Have any of you heard of the term P4 Medicine? The term was coined several years ago by biotech pioneer Leroy Hood. Following a complex recipe of the integration of biomedicine, information technology, wireless and mobile, a new phase of digital medicine is being born. The shorthand for P4 Medicine – Predictive, Preventative, Personalized and Participatory – is already in play. Right here, right now, we are witnessing the transformation of how we will receive and experience health care, and it is amazing. How is that happening, and how will it affect us?

The vision of P4 Medicine is that instead of waiting for clinical symptoms to appear, like a growth spotted on an ultrasound after it has spread, physicians will be able to see early warning signs of malignancies from a tiny bit of blood analyzed by genomic instruments and software. If the genes and proteins are really predictive, then physicians could take early action, or patients can focus on prevention via lifestyle. All of a sudden, the focus of medicine goes from reaction to an investment in wellness.

And then there is the technology portion. There are currently over 20,000 different mobile apps available which merge your phone and diagnostics. For example, you can now measure your blood glucose on your and send it to your physician, which, in turn, can help you better understand your blood sugars as a diabetic. (Already, this has covered Personalized and Participatory.) Once this information is predictive, it can also be preventative as well. And that’s just for starters.

The booming field of mobile-health technology is only one part of an equation that is playing into this transformation. For example, GE Healthcare manufacturers a portable ultrasound device about the same size of a cellphone. It’s called the Vscan, and it allows a physician to look directly into the heart of a patient. Here, both the patient and the physician can see the muscle, the valves, the rhythm, and the blood flow. Already, we are touching on the Participatory and Personalized element of P4 Medicine. When we have the experience of witnessing what is happening inside our own body, we can start approaching medicine differently. No longer is your physician simply informing you about news which you may feel slightly removed from. (The language is medical. You may feel a disconnect.)

For those of you who, like me, have had the overwhelming experience of seeing your developing fetus via ultrasound, you can remember what that experience was like. For the first time, you are drawn that much closer in, witnessing life inside you. Similarly, physicians expect that patients who witness their own health in real time will be propelled to take charge of their own health care. It stands to reason that patients are more willing to make lifestyle changes that keep them healthy when they can monitor the consequences of their actions in real time.

Here at oomphtv, we aim to be a great communicator of new age 21st medicine, so stay tuned. Dr. Hood, in particular, believes that this transformative new idea in healthcare is near the tipping point. Timing is everything – we are blessed to be a witness.

If your curiosity is piqued, check out theP4 Medicine Institute for more information.

I came across yet another study done on exercise that I wanted to share (am I overdoing this whole exercise study thing here? Please let me know. But I do find these studies endlessly fascinating)

We all know that physical activity is beneficial in countless ways, but even so, Dr. Mark Tarnopolsky, a professor of pediatrics at McMaster University in Hamilton, Ontario, was startled to discover that exercise kept a strain of mice from becoming gray prematurely.

But shiny fur was the least of its benefits. Indeed, in heartening new research published recently in The Proceedings of the National Academy of Sciences, exercise reduced or eliminated almost every detrimental effect of aging in mice that had been genetically programmed to grow old at an accelerated pace.

In the experiment, Dr. Tarnopolsky and his colleagues used lab rodents that carry a genetic mutation affecting how well their bodies repair malfunctioning mitochondria, which are tiny organelles within cells. Mitochondria combine oxygen and nutrients to create fuel for the cells. ( Just to let you know, mitochondria are microscopic power generators. I learn from these studies too)

Mitochrondria have their own DNA, distinct from the cell’s own genetic material, and they multiply on their own. But in the process, mitochondria can accumulate small genetic mutations, which under normal circumstances are corrected by specialized repair systems within the cell. Over time, as we age, the number of mutations begins to outstrip the system’s ability to make repairs, and mitochondria start malfunctioning and dying.

Many scientists consider the loss of healthy mitochondria to be an important underlying cause of aging in mammals. As resident mitochondria falter, the cells they fuel wither or die. Muscles shrink, brain volume drops, hair falls out or loses its pigmentation, and soon enough we are, in appearance and beneath the surface, old.

The mice that Dr. Tarnopolsky and his colleagues used lacked the primary mitochondrial repair mechanism, so they developed malfunctioning mitochondria early in their lives, as early as 3 months of age, the human equivalent of age 20. By the time they reached 8 months, or their early 60s in human terms, the animals were extremely frail and decrepit, with spindly muscles, shrunken brains, enlarged hearts, shriveled gonads and patchy, graying fur. Listless, they barely moved around their cages. All were dead before reaching a year of age.

Except the mice that exercised.

Half of the mice were allowed to run on a wheel for 45 minutes three times a week, beginning at 3 months. These rodent runners were required to maintain a fairly brisk pace, Dr. Tarnopolsky said: “It was about like a person running a 50 or 55 minute 10K.” (A 10K race is 6.2 miles.) The mice continued this regimen for five months.

At 8 months, when their sedentary lab mates were bald, frail and dying, the running rats remained youthful. They had full pelts of dark fur, no salt-and-pepper shadings. They also had maintained almost all of their muscle mass and brain volume. Their gonads were normal, as were their hearts. They could balance on narrow rods, the showoffs.

But perhaps most remarkable, although they still harbored the mutation that should have affected mitochondrial repair, they had more mitochondria over all and far fewer with mutations than the sedentary mice had. At 1 year, none of the exercising mice had died of natural causes. (Some were sacrificed to compare their cellular health to that of the unexercised mice, all of whom were, by that age, dead.)

The researchers were surprised by the magnitude of the impact that exercise had on the animals’ aging process, Dr. Tarnopolsky said. He and his colleagues had expected to find that exercise would affect mitochondrial health in muscles, including the heart, since past research had shown a connection. They had not expected that it would affect every tissue and bodily system studied.

Other studies, including a number from Dr. Tarnopolsky’s own lab,  have also found that exercise affects the course of aging, but none has shown such a comprehensive effect. And precisely how exercise alters the aging process remains unknown. In this experiment, running resulted in an upsurge in the rodents’ production of a protein known as PGC-1alpha, which regulates genes involved in metabolism and energy creation, including mitochondrial function.

Exercise also sparked the repair of malfunctioning mitochondria through a mechanism outside the known repair pathway; in these mutant mice, that pathway didn’t exist, but their mitochondria were nonetheless being repaired.

Dr. Tarnopolsky is currently overseeing a number of experiments that he expects will help to elucidate the specific physiological mechanisms. But for now, he said, the lesson of his experiment and dozens like it is unambiguous. “Exercise alters the course of aging,” he said.

Although in this experiment, the activity was aerobic and strenuous, Dr. Tarnopolsky is not convinced that either is absolutely necessary for benefits. Studies of older humans have shown that weightlifting can improve mitochondrial health, he said, as can moderate endurance exercise. Although there is probably a threshold amount of exercise that is necessary to affect physiological aging, Dr. Tarnopolsky said, “anything is better than nothing.” If you haven’t been active in the past, he continued, start walking five minutes a day, then begin to increase your activity level.

The potential benefits have attractions even for the young. While Dr. Tarnopolsky, a lifelong athlete, noted with satisfaction that active, aged mice kept their hair, his younger graduate students were far more interested in the animals’ robust gonads. Their testicles and ovaries hadn’t shrunk, unlike those of sedentary elderly mice.

Dr. Tarnopolsky’s students were impressed. “I think they all exercise now,” he said.

After reading a study like this, I always think if they could put exercise in a pill form and sell it, the pill would cost a fortune, due to the benefits it offers. But exercise does not cost anything except our time and energy. Not a bad deal!

This is a kind of follow-up blogpost to The Longevity Quiz (what can I say. I just recently turned fifty and have been thinking about this subject)

Today I ran across an article from Health magazine.

Apparently those born after the year 2000 are more likely than ever to live to 100, according to research from Denmark. Good news for the kids, but what about us grown-ups?

Genetics do play a big factor in how long you live (thank you grandparents), but only somewhere between 20% and 50%, depending on the experts you ask. That still leaves over 50% up to YOU!

Walter Bortz II, MD, a clinical associate professor of medicine at Stanford, suggests how you can improve your odds of a long and happy life.

We can call this The Walter Bortz II, MD, Secrets to a Long Life:

Bulk up on fruits and veggies, +5 years (plant based whole foods diets reduce disease)

Exercise five days a week, +2 to +4 years (move and elevate your heart rate for a half-hour a day, minimum)

Reduce stress, up to +6 years (from meditation to music to movement to art therapy. Find something that work for you.

Get a hobby, +2 years (provides a sense of accomplishment.)

Floss, +6.4 years (removing harmful bacteria reduces stroke and heart attack risks.)

Vacation, +1 to +2 years (leisure is a great stress reliever!)

Sleep seven to eight hours nightly, +2 years (sleep assists cell repair.)

Have sex, +3 to +5 years (releases feel good hormones and burns about 200 calories, too!)

Thought you would like to know!

By Cheryl Roby
There are days that lack oomph! Let’s face it, the fast paced techno dense life can be stressful.

My computer and blackberry conveniently provide information and up to date status that were unheard of even 10 years ago AND they provide a constant stream of messages that say READ ME, PAY ATTENTION TO ME, I AM URGENT!!

When I realize that my state of mind has gotten out of balance and I am paying more attention to the imagined urgency than to the gift of instant information and connection, my work with stress management and inquiry help bring me back into balance.

As a Reiki Master and student of conscious living I have come to understand that my work first and foremost is to be kind and peaceful in this world. If I am anxious or angry or impatient (substitute any emotions other than peace, love and kindness that resonate with you) I am adding to the energy of war. There is a war going on inside me that affects not only me but everyone I come in contact with and the collective conscious. Our energies are all connected. Our thoughts are powerful beyond what most of us can imagine.

So, before I try to fix what’s out there, I refocus on what is inside; using the tools of inquiry, breath, positive affirmation and others to regain peace.

Cheryl Roby’s website is www.rockyourchakras.com and www.robychart.com

I know that I will not live forever, but maybe, just maybe, I can make some lifestyle changes that can influence how long I do live. Most importantly I would like those years to be healthy and as active as possible.

Over the past few years I have been reading some of the work that Thomas Perls, MD has been doing with centenarians at Boston University. He has written many books, papers and articles all about the topic of longevity. He recently developed this quiz based on the latest research on what factors help lengthen a person’s life. (this quiz is recently published in Health Magazine so it’s focused a bit more towards women, but men will learn from this too) Thomas Perls, MD is the real deal and I have the highest respect for the work he has been doing.

So spend a few minutes and take this quiz. Once you figure out your number, examine your numbers to figure out on how some simple changes can potentially add years to your life. This is kind of interesting quiz and  do make you think about your own health. Give it a shot. And yes, you can make some small changes in your life that can make a difference.

LONGEVITY QUIZ

1. When you’re stressed, how do you handle it?
a) Very well. I thrive on it and find it motivating.
b) Pretty well. I have regular healthy outlets, like yoga, walking, or calling a friend.
c) Not so well. It’s hard for me to let problems and worries go.

2. How often do you do things that keep your brain sharp, like learning a language, playing chess, or solving crosswords?
1) A couple of times a week.
b) Between once a week and once a month.
c) Rarely or never.

3. Do you spend time with friends on a regular basis?
a) Yes, I have lots of friends, and I’m very social
b) Yes, I have a small circle of close friends whom I enjoy spending time with
c) No, I usually either go it alone or spend time just with my partner

4. Have any of your parents, grandparents, aunts, or uncles lived to be 97 or older?
a) Yes
b) No
c) Don’t know

5. Do you have a brother, or sister with a history of heart attack or diabetes?
a) Yes
b) No
c) Don’t know

6. How much do you exercise?
a) 30 minutes at least five times a week
b) Some, around twice a week, and/or I regularly do something active like gardening or walking
c) Rarely or never

7. Are you at a health weight? (go to health.com/healthy weight calculator if you’re not sure.)
a) Yes, I’m within my ideal weight range.
b) Pretty close. I’m a bit above what the the charts say I should be, but I’m energetic and don’t have any weight related health problems.
c) No. I am well above my ideal weight, and I get sluggish and out of breath quicker than I’d like.

8. Do you smoke?
a) Yes
b) No

9. Do you floss?
a) every day
b) Once in a while
c) No

10. How often do you eat red meat?
a) 4 times a week or more
b) 2 or 3 times a week
c) Once a week or not at all

11. Did you have a child without fertility assistance after the age of 38, or did you stop getting your period completely after the age of 54?
(If you’re too young for either of these questions or don’t have children, pick “b”
a) Yes
b) No

12. Do you have a primary care doctor you trust whom you’ve seen in the last year?
a) Yes
b) No, but I see my gyno each year
c) No

13. How would you describe your sleep?
a) Great. I sleep enough so that I wake up feeling clearheaded and rested.
b) Could be better. I don’t get enough sleep, and I’m often tired during the day.
c) Not so great. I try to sleep, but I have insomnia sometimes or often.

KEY: For women start with the number 89 and add or subtract based on your answers. Males would start with 86.

1. a) 0 b)0 c)-5
2. a)+5 b)+2 c) 0
3. a)+5 b)+2 c) 0
4. a)+10 b)0 c) 0
5. a)-3 b)0 c) 0
6. a) 0 b)-2 c) -5
7. a) 0 b) 0 c) -8
8. a) -15 b) 0
9. a) 0 b) -3 c) -3
10. a) -5 b) -5 c) 0
11. a) +5 b) 0
12. a) 0 b) 0 c) -3
13. a) 0 b) -2 c) -2

Your potential age = years old.

Click here to view the embedded video.

Tomorrow marks another birthday. As I age, I recognize that good health is more and more important than anything. It’s everything.

We’ve all heard the “be proactive” call to action. In a sense, this is assessment from a bird’s eye view. We can assess our lifestyle by repeating the mantras we’ve all heard before: Follow a healthful diet. Get plenty of exercise. Channel our stress. Don’t smoke. Moderation is key. Be engaged, be mindful. Okay, okay….let’s say that we do all that. Are we where we should be in the preventative health maze?

When I conduct an on-line search for “How to Assess Your Health”, my computer screen urges me to take a health report card quiz so that I can determine what my risk factors might be and use my overall score to evaluate my health. Been there, done that. I’m healthy, according to my on-line test results. Is there anything else included in proposed self-diagnostic test kit? Yes. One more thing: I need to trace my family history, which will give me clues about what diseases I might be susceptible to. According to my on-line guides, I am now complete. I can feel assured that I can head off problems before they ever come to the surface.

I’m not a medical professional and sincerely don’t profess to be, but through a devastating illness which my husband is currently combating, I’ve learned that assessment is key to everything. The assessment that my husband’s doctors and nurses speak of is that of learning about your own norms by following a road map and listening to your body. So this year, I’m challenging myself to actually learn something about my own norms, to “look under the hood of my engine” so to speak. I’m making my first attempt to understand how I run.

Last week, I had my annual physical. Although I get blood work done every year or so, this was the first time I requested a hard copy of my lab results. I also requested that my physician walk me through the results. He consented, and was happy to empower me to learn about the person whom I think I’ve known all too well for many-a year now. This was a valuable lesson. Having seen the same physician for years, he told me how my norms have been running for everything from blood sugar to iron, from blood pressure to cholesterol, both good and bad. I asked about hemoglobin, thyroid, and Vitamin D. And the list didn’t stop there.

I feel as though for the very first time, I’ve practiced the best prevention method: understanding. Not only did my physician take the time to teach, I became an inquisitive student. I followed up his assessment by utilizing a primer I found on the New York Times which allows the user to look at blood counts and understand what they mean. This served as a great follow up to help me interpret my test results.

As we continue to drown in this information age, it’s easy to get lost between multiple health blogs, hundreds of internet sites, and countless medical apps. The daily bombardment of drug advertisements and the conflicting (but well intentioned) studies about medical tests can be confusing at best. Ironically, the very best person to advise us, our doctor, is now more likely to spend less time with each and every patient. This is especially why we all need to get acquainted with ourselves, know our baselines and understand what they mean. How else will we recognize a change of status if and when a change happens?

Of course, when you’re sick, knowledge is power. But I’ve just learned that knowledge is power when you’re healthy as well.

I just watched “The Green Buddha” video again for the first time in few months, and am still struck with how my 81 year old mother, Jeanne Dowell, still skis, hikes and travels with great agility and flair. My friends still ask how she is able to stay that active. I always say it’s probably do to her genes, but also the fact that she has kept active all her life. There are scientific studies that back this up.

In a newly published book, “Treat Me, Not My Age”(Viking), Dr. Mark Lachs, director of geriatrics at the NewYork Presbyterian Healthcare System, discusses two major influences (among others) on how well older people are able to function.

The first, called physiologic reserve, refers to excess capacity in organs and biological systems. We’re given this reserve at birth, and it tends to decrease over time. In an interview, Dr. Lachs said that as cells deteriorate or die with advancing age, that excess is lost at different rates in different systems.

The effects can sneak up on a person, he said, because even when most of the excess capacity is gone, we may experience little or no decline in function. A secret of successful aging is to slow down the loss of physiologic reserve.

“You can lose up to 90 percent of the kidney function you had as a child and never experience any symptoms whatsoever related to kidney function failure,” Dr. Lachs said. Likewise, we are born with billions of brain cells we’ll never use, and many if not most of them can be lost or diseased before a person experiences undeniable cognitive deficits.

Muscle strength also declines with age, even in the absence of a muscular disease. Most people (bodybuilders excluded) achieve peak muscle strength between 20 and 30, with variations depending on the muscle group. After that, strength slowly declines, eventually resulting in telling symptoms of muscle weakness, like falling, and difficulty with essential daily tasks, like getting up from a chair or in and out of the tub.

Most otherwise healthy people do not become incapacitated by lost muscle strength until they are 80 or 90. But thanks to advances in medicine and overall living conditions, many more people are reaching those ages, Dr. Lachs writes: “Today millions of people have survived long enough to keep a date with immobility.”

The good news is that the age of immobility can be modified. As life expectancy rises and more people live to celebrate their 100th birthday, postponing the time when physical independence can no longer be maintained is a goal worth striving for.

Gerontologists have shown that the rate of decline “can be tweaked to your advantage by a variety of interventions, and it often doesn’t matter whether you’re 50 or 90 when you start tweaking,” Dr. Lachs said. “You just need to get started. The embers of disability begin smoldering long before you’re handed a walker.”

Lifestyle choices made in midlife can have a major impact on your functional ability late in life, he emphasized. If you begin a daily walking program at age 45, he said, you could delay immobility to 90 and beyond. If you become a couch potato at 45 and remain so, immobility can encroach as early as 60.

“It’s not like we’re prescribing chemotherapy, it’s walking,” Dr. Lachs said. “Even the smallest interventions can produce substantial benefits” and “significantly delay your date with disability.”

“It’s never too late for a course correction,” he said.

I certainly agree to Dr. Lachs. I have my own mother to observe as a living example. My mother no longer runs at 81, but she does walk a lot and keeps her active yoga practice. The whole idea here is to keep moving no matter how young or old you are.

A German study recently published in the latest issue of Deutsches Arzteblatt International reveals a link between lifestyle and exercise.

Sports scientists have revealed that impairments to health and physical performance are not primarily a result of aging but of bad lifestyle habits and lack of exercise.

Dieter Leyk and his team analyzed the stamina of more than 600, 000 marathon and half marathon runners and asked them about their lifestyle habits and their health.

Marathon running is particularly suitable for studying because participants have to put in sufficient training hours for the competition, and the athletes accommodate this into their day accordingly.

The scientists found that unfavorable characteristics such as obesity, smoking, and lack of physical activity were rare in runners, and reductions in physical performance were more likely to be the result of biological aging processes.

These reductions make their presence felt only after the 54th year of life and are but slight. More than 25 per cent of 50- to 69-year-olds had taken up running only in the preceding 5 years and participated in a marathon nonetheless. You can see this connection highlighted in the short video on oomphtv.com about the 94 year old runner Jack Kirk-The Dipsea Demon.

Something to think about when making your New Year’s resolution.

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Many agree that the recent historic overhaul of the nation’s health care system does a lot of things, but it may be more challenging to understand how the legislation will make an impact on us as individuals. While some will not see much change in their coverage, others will be greatly affected, depending on if insurance is provided through work, or if one has pre-existing conditions. As the mother of two girls in college, the benefit that allows them to stay on my insurance past the age of twenty three was one element that I could deftly recall.

Most agree that the bill can be divided into two major categories: It tightens regulation of the insurance industry, and it expands access to care for the poor and for low-income working people. But what does this reform actually do for you, as a consumer, taxpayer, and a patient?

Like many of you, I tend to make annual appointments towards the end of a calendar year, hoping my deductible has been met. Thus, with the last few months of 2010 upon us, I had scheduled a few preventative screenings, even though my insurer’s coverage would be minimal at best as preventative services are minimally covered. Regardless, some of these exams are important. As a newly minted fifty year old, the annual ob/gyn appointment is a must for me. I added a trip to my opthymologist (it’s been way too long), along with a mammogram. The colonoscopy exam is one more thing that I’ve thought about, but haven’t scheduled. Three appointments is plenty for December, right?

But wait. Perhaps the newly passed insurance legislation affects me in some small way. And thus began a phone call to my health insurer to ask that very question. After enduring sixteen minutes on hold, I was politely greeted by a young sounding voice who was all too eager to answer my question of how the new law impacts my specific insurance plan.

Turns out that if I push off all of my appointments to January of 2011, my insurer will pick up a minimum of forty percent of preventative services, including a diabetes test, vision test, mammogram, pap smear, bone density test and colonoscopy. This came as a great surprise. The representative even offered me a prostate screening test. (Yes, I am female.) Sadly, I explained to her why I’d have to decline this one.

While forty percent of adult preventative services is no windfall, it is possibly enough motivation to get myself and others into a screening mode. This small flirtation with coverage inspired me to find out more about the bill. This is where it gets more complicated. If you’re curious about the particulars, I offer this useful breakdown of the major pieces of the legislation, provided by a website I highly recommend healthycal.org.

The following legislation is categorized by the dates on which they take effect:

Taking effect in 2010:
–Increase in Medicare prescription drug benefits. A one-time rebate of $250 for seniors who have exhausted the first part of their drug benefit and are paying 100 percent of the cost of their medication. The following year, low-income and middle-income seniors would begin getting a 50 percent discount on brand-name drugs.
–A high-risk insurance pool for people with pre-existing conditions who have been turned down for regular coverage. This pool would be available until 2014, when new regional insurance exchanges will be created and take over this function.
–Insurers prohibited from imposing lifetime limits on a person’s benefits.
–Insurers prohibited from rescinding coverage when a person becomes sick or disabled, except in cases of fraud.
–Insurers required to cover dependent children on a family policy until the age of 26.
–Subsidies for small business. Tax credits covering up to 35 percent of premiums for employers with 10 or fewer workers and average wages of $25,000 or less. This subsidy would climb to 50 percent of premium costs in 2014 but would phase out as a firm’s number of employees and average wages grows. The credit would end once a company had more than 25 workers or average wages of $50,000 or more.
–Tanning tax. A 10 percent tax on the purchase of indoor tanning services.

Taking effect in 2011:
–Insurers required to spend at least 80 percent of their revenue on medical claims.

Taking effect in 2013:
–Higher payments for doctors who treat the poor. The federal government would reimburse states that increase payments to primary care doctors in the Medicaid program to match what is paid under Medicare. These federal subsidies are intended to entice more doctors into the Medicaid program in advance of major expansions in enrollment in 2014. But the new subsidies to the states expire in 2015.
–A higher Medicare payroll tax rate, adjusted for the first time according to income. The rate would increase from the current flat 1.45 percent to 2.35 percent on income above $200,000 for individuals and $250,000 for couples. These groups would pay an additional 3.8 percent tax on capital gains, dividends, interest and other investment income.
–A new cap of $2,500 on the amount of money people can set aside tax-free to pay for medical expenses.

Taking effect in 2014:
–Individual mandate, requiring most people to buy insurance. People who did not comply would face penalties beginning at $95 a year or 1 percent of their income, whichever was higher. These penalties would rise over time.
–Insurance exchange. States or regions would organize new insurance marketplaces for people who could not find coverage in the private market. There would also be two national plans, including one non-profit. Insurers competing to win customers through the exchanges would have to justify rate increases and could be barred from the exchange if they raise rates excessively.
–Insurers prohibited from charging older people more than three times what they charge younger people.
–Insurers required to offer minimum benefits, to be determined later by the federal government. The minimum plan would cover 60 percent of the costs and limit out-of-pocket costs to consumers to about $6,000 annually for individuals and $12,000 for families.
–Subsidies for individuals. Tax credits would be available for low and moderate income people who buy through the exchange. People with incomes below about $33,000 for a family of four would pay 2 percent to 4 percent of their income in premiums, and health plans would be required to pay 94 percent of the cost of their benefits. These subsidies would continue at a lower level for families with incomes up to four times the poverty level, or about $88,000 for a family of four.
–Employer penalties. Employers would not be required to offer coverage to their employees, but if they did not and their workers used the exchange, employers with more than 50 employees would have to pay a fee of $2,000 for every worker who used the exchange, after the first 30 employees. Employers that do offer coverage would also have to pay a fee if their workers opted for insurance sold through the exchange.
–Expansion of Medicaid (Medi-Cal in California). This government-subsidized insurance would expand to cover everyone with incomes up to 133 percent of the poverty level, or about $29,000 for a family of four. Currently, families with children, the aged and disabled qualify for this system, and at lower income levels. The federal government would pay the full cost of this expansion until 2016, then phase down its contribution to 90 percent by 2020. The state would be responsible for the remainder of the cost.
–Higher reimbursement rates for states that cover children through the program for the working poor, known as Healthy Families in California. The federal government currently pays an average of 70 percent of the cost. This would increase to 93 percent.

Taking effect in 2018:
–A new tax on so-called “Cadillac” or expensive health insurance plans. This 40 percent tax would take effect on individual plans costing more than $10,200 a year and on family plans costing more than $27,500.

You may want to pick up the phone and call your insurer, and ask what, if any, changes will be implemented to your plan.
After all, it’s not like they’re going to tell us. We have to do the asking.