and in states that did not conduct periodic data checks. Another recent report shows that children with gaps in coverage during a year are more likely to be children of color with lower incomes.Budgetary ImpactCBO has not yet published budgetary estimates for this section of the Build Back Better Act.Given that the length of coverage for children in Medicaid is already high (mean of 11.7 months), more than half of all states already have a continuous coverage policy in place, and costs for children are generally lower compared to other eligibility groups, new federal costs could be moderate.

In addition, reducing churn could modestly reduce Medicaid administrative costs.8. Permanent Extension of the Children’s Health Insurance Program (CHIP)Provision DescriptionUnder current law, Medicaid is the base of coverage for low-income children. CHIP complements Medicaid by covering uninsured children in families with incomes above Medicaid eligibility levels.

Unlike Medicaid, federal funding for CHIP is capped and provided as annual allotments to states. CHIP funding is authorized through September 30,2027. While CHIP generally has bipartisan support, during the last reauthorization funding lapsed before Congress reauthorized funding.Section 30801 of the Build Back Better Act would permanently extend the CHIP program.People AffectedAs of April 2021, there were 6.9 million people (mostly children) enrolled in CHIP.Budgetary ImpactCBO has not yet published budgetary estimates for this section of the Build Back Better Act.Federal CHIP funding in Fiscal Year (FY) 2020 for the states was $17.0 billion.

Since CHIP is authorized through FY 2027, CBO estimates would only account for costs in FY 2028 – FY 2031 (the current ten-year window). When CHIP was reauthorized through FY 2027, CBO estimated that this would result in net fiscal savings to the federal government because without CHIP, other alternatives would have higher federal costs and because of expected changes in the federal match rate back to traditional CHIP match rates.9. Medicaid Home and Community Based Services and the Direct Care WorkforceProvision DescriptionMedicaid is currently the primary payer for long-term services and supports (LTSS), including home and community-based services (HCBS), that help seniors and people with disabilities with daily self-care and independent living needs.

There is currently a great deal of state variation as most HCBS eligibility pathways and benefits are optional for states.Sections 30711-30715 of the Build Back Better Act would create the HCBS Improvement Program, which would provide a permanent 7 percentage point increase in federal Medicaid matching funds for HCBS. To qualify for the enhanced funds, states would have to maintain existing HCBS eligibility, benefits, and payment rates and have an approved plan to expand HCBS access, strengthen the direct care workforce, and monitor HCBS quality. The bill includes some provisions to support family caregivers.

In addition, the Act would include funding ($130 million) for state planning grants and enhanced funding for administrative costs for certain activities (80% instead of 50%).Sections 30721 and 30722 of the Build Back Better Act would make the Money Follows the Person (MFP) program and the ACA HCBS spousal impoverishment protections permanent.People AffectedThe majority of HCBS are provided by waivers, which served over 2.5 million enrollees in 2018. There is substantial unmet need for HCBS, which is expected to increase with the growth in the aging population in the coming years. Nearly 820,000 people in 41 states were on a Medicaid HCBS waiver waiting list in 2018.

Though waiting lists alone are an incomplete measure, they are one proxy for unmet need for HCBS. Additionally, a shortage of direct care workers predated and has been intensified by the buy antibiotics cipro, characterized by low wages and limited opportunities for career advancement. The direct care workforce is disproportionately female and Black.Over 101,000 seniors and people with disabilities across 44 states and DC moved from nursing homes to the community using MFP funds from 2008-2019.

A federal evaluation of MFP showed about 5,000 new participants in each six month period from December 2013 through December 2016, indicating a continuing need for the program.A KFF survey found that, as of 2018, 14 states expected that allowing the ACA provision to expire would affect Medicaid HCBS enrollees, for example by making fewer individuals eligible for waiver services.Budgetary ImpactCBO has not yet published budgetary estimates for these sections of the Build Back Better Act.The House Energy and Commerce Committee markup of the bill described the cost to the federal government as $190 billion. This is less than the $400 billion originally proposed by President Biden. While the program requirements are not the same, CBO previously estimated that the American Rescue Plan Act’s 10 percentage point increase in federal matching funds for Medicaid HCBS for 1 year would increase federal costs by about $12.7 billion.10.

Paid Family and Medical LeaveProvision DescriptionThe U.S. Is the only industrialized nation without a minimum standard of paid family or medical leave. Although six states and DC have paid family and medical leave laws in effect, and some employers voluntarily offer these benefits, this has resulted in a patchwork of policies with varying degrees of generosity and leaves many workers without a financial safety net when they need to take time off work to care for themselves or their families.Section 130001 of the Build Back Better Act would guarantee 12 weeks per year of paid family and medical leave annually to all workers in the U.S.

Who need time off work to welcome a new child, recover from a serious illness, care for a seriously ill family member, or for certain military-related reasons. Also included is three days of paid bereavement leave. The progressive benefits formula means that that the amount of pay replaced while on qualified leave is higher for workers with lower wages, with 85% wage replacement for individuals earning about $15,080/year.

While all workers taking qualified leave would be eligible for at least some wage replacement, earnings above $250,000/year are not included in the benefit formula.People AffectedAccording to the Bureau of Labor Statistics, one in five (21%) workers have access to paid family leave through their employer. It is estimated that 53 million adults are caregivers for a dependent child or adult and 61% of them are women. Sixty percent (60%) of caregivers reported having to take a leave of absence leave from work or cut their hours in order to care for a family member.

Workers who take leave do so for different reasons. Half (51%) reported taking leave due to their own serious illness, one-quarter (25%) for reasons related to pregnancy, childbirth, or bonding with a new child, and one-fifth (19%) to care for a seriously ill family member. In total, four in ten (42%) reported receiving their full pay while on leave, one-quarter (24%) received partial pay, and one-third (34%) received no pay.Budgetary ImpactCBO has not yet published budgetary estimates for this section of the Build Back Better Act.However, unofficial estimates reportedly put the cost at $494 billion over ten years.

A 2019 CBO estimate of the proposed Democratic-led FAMILY Act, which is similar to the current proposal, estimated that program would cost $547 billion over ten years.SOURCE. KFFKey FindingsThe October KFF Health Tracking Poll finds one in five adults in the U.S. Report receiving ongoing support for daily activities such as bathing, dressing, or remembering medications, and a similar share say they are providing those type of services for a close friend or family member.

About one in five adults (18%) also say they or a family member need either new or additional support from paid nurses or aides beyond what they are currently getting. The most common reason why people haven’t gotten the support they need is cost. More than three-fourths of those who say they need more help (14% of all adults) say “not being able to afford the cost of the care” is a reason why they or their family member has not received the additional support from paid nurses or aides.Many unpaid caregivers say providing support to friends or family members has caused them to worry or stress (77%), experience worsening of their own mental health (50%), financial strain due to inability to work (42%), or worsening of their own physical health (38%).

Unpaid caregivers are more likely to be racial and ethnic minorities, those with lower education, and report lower levels of household income.Significant shares of older adults in the U.S. Report difficulty paying for various aspects of health care, especially services not generally covered by Medicare. Four in ten older adults (41%) report difficulty paying for dental care while three in ten report difficulty affording hearing or vision care (30%).

Dental, vision, and hearing coverage are three benefits not generally covered by Medicare but are part of Democratic lawmakers’ proposals as part of the reconciliation spending package.Many older adults who are eligible for Medicare also report putting off or foregoing medical care due to costs. While Medicare helps older adults pay for routine doctor visits and hospital stays, substantial shares of lower income older adults report putting off or foregoing services not covered by Medicare. Overall, more than four in ten older adults in households earning less than $40,000 annually report delaying or going without some form of medical care over the past year due to costs (compared to 24% of older adults with household incomes over $40,000), including dental care (34%), vision care (20%), and hearing services including hearing aids (16%).With substantial shares of the public reporting financial strains associated with help with everyday activities for themselves or family members, and seniors reporting difficulty paying for some health care expenses, the latest KFF poll finds broad support for many of the proposals in the reconciliation package being currently discussed in Congress.Home And Community Based ServicesOne in five adults, including 27% of adults 65 and older, say they are currently receiving ongoing support with everyday activities from either a family member (19%), a friend (11%), or paid nurses or aides (5%).

Additionally, nearly four in ten (38%) adults say a family member gets ongoing help from at least one of these sources including another family member (30%), paid nurses or aides (16%) or friends (12%). About one in five adults (18%) say they or a family member need either new or additional support from paid nurses or aides beyond what they are currently getting. The most common reason why people haven’t gotten the support they need is cost.

More than three-fourths of those who say they need more help (14% of all adults) say “not being able to afford the cost of the care” is a reason why they or their family member has not received the additional support from paid nurses or aides. Other reasons include not being able to find someone to provide the services (47%, or 8% of all adults), being worried about being exposed to antibiotics (40%, 7% of all adults), being afraid or embarrassed to get help (32%, 6%), or being too busy or unable to find the time to get help (20%, 4%). With many reporting difficulty paying for cost of home and community based care, the poll also gauged support for Democratic proposals to increase funding to Medicaid to pay workers and expand home and community-based services (HCBS).

Medicaid is the primary payer for long-term services and supports (LTSS), including home and community-based services (HCBS), that help seniors and people with disabilities with daily self-care and independent living needs. Majorities across partisans (79% total, 95% of Democrats, 76% of independents, 67% of Republicans) support increased funding to Medicaid to pay workers and expand home and community-based services (HCBS).The toll On Unpaid CaregiversWith Congress discussing possible new tax credits to help with home and community based care, one in five adults (21%) say they are currently providing unpaid support with everyday activities to either a friend or family member, excluding the type of care young children need. Majorities across partisans also favor new tax credit to help people pay for such care (82% total, 94% of Democrats, 80% of independents, 73% of Republicans).The KFF October Tracking Poll finds unpaid caregivers are more likely to be Black or Hispanic (14% and 21%) compared to those who are not unpaid caregivers (10% and 15%).

About eight in ten unpaid caregivers to family and friends do not have a college degree, and about half have household incomes under $40,000. Consistent with recent focus groups conducted by KFF, the poll finds most unpaid caregivers (85%, 18% of all adults) report experiencing at least one of several negative outcomes due to their caregiving responsibilities. Over three-fourths of unpaid caregivers (16% of all adults) say they have experienced stress or worry related to the care of the individual they are caring for, with an additional half (11% of all adults) say they have experienced a worsening of their own mental health as a result of providing this ongoing support.

About four in ten (9% of total) say they have experienced financial strain, such as losing a job or having to work reduced hours. A similar share (38% and 8% of total) also say they have experienced a worsening of their own physical health. Expanding Medicare BenefitsWith Congress debating changes to the current Medicare program, eight in ten adults—and nearly all older adults—say Medicare is important to them and their family members.

This includes at least seven in ten adults across partisanship, income groups, and racial and ethnic identity. Significant shares of older adults in the U.S. Report difficulty paying for various aspects of health care, especially services not generally covered by Medicare.

Four in ten older adults (41%) report difficulty paying for dental care while three in ten report difficulty affording hearing or vision care (30%). Two in ten report difficulty affording their prescription drugs. Additionally, one-third report difficulty affording their out-of-pocket health care costs and one in five report the same about their monthly health insurance costs – shares comparable to those who report difficulty affording other household expenses such as rent or mortgage, gasoline, monthly utilities, or food and groceries.

Dental services are the most common type of medical care that people have delayed or gone without with about with about one in four (23%) of adults ages 65 and older saying they have put off dental care in the past year due to cost. This is followed by vision services or eyeglasses (15%) and hearing aids (13%). Dental, vision, and hearing coverage are three benefits not generally covered by Medicare.Few older adults report delaying or going without a doctor’s office visit (6%), hospital services (5%) or mental health care (2%) due to cost.

Overall, three in ten adults 65 and older report delaying or going without certain medical care during the past year due to cost (32%). Even among older adults who are eligible for Medicare, those with lower incomes report delaying or going without care at higher rates. More than four in ten older adults in households earning less than $40,000 annually report delaying or going without some form of medical care over the past year due to costs (compared to 24% of older adults with household incomes over $40,000).

While Medicare helps older adults pay for routine doctor visits and hospital stays, substantial shares of lower income older adults report putting off or foregoing dental care (34%), vision care (20%), and hearing services including hearing aids (16%) that are not generally covered by Medicare. A large majority of the public (90%) favor expanding Medicare coverage to include dental, vision, and hearing coverage, including 97% of Democrats, 90% of independents, and 85% of Republicans. This proposal is also largely favored by adults 65 and older, including 96% of those in that age group who identify as Democrats or Democratic-leaning and 82% of their Republican counterparts.

Proposals aimed at curbing the price individuals have to pay for their prescription drugs are favored by majorities of the public with at least eight in ten overall and at least three-fourths across partisans saying they favor each of the proposals asked about. Eighty-eight percent of adults favor limiting how much drug companies can increase the price for prescription drugs each year to not outpace the rate of inflation (including 93% of Democrats, 86% of independents, 89% of Republicans) and a similar share (85%) favor placing an annual limit on out-of-pocket prescription drug costs for people on Medicare (favored by 88% of Democrats, 85% of independents, 84% of Republicans). The proposed changes to Medicare drug negotiations as part of the reconciliation package poll findings were released earlier this week.The Affordable Care ActViews of the 2010 Affordable Care Act are still largely driven by party identification with nearly nine in ten Democrats saying they view the law favorably, while three-fourths of Republicans say they hold an unfavorable view.

Independents are slightly more favorable than unfavorable with more than half saying they hold a positive opinion of the ACA. KFF has been polling on the ACA since its passage and since 2017 views have been more favorable than unfavorable but still sharply divided on party lines. The buy antibiotics relief bill passed in early March 2021 providing additional financial help for people who buy their own health insurance coverage.

Previous KFF polling found that a small minority of those likely eligible for additional financial help or coverage reporting going online to see if they qualify for a different or cheaper health insurance plan.Among those under 65 years old, nine percent of those who are either uninsured or buy their own coverage reported going online in the in the two months before mid-May 2021 to see if they qualify for a different or cheaper health insurance plan or Medicaid as part of the buy antibiotics relief package. Four months later, the latest KFF polling finds that about one in four (23%) of those likely eligible for this assistance have gone online to see if they qualify, though majorities (75%) still have not. In addition, changes to health insurance coverage provided under the Affordable Care Act continue to be seen through a partisan lens, with overwhelming majorities of Democrats and smaller majorities of Republicans expressing support.

Overall, eight in ten adults favor making permanent the financial help to low- and moderate- income Americans who buy their own health insurance coverage (94% of Democrats, 79% of independents, 63% of Republicans). Three in four favor the federal government stepping in to provide insurance options for lower income people living in states that haven’t expanded their Medicaid programs (94% of Democrats, 76% of independents) but this is supported by a small majority (54%) of Republicans.While the poll finds broad support for many of the Democratic proposed changes to the country’s health care system including the ACA, Medicaid, and Medicare, the poll did not ask about the potential costs and savings associated with each provision, or the size and scope of Democrats’ broader legislative plan, which includes many provisions unrelated to health care. Methodology.

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Autodesk deployed it’s Octo-Copter in Africa for high resolution reality capture.  This was done in support of Louis Leakey in Kenya in search of our ancestral trails


Additonally, they deployed it on their head quarters in San Rafael.

From the Gizmag Website:

The Mikrokopter Octocopter is an 8-rotor flying platform which has a 2 kg (4.4 lbs) capacity to carry cameras. It can be flown using an internal camera to give the operator a copter-based vantage point on video glasses, or can be programmed to follow a GPS-controlled flight path. An Octocopter can fly autonomously at altitudes up to 1000 meters (3280 feet), or can be manually flown as high as 3500 meters (11,480 feet). In the Autodesk tests video was captured using a GOPro Hero 2 camera, and the still pictures from which the 3D model was later built were taken by a remotely triggered Canon SLR camera.

Autodesk 123D is a suite of programs which allow a user to create, manipulate, and construct 3D objects using a 3D printer. Catch is part of the 123D suite, and offers a standalone software package that helps you create 3D models from a series of 2D digital images of an object or a scene. The spatial resolution available using 123D Catch is about 1 part in 600, or 0.167% of the total size of the object pictured, so you would be able to accurately place individual windows on a 3D model of a Boeing 747.

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Get to the Beach and then Treat Yourself

Cranes Beach & Wingaersheek Beech, Head north on 128.  Enjoy the water, and then take the short drive to Essex and go get fried clams and soft serve, call in your fried clam order if you can.  Try Woodman’s, Farnham’s (they got picnic tables over looking the tidal marsh) or try the Village, and Essex Seafood, which has always been a solid go to.

Horseneck Beach, terrific beach going south on 24, Westport, MA almost always less traffic, then go to the Back Eddy for something to cold to drink and a snack.

You’re in and around the city.

Find a Roof Deck and/or Pool, a variety of posts on the subject from Boston.com, but it seems the Colonade for a pool stop is always mentioned. And outside of the city, Indigo in Newton is pretty nice stop.

Walk the Greenway, play in the fountains, get gelatto, try the Gelateria  in the North End.

Have a cold drink in a well air conditioned bar by the Garden, then walk over the river, across the locks into Charlestown and do the same thing there.  Your choice for locations, there are many.  But go ahead and stop at Emack and Bolio’s on the walk back.

Play in the Fountain at the Christian Science Center, walk into the Pru and Copley to soak in the air conditioning, play “how much are these shoes” at Nordstrom.  Have a friend stand back from the shoe tables, have them guess.  Most likely off by a factor of 10, go get a coolata at Dunkin.

If you are feeling particularly flush and it’s after 5, go get a martini at the Oak Room, used to come with side car sitting in ice.  That will frame the rest of your day.  Air Conditioning set on igloo.

Take your dog for a walk at the Middlesex Fells Reservation, or bring him/her to a pond, throw a stick. Jamaica Pond, Spy Pond, Fresh Pond, etc.  You might not get cool, but look at the dog, so happy.  And now I’ve seen Canoe and Kayak Rentals at Spy Pond.

So there’s a start, generally, a cold drink, cone or a slush, water, you get the idea.

 

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With Microsoft’s announcement of Windows 8, and the unveiling of the Surface Tablet, it finally appears there will be a tablet form factor that will run Revit in the field.  According to the press release there will be two versions, one based on the ARM chip and another based on the Intel i5 chip running Windows 8 Pro.  The iPad, as much it is great for so many tasks, simply does not have the horsepower to run Revit in the field, and delivering the type of user experience one would want with heavyweight programs is a real limitation in the ‘cloud.’  I understand Autodesk is now counting solely on Citrix to provide its remote platform but even if you are driving Revit remotely would you want to rely on whatever internet connection you have?  That’s just not a funnel I would want to count on in the field.

At first glance you might say so what, not a big deal.  However, if I can have a device that toggles between my heavyweight AEC programs, and delivers content the way my my iPad does then I might have an iPad to sell you; because frankly I am sick of devices, I live between the Mac and Windows camp, I’m tired of it.  I used to be an Apple fanatic, even being the only kid in business school with a Mac, the disastrous PowerPC model, but what was not to like about Apple.  Now, how did we get to the point where Microsoft is the little guy, relatively speaking.  Now if they could get their content management into a spot that works the way you want.  Imagine the central Revit model up on the sky drive, you check it out in the field, do your work, update it, booyah.

I think single purpose, highly specific apps are great to digest data,  not for the creation of it so I am real interested in the melding of tablet like functionality with horsepower.  I’m rooting for the little guy, I’m rooting for Microsoft.

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BTW anyone else bother to notice the blending and vertical integration of software/hardware.  Apple, obviously.  Google buys Motorola. Microsoft with multiple attempts, Zune, XBox, etc.  and now Surface. And more germane to AEC Trimble buys Tekla and SketchUp.  Seems to be the biz strategy du jour, watch for more.

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Tweet about PKNail Pro’s Proven Field to BIM Technology, Get Entered Automatically

PointKnown is giving away a free Apple iPad to one lucky Twitterer…er, tweeter, i.e.  one who uses the service twitter to disseminate clever, witty, informative text burst in 140 characters or less.  PointKnown does not claim to be clever, witty or informative, but will claim producing kick ahh…whup ahh…Excellent productivity software tools for documenting existing buildings.

 

 

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To participate, simply tweet using the hash tags below:

#pknail #revit #bim and mention ‘PKNail Pro’

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PKNail Pro turbo charges Revit and modeling existing buildings #pknail #revit #bim

or “Capture Existing Buildings Directly In Revit with PKNail Pro, 5x-10x faster #pknail #revit #bim

less pertinent but still acceptable “We came, we saw, we conquered with PKNail Pro, #pknail, #bim , #revit

less pertinent verging to the non-sequitur but still acceptable…

beautiful software for happy people PKNail Pro, #pknail, #bim, #revit

or certainly and you are most welcome and encouraged to tweet your own stuff; as we will have a separate drawing of $100 VISA Card for best/most creative tweet as judged by anyone at our next BBQ.

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We are on the road with Microcad and have other excellent resellers including,  Seiler Instrument (ask for Harvey) and CADDFX

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1. This giveaway is offered by PointKnown LLC and is open to anyone with a Twitter account who is at least 16 years of age. Employees of PointKnown, LLC. and/or its affiliated companies and family members of such employees may enter the contest but are not eligible to win.

2. The giveaway will begin at the time of this post and end 62 days after initial post, a winner will be randomly chosen, much like the number 62, and announced via twitter through @pointknown

3. One giveaway will be available: a 16GB Wi-Fi Apple iPad or $499 Apple Store Credit, winner’s choice.

4. You must prove ownership of the winning entry and provide your email address to collect the prize.

5. To enter the giveaway you must send out a tweet from your own Twitter account that includes the #hash tags above in your message.

6. Entries using automated tweets will be disqualified, however there is no limit on the number of tweets you may enter.

7. PointKnown LLC will choose a winner randomly from all the entries within the specified period. The winner will be announced from our twitter account (@pointknown) once the contest ends.

8. Entrants agree to allow @pointknown to use their twitter handles and entry tweets for marketing purposes.

9. Neither PointKnown LLC. nor its affiliated companies shall have any liability for (i) any technical failures of any kind, including but not limited to malfunctions, interruptions or disconnections in phone lines or network hardware or software; (ii) technical or human error which may occur in the administration of the giveaway; (iii) any malfunction of or damage to the prize; (iv) any corruption, typos or hacking of prize winners email accounts; or (v) any restrictions or delays imposed by any customs authorities or any import or other taxes of any kind imposed by any taxation authority in respect of the prizes.

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Announced today, Autodesk Acquires Vela Systems.  If you are developing products within the Building Life Cycle somewhere between and including design to demolition, you are in play.  Trimble has been going on an acquisition rampage with its acquisition of Tekla and Sketch Up and Autodesk never one to be a wallflower has just acquired Vela.  This is almost 2 years to the date that Vela was unveiled publicly.  No idea of their market size but their own press releases state that they are more than ‘twice as big’ as any competitive Field BIM Systems.  Regardless, market penetration means little at this point now that the Autodesk marketing/sales system is behind it.  How big was Revit in 2006 when they were purchased.  A primer of Vela’s Key Features below.  Congrats Vela folks, job well done.

Vela Field Management Suite Key Features
The Vela Field Management Suite of Web, Mobile and Reports enables everyone throughout the enterprise to access documents, field activities and reports in the office and in the field. Since its release a year ago, and to further broaden the usability throughout the enterprise, Vela Systems has expanded upon the following features:

  • Field BIM® for commissioning and handover that ties BIM to the field for data and document exchange
  • Company-level checklist and issue template capabilities to implement and enforce quality and safety programs
  • Increased accessibility via the Internet on multiple devices like iPads and Smart Phones
  • Better web-based reporting that turns field data into powerful information for managing quality, safety and risk at the project and company level
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As reported by Industry Week, ‘The world’s most sophisticated malware had a ‘high interest in AutoCAD drawings,’ Kaspersky Lab said.  The Flame Virus, which mainly affected computers in the Middle East used a loophole in Microsoft software tricking computers into thinking they are downloading a legitimate Windows update.  This fact, being reported by Reuters, The Times, CNET, and others. CNN reported that Flame can turn on your microphone, webcam, log e-mails, etc.  I have not read if it can do anything malicious itself as the Stuxnet Virus did to Iran Uranium enrichment facilities by having centrifuges essentially tear themselves apart.  However, going after CAD, essentially engineering and building documents can let whoever is collecting this information know what you are designing and building, and possibly have the blueprints of the building you are designing and building in.  And you thought google knowing that you smoke cigars and eat ice cream on your back porch at 5:23 PM was intrusive.

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File under cool.   The City of New York has unveiled an initiative for the electronic submission of BIM safety plans; you can learn more here; and a  Turner Press Release yesterday stated they used both 2D and 3D BIM submissions to get approval for their construction project at the Energy Building at NYU Langone Medical Center.

“The digital submission of 3D, BIM-based site safety plans reduced the approval times from weeks to days,” said Di Fillipo, Turner Senior Vice President.

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The more demos I go on, the more I get asked about our field kit, so I wanted to post what’s in my bag and what we use on a day to day basis when surveying/modeling in the field with PKNail Pro.  Those of you not interested in the day-in day-out particulars of surveying buildings may want to hit your back button now… Anyway an individual equally equipped will be ready for knocking out BIM Building Surveys, and this kit, all in, costs a fraction of most other technology solutions, plus the added benefit of surveying/modeling directly in the platform you or your clients are most likely working in.  However, always choose the tool/service that fits your needs.  In fact, we’ll be posting shortly where we combined workflows of PKNail Pro and pointclouds.  But here you go, what’s in my bag or my complete kit.

So it might seem like a lot but all fits in the bag except for the tripods.  The laptop tripod is excellent when mobility/portability with your gear is at a premium but I will use a laptop cart with wheels if the space allows;  it is easier with wheels and has more surface area to put stuff.

The real minimum you need to have with you is a laptop/tablet PC running the appropriate software, a Disto D8 or 330i, a measuring tape, and something to use for a target when needed, like an outside corner.  Stickynotes (larger size) are excellent for shorter distances, a reflective Leica Target attached with Painter’s Tape is better for longer ones.  Rechargeable batteries for both the laptop and Disto.  I prefer an external battery pack for the laptop as it can be used on any laptop and it is self contained unlike an extra battery for a specific laptop.

I  like Eneloop rechargeables for devices, my preference, they come preloaded with a charge, and seem to carry it longer when not being used.  You need a measuring tape on occasion for distances to short or sometimes nice to hook something with a tape when finding a distance manually.  I like thick banded measuring tapes because they will extend longer without ‘breaking’ but find they are just as prone to wear down as any other so sometimes not worth the expense.  LED flashlight because they are bright and do not use as much juice as others, and are always nice to have.  I also have an LED light that you can wear on your head, which is my preferred.  Diameter tape is a luxury but one side is graduated the other will measure the diameter of any round column which is helpful.

The tripod attachment from Leica allows it to pivot properly on the its axis so the measurements stay as accurate as possible.  This is great to have for exterior work  when you might not have access to the interior of the building.  Building chalk or a marking crayon can be helpful but usually would want to mark with painters tape or sticky pad because they are easily removed, however, the former comes in handy sometimes, especially in basements.

And bring food and drink, nothing clouds your mind like being hungry, so eat.

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Interioreview, utilized PKNail Pro, an add in to Revit, combined with Leica Disto D8 laser range finders as the main surveying tool and software for capturing and modeling the 28 Story DuBois Library at UMass Amherst.  The structure designed by Durell Stone in 1966 is tallest library in the United States.  While intially considering combining LIDAR and creating a pointcloud for the exterior and utilizing PKNail Pro for the interior it turned out the exterior was the easiest part of the job and it was interior that was the most difficult.  Every 3rd floor contained  90+ rooms  with study carrels combined with classrooms where very few technologies would work well.  Nico Martinez, a Project Manager with Interioreview, commented,”Without PKNail the survey work could have taken  5 times, 10 times what it was.”

The project was completed to support the design and retrofitting a fire protection system.

Interioreview, an architecural surveying firm founded in 2003 specialzies in documenting the built environment in both 2D CAD and 3D Revit formats.

PointKnown, a software firm, founded in 2008 develops productivity tools for the built environment / AEC (Architectural, Engineering, and Construction) Industry

PKNail Pro, allows a user to measure and model objects in real time directly in Revit.

Autodesk® Revit® software is specifically built for Building Information Modeling (BIM), helping building professionals design, build, and maintain higher-quality, more energy-efficient buildings.

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