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25 Dinners With No Added Sugar That Help You Stick to Your #Goals

Think about it: That tablespoon of maple syrup in your salad dressing, the honey in your Asian-inspired stir-fry sauce, the generous drizzle of ketchup on your burger. Despite many people’s best efforts, that sugar still manages to creep into so many healthy dinner dishes. But meals can be just as tasty and easy to make without the slightest hint of added sweetener. We’ve rounded up 25 added-sugar-free dinners proving just that. 

Poultry 1. Healthy Orange Peel Chicken Photo: Lively Table In a welcome contrast to the honey-soaked restaurant version, this dish uses the actual peel and fresh juice of the orange for its fruity flavor and sweetness. It’s also all done in one pan, so it’s really only marginally harder than ordering in.  2. Creamy Buffalo Chicken Pasta Photo: Living Loving Paleo Instead of sugary ranch dressing for the “creamy” portion of this pasta, this recipe’s secret weapon is blended cashews, which make the dish incredibly rich in a much healthier way. If you use the coconut oil option instead of ghee, the dish also becomes entirely dairy-free. 3. Yogurt Chicken Curry Photo: Chef de Home Along with tang, plain yogurt adds some mild sweetness to this otherwise spicy curry. It’s so much better for you than the butter chicken you’d find in a traditional Indian restaurant, but just as tasty, especially paired with naan or rice.  4. Taco Stuffed Sweet Potato Photo: Spinach 4 Breakfast Get your taco the gluten-free way by stuffing your turkey mixture into a sweet potato. You get an extra serving of fiber and a touch of natural sweetness; plus, it’s a lot more fun to eat this way.   5. Chicken, Sweet Potato, and Coconut Stew Photo: Chew Out Loud There’s a lot that’s sweet about this recipe, but none of it has anything to do with sugar. It’s all from the sweet potatoes, the creamy coconut milk, and the freshly squeezed orange juice. Clean eating really doesn’t have to be hard or bland. 6. Easy 30-Minute Turkey Chili You’ll notice that the teaspoon of sugar in this chili is entirely optional—and it’s for good reason, since you won’t miss it at all if you omit it. With sweet bell peppers, mild turkey, cumin, and chili powder to spice things up, there’s already plenty of flavor going on.  Beef/Pork 7. Weeknight Sesame Steak Salad Photo: PDX Food Love A good steak salad shouldn’t just be a meal you order at a restaurant. It’s just as easy to re-create at home. As a bonus, you control everything that goes on to this plate, from the quality of the meat to the homemade dressing to the fun add-ins such as avocado and peanuts. 8. Peanut Broccoli and Pork Stir-Fry Photo: Nutritionist Reviews Asian-inspired food is delicious, but unfortunately, tends to use alarming amounts of added sugar, such as honey or sweetened sauces. This one gets its not-too-sweet flavor from a blend of rice vinegar and peanut powder (use peanut butter as an alternative)—it’s so good and so easy, you may want to bottle some of it for future stir-fries and salads. 9. One-Pot Beef and Tomato Macaroni Soup Photo: The Recipe Rebel Even canned soup can come loaded with sweeteners and additives. Ditch the store-bought stuff and whip up your own take on the classic beef and macaroni soup with a recipe that comes together in fewer than 30 minutes and uses all real food, including whole-wheat pasta. 10. Grandma's One-Pan Hamburger Helper Photo: The Seasoned Mom Packaged Hamburger Helper may save you a few minutes in the kitchen, but it isn’t doing a whole lot for your health with ingredients such as corn syrup, sugar, and MSG. This stovetop version packs in lean ground beef, whole-grain macaroni, and plenty of actual tomato sauce, and is hardly time-consuming to put together.  11. Spring Pea Risotto Photo: Kiwi and Carrot Who needs sugar when you have rich, creamy carbs that involve bacon? Not only is this recipe the ultimate savory comfort food, it also comes together in just 35 minutes—pretty much record timing for a risotto. 12. Yellow Rice Pork Chop Bake Photo: Food Done Light This foolproof rice recipe requires no stovetop stirring—the oven-baked method gets it just right. Plus the combination of saffron, paprika, and garlic powder will have your kitchen smelling heavenly.  Seafood 13. 20-Minute Baked Pesto Salmon Photo: Skinny Fitalicious With an avocado-based pesto slathered over salmon, this recipe is all about the “s” word—that is, superfoods, not sugar. Pair the fish with asparagus for a filling—not to mention, incredibly good-looking—plate.  14. Avocado Tuna Cakes Photo: Well Plated Get your protein and healthy fats in these neat little patties. Held together with egg and breadcrumbs then baked, they’re tasty and versatile. Serve them on a salad or with roasted veggies.   15. Pineapple Chipotle Salmon Tostadas Photo: Joyful Healthy Eats Fruit is a fantastic way to give a dish some all-natural sweetness, and a little goes a long way. These tostadas, piled high with spiced salmon and cooled off with a pineapple salsa, are a perfect example. 16. Cajun Shrimp and Rice Photo: Everyday Easy Eats No room for sugar in this spicy rice dish; Cajun seasonings, a squirt of lemon, and protein-packed shrimp do more than enough to make it tasty without the need for sweeteners, all-natural or otherwise.  17. Shrimp, Orzo, Spinach, and Feta Casserole Photo: The Straight Dish Next time anyone declares that seafood and cheese don’t mix, plate them up a big ol’ portion of this. The salty feta and shrimp go so perfectly with the garlicky pasta and sauce, you’ll no doubt be serving seconds. 18. Panfried Halibut With Grapefruit and Mango Salsa Photo: Cooks With Cocktails This dish packs in so many different flavors, you won’t even feel like you’re eating “light.” Simply seasoned halibut is pan-seared until flaky and topped with an herbed and slightly spicy fruit salsa. It’s refreshing and satisfying all at once. 19. Easy Tilapia Pomodoro Photo: My Life Cookbook Crusted in bread crumbs and Parmesan, and lightly browned—not fried—in a pan, this tilapia dish looks fancy, but requires just six ingredients. The easy tomato sauce makes for a tangy complement to the mild fish.  Meatless 20. Garlic Asparagus Artichoke Pasta Photo: Pumpkin and Peanut Butter While there’s no sugar in this recipe, it does use funky store-bought cubes of garlic, herbs, and ginger. If you can’t find them, just use regular garlic cloves and spices. This super-simple pasta will be just as delicious either way. 21. Pad Thai Zucchini Noodle Quinoa Salad Photo: Simply Quinoa Sugar is almost always included in an authentic pad Thai. This recipe departs from tradition, going for a loosely inspired version that not only skips sugar, but also uses zucchini “noodles” and adds quinoa for extra protein.  22. Quinoa Fried Rice Photo: Everyday Easy Eats Everyone needs a fried rice recipe in their arsenal, but give yours a superfood upgrade by using quinoa as a base instead. The fluffy kernels are chewy enough to hold up to the veggies and do a great job of absorbing the soy and Sriracha sauce. 23. Vegetable Samosa Bowl Photo: Kristin's Kitchen Who doesn’t love going to an Indian restaurant and starting off with a plate of crispy, deep-fried samosas? While that’s all well and good once in a while, try a healthier version at home. The veggie filling is piled on top of rice instead of wrapped in dough, and a spicy, cilantro sauce replaces the sugary tamarind one on the outside. 24. Easy Tempeh Fajitas Photo: B Brtinell Like tofu, tempeh soaks up whatever flavors you put on it. Here, it’s marinating in lime juice, garlic, and classic Mexican spices, then quickly sautéed with veggies for a fantastic weeknight fajita dinner.  25. Lentil Sloppy Joes Photo: Modern Little Victories Using lentils instead of meat for sloppy joes is a common vegetarian fix, but lots of recipes use brown sugar to sweeten the tomato sauce. This one nixes the sweetness, letting the tomato sauce and spices speak for themselves.  

 

15 Things Yogis Can’t Live Without

Sure, you have a yoga mat (you’re not doing your flow on a hard floor, right?), but if you really want to embrace your inner yogi, a mat is just the tip of the iceberg. We found more than a dozen irresistible products that all yoga lovers will be obsessed with. They range from the useful (yoga blocks and yoga bags) to the silly (namaste puns, anyone?). Having them around has been making us feel all sorts of zen.

1. Pinch Provisions Fitness Kit How many times have you walked into yoga class only to realize you don’t have a hair tie? This cute kit has you covered. You'll find the hair tie you were looking for, plus bobby pins, extra socks, ear buds, sample-size dry shampoo, deodorant towelettes, a foldable brush, a headband, a tampon, lip balm, blister balm, Band-Aids, safety pins, and breath mints. It's the definition of a lifesaver. ($22; shopspring.com) 2. Namast’ay in Bed Mug We all have that chipper friend who’s an unapologetic morning person and thinks it’s OK to say, “You sure you don’t want to sign up for a 7 a.m. flow this Sunday?” Just send them a selfie while sipping on some coffee (or booze—we’re not here to judge) from this cheeky mug. Problem solved. ($16.75; zazzle.com) 3. ClassPass We’re all about at-home yoga, but doing the same flow again and again gets boring. Classes are our favorite way to spice things up (Bikram, aerial, and beer yoga are all amazing), and ClassPass makes it so easy to sign up for the coolest yoga classes in your area. Bonus: They’re giving Greatist readers 70 percent off their first month.  (Price varies depending on location; classpass.com) 4. Yoga Joes G.I. Joe must be stiff from standing at attention for so long. You know what he needs? Yoga. These Yoga Joes flawlessly demonstrate nine moves, from child’s pose to warrior I (appropriate, right?). They'll be an awesome addition to any shelf or desk.  ($25; uncommongoods.com) 5. Sweaty Betty Yoga Block Unless you’re uber flexible, you’re going to need a yoga block at some point in your flow. Maybe you use it for support during triangle pose, or you grab two blocks to deepen your stretch in downward dog. You could purchase any old block, or you could get this one from Sweaty Betty. It might be made from the same foam, but it looks so much better. ($16; shopspring.com) 6. Quiver of Arrows Yoga Bag Embrace your inner Katniss Everdeen with this sweet yoga bag from Brogamats. It’s functional (a full-length zipper means you can fit all standard-size mats) and a great conversation starter. Next time you head to a new studio, bring this bag, and you’re pretty much guaranteed to make some new friends.  ($40; amazon.com)   7. Namast’op I Can’t Even T-Shirt You know those moments when you’re in a hot yoga class and you slip while easing into warrior II because you’re basically a puddle of sweat? The little voice in our head says what's printed on this t-shirt (plus an expletive or two). So obviously we need to be wearing it. ($35; shopbetches.com) 8. Bed of Nails Acupressure Mat and Pillow Twisting yourself into a pretzel in yoga class might work wonders to relieve muscle tension, but this mat takes it to the next level. Don’t let the name “bed of nails” scare you—there isn't anything you would find in a hardware store attached to this mat. Instead, the pointy acupressure plates stimulate blood flow to ease any lingering muscle soreness or pain.  ($39.95; amazon.com) 9. Athleta Get to Work Gym Bag Finding a fashionable gym bag that actually holds your yoga mat? We thought that was impossible until we came across this beauty from Athleta. The straps along the side of the bag are specially designed to hold your mat. And, on top of that, both the interior and the exterior have lots of pockets so this doesn't become the giant black hole that most gym bags are.  ($79; athleta.gap.com) 10. Yogitoes Yoga Mat Towel Call us skeptical, but every no-slip yoga mat we’ve tried hasn’t worked as advertised. At the beginning of class it appears to be doing its job, but the second we start sweating, our mat turns into a slip 'n slide. OK, fine. We're being a *little* dramatic, but you get the point. And that’s why these towels come in handy. They’re pricey, but washable. Put one over your yoga mat and never slip again—seriously.  ($59.01; amazon.com) 11. Every Body Yoga We wish we had someone like Jessamyn Stanley by our side when we started practicing yoga—someone to tell us to stop comparing ourselves to everyone else in class, someone to tell us how yoga can help us love our bodies. Her how-to book has 50 basic poses and 10 sequences, but it’s not just for beginners. We can all learn something from the way Stanley thinks (and talks) about yoga.  ($11.56; amazon.com) 12. Yummi Yogi Cutting Board Your charcuterie board has never looked so balanced! This adorable handmade cutting board is shaped like someone in tree pose, making it super Instagrammable when you’re using it to cut fruit or serve cheese and crackers.  ($50; etsy.com)  13. Pug Yoga Poster We’ll spare you the downward dog puns and just say this poster of pug poses is perfect for anyone who loves dogs or yoga—or both! And doesn’t that cover pretty much everyone out there?   ($24.88; society6.com) 14. The Mindfulness Coloring Book Feeling stressed? Chakras out of whack? Keep this mini coloring book in your bag or your back pocket—it really is small enough to fit. Its 70 designs range from flowers to butterflies to rolling waves, making them all a quick way to zen out on those days when you're too busy to take an hour-long yoga class.  ($6.45; amazon.com) 15. Hey What’s Up Let’s Flow T-Shirt We’re not sure if Fetty Wap does yoga, but it doesn't matter. This twist on the opening line in his song “Trap Queen” makes us laugh every time anyway. We know, we know—$50 is pricey for a tank top. But can you really put a price on telling the world, “Hey, I’m zen and on trend?” Didn't think so. ($50; y7-studio.com)

 

12 Boxing-Inspired Core Exercises for Rock-Solid Abs

You might find it surprising that boxing is one of the most complete, full-body workouts you can do. Your aerobic, anaerobic, and nervous system have to work together, and as a result, your musculature and mental sharpness, or reaction time, improves, explains Noah Neiman, cofounder and head trainer at Rumble Boxing in New York City. 

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“A common misconception most people have is that launch power for a punch comes from strong arms,” he says. “But it’s actually the ability to generate power from your legs, from the speed and power of rotation through your hips and core, and then ultimately the extension of your arms that creates a strong punch.” 

Translation: Core strength is integral to generating the force necessary for boxing (whether you're a casual kickboxer or a serious competitor). And a strong core isn’t just beneficial in the ring; it's important outside of it too. “Poor core strength can lead to back, lower back, neck, and even knee pain,” Neiman says. So to keep you in top shape on and off the ropes, we collected 12 abs exercises borrowed from boxers that'll help you build serious core strength. How to use this list: Start by performing each exercise below for 30 seconds. Use the modifications or progressions listed, if applicable, to better suit your personal strength. Build up to 60 seconds each. Perform each move with no rest in between for a killer 12-minute workout or scroll down to try our 12-minute, 4-move sample workout below. You can substitute any exercise in this list for another in the workout. Grab an exercise mat to get started.

Inchworm Push-Up Stand with feet shoulder-width apart. Hinge at hips to bend over and touch floor with hands, then walk hands out to high plank position. Keeping elbows close to sides, bend elbows and lower chest to floor. Push back up, then walk hands back toward feet. Repeat. Make it easier: Drop to knees for the push-up then return to plank.  Sit-Up With One-Two Punch Lie faceup on mat, knees bent, feet flat on the floor in front of you. Keeping feet planted, engage core and use abdominal muscles to sit up while keeping hands in fists in guard in front of face. At the top, throw a right and left punch, then slowly lower back down one vertebrae at a time to return to starting position. Repeat. Make it harder: Add 16-ounce gloves or a light set of hand weights.   Walking Plank Start in high plank position, hands directly under shoulders, legs extended out behind you, core engaged to keep body in straight line from head to toe. Lift up right hand and lower right forearm to the floor. Do the same with left hand and forearm. Then lift right forearm and place right hand back on ground, followed by the left hand. Continue repeating. Make it harder: Place a BOSU ball underneath your forearms to challenge your stability.  V-Up Lie faceup on mat, legs extended straight, arms extended overhead. Keeping core engaged, sit up, lifting arms and legs simultaneously toward each other, so body forms a V shape. Slowly lower back down until arms and legs are two inches above ground. Repeat. Plank Jack Start in a forearm plank, elbows directly under shoulders, core engaged so body forms a straight line from head to toe. Without moving upper body, jump feet apart, then back together. Continue jumping.Make it harder: Increase your speed.  Sprinter Crunch Lie faceup on mat, legs extended out in front of you, hands up in guard. Keeping core tight, sit up and twist toward left while simultaneously bringing left knee to right elbow. Lower back down to starting position. Repeat on other side. Continue alternating.  Straight Leg Scissor Sit on mat, legs extended straight out in front of you. Lean torso back and place fingertips on floor next to hips for support. Keeping legs straight NS core engaged, lift right leg toward ceiling. Lower, then lift left leg toward ceiling. Continue alternating. Make it harder: Add ankle weights.  Push-Up to Superman Start in high plank position, hands slightly wider than shoulder-width apart, body in straight line from head to toe. Bend at elbows to lower chest to floor to perform a push-up. Release hands, pull shoulder blades together, and lift chest, arms, and legs off mat. Lower down, place hands on ground, and push back up to plank position. Repeat. Russian Twist  Sit on mat with knees bent, feet on floor in front of you about hip-width apart. Engage core, lean back about 45 degrees, and bring fists up to chest with elbows out. Twist at waist to tap right elbow to the mat on right side, then left elbow to mat on left side. Continue alternating. Make it harder: Grab a medicine ball or kettlebell in the weight of your choice and hold at chest.  Shoulder Tap Start in high plank position, hands directly under shoulders, body in straight line from head to toe. Without shifting weight and keeping body still, lift right hand and tap left shoulder, then lift left hand and tap right shoulder. Continue alternating as fast as possible.   Reverse Oblique Crunch  Start sitting on mat, legs extended out in front of you, hands on mat behind you. Lean back slightly onto fingertips for balance and lift legs two inches off floor. Keeping core tight, twist at the waist and bring bent knees toward chest, then extend back out (don't drop legs to mat). Twist to the other side and repeat. Continue alternating. Sit-Up to Stand Up  You might also like {{displayTitle}} READ This is a classic Mayweather move that'll challenge your entire body. Grab a partner (or just use the base of a couch, dresser, or heavy object to lock down your feet). Start lying faceup on mat, knees bent, feet flat on the floor in front of you with partner anchoring feet. Engage core, perform a sit-up, and continue to come all the way up to standing, reaching arms overhead. Slowly reverse the movement back down to return to starting position. Repeat. Make it harder: Add a set of dumbbells. 

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Photography: Julia Hembree Special thanks to Gotham Gym NYC and our model, Tatiana Firpo, Gotham group fitness manager and trainer. 

Severe Shortage Of Home Health Workers Robs Thousands Of Proper Care

Acute shortages of home health aides and nursing assistants are cropping up across the country, threatening care for people with serious disabilities and vulnerable older adults.

In Minnesota and Wisconsin, nursing homes have denied admission to thousands of patients over the past year because they lack essential staff, according to local long-term care associations.

In New York, patients living in rural areas have been injured, soiled themselves and gone without meals because paid caregivers aren’t available, according to testimony provided to the state Assembly’s health committee in February.

In Illinois, the independence of people with severe developmental disabilities is being compromised, as agencies experience staff shortages of up to 30 percent, according to a court monitor overseeing a federal consent decree.

[caption id="attachment_723078" align="alignright" width="370"] Renzo Viscardi (center), pictured with his parents Anthony Viscardi and Cheryl Dougan, relies on round-the-clock care from home health aides. (Courtesy of Cheryl Dougan)[/caption]

The emerging crisis is driven by low wages — around $10 an hour, mostly funded by state Medicaid programs — and a shrinking pool of workers willing to perform this physically and emotionally demanding work: helping people get in and out of bed, go to the bathroom, shower, eat, participate in activities, and often dealing with challenging behaviors.

It portends even worse difficulties to come, as America’s senior citizen population swells to 88 million people in 2050, up from 48 million currently, and requires more assistance with chronic health conditions and disabilities, experts warn.

“If we don’t turn this around, things are only going to get worse” said Dr. David Gifford, senior vice president of quality and regulatory affairs for the American Health Care Association, which represents nursing homes across the U.S.

“For me, as a parent, the instability of this system is terrifying,” said Cheryl Dougan of Bethlehem, Pa., whose profoundly disabled son, Renzo, suffered cardiac arrest nearly 19 years ago at age 14 and receives round-the-clock care from paid caregivers.

Rising Demand, Stagnant Wages

For years, experts have predicted that demand for services from a rapidly aging population would outstrip the capacity of the “direct care” workforce: personal care aides, home health aides and nursing assistants.

The U.S. Bureau of Labor Statistics estimates an additional 1.1 million workers of this kind will be needed by 2024 — a 26 percent increase over 2014. Yet, the population of potential workers who tend to fill these jobs, overwhelmingly women ages 25 to 64, will increase at a much slower rate.

After the recession of 2008-09, positions in Medicaid-funded home health agencies, nursing homes and community service agencies were relatively easy to fill for several years. But the improving economy has led workers to pursue other higher-paying alternatives, in retail services for example, and turnover rates have soared.

At the same time, wages for nursing assistants, home health aides and personal care aides have stagnated, making recruitment difficult. The average hourly rate nationally is $10.11 — a few cents lower than a decade ago, according to PHI, an organization that studies the direct-care workforce. There is a push on now in a handful of states to raise the minimum to $15 an hour.

Even for-profit franchises that offer services such as light housekeeping and companionship to seniors who pay out-of-pocket are having problems with staffing.

“All the experienced workers are already placed with families. They’re off the market,” said Carrie Bianco, owner of Always Best Care Senior Services, which is based in Torrance, Calif., with franchises in 30 states.

Finding new employees was so difficult that Bianco started her own 14-week training program for caregivers nine months ago. To attract recruits, she ran ads targeting women who had left the workforce or been close to their grandparents. In exchange for free tuition, graduates must agree to start working for her agency.

“There’s much more competition now — a lot of franchises have opened and people will approach our workers outside our building or in the lobby and ask if they want to come work for them,” said Karen Kulp, president of Home Care Associates of Philadelphia.

Hardest to cover in Kulp’s area are people with disabilities or older adults who live at some distance from the city center and need only one to two hours of help a day.  Workers prefer longer shifts and less time traveling between clients, so they gravitate to other opportunities and “these people are not necessarily getting service,” she said.

It isn’t possible to document exactly how common these problems are nationally. Neither states nor the federal government routinely collect information about staff vacancy rates in home care agencies or nursing homes, turnover rates or people going without services.

“If we really want to understand what’s needed to address workforce shortages, we need better data,” said Robert Espinoza, vice president of policy at PHI.

Hard Times In Wisconsin

Some of the best data available come from Wisconsin, where long-term care facilities and agencies serving seniors and people with disabilities have surveyed their members over the past year.

The findings are startling. One of seven caregiving positions in Wisconsin nursing homes and group homes remained unfilled, one survey discovered; 70 percent of administrators reported a lack of qualified job applicants. As a result, 18 percent of long-term facilities in Wisconsin have had to limit resident admissions, declining care for more than 5,300 vulnerable residents.

“The words ‘unprecedented’ and ‘desperate’ come to mind,” said John Sauer, president and chief executive of LeadingAge Wisconsin, which represents not-for-profit long-term care institutions. “In my 28 years in the business, this is the most challenging workforce situation I’ve seen.”

Sauer and others blame inadequate payments from Medicaid — which funds about two-thirds of nursing homes’ business — for the bind. In rural areas, especially, operators are at the breaking point.

“We are very seriously considering closing our nursing facility so it doesn’t drive the whole corporation out of business,” said Greg Loeser, chief executive of Iola Living Assistance, which offers skilled nursing, assisted living and independent living services in a rural area about 70 miles west of Green Bay.

Like other short-staffed operators, he’s had to ask employees to work overtime and use agency staff, increasing labor costs substantially. A nearby state veterans home, the largest in Wisconsin, pays higher wages, making it hard for him to find employees. Last year, Iola’s losses on Medicaid-funded residents skyrocketed to $631,000 — an “unsustainable amount,” Loeser said.

Wisconsin Gov. Scott Walker has proposed a 2 percent Medicaid increase for long-term care facilities and personal care agencies for each of the next two years, but that won’t be enough to make a substantial difference, Loeser and other experts say.

The situation is equally grim for Wisconsin agencies that send personal care workers into people’s homes. According to a separate survey in 2016, 85 percent of agencies said they didn’t have enough staff to cover all shifts, and 43 percent reported not filling shifts at least seven times a month.

Barbara Vedder, 67, of Madison, paralyzed from her chest down since a spinal cord injury in 1981, has witnessed the impact firsthand. Currently, she qualifies for 8.75 hours of help a day, while her husband tends to her in the evening.

“It’s getting much, much, much more difficult to find willing, capable people to help me,” she said. “It’s a revolving door: People come for a couple of months, maybe, then they find a better job or they get pregnant or they move out of state. It’s an endless state of not knowing what’s going to happen next — will somebody be around to help me tomorrow? Next month?”

When caregivers don’t show up or shifts are cut back or canceled, “I don’t get proper cleaning around my catheter or in my groin area,” Vedder continued. “I’ll skip a meal or wait later several hours to take a pill. I won’t get my range-of-motion exercises, or my wheelchair cushion might slip out of place and I’ll start getting sore. Basically, I start losing my health.”

[caption id="attachment_723079" align="alignright" width="370"] Debra Ramacher is executive director of Wisconsin Family Ties, an organization for families of children with emotional, behavioral and mental disorders. Her daughter Maya, 20, pictured in 2015, has cerebral palsy, epilepsy and other significant disabilities. (Courtesy of the Ramacher family)[/caption]

Debra Ramacher and her husband have been unable to find paid caregivers since June 2015 for daughter Maya, 20, and son Michael, 19, both of whom have cerebral palsy, epilepsy and other significant disabilities. The family lives in New Richmond in western Wisconsin, about 45 minutes from the Minneapolis-St. Paul metropolitan area.

“At least three agencies told me they’ve stopped trying to hire personal care aides. They can’t find anybody and it costs them money to advertise,” said Ramacher, executive director of Wisconsin Family Ties, an organization for families with children with emotional, behavioral and mental disorders.

“It’s incredibly stressful on all of us, living with this kind of uncertainty,” she said.

Every few months, Ramacher tries to find caregivers on her own by putting ads up on Craigslist, in local newspapers and on job boards.

“We get a few bites,” she said. “Most recently, two people came and interviewed. One never got back to us; the other got a better job that paid more.”

In the meantime, she and her husband are being paid by Medicaid to look after Maya and Michael.

“We don’t want to be the caregivers; we want to have our own life,” Ramacher said. “But we don’t have any option.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Pre-Obamacare, Preexisting Conditions Long Vexed States And Insurers

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For most of his life, Carl Goulden had near-perfect health. He and his wife, Wanda, say that changed 10 years ago. Carl remembered feeling “a lot of pain in the back, tired, fatigue, yellow eyes — a lot of jaundice.”

“Gray-like skin,” Wanda added. His liver wasn’t working, she explained. “It wasn’t filtering.”

Carl was diagnosed with hepatitis B. He is now 65 and on Medicare, but back then he had a flower shop in Littlestown, Pa., so he had been buying health insurance for his family on the market for small businesses and the self-employed.

The medications to manage Carl’s hepatitis cost more than $10,000 a year — and if he ever needed a liver transplant, as some people with hepatitis eventually do, the costs could be formidable. Thank goodness they had health insurance, the couple thought.

But then, Carl said, “the insurance renewals went way up.”

After a few years, he could no longer afford to buy the coverage — more than $1,000 a month — and maintain his business. So he dropped the insurance.

“I was devastated,” he said, “because I didn’t know when my liver might fail.”

Teresa Miller, Pennsylvania’s insurance commissioner, said that steep increase in insurance rates was legal. And before the Affordable Care Act became law, a patient like Goulden might have had a hard time buying another policy. He likely would have been turned down by private insurers because he had a “preexisting” medical condition.

A family like the Gouldens would “just have been out of luck,” Miller said.

Pennsylvania: The Wild, Wild West 

Before the ACA, states had differing approaches to handling preexisting conditions.

Pennsylvania was typical. Until the ACA mandated that insurers treat sick and healthy people equally, buying insurance seemed as lawless as the Wild West.

Insurers couldn’t overtly kick people off a plan if they got sick, but they could find ways to charge them much more, even those whose chronic condition wasn’t that serious — such as acne. For individuals looking to sign up in the first place, “an insurance company could simply decline to offer you insurance at all because of your preexisting condition,” Miller said.

Insurers who did offer a policy to someone with a preexisting condition might have done so with a catch — the plan could require a waiting period or might exclude treatment for that condition.

“So, let’s say you had diabetes, for example,” Miller said. “You might have been able to get coverage for an unexpected health care need that arose, but you’d still be on your own for any treatment and management of your diabetes.”

From the perspective of an insurance company, these practices were intended to prevent the sick from signing up for a health plan only when they needed costly care.

Pennsylvania tried to partially solve this problem by creating a scaled-back health plan, called adultBasic, for those with incomes too high to qualify for Medicaid who didn’t have any coverage. Household incomes had to be less than 200 percent of the federal poverty level, which at that time would have been $21,660 for an individual. More than 40,000 people were signed up in 2011, and nearly half a million were on the waiting list,  but the plans didn’t include coverage for mental health care, prescription drugs or more than two nights in a hospital. Even so, Miller said, the strategy proved too expensive for the state.

“That program was spending $13 million to $14 million a month when it was shut down,” she said.

High-Risk Pools

More than 30 other states dealt with preexisting conditions by setting up what are called high-risk pools, a separate insurance plan for individuals who couldn’t get health coverage in the private market.

These plans could be lifesavers for some people with conditions like cancer — which can cost tens if not hundreds of thousands of dollars to treat.

The experiences with high-risk pools varied, but states faced challenges, said John Bertko, an insurance actuary with the state of California. And the main problem was the high cost.

“The one in California, which I was associated with, limited annual services to no more than $75,000, and they had a waiting list. There was not enough money,” Bertko said. “The 20,000 people who got into it were the lucky ones. At one point in time, there were another 10,000 people on a waiting list.”

The pools also had catches: Premiums were expensive, as were out-of-pocket costs. And plans often excluded the coverage of preexisting conditions for six months to a year after the patient bought the policy.

New Jersey: Preexisting Conditions Covered, With A Catch

Around that same time, across the Delaware River, the state of New Jersey was trying something different.

“Insurers could not take health status into account,” said Joel Cantor, director of Rutgers’ Center for State Health Policy who has been analyzing the New Jersey experience.

Before the ACA, New Jersey was one of just a handful of states that prohibited insurers from denying coverage to people with preexisting conditions. Insurers also weren’t allowed to charge people significantly more for having a health issue, and the plans had to offer robust coverage of services.

There was a one-year waiting period for coverage of a preexisting condition, but a larger issue became cost. The entire individual market in New Jersey became expensive for everyone, regardless of their health status, Cantor said. Because there was no mandate to have health insurance coverage, those who signed up tended to need it, and healthy people did not enroll.

And so, “the prices went up and up,” he said. And the premiums and enrollment “went down and down.”

The state tried to address this in the early 2000s by introducing a “skinny” health plan, Cantor said.

“By that I mean very few benefits,” he explains. “It covered very, very limited services.”

The plan was affordable and really popular, especially among the young and healthy people, and about 100,000 people signed up. But if a person had a health need, many costs shifted to the individual.

“It left people with huge financial exposure,” he said.

That’s, in part, why the ACA included a rule that insurance plans now must offer good benefits and be available to everybody. In exchange, insurers have the mandate and subsidies — so that everybody will buy in.

Cantor said these experiences point to an ongoing quandary: A small portion of people consume a big chunk of health care costs. It’s hard to predict who will cost a lot — or when.

This story is part of a partnership that includes The Pulse, NPR and Kaiser Health News.

How to Meet Your Protein Needs without Meat

Eating a vegetarian diet can be very healthful and rewarding. However, most vegetarians—including soon-to-be vegetarians and their meat-eating loved ones—are concerned about getting adequate protein. Most people are accustomed to getting protein from meat, but what else contains protein? Aren't plant-based proteins "incomplete" or lower quality? Fortunately, with a bit of extra attention, you won't have any trouble meeting your protein needs just because you give up meat. There are so many protein-packed vegetarian options! Did you know that most foods, including vegetables, have some of the essential muscle-building nutrient? Without looking closely, it is easy to miss some great sources. (Who knew a cup of broccoli had 3 grams!) Nuts, seeds, soy products, cereal, eggs and dairy are all good meatless protein choices. These groups of food each contain different amino acids (the building blocks of proteins) and different levels of protein quality. There is no need to consume certain foods in special combinations as nutritionists once thought! When your diet includes a variety of each of these types of foods, you can rest assured that you're consuming all the amino acids you need for muscle growth and cell repair.  Pin this graphic for easy reference and scroll down for more details. Nuts Nuts provide a good dose of protein along with some heart-healthy fatty acids and antioxidants (vitamins A and E). They are also packed full of fiber. Take your pick! Many nuts have a significant source of protein ready to work for your body. Peanuts, almonds, pistachios, cashews, and pine nuts are among the highest in protein, while chestnuts and hazelnuts, although they do still have some protein, are the lowest. Think out of the box when you’re adding nuts to your diet. They can be grated, toasted, ground or eaten raw and are great when combined with salads, wraps, soups and stews and baked goods. But pay special attention to portion size! Nuts are a great source of many nutrients, but do come with a hefty dose of calories, thanks to the healthy fats they contain. A single serving is just 1 oz! Many nuts are best when stored in a refrigerator, which helps keep their fats from going rancid (for up to 6 months).   Nuts, 1/4 cup Protein Calories Fat Peanuts, raw 9 g 207 18 g Almonds, dry roasted 8 g 206 18 g Pistachios 6 g 171 14 g Hazelnuts 5 g 212 21 g Pine nuts 5 g 229 23 g Cashews, raw 5 g 197 16 g Walnuts 4 g 164 16 g Seeds Seeds are another great way to grab a few grams of protein and many other nutrients. Healthful unsaturated fats, as well as phytochemicals, make seeds a powerhouse for heart disease and cancer prevention. Just a quarter cup of pumpkin seeds (also called pepitas) has 8.5 grams of protein. Add this amount to a salad or eat them plain for a quick snack. Sunflower seeds are easy to add to pasta or salads, or sandwich wraps, while sesame seeds are easily ground and sprinkled onto steamed veggies for a protein dusting.   Seeds (1/4 cup) Protein Calories Fat Hemp seeds 15 g 232 18 g Pumpkin seeds, roasted 9 g 187 16 g Flaxseed 8 g 191 13 g Sunflower seeds, roasted 8 g 205 18 g Sesame seeds, roasted 6 g 206 18 g Legumes Dried peas, beans and lentils belong to a group of food known as "pulses" or "legumes." Aside from soybeans, these plants have a very similar nutrient content, which includes a good dose of protein. On average, they have about 15 grams of protein per cup, and tagging along with the essentials protein are fiber and iron. Adding beans, lentils and dried peas to your meals is a great way to replace meat (a beef burrito can easily become a black bean burrito, for example) while still getting your much needed protein. Add pulses to soups, salads, omelets, burritos, casseroles, pasta dishes, and more! Make bean dips (such as hummus, which is made from garbanzo beans, or black bean dip) to spread on sandwiches and use as protein-packed dips for veggies or snack foods.   Legumes, 1 cup cooked Protein Calories Fiber Soybeans 29 g 298 10 g Lentils 18 g 230 16 g Split peas 16 g 231 16 g Navy beans 16 g 258 12 g Garbanzo beans (chickpeas) 15 g 269 12 g Black beans 15 g 227 15 g Kidney beans 15 g 225 11 g Lima beans 15 g 216 13 g Pinto beans 14 g 234 15 g Soy Soybeans are a complete protein that is comparable in quality with animal proteins. Eating soybeans (and foods made from soybeans) has been growing trend in America for only five decades, but this protein-rich bean has been a staple in Asia for nearly 4,000 years! This plant powerhouse is used to create a variety of soy-based foods that are rich in protein: tofu, tempeh, textured vegetable protein (TVP, a convincing replacement for ground meat in recipes), soymilk and "meat analogs," such as vegetarian "chicken" or faux "ribs" are all becoming more popular as more Americans practice vegetarianism. To learn more about using tofu, read Tofu 101. To learn how soy may impact your health, click here.   Soy Foods Protein Calories Fat Soybeans, 1 cup cooked 29 g 298 10 g Tempeh, 4 oz cooked 21 g 223 13 g Edamame, 1 cup shelled 20 g 240 10 g TVP, 1/4 cup dry 12 g 80 0 g Soy nuts, 1/4 cup roasted 11 g 200 1 g Tofu, 4 oz raw 9 g 86 5 g Soy nut butter, 2 tablespoons 7 g 170 11 g Soymilk, 1 cup sweetened 7 g 100 0.5 g Soymilk, 1 cup unsweetened 7 g 80 0.5 g Grains In a culture that focuses largely on wheat, it's easy to overlook the many types of other grains available to us. Some of these grains are very high in protein and can be included in your diet for both whole-grain carbohydrates and muscle-building protein. Quinoa is unusually close to animal products in protein quality, making it an excellent grain to replace white rice or couscous. It can also be cooked and mixed with honey, berries and almonds in the morning for a protein-packed breakfast. Other grains high in protein include spelt, amaranth, oats and buckwheat. Choose whole-grain varieties of cereals, pastas, breads and rice for a more nutritious meal.   Grains Protein Calories Fiber Amaranth, 1 cup cooked 9 g 238 9 g Quinoa, 1 cup cooked 9 g 254 4 g Whole wheat pasta, 1 cup cooked 8 g 174 6 g Barley, 1 cup cooked 7 g 270 14 g Spelt, 4 oz cooked 6 g 144 4 g Oats, 1 cup cooked 6 g 147 4 g Bulgur, 1 cup cooked 6 g 151 8 g Buckwheat, 1 cup cooked 6 g 155 5 g Brown rice, 1 cup cooked 5 g 216 4 g Whole wheat bread, 1 slice 4 g 128 3 g Sprouted grain bread, 1 slice 4 g 80 3 g Dairy If you consume milk products, dairy is a great way to add some extra grams of protein to your day. Low-fat milk, cheese and yogurt are easily accessible, quick to pack and fun to incorporate into many meals and snacks. Whether you’re drinking a cup of skim milk with your dinner or grabbing some string cheese before you run errands, you can pack about 8 grams of protein into most servings of dairy. You’re also getting some bone-building calcium while you’re at it! Keep in mind that low-fat varieties of milk products are lower in calories and fat, but equal in calcium to the full-fat versions; low-fat varieties may also be higher in protein.   Dairy Protein Calories Fat Fat-free cottage cheese, 1 cup 31 g 160 1 g 2% cottage cheese, 1 cup 30 g 203 4 g 1% cottage cheese, 1 cup 28 g 163 2 g Fat-free plain yogurt, 1 cup 14 g 137 0 g Low-fat plain yogurt, 1 cup 13 g 155 4 g Parmesan cheese, 1 oz grated 12 g 129 9 g Whole milk yogurt, 1 cup 9 g 150 8 g Goat's milk, 1 cup 9 g 168 10 g 1% milk, 1 cup 8 g 102 2 g Swiss cheese, 1 oz 8 g 106 8 g 2% milk, 1 cup 8 g 121 7 g 3.25% (whole) milk, 1 cup 8 g 146 8 g Low-fat cheddar/Colby cheese, 1 oz 7 g 49 2 g Part-skim mozzarella cheese, 1 oz 7 g 72 5 g Provolone cheese, 1 oz 7 g 100 8 g Cheddar cheese, 1 oz 7 g 114 9 g Blue cheese, 1 oz 6 g 100 8 g American cheese, 1 oz 6 g 106 9 g Goat cheese, 1 oz 5 g 76 6 g Feta cheese, 1 oz 4 g 75 6 g Part-skim ricotta cheese, 1 oz 3 g 39 2 g Eggs Eggs contain the highest biologic value protein available. What this means is that an egg has a near perfect combination of amino acids within its shell; when assessing protein quality of all other foods (including meat), nutrition experts compare them to the egg. This doesn’t mean that all other sources of protein are less healthful or less important but does mean that an egg is an awesome way to get a few grams of protein. At 6 grams for one large egg, there are endless ways to add it to your diet. Salads, sandwiches, breakfasts or snack—an egg can fit in anytime!   Eggs Protein Calories Fat Egg, 1 boiled 6 g 68 5 g Egg white, 1 cooked 5 g 17 0 g Liquid egg substitute, 1.5 fl oz 5 g 23 0 g As you can see, protein is EVERYWHERE in our diet, and even without meat you can get enough every day; you just have to look in the right places! For more ideas for using these various plant-based proteins, check out our dailySpark series, Meat-Free Fridays for recipe and cooking ideas! Selected Sources Information Sheet: Protein from The Vegetarian Society (VegSoc.org) Various nutrient profiles from The World's Healthiest Foods (WHFoods.com) Want to learn more about going meatless? Check out SparkPeople's first e-book! It's packed with over 120 delicious meat-free recipes, plus tips and tricks for going meatless. Get it on Amazon for $2.99 and start cooking easy, wholesome veg-centric meals the whole family will love!Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=158

Best and Worst Salad Toppings

A few years back I typed up a list of New Year’s resolutions on a small piece of cardstock, laminated it, and put it in my wallet. On that list was the resolution to eat a salad every day, simply because eating salad always made me feel like I was doing something good for myself. After all, salad provides several vitamins and can fill you up while reducing your caloric intake. What could be healthier than a big, fresh salad? Unfortunately, many things, as I later found out. Salads can run the gamut of healthiness, depending on what is in them. Although that big bowl of greens may be packed full of antioxidants and fiber, it can also be laden with fat, cholesterol, and sodium—not to mention an overabundance of calories. Some restaurant salads can even contain more calories than a cheeseburger! Luckily, like most things in life, a salad is the outcome of several small decisions. To make sure you don't sabotage your healthy diet unintentionally, choose wisely the next time you order a salad from a restaurant or visit the salad bar. When dining out, don't be afraid to ask questions, make special requests (extra veggies, dressing on the side, light cheese) and ask about substitutions (like grilled chicken for breaded). Most restaurants will be happy to accommodate you as long as their kitchen is stocked with the ingredients you want. Here’s how to choose wisely next time you're making a salad at home or choosing one from a menu. Lettuce The foundation of most salads, lettuce adds substance, crunch, water, and fiber for very few calories—only about 10 per cup. But if you want all that and vitamins, too, toss out the iceberg and toss in the romaine, mixed baby greens and spinach. While iceberg lettuce is lower in nutrients (and still makes a decent choice if it's the only thing available), these other greens are rich in vitamins A, C and K, manganese, and folate. Protein Adding protein, such as lean meat, tofu, eggs or beans, will help bulk up your salad and keep you full longer. Unfortunately, many protein toppings are deep-fried, breaded and greasy, which adds unnecessary calories plus cholesterol, sodium and fat to your salad. Skimp on fattier toppings such as bacon and fried (breaded) chicken strips, and go for lean proteins instead. Grilled chicken, canned beans of all kinds, chickpeas, tofu, hardboiled eggs (especially whites), or water-packed tuna are leaner choices. Nuts and seeds are popular in salads, too, and while they’re a healthy source of good fats and some protein, they’re not exactly low-cal. If you choose to add them, watch your portions (1/2 ounce contains more than 80 calories). Cheese Restaurants know that people love cheese, so they tend to pile on multiple servings of it on their salads. It might be tasty, but it sends the calorie counts sky high! While cheese is a nutritious food that adds flavor, calcium, and protein to a salad, enjoy it in moderation due to its high fat content. Just a half-cup of cheddar cheese (the amount on many large restaurant salads) contains 18 grams of fat and 225 calories. To keep calories in check, use a single serving of cheese (approximately 2 tablespoons). Choose low-fat varieties as much as possible to save on saturated fat and calories. A smaller amount of a stronger-flavored cheese, such as Brie, feta, chevre, gorgonzola, sharp cheddar or bleu cheese will go a long way in helping you cut down on your portions. Pile on the Veggies Vegetables like bell peppers, grated carrots, sugar snap peas, and tomatoes provide flavor, fiber, and vitamins for few calories. Grated carrots, for example, have only 45 calories in a whole cup, and there are only about 20 calories in an entire red bell pepper. When building your best salad, use as many veggies as possible for extra filling power—and a nice crunch! Practice moderation when it comes to starchy vegetable toppings like corn and potatoes, which are higher in calories. And remember to go for a variety of colors to ensure you're getting several different nutrients and antioxidants in your salad bowl. Don't Forget the Fruit Don't leave fruit on the sidelines! Fresh, canned and dried fruits add a sweetness that can help temper the slightly bitter taste of greens and veggies. They also provide color and texture (not to mention nutrition) to your salad bowl. Chopped apples, pears, grapes, or mandarin oranges (canned in juice—not syrup—and drained) are excellent salad toppers. Chewy dried fruits (cranberries, raisins) work well, too, but they are also high in calories (so only use a sprinkle!). Avocados (and the guacamole made from them) are creamy and nutritious thanks to their heart-healthy fats, but they're also a concentrated sources of calories. Keep your use of avocado to a minimum if you're watching your weight. Crunchy Toppings Sesame sticks, crispy noodles and croutons are salty and crunchy but conceal lot of hidden fat. Better options include water chestnuts, apple slivers, a small serving of nuts, crumbled whole-grain crackers, and homemade croutons. To make your own low-fat croutons, just slice a large clove of garlic and rub it over both sides of a piece of whole-grain bread. Cut the bread into cubes and then brown it in the toaster or conventional oven. Dressing A very healthy salad could go very wrong with one too many shakes of oil or dressing. The main issue with dressing is its fat and sodium content—and the fact that people have trouble controlling their portions. Two tablespoons is an appropriate serving of dressing, but most restaurants serve much more than that, whether mixed in to your salad or served on the side. Those calories add up fast. When dining out, always ask for dressing on the side and dip your fork into the dressing before picking up your bite of salad. Caesar, ranch and other cream-based dressings (when not specified as low-fat) are calorie bombs worth avoiding. Look for dressings specified as "low-fat" that contain no more than 60 calories per serving. You can also add flavor for minimal calories by using salsa, vinegar or lemon juice. Salad may be the symbol of healthy eating, but not every salad is healthful—or diet-friendly. The healthfulness of your next salad depends on the simple choices you make when topping or dressing it. Perhaps my greatest discovery about salads was that because you can customize them so easily, you could make a huge main-course salad for a very small amount of calories. Pile in the lettuce and veggies, add a moderate amount of lean protein, sprinkling some cheese and a little something crunchy and measure a portion-controlled side of dressing, and you’ve got a dinner that won’t leave you feeling hungry.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1388

30 Ways to Revitalize Your Lunch Break

Lunchtime doesn't have to be bland or boring, just as it doesn't have to be a frenzied time to run errands or multitask. Our printable calendar provides 30 ideas to add a little adventure to your midday break. Click here to download and print your Adventurous Lunch Break Calendar. (You need Adobe Acrobat Reader to download this PDF.) If you think your friends or family members might benefit from these heart-healthy tips, share this calendar with them by clicking the "Share" button below.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1336

Umami: What You've Been Missing!

You've slimmed down your recipes, made healthy food swaps, and integrated vegetables into your meals. But do you ever feel like your food is missing something? When you finish eating, do you ever wonder why a meal just didn't hit the spot? You're probably missing umami. You've probably heard of the four basic tastes: bitter, sour, sweet and salty. Well, "umami," which means "yummy" in Japanese, is another distinct taste. Commonly found in fermented or aged foods, umami (pronounced ooh-mah-mee) adds that "mouth feel" to food. It makes your food feel richer, more delicious and more decadent. A key component in Chinese and Japanese cuisine, umami is starting to gain importance in Western cooking. American cooking tends to rely on fat or salt to get that feeling, but there are other, healthier ways to give your food and meals a little more oomph. Ever notice how parmesan makes pasta taste so much better? Or how much tastier ketchup makes your burgers? The parmesan, the tomatoes, and the beef all contain umami. Think about Japanese miso soup or almost any Chinese food. They're delicious and satisfying, thanks to umami-rich seaweed, fish, and soy sauce. Many foods are considered to have umami, including familiar foods like pepperoni pizza and hamburgers! And many condiments that seem to add "empty" calories (ketchup, steak sauce and Worcestershire sauce) actually help food feel more satisfying when you eat it. Here's a list of some umami rich foods:

By adding more of these foods to your meals, you can boost your satisfaction and potentially eat fewer calories overall and avoid overeating. A little goes a long way, and many foods rich in umami should be used as seasonings rather than main ingredients because they can be high in sodium and fat. Try adding a pinch of Romano cheese to steamed veggies or adding asparagus or mushrooms to your salad. If you're feeling decadent, put a pinch of crumbled bacon or a couple of sun-dried tomatoes in an egg white omelet. That could be just what hits the spot! Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1348

Health Care Worries Pull Crowd To Conservative Ohio Rep’s Town Hall

LIMA, Ohio — Speaking over constituents’ often-hostile shouts and angry murmurs, one of Congress’ most conservative Republicans told a tense town hall meeting here Monday that less government regulation — not more — is the solution to their rising health care premiums.

“What we want to do is make sure we have the best health care system in the world and bring back affordable insurance plain and simple. That’s what I’m trying to do. That’s what we continue to focus on,” said Rep. Jim Jordan, the co-founder of the House’s conservative Freedom Caucus. Its firm opposition to the GOP’s plan to replace the Affordable Care Act forced party leaders last month to yank their bill from a vote on the House floor.

But on the eve of Congress’ return to Washington after a two-week Easter recess, Jordan offered no clues to his party’s next move on a health care bill or the prospects for a government shutdown if Congress fails to agree before the Friday deadline on a bill to provide short-term funding to keep it operating.

More than 200 people attended the Ohio congressman’s 2 1/2-hour meeting, mostly pummeling him with questions and personal stories about their health care. Jordan heard from constituents with sick children, veterans who couldn’t access Veterans Affairs’ care and nervous families who feared what could happen to them if federal Medicaid funding is cut, among others.

Seated on black folding chairs in a windowless hall of the Lima Veterans Civic Center, many in the audience followed a practice that’s been common this year at congressional members’ town hall meetings — holding up red signs when they disagreed with Jordan and, less frequently, green signs when they agreed. Jordan, unruffled by opposition, drew laughs once when he referred to a woman in the crowd as “gentlelady,” in the formal way that male members of Congress sometimes address female members when the House is in session.

Tobias Buckell told the congressman the ACA’s mandate that insurers cover preexisting conditions had made it possible for both his wife, Emily, and him to have careers as freelancers — he as a science fiction writer and Emily as an e-book designer. Buckell, the father of twin 8-year-old daughters, told Jordan the only way he could risk that career choice was because he was able to buy insurance through the law’s exchanges. He has a genetic heart condition that he said had made him virtually uninsurable before.

“We’re going to be moved to a high risk pool, we’ll pay three times as much our current rate … how will that help me?” asked Buckell, 38.

Though the most vocal members of the crowd were largely in disagreement with Jordan’s views, a quiet minority in the front of the room shook their heads and waved green signs in agreement when the congressman responded to a question by saying he did not believe health care is a universal right.

[caption id="attachment_723898" align="alignright" width="270"] (Rachel Bluth/KHN)[/caption]

“I do not believe health care is a right. Rights are not given to us by the government, rights come from God, although Jim acknowledged that the American people have come to accept it as a right,” said Linda Gentry, a 66-year old constituent who works for an insurance company.

Of the 17 questions Jordan was asked, 13 related to health care. Lisa Robeson, the event’s moderator, estimated that around half of the 45 questions submitted in advance focused on the topic.

Jordan’s comments on the federal government’s role in solving the opioid crisis brought what might have been his audience’s most negative reaction of the night.

Ohio has been especially hard hit in recent years. It led the nation in opioid overdose deaths in 2015, according to the Kaiser Family Foundation, while Dayton, just an hour and a half south of Lima, topped a criminal justice group’s national ranking of America’s most drugged-out cities last year.

“I’m not convinced the federal government giving more money will solve the problem,” Jordan said. Instead of a “grand scheme” handed down from Washington, he suggested churches, schools and families are best equipped to handle the opioid epidemic – a remark that raised a sea of red signs across the room.

Jordan’s 4th District touches the northern part of the state near Lake Erie, and includes rural areas and suburbs of Columbus, the state capitol. He has been the district’s congressman since 2007 and he has little reason to be alarmed by contentious town halls. Jordan was reelected last November with more than 68 percent of the vote.

By the end of Monday’s town hall, some of Jordan’s constituents were divided on whether they’d heard what they came to find out.

“It’s clear to me that there is sort of a vague idea what the Republican replacement would be, and I don’t think we got a statement about that,” said Robert Kemp, 62, a health care economist that also rose to speak in favor of universal health care.

Barbara Mayer, 81, a retired teacher, didn’t mind the lack of specificity. She said it was unfair for people to demand comment on a measure that hasn’t been finalized yet.

“They’re quoting things about what Trump’s bringing out and it isn’t even public yet,” Mayer said. “People aren’t giving the new Congress a fair trial.”

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