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  • FactCheck Examines ‘The Life of Julia,’ Corrected

    FactCheck finds some bogus assumptions in the Obama campaign’s fable about a fictional woman.Julia paying a visit to her ob

    by Eugene Kiely and Brooks Jackson

    Summary

    The Obama campaign depends on some false or dubious assumptions in its “Life of Julia” slide show. The infographic depicts a fictional woman whose life from age 3 to 67 is better under the president’s policies than under those of Republican Mitt Romney. But in reality, the contrasts are not so stark or simple as the Obama team would have viewers believe.

    For example:

    • The campaign falsely claims Romney would leave Julia with “nothing but a voucher” to buy health insurance at age 65. Actually, the plan Romney has endorsed would let her choose between traditional Medicare fee-for-service coverage, or a variety of private plans with premiums partially paid by the government.
    • The slide show also contends that Julia, as a senior citizen, will have to pay “$6,350 extra per year” for a health care plan similar to Medicare. But that’s an out-of-date cost estimate based on a year-old plan that since has been made substantially more generous.
    • At age 67, Julia can “retire comfortably” under Obama but, “Under Mitt Romney: Julia’s benefits could be cut by 40%.” But the fact is Obama has not proposed any plan to avoid a 25 percent cut in benefits for all Social Security beneficiaries, which the system’s trustees say is looming in 2033 unless changes are made.
    • As a 22-year-old college student, Julia needs surgery that is covered “due to a provision in health care reform” keeping her on her parents’ insurance. Fair enough. But she’d probably be covered anyway: Thirty-seven states already have similar mandates on the books.
    • As a 31-year-old expectant mother, Julia “benefits from maternal checkups” required under the new health care law. But she would probably get that care anyway; 85 percent of full-time workers have health insurance now, and a 1978 federal law already requires that employer-provided insurance generally must “cover expenses for pregnancy-related conditions.”

    Analysis

    The president’s opponents heaped ridicule on the (nearly) cradle-to-grave philosophy of government embodied in the “Julia” infographic. We’ll stay out of that debate, and just focus on the factual assumptions made or implied.

    Julia on Medicare

    Some of the more factually challenged claims in “The Life of Julia” involve Medicare — which has been a flashpoint for both parties ever since Rep. Paul Ryan a year ago released a budget document called “Path to Prosperity,” which included major changes to the government-run health care program for senior citizens.

    The Obama campaign makes two false claims when it says Julia at 65 years old could be left “with nothing but a voucher to buy insurance coverage” and pay “$6,350 extra per year” for Medicare under Romney. Both claims are references to Romney’s support for Ryan’s Medicare proposal. But as wewrote in April, both claims are based on Ryan’s 2011 plan — not his current plan, which would in fact allow Julia to choose to be covered by traditional Medicare and may or may not cost her more money.

    Under President Obama: Julia enrolls in Medicare, helping her to afford preventive care and the prescription drugs she needs.

    Under Mitt Romney: Medicare could end as we know it, leaving Julia with nothing but a voucher to buy insurance coverage, which means $6,350 extra per year for a similar plan.

  • A Small Hurrah! Most of April’s Modest Job Gains Go to Women

    Analysis by the National Women’s Law Center of jobs data released by the Bureau of Labor Statistics shows that women gained 73 percent of the 115,000 jobs added in April — the largest share of monthly job gains for women since the start of the recovery. For the recovery overall (June 2009 – April 2012), women’s gains have been much smaller. Women have gained only 16 percent of the nearly 2.5 million net jobs added in the recovery.  Women’s substantial losses in the public sector have driven their small overall job gains in the recovery. In fact, for every two jobs women gained in the private sector during the recovery, they lost one in the public sector.WWII womens' jobs

    “Today’s data show that while most of April’s modest job gains went to women, there’s still a long way to go to reach a full recovery for women and men,” said Joan Entmacher, Vice President for Family Economic Security at the National Women’s Law Center. “This is not the time to cut back on programs that create jobs and help families get back on their feet.”

    The largest job gains for women in April came in professional and business services, which include temporary help services, private education and health, and leisure and hospitality. Women also gained jobs in the manufacturing sector. Women gained 62 percent of the 130,000 private sector jobs added in April.  During the recovery, women gained 26 percent (800,000) of the nearly 3.1 million net private sector jobs added.

    The public sector lost 15,000 net jobs last month; men bore all of the losses, while women gained 4,000 public sector jobs. During the recovery, the public sector lost 601,000 net jobs — two-thirds of which (400,000) were held by women.

    The overall unemployment rate for adult women was unchanged for the month at 7.4 percent, while adult men’s unemployment rate declined slightly to 7.5 percent. Since the start of the recovery, adult women’s unemployment rate has dropped by only 0.2 percentage points, while men’s unemployment rate has declined by 2.4 percentage points.  The unemployment rates for single mothers and adult black and Hispanic women declined in April. However, the unemployment rates for these economically vulnerable groups of women remain well above the overall unemployment rate, at 10.2, 10.8, and 9.6 percent respectively.  The long-term unemployment rate—the percentage of unemployed workers looking for jobs for 27 weeks or more—increased for adult women last month to 45.2 percent; the long-term unemployment rate for adult men rose to 47.4 percent. The long-term unemployment rates for both adult women and men are substantially higher than at the start of the recovery.

    “There aren’t enough jobs for everyone who wants to work and millions of Americans are still struggling to meet their basic needs,” Entmacher said.  “Yet the House is expected to vote next week on bills that would slash programs for vulnerable Americans — food stamps (SNAP), Medicaid, funding for services for children and seniors, tax credits to make health insurance affordable, the Child Tax Credit, and more.  These measures would cripple families — and the economy.”

  • Making Your Phone Work: Just-in-time Information through Mobile Conections

    Editor’s Note: We’ve observed an uptick in cell phone use for researching purposes recently, including confirmation of the owner’s accuracy in a conversation with friends. “Let me check that (on my phone)”. Other topics we’ve observed being consulted through apps as well as favorite website are: times that events start, nearby restaurants, objects on view at a museum, shopping nearby and for endless other purposes.

    There has also been a rush travel apps including places to stay near an airport, food courts within airlines, seat and gate selection and location (seatGuru, for instance), the TSA mobile APP, an ATM locator as well as the indispenable GPS.

    Smartphones

    Strolling stops, a fork is laid down, conversations suspend and the cell phone owner  is in action. Increasingly, the wielder is a woman over 50. A summary of a new Pew Internet report follows:

    By Lee Rainie, and Susannah Fox

    The rapid adoption of cell phones and, especially, the spread of internet-connected smartphones are changing people’s communications with others and their relationships with information. Users’ ability to access data immediately through apps and web browsers and through contact with their social networks is creating a new culture of real-time information seekers and problem solvers.

    The Pew Research Center’s Internet & American Life Project has documented some of the ways that people perform just-in-time services with their cell phones. A new nationally representative survey by the Pew Internet Project has found additional evidence of this just-in-time phenomenon. Some 70% of all cell phone owners and 86% of smartphone owners have used their phones in the previous 30 days to perform at least one of the following activities:

    • Coordinate a meeting or get-together — 41% of cell phone owners have done this in the past 30 days.
    • Solve an unexpected problem that they or someone else had encountered — 35% have used their phones to do this in the past 30 days.
    • Decide whether to visit a business, such as a restaurant — 30% have used their phone to do this in the past 30 days.
    • Find information to help settle an argument they were having — 27% haveused their phone to get information for that reason in the past 30 days.
    • Look up a score of a sporting event — 23% have used their phone to do that in the past 30 days.
    • Get up-to-the-minute traffic or public transit information to find the fastest way to get somewhere — 20% have used their phone to get that kind of information in the past 30 days.
    • Get help in an emergency situation — 19% have used their phone to do that in the past 30 days.

    Overall, these “just-in-time” cell users — defined as anyone who has done one or more of the above activities using their phone in the preceding 30 days — amount to 62% of the entire adult population.

    Read or download the full report: http://pewinternet.org/Reports/2012/Just-in-time.aspx; Copyright © 2012 Pew Internet

  • Willem van Aelst, A Member of the Golden Age of Dutch Painting

    The exhibition of Dutch still-life painter Willem van Aelst (1627-1683) continues until May 28, 2012 at the Museum of Fine Arts, Houston. Organized by the MFAH, the National Gallery of Art, Washington, and the Sarah Campbell Blaffer Foundation, Elegance and Refinement: The Still-Life Paintings of Willem van Aelst features 28 of the artist’s works culled from private and public collections in the United States and Europe.still life with game and blue velvet bag

    “Van Aelst’s luxuriant compositions, rich in detail, bring to life the elegant tabletop settings of the 17thcentury. Over two dozen of his detailed, vibrant paintings are on view, filled with sumptuous fabrics, elegant stone tables, ripe fruit, artfully arranged hunting trophies and brilliant platters, cups, watches, armor and more,” said James Clifton, Director of the Sarah Campbell Blaffer Foundation and Curator of Renaissance and Baroque Painting at the MFAH.

    “Also on view will be a large-scale painting, long credited to artist Willem Kalf, which was recently reattributed to Van Aelst during a technical examination by a National Gallery of Art conservation scientist. Within the exhibition, the painting will be rightly reunited with other works from the artist’s oeuvre.”

    Elegance and Refinement is co-curated by Clifton and Arthur Wheelock, Curator of Northern Baroque Painting at the National Gallery of Art. The project was conceived by Tanya Paul, Ruth G. Hardman Curator of European Art at the Philbrook Museum of Art in Tulsa, following her Ph.D. dissertation on the artist and was developed while she was a curatorial fellow at the Sarah Campbell Blaffer Foundation in Houston.

    Following Houston, the exhibition will be presented at the National Gallery of Art June 24 – October 14, 2012. A hardcover, illustrated catalogue of the same title, published by Skira Rizzoli in association with the MFAH, accompanies the exhibition. It is the first book dedicated solely to Van Aelst’s oeuvre.

    About the Exhibition
    The paintings in the exhibition cover the range of the artist’s career and are culled from collections including the Sarah Campbell Blaffer Foundation (permanently on view at the MFAH) and the National Gallery of Art. Five paintings will be on loan from the Galleria Palatina at the Palazzo Pitti in Florence, which holds the largest concentration of Van Aelst’s work since it was collected extensively by the Medici court and later transferred to state collections. Others works have been lent by the Staatliche Museen zu Berlin; The Fitzwilliam Museum, Cambridge; Liechtenstein Museum, Vienna; Mauritshuis, The Hague; and The Fine Arts Museums of San Francisco.

    Painting: A Still Life with Game and Blue Velvet Game Bag on a Marble Ledge, c. 1665 Oil on canvas. Sarah Campbell Blaffer Foundation, Houston

  • TSA Reveals Passenger Complaints … Four Years Later

    by Michael Grabell
    ProPublica, May 4, 2012,

    From intrusive pat-downs to body scans to perceived profiling, the Transportation Security Administration always seems to be the target of complaints.

    Here’s another one: It took the TSA almost four years to tell me what people complained about — in 2008.

    TSA screening at DTW airport

     

    In my first week at ProPublica in June 2008, I filed a public records request for the agency’s complaint files. Such records can provide good fodder for investigations.

    For example, amid the brouhaha over the agency’s introduction of intensive full-body pat-downs in 2004, I requested complaints and discovered an untold story of the pain and humiliation suffered by rape victims and breast cancer survivors. In one incident that I found from that request — while I was a reporter at the Dallas Morning News — a woman complained that a screener asked her to remove her prosthetic breast to be swabbed for explosives.

    When I made a similar FOIA request in 2008, I assumed the TSA would respond in a few months. Government agencies have about a month to respond to public record requests, though they often take longer. I figured even if their response took months, I’d be able to repeat it regularly to get a timely, inside look as to what passengers were complaining about and find out about incidents that required some more digging.

    Boy, was I wrong.

    After waiting and waiting and narrowing my request and some more waiting, the files finally arrived this week.

    The information is now four years old — but it echoes much of what people are still complaining about.

    For instance, an elderly woman in a wheelchair was asked to walk through security and fell at Orlando International Airport. Elderly woman at Orlando International Airport (p. 3)

    In another case, someone expressed concerns about a lethal plastic knife that can reportedly pass through metal detectors. (This was two years before the TSA widely deployed body scanners, which can detect plastic.)

    In another complaint, a man flying to Cancun demanded an investigation after finding that the bottle of Jack Daniels he packed in his luggage was empty by the time he arrived.

    Rather than let the files gather dust at the bottom of my desk drawer, I’m posting them for your perusal.

    Why did the files take so long to release? Various FOIA officers over the years blamed the delay on the agency’s backlog and on the volume of the records that had to be reviewed. It turned out to be 87 pages.

    When I reached out again today to the TSA, spokeswoman Lorie Dankers provided a statement pointing out that the agency has received an average of more than 800 requests annually over the past four years. Then the TSA apologized.

    “TSA should have responded to ProPublica’s request sooner,” the statement said. “TSA currently is working on 12 requests that are more than three years old. The agency is working diligently to finalize and respond to these requests.”

    I just filed my request for the 2012 complaints. Hopefully, we won’t have to wait until 2016 to see those.

    Editor’s Note: Photo by photographer Dean Shaddock is of a screening  at the Detroit Metro Airport, Concourse A; Wikimedia Commons.

  • Stagebridge: A Performing Arts Camp for 50 and Over

    Performing Arts Camp 2012*

    Performing Arts Camp 2012

    July 16-20, 2012: Stagebridge offers you the opportunity to learn and create at a Performing Arts Camp for Adults 50+.

    Campers will get to take two classes in the morning and two classes in the afternoon with some of the finest artists in the country. In the morning, campers will select one acting and one storytelling class and in the afternoon, choose any two classes. There will be:

    • Special lectures, discussions, films and workshops at the end of each day.
    • All campers will participate in the BIG SHOW on Friday afternoon which will be videotaped.
    • Returning by popular demand —  “Summer Stock” where campers choose to concentrate on a musical in singing and dancing classes in the afternoon. The “company” will present selections from Little Shop of Horrors at the Friday’s show.

    We are also pleased to offer “Expanding Creativity in the Workplace” which includes special workshops for health care professionals and activity directors of senior facilities. This mix of classes and special workshops will give you the tools to apply creative activities to your work.

    Stagebridge uses the performing arts to change the way people view or experience aging.  For the last 30 years, our innovative workshops and critically acclaimed performances have had a dramatic impact on a wide range of communities. Our theatre-based programs range from empowering vulnerable youth through storytelling, to helping seniors with dementia reclaim their dignity with creative expression, to using improv techniques that help healthcare professionals better understand their patients.

    Our Programs include:

    Storytelling in the Schools. Specially trained elders use storytelling to help at-risk school children increase literacy – and confidence. Click here to learn more about Storybridge.

    Senior Centers. We provide entertainment and workshops for residents of senior centers and nursing homes. Click here to learn more about Seniors Reaching Out.

    Residences and Day Programs. Our TimeSlips program helps seniors with memory loss and their caregivers experience the dignity of creative expression. Click here to learn more about TimeSlips.

    Nurse Training. Designed for professionals who work with the elderly, our sensitivity training uses improv and storytelling to help you get into the heads and hearts of your clients. Click here to learn more about Healthy Aging.

    On Call Theatre! Send a workshop or performance to a corporate headquarters, library, etc. Click here to learn more about your live entertainment options.

    Want to Replicate Stagebridge in your community? Contact Stuart Kandell to learn how:  founder@stagebridge.org

    *Editor’s Note:  Although we have had no personal experience with this program we do note that a number of charitable groups like the Elise and Walter Haas Foundation have recently granted  Stagebridge monies for their program:

    Stagebridge – $25,000: Stagebridge trains older adults as storytellers, then places them in classrooms where they perform stories and teach students to collect, write, and perform stories of their own. Under new leadership, Stagebridge is experimenting with a curriculum that integrates music and movement with storytelling. This grant from the Fund matches an award from the National Endowment for the Arts. It allows Stagebridge to pilot the new program for 18 weeks in three Oakland public schools, adding to area arts education opportunities.

  • “Torches of Freedom”: How Big Tobacco Targets Women and Adolescent Girls

    If the nearly ten billion dollars spent by the tobacco industry in 2008 to encourage Americans to smoke doesn’t shock you, perhaps the story the ads tell will. It is a story that has special relevance for young women and teenage girls and feminists of all ages.Ad for

    For nearly 100 years, cigarette companies have worked hard to attract female customers, and they have been effective. In 2008, 18.3 percent of women (that’s 21.1 million of them) smoked. Research by Stanford scholars Dr. Robert Jackler and Laurie Jackler presented at the Clayman Institute for Gender Research shows how tobacco companies have tailored their marketing campaigns to appeal to young women. Cigarette advertising has suggested that smoking will make women thinner, more self-confident and independent, and more fashionable, sophisticated, and cool. These tricks of the tobacco trade have remained surprisingly consistent despite changing beliefs about smoking and women’s rights.

    Cigarette smoking and women’s rights

    Over the past six years, the husband and wife duo has amassed a collection of nearly 15,000 cigarette advertisements and worked to analyze the themes contained in them. The ads show that the story of women and tobacco is enmeshed with the story of women’s rights. Smoking was largely a male preserve until the World War I era. Women appeared in tobacco advertisements prior to this time, but they were depicted as serving cigarettes to men, and their fashionable and often exoticized images were designed to appeal to men. This matched a cultural attitude towards women’s smoking that linked it with loose sexual morality and even prostitution. During World War I, however, as women grew more assertive and visible in public life, ads targeting women as smokers began to appear.

    By the mid-1920s, market-seeking tobacco companies set out more purposefully to attract women smokers. They sensed a change in cultural attitudes and a reduced threat from prohibitionist forces that would outlaw smoking along with alcohol. To vanquish remaining cultural taboos, they appropriated individualist and feminist messages and presented smoking as a way for women to demonstrate their liberation from confining traditions. In an ironic echo of the giant suffrage parades of the prior decade, one enterprising company marched cigarette-smoking women in flapper-style dress down New York’s 5th Avenue. They called the cigarettes the women’s “torches of freedom.”

    The Jackler’s exhibit also shows that for nearly a century the cigarette industry has lured women by equating smoking with thinness. When the young flappers of the 1920sVirginia Slimsembraced a slimmer and less-confined bodily ideal, the cigarette companies followed suit. Ads suggested that smoking would make women thin or allow them to avoid bulkier figures as they aged. One company’s popular slogan urged women to “Reach for a Lucky Instead of a Sweet.” In the 1970s companies created new women’s cigarettes with names such as “Slims” and “Thins” which today have become the even more anorexic “Superslims.” Says Robert Jackler, “In 2012, women-targeted cigarette brands are almost universally promoted as slender, thin, slim, lean, or light. Some brands have even gone so far as to recommend ‘cigarette diets.’”

    While it may be tempting to dismiss these campaigns as quaint Americana from the days before everyone knew better, the Jacklers warn that we should think again. They show earlier ads alongside more contemporary ones to demonstrate the persistence and adaptability of marketing themes directed at women. Tobacco companies continued, for example, to co-opt messages about women’s empowerment throughout the twentieth century.  The Phillip Morris Company developed Virginia Slims cigarettes to appeal to women, and their “You’ve Come a Long Way, Baby” advertising campaign coincided with the emergence of second wave feminism in the late 1960s. In the mid-1990s, the brand used “It’s a Woman Thing” as a slogan, and more recently adopted the tagline “Find Your Voice.” Cigarette ads often feature women smoking together like “sisters” or proclaiming their individuality and their independence from, or even dominance over, men.

  • Joan Cannon: Suspense, Motives, Reactions, and Emotions: How Do Authors Do It?

    by Joan L. Cannon

    Trying to make a dent in a reader’s resistance is like trying to freeze the ripples on the water’s surface after you’ve tossed a stone. Yet that’s what most writers are trying to do whether we realize it or not. There are a few mentors who have taught that lesson. I remember with awe those who made an effort to encourage such an ambition.

    The art of the written word seems to be most capable of making that kind of ephemeral impression. One reason is that imaginative writing makes the closest approach to painless learning possible for most of us. When it’s effective enough, the impression made won’t disappear in the flood of experience.

    Jesse Stuart wrote a book about his youthful adventures as a teacher in an Appalachian one-room schoolhouse. The “thread that runs so true” of the title tells how he discovered that games in teaching can point to how to play the game of Life with a capital L. Children of all ages (into old age) learn with fun.Joyce Carol Oates book, Blonde

    I attended a writer’s conference where the keynote speaker was Joyce Carol Oates. She was already a celebrity in the literary world, and the attendees were virtually holding our breaths to hear her. She said, “All art begins in play.”

    At the time, that approach to art struck me as eccentric and frivolous. I was old enough to know better, but I didn’t. It’s taken a long time for me to begin to grasp the import of her declaration. I confess that as soon as I began teaching, I appreciated Jesse Stuart’s secret even if I never did master it, and it was probably ten years or more into my years of trying to be a writer that I began to grasp Ms. Oates’s dictum.

    Eventually I’ve come to understand at least a little of what she meant. The great thing about a story or a poem is that if there’s a message that’s told or written the right way, the author doesn’t have to apologize for having an ax to grind. Not only that, it’s possible that even many months or even years afterwards, the reader will notice what that hint of a moral or secret of success or touchstone for better or wiser or funnier living was.

    Even eager students find some studying burdensome, tedious, purposeless. The great artists of fiction could have kept those grim Puritans from struggling against sleep; they might have gone home without the uncompromising certainty that they’d endured a sermon. Everyone could have listened with pleasure and perhaps have left with notions that could linger to develop. Even the bloody tales of the brothers Grimm or the cataclysms of mythology provide entertainment. Suspense and amusement make learning comparatively easy, even imperceptible.

  • Elaine’s Caregiving Series: Paint by Number

    Tommy's Paint-by-Number

     

    by Elaine Soloway

    I wasn’t jealous when Tommy beamed as he led Julie on a tour of our house. He was showing off his paintings and smiled at her, like a teen smitten with a cheerleader.

    But, later that morning, when my husband revealed something to this art therapist he had not shared with me, I felt as envious as a plain-Jane watching from the sidelines.

    I had hired Julie to work with Tommy following the recommendation of the social worker at Northwestern Hospital who has been guiding me since my husband was diagnosed with Primary Progressive Aphasia, a dementia that robs the brain of language.

    Julie had premature grey hair, was dressed in a black outfit accessorized with colorful scarves, and looked the part of Artist. In some ways, she resembled a younger version of me. I’d like to think that led to Tommy’s easy acceptance of her into his therapeutic life.

    He had 15 Paint By Number* pictures to show her. They are on walls throughout our house. All are beautiful and match the example on the cover of each kit. Over the years, as Tommy completed each painting, he’d select a frame, tuck the painting into protective glass, then hang it where it could be seen and admired.

    Tommy chose Paint By Number as a winter hobby, when the weather prohibited his favorite pastime, golf. I was happy to see him engaged in something creative. To show my support, I bought an easel for the spare bedroom, a goose neck lamp to clip to the top of the board, and a French beret to complete the picture of artist’s atelier.

    For several years, Tommy finished two paintings per season. Then, last year, trouble. His work no longer matched the box’s cover. He halted this effort midway, eventually tossing it in the trash. I guessed the cruel illness that was stealing his speech was now affecting his brush strokes.

    So, when Tommy wanted to try again this year, I was surprised. I helped him choose a new kit from our usual online store, and watched as he assembled the easel, attached the light, spread the baby pots of paint on a makeshift table, and started in. (The beret is long gone.) But, after a few days, he stopped. He turned off the lamp, put the brush down alongside the pots, and left the unfinished painting on the easel. Then, he closed the door to his studio.

    “These are marvelous,” Julie said, as Tommy led her through the first floor and pointed to each one of his paintings. When the two of them went upstairs, I could hear her praising the works in the hall and in our bedroom. Then, I heard him open the door to the room where the abandoned painting still stood on the easel. I remained downstairs, wondering how artist and teacher would handle what they found.

  • Private Health Insurance: Estimates of Individuals with Pre-Existing Conditions Range from 36 Million to 122 Million

    United States Government Accountability Office’s Report to Congressional RequestersHigh blood pressure complications

    Why GAO Did This Study

    Individuals who buy coverage directly
    from a health insurer are often denied
    coverage due to a pre-existing
    condition during a process called
    medical underwriting, which assesses
    an applicant’s health status and other
    risk factors. Beginning January 1,
    2014, the Patient Protection and
    Affordable Care Act (PPACA) prohibits
    health insurers in the individual market
    from denying coverage, increasing
    premiums, or restricting benefits
    because of a pre-existing condition.
    GAO was asked to examine the effect
    of this provision on adults who are 19-
    64 years old. GAO examined (1) the
    most common medical conditions that
    would cause an insurance company to
    restrict or deny insurance coverage for
    adults and the average annual costs
    associated with these conditions,
    (2) estimates of the number of adults
    with pre-existing conditions, and (3) the
    geographic and demographic profile of
    adults with pre-existing conditions.
    To address these three issues, GAO
    (1) identified four recent studies that
    narrowly or more broadly identified five
    lists of conditions likely to result in
    restricted coverage in the individual
    insurance market and (2) used the
    2009 Medical Expenditure Panel
    Survey to generate five separate
    estimates, referred to as estimates
    1 through 5.  There is no commonly
    accepted list of pre-existing conditions
    because each insurer determines the
    conditions it will use for medical
    underwriting. We also contacted state
    insurance department officials in all
    50 states and the District of Columbia
    to confirm information about state
    insurance protections that currently
    limit or prohibit medical underwriting.
    What GAO Found
    Hypertension was the most commonly reported medical condition among adults
    that could result in a health insurer denying coverage, requiring higher-thanaverage premiums, or restricting coverage. GAO’s analysis found that about 33.2
    million adults age 19-64 years old, or about 18 percent, reported hypertension in
    2009. Individuals with hypertension reported average annual expenditures
    related to treating the condition of $650, but maximum reported expenditures
    were $61,540. Mental health disorders and diabetes were the second and third
    most commonly reported conditions among adults. Cancer was the condition with
    the highest average annual treatment expenditures—about $9,000.
    Depending on the list of conditions used to define pre-existing conditions in each
    of the five estimates, GAO found that between 36 million and 122 million adults
    reported medical conditions that could result in a health insurer restricting
    coverage. This represents between 20 and 66 percent of the adult population,
    with a midpoint estimate of about 32 percent. The differences among the
    estimates can be attributed to the number and type of conditions included in the
    different lists of pre-existing conditions. For example, estimate 1, which is the
    lowest estimate, includes adults reporting that they had ever been told they had
    1 or more of 8 conditions. Estimate 3, the midpoint estimate, includes any
    individual reporting they had one of over 60 conditions. Estimate 5, the highest
    estimate, includes any individual reporting a chronic condition in 2009.
    Estimates of Adults (Age 19 to 64) with Pre-Existing Conditions, 2009
    Note: The 95 percent confidence int

    Individuals who buy coverage directly from a health insurer are often denied coverage due to a pre-existing condition during a process called medical underwriting, which assessesan applicant’s health status and other risk factors. Beginning January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) prohibits health insurers in the individual market from denying coverage, increasing premiums, or restricting benefits because of a pre-existing condition.

    GAO was asked to examine the effect of this provision on adults who are 19-64 years old. GAO examined (1) the most common medical conditions that would cause an insurance company to restrict or deny insurance coverage for adults and the average annual costs associated with these conditions,  (2) estimates of the number of adults with pre-existing conditions, and (3) the geographic and demographic profile of adults with pre-existing conditions.

    To address these three issues, GAO (1) identified four recent studies that narrowly or more broadly identified five lists of conditions likely to result in restricted coverage in the individual insurance market and (2) used the 2009 Medical Expenditure Panel Survey to generate five separate estimates, referred to as estimates 1 through 5.  There is no commonly accepted list of pre-existing conditions because each insurer determines theconditions it will use for medical underwriting.

    We also contacted state insurance department officials in all 50 states and the District of Columbia to confirm information about state insurance protections that currently limit or prohibit medical underwriting.

    What GAO Found

    Hypertension was the most commonly reported medical condition among adults that could result in a health insurer denying coverage, requiring higher-than-average premiums, or restricting coverage. GAO’s analysis found that about 33.2 million adults age 19-64 years old, or about 18 percent, reported hypertension in 2009. Individuals with hypertension reported average annual expenditures related to treating the condition of $650, but maximum reported expenditures were $61,540. Mental health disorders and diabetes were the second and third most commonly reported conditions among adults. Cancer was the condition with the highest average annual treatment expenditures — about $9,000.

    Depending on the list of conditions used to define pre-existing conditions in each of the five estimates, GAO found that between 36 million and 122 million adults reported medical conditions that could result in a health insurer restricting coverage. This represents between 20 and 66 percent of the adult population, with a midpoint estimate of about 32 percent. The differences among the estimates can be attributed to the number and type of conditions included in the different lists of pre-existing conditions. For example, estimate 1, which is the lowest estimate, includes adults reporting that they had ever been told they had 1 or more of 8 conditions. Estimate 3, the midpoint estimate, includes any individual reporting they had one of over 60 conditions. Estimate 5, the highest estimate, includes any individual reporting a chronic condition in 2009.

    The estimated number of adults with pre-existing conditions varies by state, but most individuals, 88-89 percent depending on the list of pre-existing conditions included, live in states that do not report having insurance protections similar to those in PPACA. Compared to others, adults with pre-existing conditions spend thousands of dollars more annually on health care, but pre-existing conditions are common across all family income levels.

    The Department of Health and Human Services reviewed a draft of this report and had no substantive or technical comments.

    For more information, contact John E. Dicken at (202) 512-7114 or DickenJ@gao.gov.

    View Report (PDF, 46 pages)