Methow Valley Health & Wellness

Methow Valley

Health & Wellness

2013/2014

Inside: Understanding Affordable Care The sweetener dilemma Bonding with babies The outlook for rural care

Free A supplement to the Methow Valley News

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2 HEALTH & WELLNESS

Change & choices

Methow Valley

Health

&

Wellness 2013/2014

Don Nelson, publisher/editor Sue Misao, design Robin Doggett, advertising manager Callie Fink, advertising Dana Sphar, ad design/production Linda Day, ad design Marilyn Bardin, office manager Contributors Ann McCreary Marcy Stamper Laurelle Walsh A publication of the Methow Valley News P.O. Box 97, Twisp WA 98856 (509) 997-7011 • Fax 509-997-3277 editor@methowvalleynews.com www.methowvalleynews.com

The most sweeping changes in the American health care system in decades are upon us, and that means some important decisions loom for Washington state residents. With the federal Affordable Care Act comes the Washington Health Benefit Exchange, which offers a range of plans that meet the minimum requirements set by the ACA to cover essential health care services, and Washington Healthplanfinder (www.wahealthplanfinder.org), an online marketplace which explains the insurance plans approved by the state and provides a way to sign up for coverage.

In our annual Health & Wellness special publication for 2013-14, we provide a primer on understanding the state’s offerings and how to take advantage of them. See the thorough story by reporters Marcy Stamper and Ann McCreary beginning on page 4.

Also in Health & Wellness you’ll find stories about Three Rivers Hospital’s Baby-Friendly program, the debate over natural and artificial sweeteners, and the prognosis for rural health care.

The Methow Valley and Okanogan County health care communities offer many options for preventative care and treatment. You’ll find many of them represented as advertisers in Health & Wellness. We appreciate their support and we hope you’ll appreciate their services.

–Don Nelson

Contents Navigating the Affordable Care Act ..................................... 4 Being Baby-Friendly .................. 8 Choosing a sweetener ............ 10 The outlook for rural care ...... 12

Cover photo by Don Nelson

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Navigating the Affordable Care Act The choices are complex, but the state’s Health Benefit Exchange will help

By Marcy Stamper and Ann McCreary

T

he stated goal of the federal Affordable Care Act (ACA) is simple – to expand health coverage to the 15 percent of Americans without it, to make that coverage more affordable, and to make sure it’s there when you need it.

But the system itself is complex. It keeps many aspects of the existing private insurance system intact, but requires insurers to provide 10 basic areas of essential health coverage in insurance plans – including preventive screenings, maternity care, hospitalization and re-

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priced options and provide a way for people to compare plans side by side. Washington’s Health Benefit Exchange offers a range of plans that meet the minimum requirement set by the ACA to cover essential health care services.

The plans have different categories of coverage (how much they’ll pay for your care) and are offered by different insurance companies. There will still be other insurance policies offered to individuals (similar to today’s system), but only those policies bought through the Exchange are eligible for

hab, and mental health care.

The ACA (sometimes called “Obamacare”) also prevents insurance companies from denying coverage to people who are sick or who have chronic conditions, and from cutting off their insurance when they get sick.

Although the system is complicated, Washington state has done more than many states to help people understand their choices and navigate the process. It is one of 17 states (along with the District of Columbia) to create an exchange to sell different-

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subsidies to help offset the cost of premiums or copays.

The state’s Insurance Commissioner has approved 38 Qualified Health Plans that meet the basic requirements, but not all plans are available in all counties. In Okanogan County, three insurance companies have been authorized to sell policies through the new Exchange: Community Health Plan of Washington, LifeWise Health Plan and Premera Blue Cross.

What do you need to do?

As part of national health care reform, Washington has created Washington Healthplanfinder (www.wahealthplanfinder.org) – an online marketplace where individuals, families and small businesses in Washington can compare health insurance plans approved by the state and sign up for insurance coverage.

The site will provide side-byside comparisons of the qualified health plans. It will also provide information on tax credits and financial help. A calculator on the site allows people to learn their

estimated monthly premium based on household size, income and other factors. Once consumers have found a plan that meets their needs and budget, they can enroll on the site.

Many people will likely have questions as they navigate this new approach to health insurance. So, where can you find help?

In the Methow Valley, Room One in Twisp will have two “inperson assisters” trained to help individuals, families and small businesses. Room One is part of a statewide network of in-person assisters created in accordance with the ACA. The Room One assisters can help people – in person, by phone or electronically – research their options and sign up for insurance on Healthplanfinder. Washington has also created a customer-support phone center to help with the process. Online help is also be available through Healthplanfinder.

People can also work with insurance brokers, who are required to get training on specific plans and options in order to sell insurance

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Categories of coverage

Plans in the Exchange are separated into three different categories: bronze, silver and gold. These categories describe how much of your medical costs you pay and how much the plan pays.

Bronze plans pay 60 percent of your medical costs; silver pay 70 percent; and gold, 80 percent, with the individual paying the rest

through a copay. Silver plans offer a more generous level of benefits than most plans in the current individual market, according to a state fact sheet.

What do you get?

Qualified health plans must offer coverage in 10 overall categories.

Adults

For adults, essential coverage includes outpatient care, preventive services with no out-of-pocket costs (including mammograms and colorectal-cancer screening), emergency services, hospitalization, and rehabilitation and associated devices. There is maternity and newborn care, and contraception for women.

Policies must provide depression screening and mental health and substance-use services, including counseling and psychotherapy.

Plans cover prescription drugs, lab tests and vaccinations. They also provide screening and counseling for HIV and sexually transmitted See Affordable Care Act, Page 6

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through the state Exchange. The brokers will receive commissions from the insurance companies that sell policies on the Exchange.

In-person assisters and the state’s support center are allowed to provide information – but not advice – about plans and the enrollment process. People can choose and enroll in a plan on their own through the Healthplanfinder, or they can find a registered broker there.

“Brokers are the only piece of our customer support network that can recommend a certain plan,” said Bethany Frey, communications specialist for the Washington Health Benefit Exchange.

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HEALTH & WELLNESS 5

Affordable Care Act from P. 5

infections, screening and counseling connected with tobacco and alcohol use, and screening and counseling for obesity.

People may choose their own provider from within each plan’s network. Alternative medicine is covered with a referral if deemed medically necessary.

The number of visits to practitioners may depend on the plan, and some coverage only applies to people in certain age or high-risk groups.

Children

Children get basic check-ups, vision care (up to age 19), immunizations, and hearing and vision screening. There is also screening for autism and behavioral issues, and depression screening for adolescents. Pediatric dental insurance will be available on the Exchange (meaning there can be financial subsidies).

Other changes

Some significant changes from the current system apply to everyone. No one can be denied health coverage for being sick or having a pre-existing condition, and people also can’t be charged more for coverage because they are sick. Women can’t be charged more for insurance than men, and there is no cap on lifetime benefits (nor on annual benefits, starting in

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6 HEALTH & WELLNESS

2014). Young adults can stay on their parents’ plan up to age 26, even if they are married, not living with their parents, or are financially independent. People have the right to appeal a decision on a claim.

Cost protections and transparency

The ACA also aims to provide increased cost protections and transparency. Insurance companies must justify any rate increase of 10 percent or more before raising a premium.

They also must spend at least 80 percent of the premium on your health care, instead of on administration and marketing (the 80/20 rule).

Seniors

Seniors who have Medicare are considered covered and their benefits won’t change.

But health reform will help seniors with high medication bills. Phased-in discounts will begin to close the “donut hole” (the gap in coverage for prescription-drug expenses between $2,970 and $4,750). The ACA has provisions to close the gap by 2020.

What don’t you get?

Dental care is only available through the Exchange for children up to age 19. Vision care for adults is not required (but some plans may include it).

“Grandfathered” individual health insur-

ance plans – those in effect since March 23, 2010 – do not have to incorporate all the new requirements. For example, grandfathered plans do not have to provide free preventive care, the choice of provider, or protections on rates, such as the 80/20 rule. Anyone with an existing plan has the option of switching to a new plan that meets the ACA guidelines.

What will it cost?

There are two types of subsidies available to people who qualify: • cost-sharing, which helps offset out-ofpocket expenses for copays.

• tax credits, which help offset monthly premiums.

Cost-sharing is available for people with incomes up to 250 percent of the federal poverty level ($28,725 for an individual and $58,875 for a family of four). It will only be available for silver plans.

Tax credits are available for any plan (bronze, silver or gold) sold through the Exchange and are based on income and family size. People can choose to have the credits paid directly to the insurance company or to take them as a credit on their tax return.

Savings on premiums in the form of tax credits are available for people earning from 138 to 400 percent of the poverty level (up to $45,960 for an individual and up to $94,200 for

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a family of four). Anyone whose income is less than 138 percent of the poverty level will qualify for Medicaid (Washington Apple Health). A family of four making less than $32,500 can qualify for free health coverage.

If someone chooses a bronze or gold plan, the individual could still qualify for a tax credit to help with the monthly premium, but would not get the help with out-of-pocket expenses.

You can check whether you qualify for a tax credit using the basic calculator, but details about the cost-sharing options will not be available until Oct. 1, when the Exchange is officially launched.

“The Washington Health Benefit Exchange is the only place where you can get access to tax credits or cost-sharing subsidies,” Frey said.

All premiums will be based on age, county of residence, and whether someone is a smoker or non-smoker.

People under 30 can buy a less-expensive “catastrophic” plan that covers only very high medical costs. These plans will cover three

primary-care visits per year at no cost and free preventive benefits.

People choosing these plans will not be eligible for subsidies.

Plans will also have a range of deductibles, depending on the insurance company and level of coverage, most likely from $500 to $6,000 (for catastrophic plans).

Required essential services will be covered before a person meets the deductible.

Medicaid

Washington is one of about 25 states that have declared their intention to expand Medicaid coverage (called Washington Apple Health here) to poor and low-income individuals through the ACA. Under this expansion, people can earn more money – up to 138 percent of the federal poverty level – and still get Medicaid.

Under the law, the federal government will pay 100 percent of the Medicaid costs for newly eligible people for the first three years. It will pay no less than 90 percent of the costs in the future.

See Affordable Care Act, Page 14

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HEALTH & WELLNESS 7

The Baby-Friendly experience Three Rivers Hospital’s ‘culture of breastfeeding’ earns it a rare distinction

By Ann McCreary

F

or Madeleine Naumann, the experience of delivering her baby last July at Three Rivers Hospital in Brewster gave her “all the things I value – natural childbirth, breastfeeding, being able to get up and walk around during labor.”

Naumann, an Omak resident, said her “aftercare was awesome. They were really helpful with breastfeeding support. My daughter was never removed from the room.”

Naumann’s supportive birth experience at Three Rivers Hospital was hardly a coincidence. It was the result of an investment of time, training, money and commitment by Three Rivers

Hospital staff to achieve the status of a “Baby-Friendly” hospital.

Baby-Friendly is an international program launched by the World Health Organization and the United Nations Children’s Fund in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding.

“Becoming a BabyFriendly facility is a comprehensive, detailed and thorough journey toward excellence in providing evidence-based, maternity care,” explains the BabyFriendly USA website.

Karen Hurley, obstet-

Photo courtesy of Robin Kamerling

Breastfeeding is at the heart of the Baby-Friendly program. rics team leader at Three Rivers Hospital, said the hospital achieved its BabyFriendly designation 10 years ago, one of only six hospitals in Washington,

and the smallest in the state with that designation.

“To become a BabyFriendly designated hospital you have to meet all the criteria that Baby-Friendly

USA has established. It’s international criteria,” Hurley said.

At the heart of the initiative is promoting and supporting breastfeeding, Hurley said. “To be BabyFriendly you have to be able to educate your patients and give them the skills to be able to breastfeed exclusively, and maintain exclusive breastfeeding for six months – that’s our goal,” Hurley said.

Qualifying hospitals are required to follow “Ten Steps to Successful Breastfeeding” developed by the World Health Organization.

“We present a culture of breastfeeding,” Hurley said. To do that, every health

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provider in the hospital who has contact with mothers and newborns receive training in Baby-Friendly practices, she said.

“Staff nurses, interpreters, nursing assistants, doctors all get 20 hours or more of lactation education. They’re paid to take that education,” Hurley said.

Early education

Setting mothers and babies on the path to successful breastfeeding includes education about the benefits of exclusive breastfeeding during the first months after birth, Hurley said.

Blue Bradley, a Methow Valley nurse-midwife, chooses Three Rivers Hospital for all her hospital deliveries because of the facility’s dedication to the Baby-Friendly standards. Bradley said rates of breastfeeding at Baby-Friendly hospitals have been shown to be higher than other hospitals.

Bradley said scientific studies of breastfeeding show that human milk provides the complete nutrition and antibodies necessary for babies to thrive. “Breastfeeding

is known to reduce SIDS [sudden infant death syndrome], infections and diarrhea in the first year for infants,” Bradley said.

“Also, those children who are breastfed have a lower risk of obesity, asthma, high cholesterol and allergies later in life,” Bradley said. Studies have also found that women who breastfeed have decreased risks of breast and ovarian cancer, anemia, and osteoporosis.

And because breast milk is free, breastfeeding has economic advantages as well.

Being Baby-Friendly means that Three Rivers turns down offers of free formula, bottles and gifts from infant formula companies. In other hospitals, formula companies routinely target new mothers with their products, enticing them to feed their babies formula.

“Formula companies are a little sneaky,” Hurley said. “They will give diaper bags to moms. Inside will be advertising and coupons [for formula products]. They are advertising to two of the most vulnerable people: Moms who can’t make up See Baby-Friendly, Page 15

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HEALTH & WELLNESS 9

Sweet mystery Opinions still vary on natural versus artificial sweeteners

By Laurelle Walsh

T

he health pages and talk shows these days are full of talk about sugar, leading with somewhat alarming headlines like, “Study finds moderate levels of sugar toxic in mice.”

Artificial sweeteners have received similar media scrutiny – “Diet soda can be deadly” – compelling industry giant Coca Cola to defend its use of aspartame and to begin marketing a cola with the “natural” no-calorie sweetener stevia.

Which is better, natural or artificial sweeteners? Are we “bad” if we crave sweets? How are consumers supposed to sort out all the choices on the shelves these days?

First of all, we know for sure that the desire for sweet things is a universal trait among humans and other mammals. In the natural

Photo by Laurelle Walsh

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sweet-tasting things were good.

We are also at the mercy of our

brains, which release the pleasure chemicals dopamine, seratonin and endorphins while, and even before, eating sugar.

Nurse practitioner Kathleen Manseau, with Methow Valley Family Practice in Twisp, thinks, in general, that “sugar is a source of energy in our diets that should be enjoyed in moderation.” While some populations, diabetics for example, may need to worry more about sugar, Manseau says that added sugars should be “a concern for everyone exposed to the modern American diet, which is very high in added sugars.”

Added sugar is what we, or the food industry, add to food, not the sugars that occur naturally in fruits, vegetables and milk. The American Heart Association recommends that women consume

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no more than 6 teaspoons of added sugar per day, and men no more than 9 teaspoons. Unfortunately, most Americans get more than 22 teaspoons – 355 calories – of added sugar per day, far exceeding these recommendations.

Among other problems, excessive consumption of added sugars is associated with the development of tooth decay, diabetes type 2, metabolic syndrome, high triglycerides and fatty liver disease, according to the experts.

But sugar also plays an important role in cooking, and has for centuries. Besides tasting good, sugar boosts flavors, gives baked goods texture and color, acts as a preservative, fuels fermentation, acts as a bulking agent and balances acidity.

Natural versus artificial

Google “natural sweeteners” and you’ll see ads for Nectresse, “a natural no calorie sweetener made from monk fruit;” Truvia, “nature’s calorie-free sweetener;” NOW Foods Xylitol Plus “with stevia extract;” Madhava Natural

Sweeteners, “organic amber agave nectar;” SweetLeaf, “100% natural stevia sweetener;” and Pure Via Stevia, “all natural zero calorie sweetener” – all highly refined products that claim a plant-based, and thus natural, history.

But the term “natural” seems to be based more upon consumer perceptions than a scientific definition these days.

The U.S. Food and Drug Administration (FDA) admits that it “has not developed a definition for use of the term natural or its

Based on volume sold, local honey seems to be “the sweetener of choice ... for a lot of households in the Methow,” according to Glover Street Market owner Molly Patterson.

“We do not sell any artificial sweeteners,” says Patterson, “but we do offer a couple of low- or nocalorie options.”

Stevia and xylitol “are great for people who are counting calories or trying to maintain good blood sugar levels: no carbs, calories, zero See Sweetners, P. 14

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derivatives. However, the agency has not objected to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances.”

Natural foods retailer Whole Foods Market limits its list of natural sweeteners to cane and beet sugar products, honey, maple syrup, molasses, barley malt and rice syrups, and agave nectar.

Twisp grocer Glover Street Market carries all of the above plus some products containing stevia and xylitol.

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HEALTH & WELLNESS 11

Paging country doctors Rural medicine presents economic and lifestyle challenges

By Marcy Stamper

I

t’s no wonder that the images most associated with the rural doctor come from Norman Rockwell’s idealized illustrations from more than half a century ago.

“It would be very hard to start out as a solo practitioner – I’m sure that’s what dissuades people,” said Joe Jensen, who started Methow Valley Family Practice in Twisp 22 years ago. “You can’t make a profit as a small practitioner, particularly in a rural setting.”

The Methow Valley is unusual in having two private medical practices – Jensen’s Family Practice in Twisp and the Country

Clinic in Winthrop, started

by Ann Diamond 13 years ago. There are virtually no others remaining in Okanogan County, said Jensen.

“Ann Diamond, Joe Jensen – those folks, in the grand scheme of things today, they are very much the exception,” said Bud Hufnagel, chief executive officer of Three Rivers Hospital in Brewster.

Methow Valley Family Practice is certified as a designated rural health clinic, which helps through higher reimbursements from Medicaid and Medicare. Medicaid and Medicare patients account for more than half of his patient base.

Although enormous

school loans and malpractice insurance are factors, the biggest costs come from the staff necessary to process bills and deal with insurance companies, said Jensen, who employs three people to handle insurance claims and billing.

“Running a small business is very expensive,” said Susan Skillman, deputy director of the rural Health Research Center at the University of Washington. Throughout the industry, there has been a tremendous amount of consolidation of medical practices, where a corporate entity runs the business side, she said.

Brewster lost three

Photo by Marcy Stamper

Health-care providers often have to accept a lower salary and less-generous benefits to work in the Methow, but for Jill Duncan, a physical therapy assistant at Winthrop Physical Therapy, the lifestyle trade-offs and access to outdoor recreation were worth it.

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feelalike my family can join dinner-table “I feelI like partaofpart my of family again. I again. can joinI dinner-table conversations and my grandchildren forItime the time in years. conversations andlike heara hear my for the first years.”

“I feel partgrandchildren of my family again. caninfirst join dinner-table - Angela Omak - Angela L., Wenatchee conversations and hear my grandchildren for the first time inL., years.”

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Connie Miller, PT Julie S-Buttelo, PT Assistant 123 Johnson Ave., Chelan • (509) 682-4713

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physicians, all with long-established practices, in 2012 and has been getting by since then with nurse practitioners and temporary physicians, according to Hufnagel.

“The burden of the overhead and dealing with insurance coverage and federal and state demands is so great that they could no longer reasonably practice medicine,” he said.

Hufnagel is not optimistic about the future for solo practitioners. “Unless you’ve got really deep pockets and are doing this for philanthropic reasons, you’d better be finding a group to get affiliated with, or you’re not going to survive,” he said.

Recruitment strategies

Finding a skilled workforce for rural populations is a nationwide problem, according to Skillman. Part of it is a function of population density, since areas with low populations cannot support specialists, which can be a concern for family-medicine doctors who need colleagues with specialized skills as part of pro-

viding appropriate patient care.

Tele-health programs and other technological innovations can help provide access to specialists who are not needed as often, she said.

Anew emphasis on team-based care gives medical professionals the opportunity for interactions with peers through conferences and other exchanges, said Skillman. The increased knowledge in their field and the intellectual satisfactions are good for the practitioners and their community, she said.

“The very things that attract a family-medicine physician to a rural area – the ability to practice full-spectrum medicine, make hospital rounds, the opportunity to do obstetrics – those are exactly the same things that make them go someplace else,” said Hufnagel.

“Some choose an urban area because they don’t want all that, and they want to make more money.”

The research on recruitment supports a “grow-your-own model,” to encourage people who have grown up in rural areas and are comfortable in that environment to pursue medical, dental and nursing

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careers, said Skillman.

Other effective strategies are to recruit people to do their residencies in rural areas or to hire people just out of school, giving them a chance to build roots in a community and practice a wide range of medicine, said Skillman.

Loan-repayment programs that require someone to practice in an underserved area for a number of years are geared toward these people.

Still, there are only about 90,000 family physicians in the United States and only 7,500 have special training in obstetrics, said Hufnagel. “You’ve completely reduced the universe in recruiting your target group,” he said.

Three Rivers Hospital has been working with area clinics to recruit physicians who will treat patients through the clinics and at the hospital. In addition to obstetrics, they are also looking for people with experience in pediatrics and gerontology, said Hufnagel. They are hoping to hire two to three new practitioners by the end of the year.

Beyond the medical expertise,

the hospital and clinics are specifically looking for family-medicine physicians with a commitment to a long-term practice in a rural area, said Hufnagel. Not all applicants are just starting out in their careers, either. In fact, 60 percent of those invited for interviews have already worked in other areas; the other 40 percent are recent graduates, he said.

While opportunities for collaboration have increased through technology, people have to be comfortable going it alone. “There is no hospital across the street – that can be very scary,” said Jensen.

There are also family issues, such as the difficulty of finding work for a spouse and meeting the educational needs of children, as well as practical and lifestyle preferences such as convenient shopping, said Hufnagel. People who have grown up in a rural area know what to expect, making them good candidates, said Skillman.

“The biggest drawback here is financial,” said Jensen. “It’s like anyone else who works here – you have to trade lifestyle for money.”

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Resources and contacts

Affordable Care Act from P. 7

What if you already pay for an individual plan or have insurance through work?

Frey advises people who already have insurance through individual plans to evaluate the plans available at healthplanfinder.org. The state has approved 43 qualified health and medical plans (five are dental plans for children), and several other “multi-state” plans may be offered as well.

People who already get insurance through their employers “probably won’t need to do much,” Frey said. Plans available to employers are likely to change to meet ACA criteria, she said. “There probably won’t be too many plans grandfathered, [so] people might have to enroll in a new plan through their employer.”

Still, people are advised to evaluate new options and compare them with existing coverage.

What if you don’t sign up?

The law has a stick built into it to encourage people to buy insurance. Starting in 2014, individuals who do not have health insurance will pay a penalty of $95, which increases to $325 in 2015, and $695 or 2.5 percent of household income in 2016. For families, the penalty will be $2,085, or up to 2.5 percent of household income.

This penalty is administered by the Internal Revenue Service through the tax return system.

The ACA provides for nine exemptions from the individual mandate to buy insurance, which include Americans with religious objections, incarcerated people, and those who cannot find an affordable plan.

Affordable Care Act (general information): www. hhs.gov/opa/affordable-care-act Washington Health Benefit Exchange: www. wahbexchange.org Washington Health Plan Finder: www. wahealthplanfinder.org Premium and subsidy calculator: www. wahealthplanfinder.org/calculator Washington Customer Support Center (questions about health coverage options, how to access financial help and what you need to know about the enrollment process): 855-WAFINDER (855-923-4633) or TTY/ TTD 855-627-9604, 7:30 a.m. to 8 p.m., Monday through Friday Room One (help with the Exchange, Medicaid and Medicare): (509) 997-2050 Office of the Insurance Commissioner: www. insurance.wa.gov/current-issues-reform/healthcare-reform Insurance Consumer Hotline: 800-562-6900, 8 a.m. to 5 p.m., Monday to Friday Washington Apple Health (for kids): 877-543-7669 or www.hca.wa.gov/applehealth Medicaid/Apple Health (for adults): 800-562-3022 or www.hca.wa.gov/medicaid Medicare: (800) 633-4227 (general information), 800-562-6900 (personalized counseling); www. medicare.gov. Statewide Health Insurance Benefits Advisors: (509) 782-5030

Important dates Health Benefit Exchange: Open enrollment starts Oct. 1, 2013; ends March 31, 2014. For people who enroll by Dec. 23, coverage will take effect Jan. 1, 2014.

Medicare: Open enrollment period for Medicare is Oct. 15 to Dec. 7.

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Sweeteners from P. 11

glycemic index. It can really help with those sugar cravings without messing with your diet,” she says.

Any artificial sweetener on the shelf these days has been declared by the FDA “generally recognized as safe,” with “acceptable daily intake” levels: the maximum amount considered safe to consume each day over a lifetime.

And the Mayo Clinic recognizes three possible health benefits of artificial sweeteners: they don’t contribute to tooth decay; they are a good alternative for people trying to lose weight; and they do not raise blood sugar levels.

But other health care providers, like Manseau, say that “the jury is still out regarding specific health risks” of artificial sweeteners.

“Diet cola is a good example,” Manseau says. “Many people think diet cola is perfectly fine for excessive consumption because it uses artificial sweeteners that have no calories. Some research, though, shows an association between diet soda intake and weight gain.”

“Then again,” she points out, “other studies seem to disprove that, so where does that leave us? It seems that a new study comes out every month contradicting the findings of the study the month before.”

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Baby-Friendly from P. 9

their minds and moms who want to do the best for their baby.�

The campaign by formula companies to win over new mothers is well coordinated, Hurley said. “In non-Baby-Friendly hospitals you would receive free formula from the company in pre-mixed bottles,� she said. “We don’t allow any advertising.�

Nor is any patient contact information provided to formula companies, which means mothers who deliver at Three Rivers won’t receive formula samples and advertising from formula companies in the mail when they get home, which is the case with other hospitals.

If Three Rivers does provide formula to a baby, Hurley said, it has been purchased by the hospital, rather than donated by formula companies as in other hospitals.

Facilitating successful breastfeeding means providing a natural birth experience. The hospital has a birthing tub, which many mothers find helpful during labor. Patients are encouraged to walk around during labor and use a birthing ball to

relieve pressure during labor.

After delivery, moms and babies room together so they are not separated. “We have no nursery,�

Hurley said. “We encourage the father or other family members to stay. All postpartum rooms have a couch that pulls into a bed and we provide blankets and pillows.�

Immediate connection

In addition, the hospital helps moms and babies establish a close connection immediately after birth that is critical to successful breastfeeding. “After delivery, we encourage skin-to-skin contact ‌ that helps facilitate breast feeding and bonding, and helps stabilize the baby,â€?

Hurley said.

The baby, wearing nothing but a diaper, is placed on the mother’s stomach to establish that vital contact. “Along with that, we encourage skin-to-skin contact with dad too,�

Hurley said.

The hospital staff supports breastfeeding-on-demand, and helps new mothers learn to recog-

nize the cues their baby provides when it wants to feed, such as lip-smacking, turning its head and rooting. No pacifiers are provided, because that disrupts an infant’s learning to breastfeed and may interfere with the mother’s production of milk. “The baby needs to suck on the breast and on their hands to be pacified. That is telling mom’s body how much milk the baby needs, not just now, but in six months. They’re laying down all those milk-producing cells in the breast. It’s amazing,�

Hurley said.

Three Rivers supports mothers after they leave the hospital to maintain breastfeeding, even if the moms have to return to work. “We teach them how to maintain their milk supply and work part-time and full-time,� Hurley said. Hospital staff helps mothers learn to pump and store breast milk to continue breastfeeding.

Being Baby-Friendly doesn’t mean that Three Rivers forces women to breastfeed, or refuses to give bottles, Hurley said. “But we

do educate and support.�

Hurley said she doesn’t have current figures on how many mothers are still breastfeeding exclusively six months after giving birth. “I think we have a pretty high volume from what I hear from the clinics of moms that are exclusively breastfeeding,� she said.

In addition to the investment of time and training required to be Baby-Friendly, Three Rivers Hospital pays $1,000 each year to Baby-Friendly USA for the designation, and must recertify every five years. Baby-Friendly USA reviews hospital policies and procedures, patient care, breastfeeding rates, and takes feedback from mothers in the months following birth.

Noting that Three Rivers Hospital has faced significant financial issues in recent years, midwife Bradley said she’s impressed by the hospital’s commitment to a program that carries considerable cost. “It’s a significant amount of money,� Bradley said. “I think they’re amazing for a little hospital.

They’re so progressive.�

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