Dr. Kevin Most: Tiger Woods, Juice for infants & ACA- ACHA

Lets first discuss the news that came out last week about Juice  and kids, this has to have moms scratching their heads and juice box makers concerned. In case you missed it the American Academy of Pediatrics came out last week with some big changes in their recommendations around children and juice. I am sure we all see toddlers and infants holding their sippy cups and drinking juice. Pediatricians are now urging that we refrain from giving juice to children under the age of six!! Wait, having we been giving infants juice forever? Isn’t it loaded with Vitamins, nutrients and anti oxidants? Why the massive change?

The concern covers a few areas, one is whole fruit is loaded with all of the same vitamins but also has fiber which helps with digestion. The other concerns are the tooth decay that occurs when teeth are exposed to carbohydrates continuosly. It also is thought to lead to weight gain, this would be minimized as it takes longer to eat a piece of fruit that contains the same calories as the juice would.

They are recommending now that children under the age of six are given whole fruit instead of fruit juices. The whole fruit should be supplemented with water, formula or breast milk at young ages.

So what are the new recommendations. For infants under the age of 6 months, they should not have any juice at all. The only fluids this infant should be consuming are breast milk or formula. These fluids contain the nutrients that the growing infant actually needs like calcium, iron and essential fats, which help with brain and nerve development. So actually by substituting juice in this age group we may actually be causing harm. As children start to add solid foods to their diet, pureed fruits should be added and liquids should be restricted to Breast milk, formula or water. Some parents may push to add fruit juice at this age out of convenience, if so, they should limit it to no more than 4 ounces a day. Children who have diarrhea and need rehydration should be given electrolyte solutions like pedia lyte vs juices.

As the child becomes a toddler this restriction will become more difficult because the convenience and packaging that juice companies have prepared. Juice boxes are easy to use, easy to transport and simple enough for the toddler to actual hold and use without help.  The Academy is holding saying no juice at this age as well, but is understanding and sets limits on its recommendations. For children between ages 1 and 3, the limit should be no more than 4 ounces a day. For children aged 4-6 they say to limit it to 6 ounces a day.  After age 7 they are recommending no more than 8 ounces of juice.They also are recommending that if you do allow the use of juice make sure it is pasteurized to prevent exposing the infant to some dangerous bacteria.

The other concern is for parents to know their is a huge difference in Fruit juices , fruit drinks and fruit beverages. Only 100% fruit juice may be called “juice” the others amy have a portion of juice but not 100%, these are often loaded sugar and other artificial flavors. Be careful and read the label before giving your child any beverages.

Lets talk about the craziness that is going on in Washington as well

What a crazy time we are going thru in healthcare right now. The CBO came out last week with its estimates on the AHCA impact on patients as well as the deficit.  Hospitals and doctors are weighing in on the possible impact it would make.  Wisconsin announced that it plans to be the first state to drug test Medicaid applicants. California is taking steps to reduce what it considers overly aggressive healthcare testing and treatments. Insurance companies are hinting that the uncertainty of the ACA will cause them to increase their premiums. So not much going on at all.

Lets take a few minutes to understand a little bit about each of these complex issues.

The AHCA just got its scorecard from the CBO. Now a lot of people are making a lot of noise about this which is interesting as we know that the bill the Senate is reviewing will look nothing like the law that they would advance to the President. In fact it is being reported that the Senate will essentially start with a clean sheet as they design the plan that may be advanced. I find it very interesting with all the discussion and the comparison to previous plans, when we know we will be jumping thru the same hoops and story months from now if and when the Senate puts forward what it would like the president to consider as the next healthcare plan.

That being said, lets just look at some of the issues that are being raised regarding the AHCA bill. The CBO came out last week and shared its estimates that 14 million more people under the age of 65 would be without insurance and that it would jump to 23 million by 2026. The deficit would be cut by 119 billion dollars between 2017 and 2026. Where do they come up with these estimates?

The CBO looks at the bill and notes that this proposal eliminates the individual and employer mandate, this will impact the uninsured. It also allows for a premium difference based on age not need. For the ACA the premium subsidy is based on financial need.  These few factors will impact the number of individuals insured. Other areas of concern is this bill allows states to opt out of some of the ACA provisions. For the ACA there were some essential benefits that must be covered, in this bill states are allowed to have insurance plans that offer less comprehensive coverage, this will come with a lower premium but will impact some of the preventative testing and treatments that in the long run lower costs and increase the quality of care. Those decisions should be left in the hands of health experts not insurance companies

The other concern is the preexisting condition issue, this one is a bit more confusing as they tout that it is not an issue. Currently the plan would add 8 billion dollars to the 130 billion dollar pool for these patients and their care. What is not as clear, is the individual who lets their insurance lapse ( remember no individual mandate) and a few months later tries to get insurance with a  preexisting condition. The new plan would allow insurance companies to charge a higher premium for a year.

Needless to say, what moves forward will not look anything like the bill being reviewed by the Senate.

Another newsmaker last week in healthcare was Wisconsin announcing that they plan to do drug screens on any individual applying for Medicaid . There would be no benefits extended for anyone who refused the drug screen. Some are concerned about this from many angles and it will be tested in the courts. The state is saying this is no different from companies who provided health benefits to their employees and require drug screening. The thought that drug addicts would not apply for Medicaid is concerning as they often have health related illnesses. The Governor is saying we are not going to turn down those who test positive, in fact we are going to provide treatment to help them break the addiction. It is unclear how this will play out but their will be a lot of interest from other states as this moves forward.