CARSON CITY, Nev. - More than 370,000 Nevadans could lose health coverage by 2019 if the Affordable Care Act is repealed without a replacement, according to a new report.

The study, from the nonprofit People's Action Institute, also predicted that more that 22,000 people in Nevada would lose their jobs as a result of decreased economic activity in the health-care industry.

Clark County Commissioner Chris Guinchigliani said Congress needs to take these figures into account and slow things down.

"I'm astonished at the numbers," she said. "The impact on the state is absolutely clear cut, and I think Congress needs to take a step back and say, 'Wait a minute. What is it that's broken that you think needs to be fixed before you throw all of our constituents into a panic?' "

Republican leaders have said they are working on a replacement. Proposals floated so far include plans to end the individual mandate to buy insurance and cap federal Medicaid funds with block grants, which could force states to cover fewer people. Giunchigliani said county-owned University Medical Center would be gravely affected if thousands of Medicaid patients lose their coverage and turn to hospital emergency rooms for free care.

Before the ACA, said Amber Howell, director of social services for Washoe County, the county had to spend more than $7.1 million a year to care for people too poor to pay for medical services. She said the county may have to make some cuts in services if its bills for uncompensated care start to increase.

"We've been able to redirect dollars into housing and job-related activities, and shifted our eligibility workers to case work, so it's allowed us to really enhance our services," she said. "We would have to look at whether we'd be able to sustain those types of services if the ACA was reversed."

The study also estimated that if the ACA is repealed without a replacement, Nevada hospitals and medical practices would see their incomes drop by more than $1 billion in 2019, and the state would lose more than $10 billion in federal funding between 2019 and 2023.

The report is online at planaction.org.


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February is National Heart Month, and doctors want Virginians to understand heart health a bit better - specifically, heart attacks and cardiac arrest.

According to the Centers for Disease Control and Prevention, more than 800,000 people have heart attacks every year, and the majority are first-time heart attacks. Cardiac arrest can involve numerous factors, and heart attack is the most common.

Dr. Benjamin Galper, assistant chief of cardiology at Mid-Atlantic Permanente Medical Group in northern Virginia, said this is partly why the two get mixed up. He said typically, signs of a heart attack can be chest pressure, nausea or sweating - but the signs of cardiac arrest are more dire.

"Cardiac arrest, itself is not subtle," he said. "If you've gotten to the point of cardiac arrest, it means the person is unconscious, that they don't have a pulse when you take their pulse and they're not breathing. So, when someone's had cardiac arrest, it's usually obvious and usually quite concerning."

National Heart Month is a good time to commit to reducing those risks, with a heart-healthy diet and regular exercise. Galper also encouraged people to get CPR training, to be able to aid someone having a heart attack until first responders arrive - and possibly save a life.

Underlying diseases such as diabetes or prediabetes can make a person more susceptible to heart problems. Dr. Ravi Johar, chief medical officer at UnitedHealthcare, said genetics can be another risk factor.

"Things like Marfan Syndrome increases the risk of aneurysms and abnormal blood flow to the heart, and things of that sort, so there can be some genetic consequences," he said. "There can also be genetic history; if your parents had problems with their hearts, there's a higher likelihood that you may."

He added that heart disease can affect people at any age. CDC research has found it can start as early as 35, and the risks increase with age. Anyone experiencing new chest pains or shortness of breath is encouraged to talk with their doctor about their heart-health options.

With Black History Month underway, Wisconsin researchers and support groups are highlighting the disparities in cases of Alzheimer's disease.

The Centers for Disease Control and Prevention said older Black Americans are about two times more likely than whites to have Alzheimer's and other dementias.

As drugs designed to treat conditions accelerate toward the market, the University of Wisconsin School of Medicine and Public Health noted Black adults are less likely to be included in the research. The school has made it a priority to focus on the Black population in an ongoing study.

Diane Beckley Milner, director of diversity, equity and inclusion for the Alzheimer's Association Wisconsin Chapter, said participation is important.

"Without us being involved in those clinical trials as Black Americans, then the research, it's not going to lend itself to giving accurate information," Milner pointed out.

The university acknowledged Black individuals can be reluctant to participate in studies, citing historical trauma from events such as the Tuskegee experiment. Officials say when it comes to the UW study, Black volunteers account for 27% of the people enrolled, which is much higher than the state's Black population, suggesting it provides hope in boosting research inclusivity.

Milner emphasized partnerships her group has with organizations such as the African Methodist Episcopal Church can help ease fears and create more awareness within the Black community.

"Having that partnership has proved to be very, very important and critical to making sure that people get information that they can trust," Milner explained.

She added a common challenge her group has found in outreach is many Black Americans view cognitive decline as simply a sign of aging, and not a disease. The association also works with nursing organizations in hopes of educating more people within the Black population.

Preventing maternal and infant mortality in Georgia is a top priority for health care providers in the state.

Georgia already has the nation's highest maternal mortality rate, with more than 46 deaths per 100,000 live births, and ranks 16th for infant mortality.

In Lawrenceville, Obria Medical Clinics has what it calls a Supportive Pregnancy Care program, where people meet monthly in two-hour group sessions during pregnancy.

Robin Mauck, executive director of Obria, said they ask questions, learn how to take their own vital signs, and also meet with their providers for checkups.

"And then, March of Dimes has provided a curriculum that our facilitator goes through that has been proven to reduce maternal mortality," Mauck explained. "The great thing we see in this program is, it creates community for these girls. A lot of them don't have support in the community, they don't have family close by."

Mauck pointed out the group discussions help the participants build confidence, and the clinic also offers resources to help ensure new parents can take the best care of themselves and their babies.

Shelmekia Hodo, maternal and infant health director for the March of Dimes, said her organization is also focused on reducing health inequities in Georgia, with programs to address postpartum care and preterm birth, plus maternal and infant mortality.

One is a Neonatal Intensive Care Unit Family Support program, to help improve the experience for new parents. Hodo noted the program has been around for more than 20 years, with more than 70 sites across the country.

"March of Dimes provides an in-house coordinator that is on-site in the NICU, that does patient education with the actual moms, as well as staff education," Hodo outlined. "We know that so many moms are facing so many challenges and barriers having to be away from their babies, with their babies being in the NICU."

She added Georgia took a big step last year to address the maternal mortality rate, by extending Medicaid coverage to low-income mothers to a full year after giving birth, instead of only six months.