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Brandi Is Terrified That She’ll Fall Back Into Addiction if Obamacare Is Repealed

Mother Jones

Brandi, 30, depends on Medicaid expansion for opioid addiction medication. Courtesty of Brandi

For much of her twenties, Brandi was in a bad place: staying up all night to sniff OxyContin and dealing marijuana from her apartment in a dingy Rochester, New York, housing project to feed her insatiable painkiller addiction. Drug users were always coming in and out of her place, a nearly empty one-bedroom that smelled of cat pee. Dinners consisted of instant noodles or McDonald’s, where a friend would trade chicken nuggets for a gram of marijuana. “Any money would go directly into buying pills,” said Brandi, who requested to go by her first name.

A 30-year-old with piercing green eyes, Brandi hasn’t used drugs since January of 2015, when she started taking buprenorphine, a medication that treats opioid addiction. She lives in a townhouse with her fiancé, also a former drug user, and their cats. Thanks to the medications, she says, “both of our lives are a total 180 from what they used to be.” She works the night shift at the supermarket during the week, visits family on Sundays, occasionally splurges at Bonefish Grill or TGI Friday’s. Each day, the couple takes their medications: buprenorphine for her, methadone for him. She’s been reading the news about the potential repeal of Obamacare and Trump’s budget proposals, and she finds it “all terrifying”—because if Obamacare is repealed and Medicaid expansion is cut, she, like hundreds of thousands of Americans, could lose her ability to pay for buprenorphine. Without the medication, she worries, she’ll fall back into the cycle of drug abuse.

She’s been there before. Brandi first got her life back on track when she went on buprenorphine as a 22-year-old straight out of rehab. She did well for a few years: She got a job as a cashier, moved into a nicer place, started buying groceries and brushing her hair. But when she was 26, just before New York expanded Medicaid, she was kicked off her mom’s health insurance. Knowing she didn’t make nearly enough to be able to pay for her own coverage, she stretched out her buprenorphine supply as long as she could, stockpiling what she had in the months before her 26th birthday and weaning her dose down. But eventually there was none left, and within two weeks, she says, “I found pills and it was just done and over with.” She used for nearly two years before going back to rehab and realizing that, with Medicaid expansion, she could pay for the medication once again.

On the campaign trail, President Donald Trump promised to “spend the money” to tackle the nation’s opioid epidemic. Yet drug policy experts fear that passage of the American Health Care Act, also known as Trumpcare, would cut off former drug users from their addiction medications, making an already devastating epidemic even worse. That’s largely because the AHCA would dramatically cut funding for Medicaid—the federal program that provides health insurance to poor Americans and the largest federal funder of addiction services. It would also phase out Medicaid expansion, which expanded the eligibility requirements of the publicly-funded insurance program to include those who earn up to 138 percent of the federal poverty level in the 31 states that opted to expand it. Cuts to Medicaid would hurt most in many of the states that helped vote Trump in: in places like Ohio, West Virginia, and Kentucky, Medicaid pays for at least forty percent of buprenorphine prescriptions.

“People talk about being committed to doing something about drugs,” says Keith Humphreys, a Stanford University psychiatry professor who advised the Obama administration on drug policy. But “their Medicaid cuts would swamp anything else they could do.”

Nearly three million Americans with a substance use disorder, including more than 200,000 who were addicted to opioids, would lose some or all of their insurance coverage if Obamacare is repealed, according to an analysis by researchers Richard Frank of Harvard Medical School and Sherry Glied of New York University. In a report released last week, the Congressional Budget Office found that if the AHCA passes, addiction treatment services “could increase by thousands of dollars in a given year” for those who aren’t covered by insurance through their employers.

Both Humphreys and Frank worry that many politicians don’t understand just how critical addiction medications can be. Indeed, last month, Health and Human Services Secretary Tom Price said addiction medications were “substituting one opioid for another,” contradicting years of research by the agency he now runs. Buprenorphine and methadone, the two most common such medications, work by binding to the brain’s opioid receptors and decreasing craving for more harmful opioids like painkillers or heroin—without inducing the high. They come with some side effects: It’s still possible to abuse the medications, and coming off of them too quickly can result in a painful process similar to withdrawing from other opioids.

But a wealth of research has found that addiction medications like buprenorphine help curb opioid addiction and prevent relapse and overdose. Organizations from the Centers for Disease Control to the Substance Abuse and Mental Health Administration to the World Health Organization support access to the medications for opioid users. “I don’t think that there are any areas where the data is shaky,” said Dr. Nora Volkow, the head of the National Institutes on Drug Abuse, part of the National Institutes of Health, to STAT news. “It clearly shows better outcomes with medication-assisted therapy than without it.”

Brandi may be lucky: If the AHCA does pass, there’s still a chance that her home state of New York would find a way to fund treatment for people in her position. But many Americans may not be so fortunate. As Humphreys told me this spring, without Obamacare, “We’re back where we were before: bad access, low quality of care, and a lot of patients being turned away.”

For now, Brandi plans to keep taking the medication for as long as she can. “People I work with right now would never in a bajillion years picture me as a drug addict—ever.” The impact of the medication is “like night and day,” she said—and going back to the days without coverage would amount to “a nightmare.”

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Brandi Is Terrified That She’ll Fall Back Into Addiction if Obamacare Is Repealed

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Why a Walk in the Woods is Vital for Your Health: The Science Behind Forest Bathing

Forest bathing is a concept originally developed in Japan in the 1980s. Its called shinrin-yoku in Japanese, which means taking in the forest atmosphere or forest bathing.

Its as simple as it sounds. Forest bathing involves relaxing in a forest or other natural area, often taking a slow walk while observing the environment around you. It has become such a respected practice in Japan and Korea that forest therapy is now covered under their medical insurance systems.

The healing power of nature has been known for millennia, but modern science is just discovering the importance of this ancient knowledge.

The Health Benefits of Forest Bathing

1. Lowers Stress

A Japanese study looked at the physiological effects of forest bathing. They found it promotes lower levels of stress hormones, lower pulse rate and blood pressure, as well as improved nervous system function.

In addition, these benefits were found after participants went forest bathing only once. They walked in a forest for about 15 minutes, then simply viewed it for another 15 minutes.

2. Improves Memory

One Stanford University study had participants do a memory test before and after either a nature walk or a walk in an urban area. Those who walked in nature improved their performance on the second memory test. Whereas, the urban walkers had no improvement.

3. Increases Vitality

Vitality means having physical and mental energy. When you feel vital, you experience a sense of enthusiasm, aliveness and energy.

Through a series of studies, a research group looked at the effect of nature on vitality. They found that walking outdoors increases your vitality, and it was not from the exercise or social interactions. It appeared to be the presence of nature that strengthened peoples sense of aliveness. Interestingly, viewing pictures of nature also had a positive effect.

Researchers concluded its important to spend at least 20 minutes each day interacting with nature to feel more energized.

4. Enhances Mental Wellness

A 2015 study found that forest bathing reduces repetitive, negative thoughts, which are a known risk factor for mental illness such as depression. Participants also had reduced activity in an area of the brain linked to mental illness.

Researchers pointed out that currently 50 percent of people live in urban areas. This is estimated to rise to 70 percent by 2050. Urbanization is also linked to higher levels of mental illness. They felt that access to natural areas may be vital for mental health in our rapidly urbanizing world.

5. Boosts Immune Function

Forest bathing is shown to increase the activity of natural killer cells and anti-cancer proteins. Both of these compounds are important parts of your immune system. They actively target and destroy dangerous cells in your body, such as virus-infected cells or tumor cells.

Tips on Getting the Most Out of Forest Bathing

Forest bathing is about experiencing a natural space, not getting somewhere or achieving a goal. Low-impact ways of observing your surroundings work best, such as walking or simply sitting and touching the ground or plants around you.

More vigorous activities, like running or cycling, can also be beneficial when done in nature. Although, it is difficult to fully immerse yourself in a natural setting when youre moving through it quickly.

Exposure to any form of nature is shown to have health benefits. If you cant easily get to a forested area, going to a local park, your back yard, a river, or even a secluded beach are all great options.

Try one of these exercises next time youre out in nature:

Whether youre walking, sitting or standing, pay attention to the bottom of your feet. If your mind starts to drift towards a project you need to finish or other stressful thoughts, bring it back to the bottom of your feet.
Take in your surroundings with all your senses. Listen for birds and insects, smell the soil, touch the bark of a tree.
Pick up a rock and see whats underneath it.
Bring a field guide book with you to learn more about the plants and animals you see.
Choose a short nature trail or a garden path you know well. Challenge yourself to walk through it as slowly as possible.
At the beginning of your forest bathing session, take a moment to notice how you feel. Then, check in with yourself again at the end of the session. Is there a difference?

The Association of Nature and Forest Therapy offers a certification program on becoming a forest guide. Their video is a great overview of forest bathing fundamentals.

Harness the Power of Daydreams and Your Brain Will Reap the Rewards
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Disclaimer: The views expressed above are solely those of the author and may not reflect those of Care2, Inc., its employees or advertisers.

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Why a Walk in the Woods is Vital for Your Health: The Science Behind Forest Bathing

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How to Monitor and Control Indoor Air Quality in Your Home

The air that we breathe is, quite literally, our life source. But it could also, quite possibly, be killing us. Air quality is becoming a modern crisis, with the World Health Organization (WHO) classifying air pollution as the worlds largest health risk, linking one in eight total global deaths to air pollution exposure, both indoor and out.

According to the U.S. Environmental Protection Agency, the air inside our homes is commonly five times more polluted than that of the outdoors, and in some cases, up to 10 times. So, what can you do to protect your health, and that of your family, from this silent killer lurking in your home? Detect and correct. Find out what is causing air pollution in your home and then take whatever steps you can to help correct or mitigate those causes. Here well look at how you can achieve this.

What Is Indoor Air Pollution?

Poor indoor air quality is caused by particle matter in the air, most commonly from dust and smoke (commonly released into the air from burning oil, gas, wood and coal in the home); carbon dioxide from those same sources; volatile organic compounds (VOCs) released by both natural and manmade materials (primary culprits are paints, stains, cleaning solutions and glues in furniture and carpets) and humidity, which can cause mold to grow in our homes and offices.

According to the WHO, pollutants found in indoor air that are known to be health hazards include:

carbon monoxide
nitrogen dioxide
polycyclic aromatic hydrocarbons

How to Get Cleaner Air

Cleaning up the air we breathe prevents non-communicable diseases as well as reduces disease risks among women and vulnerable groups, including children and the elderly, says Dr. Flavia Bustreo, WHO Assistant Director-General.

One of the simplest ways to do this in your own home is to regularly change the filters in your heating and air conditioning system. Check them at least once a month for build-up, and replace them at least every three months. Invest in high-efficiency air filters with a MERV rating of 8 or higher. (This is the Minimum Efficiency Reporting Value that assesses the overall effectiveness of air filters. A higher rating equals finer filtration.)

The second simplest step to take is ventilate your home. Open doors, windows, turn on fans and get the air circulating, especially if you have recently introduced something into your home that may be off-gassing chemicalssuch as new carpet or flooring.

What to Get Rid Of

You can help keep your air cleaner by banishing or reducing some of the following from your home:

Dont allow anyone to smoke in or near your home.
Never idle a car in or near the garage.
Remove all chemicals and toxic materials from your garage, especially if its attached to the house.
Reduce carpeting, which traps unhealthy particles that are released again when vacuuming.
Replace chemical based cleaners and detergents with those with natural ingredients, and avoid using products with fragrance (such as air fresheners and carpet deodorizers), as these can contribute to the formation of formaldehyde and other nasty VOCs.

What to Invest In

Use alternatives to traditional items that give off VOCs and invest in some tools and tests to keep your homes air healthier:

Install a carbon monoxide detector to alert you when levels of this deadly gas, produced by the incomplete burning of carbon-based fuels, rise rapidly.
Buy no- or low-VOC paints/stains when redecorating or doing projects in the home.
Have a radon test done on your home. A colorless, odorless gas, radon is the leading cause of lung cancer among non-smokers.
Fix leaks in your roof and/or basement, to avoid creating conditions that can grow mold.
Combat humidity to further reduce the risk of mold with a dehumidifier. Keeping levels below 50 percent also helps keep dust mites, another indoor air pollutant, at bay.

Go High Tech

One of the challenges in combating indoor air quality is knowing exactly what the problem is. As weve seen, indoor air quality is affected by myriad different elements. If you or your family are suffering from specific ailments or are at higher risk from contaminated air, consider purchasing an indoor air quality (IAQ) monitor. The good news is these devices, which used to cost thousands of dollars, are now a lot more affordable thanks to advances in wireless and sensor technology.

An IAQ monitor can measure VOCs, humidity, particulate matter and carbon dioxide, and alert you when levels rise so you can take action. They will also help you understand what pollutants are present in your home and at what levels, so you can work on eradicating them over the long term. Many new IAQ monitors are Wi-Fi connected and use data from the internet combined with learning software to monitor your air quality and help you understand what is specifically causing your air pollution.

A few examples of consumer IAQs on the market today include Foobot and AWAIR (both around $200). They can track VOCs, particulate matter and CO2, as well as temperature and humidity. They also work with some smart thermostats, such as Nest and Ecobee, triggering them to activate the fan if levels rise too high and give you actionable insights into your air quality.

If you are specifically concerned about humidity and temperature, less-expensive devices such as the Leeo Smart Alert ($50) and First Alert Onelink Environment Monitor ($70) can track both. The Leeo can also listen for the sound of smoke and CO alarms and alert you on your smart phone. The Onelink is also a CO monitor, making it a good option for a baby or childs room.

The important thing to remember about indoor air quality is that everything you bring into your home is contributing to it in some waygood or bad. Its crucial to be proactive: Check products for VOCs before you purchase, add houseplants to help filter the air naturally, and be sure to ventilate properly when cooking or burning any fossil fuels.

As an earth-conscious mom and tech guru, Jennifer Tuohywrites for The Home Depot about how you can use technology to become more sustainable. She provide tips on how to save money and energy, from switching to LED bulbs to using an Wi-Fi-enabled monitor to alert you when you need to change your air filters.

Disclaimer: The views expressed above are solely those of the author and may not reflect those of Care2, Inc., its employees or advertisers.


How to Monitor and Control Indoor Air Quality in Your Home

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The GOP Health Bill Would Make Zika the Newest Preexisting Condition

Mother Jones

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The controversial GOP health care bill that narrowly passed the House of Representatives this month could have devastating consequences for mothers and children infected with Zika, experts say. The mosquito-borne virus is just one on a nearly endless list of preexisting medical conditions—cancer, asthma, pregnancy—for which insurers could potentially charge higher premiums if Republicans get their way.

One of the most popular features of Obamacare is a provision known as “community rating,” which bars insurance from charging more for people with preexisting conditions. This was a common practice before Obamacare was enacted in 2010; stories of sick people being unable to find affordable coverage were one of the main arguments used by the legislation’s supporters. Of course, the public health crisis surrounding Zika—and the birth defects it can cause—wasn’t an issue at the time; no one in the United States had yet contracted the virus. But if the House’s Obamacare repeal bill becomes law, people with Zika could end up paying far more for their health care—and could even end up priced out of insurance entirely.

Multiple health care experts told Mother Jones that the GOP bill would almost certainly mean a host of insurance problems for both pregnant women who have had Zika and infants born with microcephaly, a condition where a child has a smaller brain and other health defects. Zika can cause a host of other birth defects and in rare cases has been linked to Guillain-Barré syndrome, which can cause temporary paralysis in adults. What’s more, the GOP bill cuts funding to the Centers for Disease Control and Prevention, the agency on the front lines of the battle against the disease.

The Republican bill includes an amendment that allows states to opt out of the Obamacare community rating protection. Under the GOP plan, if a person’s health coverage were to lapse longer than 63 days in a state that opts out, that person could be charged a prohibitive cost on the private market. Short lapses in coverage are incredibly common. The Kaiser Family Foundation estimates that 27.4 million nonelderly adults had a several-month gap in coverage in 2015. For the 6.3 million of these adults who have preexisting conditions, the costs could be significant. The liberal Center for American Progress estimated that under the GOP bill, people with even mild preexisting conditions would pay thousands more per year—a 40-year-old, for example, would likely be charged an extra $4,340 in premiums if she had asthma, or $17,320 extra if she were pregnant.

Zika was first identified in 1947 in Uganda. It didn’t emerge in Brazil until 2015, when researchers began to notice the link to a spike in birth defects. Since then, mosquitoes carrying the Zika virus have been found in almost every country in the Western Hemisphere. Zika is particularly prevalent in Latin American, but it has also appeared in the United States. There have been more than 30,000 cases confirmed in Puerto Rico, including 3,300 pregnant woman, and more than 1,000 cases in Florida. The spread of Zika has varied wildly from year to year, with cases this year down sharply from 2016.

Yet our understanding of the Zika virus and its related health problems is still evolving. In most people, the virus shows no visible symptoms or just mild problems such as aches and a fever. But it does raise the risk of microcephaly, a rare brain defect in which a child develops with an abnormally small head and brain. Microcephaly is incredibly rare in a normal pregnancy, but a Zika infection in the first trimester raises the risk to 1 to 13 percent.

Zika is linked to various health problems in infants, but microcephaly itself is an expensive medical condition. The CDC estimates it would cost an additional $1 million to $10 million in medical care over the child’s lifetime. Zika-associated microcephaly would probably cost somewhere in the tens or hundreds of thousands of dollars per year in premium surcharges, according to the Center for American Progress health policy team.

Experts say that, under the Republican plan, insurers would almost certainly treat Zika as a reason to charge higher premiums.

“If it’s documented in your medical records that you had this infection and you have it now, they might well act on it,” Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told Mother Jones. And if an infant was born with microcephaly, Pollitz added, “you’d have to be very careful as the parent of a child to never have a break in coverage.” Pollitz also added that the total number of Zika cases is small, but the issue could come up in medical records and be cause for insurers to “jump on that and possibly charge you a higher premium.”

In other words, insurers would be tempted to charge more based on the expensive medical costs sometimes associated with Zika, and there would be nothing preventing them from doing it. “There’s no rule about what can or cannot qualify” as a preexisting condition, New York University health care expert Sherry Glied said in an email, “and Zika will certainly raise later costs, so would count.”

David Anderson, a Duke University health policy researcher who has worked in the health insurance industry, added that another part of the GOP’s health bill—massive cuts to Medicaid spending—would add more strain to state budgets in the case of a Zika outbreak. The bill reduces Medicaid expenditures by $834 billion over the next decade, according to an analysis by the nonpartisan Congressional Budget Office. Trump’s 2018 budget released Tuesday proposes even deeper cuts than the GOP bill. If passed, the budget would reduce Medicaid spending by $1.4 trillion over 10 years.

Anything affecting babies is a big deal for Medicaid, which covers nearly half of all births in the United States. That would cause a significant problem if Zika leads to an unexpected spike in microcephaly. “If it’s not that common, states can handle one or two isolated events,” Anderson says. “If it’s very common and there are hundreds of babies born with microcephaly under high-cost conditions, then states can’t handle it.”

The House bill would have other impacts on Zika prevention efforts. It cuts nearly $1 billion from the CDC’s budget. The CDC funds testing and research and deploys emergency teams to provide extra medical assistance and to control the spread of Zika-infected mosquitoes. The CDC fights Zika by monitoring mosquitoes that transmit the virus, and it collects data about how Zika affects pregnancies. Trump’s budget doesn’t help the situation either. Although it sets up a CDC emergency response fund to deal with outbreaks like Zika, the budget weakens prevention efforts by seeking a 17 percent cut to the CDC and an 18 percent cut to the National Institutes of Health.

The confluence of Zika and the GOP health care bill could have political consequences in places like Florida, where the virus has already proved to be a potent electoral issue. Two South Florida congressmen—GOP Reps. Carlos Curbelo and Mario Diaz-Balart—championed a bill last year that sent $1.1 billion to the CDC and the NIH to combat Zika. Both also voted for the Obamacare repeal bill. Neither of their offices responded to requests for comment.

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The GOP Health Bill Would Make Zika the Newest Preexisting Condition

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The pope’s gift to Trump is the subtlest shade we’ve seen all week.

If cities are the future of sustainability, they can’t only be green — they have to be livable, too. Enter Ritchie Torres, New York City’s youngest elected official, hell-bent on making the city more affordable for its most vulnerable inhabitants. Torres, who is Afro-Latino and the first openly LGBT politician from the Bronx, cut his political teeth as a tenant organizer. He ran for city council in 2013 at the behest of a mentor who saw potential in the self-described introvert — and won.

The young councilman’s driving issue is affordable housing, because, he says, “there can be no city without housing.” Torres grew up in Throggs Neck public housing directly across the street from Donald Trump’s golf course — as Torres puts it, with Trump’s shadow hanging “both literally and metaphorically over public housing.”

Torres is taking on the health, safety, and sustainability of public housing in New York from all angles: eliminating mold infestation, requiring more carbon-conservative building materials, and creating the first LGBT youth shelter in the Bronx.

For those young people who may feel inspired to seek political office themselves, Torres provides these words of encouragement: “The lesson from 2016 is that millennials are more powerful than we realize — it was the only ray of hope in an otherwise dark election year.”

Meet all the fixers on this year’s Grist 50.

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The pope’s gift to Trump is the subtlest shade we’ve seen all week.

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