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Looking for professional dental service in Rocky Mountain House? Our Mountainview Dental Centre with a wide range of services from routine check-ups, cosmetic dentistry, and emergency treatments. Book your appointment today and experience exceptional dental care in a comfortable environment!
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Get top-notch dental services Rocky Mountain House at MountainView Dental. Our skilled team offers comprehensive dental care, including preventive, restorative, and cosmetic treatments.
#porcelain veneers rocky mountain house#teeth whitening rocky mountain house#dental services Rocky Mountain House
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Mountainview Dental is a dental clinic located in the heart of the city. They provide a wide range of services, including general dentistry, cosmetic dentistry, and family dentistry. They have an experienced team of dentists who are dedicated to providing you with the best possible dental care.
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Top Three Hotels in Colorado Springs, CO 80903
Colorado Springs is a city in Colorado, USA. It is one of the major cities in the state and has been ranked as one of the business-friendly cities in the state. It is the seat of El Paso county and it is one of the well known tourist sites in the country. As a result of its location at the east of the rocky mountain, it experiences a dry winter and a semi arid climate. The tourists in the city enjoy this climate as well as luxurious hotels with many features that provide comfort away from home. There are many hotels in Colorado Springs but the top three of them are:
· The Academy Hotel: this is a luxurious hotel located at 8110 N. Academy Blvd.Colorado Springs, Colorado 80920. It is a beautiful hotel that provides services like indoor heated pool, cozy lounge, standard bedrooms and complimentary breakfast.
· The Antlers: this is a modern hotel located at 4 S Cascade Ave, Colorado Springs, CO 80903,USA. It has state of the art bedrooms with a beautiful view of the mountains. It also has recreational centers.
· The Broadmoor: this hotel has 779 rooms and it is located at El Paso , Colorado. It is a beautiful hotel designed in a Renaissance style architecture. It houses Penrose Room restaurant on top of the building. Apart from the climate and hotels, the ability for businesses to thrive is one of the reasons the city gets lots of visitors.
Member Spotlight
One Stop Dental
219 W Colorado Avenue #206
Colorado Springs, CO 80903
(719) 447-1199
Both tourists and residents of Colorado Springs are privileged to enjoy quality dental care from the professionals pretension clinics like One Stop Dental. The aim of these dental association health professionals is to give the people an healthy and confident smile. Learn more about them by checking their website.
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Retirement in Puerto Vallarta - What is Heading on South of the Border?
Consciousness, toddler boomers never be late for the celebration! If you have not observed what's possible on south of the border, possessing only read through about illegal immigration north of the border, the subsequent may perhaps probably show to be fairly awakening and insightful.
Puerto Vallarta, Mexico, a sleepy insignificant Mexican fishing village positioned in the foothills of the Sierra Madres on Banderas Bay alongside the Mexican Riviera is no longer sleepy or insignificant. The populace has in essence exploded due to the fact the filming of "The Night time of the Iguana" in 1963. Vallarta has grown from two,000 inhabitants prior to 1963 to the most recent decide of 350,000 inhabitants in 2007. Suitable now, the populace of much better PV would make it the subsequent most significant town in the Mexican condition of Jalisco, only driving Guadalajara. You should refer to the pursuing graph in purchase to check this explosive improvement and its projection for the adhering to 10 many a long time: (Make confident you pay back a pay a visit to to the web web page under for graph facts) Placing this in issue of view, you are going to discover the earlier pointed out chart implies that Vallarta has now attained the sizing of St. Louis and assuming the projected growth retains accurate, it will be equivalent in proportions to Cleveland in just ten many years. The sizeable just take take note of curiosity is that St Louis, Pittsburgh, Cleveland, and so forth., will all most likely display minimum to no, it's possible even detrimental growth, whilst PV is expected to develop by still an additional 50% all through the upcoming 10 many many years. Now, we inquire, what is heading on down there? First, permit us look at who's moving there. The complete sector of Vallarta is dependent on tourism and the immigration of North Us inhabitants. The US information from the IRS returns implies a development from two hundred,000 US citizens a number of yrs ago to 750,000 Men and women in america residing in Mexico in 2005. Of the 750,000 Us people, we can only estimate that fifty,000 Men and women in the us and Canadians now get hold of Vallarta household. With the tens of many quantities of condos and villas at this time beneath developing or in the ten 12 months placing up section, we can only envision that by 2017, the North American inhabitants in better PV will be someplace relating to a hundred,000 and a hundred and fifty,000 retirees. The adhering to are some of the very good motives for this explosive progress: Local climate--The 7 month "exceptional time" of November by implies of Might well has an regular every day temperature of seventy three*F with nearly no probability of rain. Environment--Vallarta, positioned in the foothills of the Sierra Madres on the Banderas Bay, a person specific of the best and most amazing bays in the globe, is in the center of the Mexican Riviera on the Pacific Ocean. Beautiful seashore locations, rocky cliffs, mountain sides overlooking the bay, tropical bouquets and wildlife, and all the sights that a human being would hope to obtain in Paradise. Protected--With tourism getting the existence blood of the economic technique, North People today in the usa are "off restrictions" pertaining to any style of authorized workout. Because guns are strictly prohibited in Mexico, burglaries, robberies, etcetera., are pretty much unheard of. The principal aim of most all of the youthful technology of natives is to ensure all North People in america a pleasurable and safe just take a seem at to Paradise so that they are likely to return shortly and usually. Stress of a terrorist attack in Vallarta? Ignore it! Friendliness--In 2001, a viewers poll taken by Conde Nast journal in depth Vallarta as the friendliest vacation resort wanted destination in the world. The locals take care of North People today in the us with dignity, respect, and as mates, household, and basically as royalty. Cleanse up Foods and H2o--The explosive populace expansion has triggered a full revamping and rising of the town infrastructure. This functions the freeway method, electrical power period and distribution, and of education course, consuming drinking water treatment and distribution units. The water is pure and harmless to consume from the tap during the city. All meals things merchandise are now available in the pretty a several new contemporary supermarkets equivalent to the very best in the States. Foodstuff for home or restaurant consumption is intently monitored for cleanliness and managed as in North The usa. Health care treatment method--Two new enormous modern hospitals and just a person lesser present day-day clinic in Vallarta are totally capable of handling all emergencies as proficiently as challenging surgical strategies. Contemporary dental clinics are also in Vallarta offering crowns, caps, implants, as correctly as all the basic dental solutions. When you loved this information along with you wish to be given more information about Fishing in Vallarta generously pay a visit to our own site. All of the wellness pros and dentists converse English and loads of of them have professional at the pretty the very least some qualified coaching in the States. Good friends--Every single single North American that you see in Vallarta, and they are easy to location, is maybe on family vacation or retired, i.e., none of them have to go to accomplish tomorrow! They are all open up to new friendships and new comers are frequently welcome. It can be 1 substantial party with no looming pressures of the business workplace or the commuter vacation in the morning. Language--Due to the fact the general overall economy in PV is based mostly on tourism, it is crucial to connect English. As a outcome, it is estimated that at the really least 80% of the youthful era is now conversing or at least knowing English. Dialogue is not a concern in Vallarta and there is no have to have to come across out Spanish. Vacation Time--Even with the truth that Vallarta is on the equivalent latitude as Hawaii, it is only two to 3 a number of several hours from most of the US cities. All the highways coming down from the US are now super fashionable tollroads and the generate to PV can be manufactured in two instances from the border. Connectivity--With higher velocity on line help available citywide, on the internet primarily dependent telecommunications, and satellite Television available all about the position, you have the correct very same get in contact with with the entire globe that you would have where ever in the US or Canada. Actions--Overall planet class deep sea fishing has been for a number of many years, and will commonly be, a big activity in Vallarta. There are now 7 lovely golfing plans with more beneath enhancement. There are hundreds of tennis courts, h2o pursuits, night day to day residing galore, and as nicely a lot of golf equipment and providers to level out. If you have nothing at all to do in PV, it actually is only for the reason that which is your alternate! Benefit of Residing--The expense of common staples is about the comparable as in North The united states, even so, housing is roughly fifty % the price and housing similar taxes are a portion of these in the States. All products and solutions and products and services are a 50 % to a third of these in the US like specialist healthcare and dental remedy just simply because labor fees are so substantially decreased. The selling price of eating, outdoor routines, and so forth., are really substantially in line with folks in the States. Financial Security--The Mexican peso, at somewhere all over ten.8 pesos per US dollar, has held firm for the earlier 10 a lot of decades. There are no devaluation troubles at this time as the Mexican economic system booms. Political Stability--The PAN occasion has ruled in Mexico specified that 2000 and will remain in energy at minimum right up until 2012, assuring a twelve calendar year consecutive operate of Mexico getting to be governed by Harvard graduates! Avoidable to say, they are specialist-US and pleasant to the North. Economical expense--Residence values have tripled for the duration of the earlier ten yrs and are envisioned to double once again all via the future 5 yrs. With the booming all round financial state, the Mexican inventory marketplace has also tripled by the past 10 quite a few a long time. There is no gradual down of progress in the foreseeable impending. With any luck ,, the earlier described 15 merchandise will offer some rationalization for the booming financial process and explosive expansion in Vallarta. They say that the party's not previously mentioned, that it has only just began. The Mexican Countrywide Tourism Improvement Basis (Fonatur), has specified a 30 mile stretch of pristine Pacific Ocean shoreline north of Vallarta as the new Riviera Nayarit, anywhere a lot more than five billion kilos will be invested throughout the pursuing 10 quite a few decades building 30,000 new occupations as they develop shut to twenty,000 new condos, villas, motels, and so forth. As the North Men and women continue on to flock to Paradise, the infrastructure advancement and forthcoming scheduling functions continue at a torrid tempo.
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Living in Calgary
I've been living in Calgary for 2 years already, and I think it's time to recap few things about living here, pros/cons and possible remedies to the issues you might face here.
Please note that life now is different compared with what you could have even 10 years ago. I guess both Vancouver and Calgary (as those are the only cities I've lived in long enough) were nice for newcomers (by newcomers I've meant people who just moved there and didn't have a lot of money to settle in). Right now, both cities have changed and introduced more obstructions to residents.
That's why despite a lot of cons of Calgary below, it doesn't mean that this city shouldn't be considered for living. It's all about tolerance and life choices. If you have proper expectations, it will be easier to adapt. There are definitely people who love Calgary (esp. if they are mortgage-free and/or love winter activities), and who hate it (e.g. who got their houses ruined by hail or flood).
I'm not going to provide a simple list of pros/cons (as cons for me could be pros for you, for example, long winter season), but rather take the most important areas and describe them.
Services
Calgary is definitely a family-friendly city, much more friendlier than Vancouver. Schools and kindergartens are not so busy and expensive. If you want some particular school, you still need to be in the wait-list though, but if you’re not picky, there are definitely some options available. All levels of education, including universities, are presented.
It’s not a problem to get the family doctor too. Walk-in clinics are not so busy too, and emergency wait times are bearable.
Entertainment options are quite good: museums, libraries, one of biggest YMCA in Canada, Calgary Philharmonic Orchestra, Alberta Ballet, Calgary Zoo etc
However, I have to note the prices of the dental services. Alberta has the highest prices for dental. Historically, oil and gas companies provided full dental coverage and didn’t care much about prices. It’s all changed, but the prices are still high. I hope it’s going to change, but right now please be careful about it.
Transportation
I can’t say much about public transit, I guess it's ok-ish in downtown and not so good in the outskirts, but that's applicable for all cities in general. For reference, in 2020 the single fare for adults is $3.50 for 90 minutes (there are no zones in Calgary). There is CTrain too (light rail transit), but it's not as extensive as in Vancouver. There are some plans to improve it (e.g. add Green Line), but it has been delayed many times already, and it's difficult to predict when they will finish it.
Calgary is a private car city - it has 2 major highways (100 km/h limit) through the city, plus there some long streets and avenues which could be considered minor highways (the speed limit up to 80 km/h). Essentially, you can get to any location in Calgary in 30 minutes on average. I guess the only real traffic jams I’ve seen was during Stampede, and it’s just a week in a year. In general, it’s a real pleasure to drive here, especially if you leave Calgary core and takes any of the scenic routes it has on the outskirts and further in the numerous parks.
Despite that there are few obstacles for being a happy driver here:
a lot of speed cameras. Speed tickets are a source of income for the city, and sometimes they abuse it. Radars are legal, including hidden mobile radars, and the abuses include sudden speed sign changes and school zones limits which disregard the school days, and enforced from 7am to 9pm everyday including weekends and holidays.
gravel on the road. They use sharp-edged gravel in the winter, and considering speeds on highways and lots of semi, you may forget about having a nice non-cracked windshield and sunroof (I've got huge cracks on both). Glass insurance is not included in the basic packages, and should be bought separately.
a note about insurance. It's not cheaper than ICBC, it's actually more expensive and has more restrictions (at least for immigrants).
a lot of construction. Mostly closer to downtown, but major highways are affected too. Fortunately, there are not many two-lane highways like in BC (mostly 4 or 6 lanes), so the delays are not so huge, but could easily take 20-30 minutes.
My recommendations: don’t buy luxury cars (not only winter tires and windshields are expensive, it’s difficult to maintain the low speed), get glass insurance ASAP, use apps like Waze to check the road condition ahead.
Climate
Calgary has more sun than Vancouver, however I can't say it's a sunny city (I guess Canada just in general doesn't have a lot of sun). Moreover, the sun doesn't matter so much as it doesn't mean that the city is getting a lot of its heat - it has snow for at least 6 months a year (first snow could fall in Sep, but usually it doesn’t stay for long, and the last snow is melted in Apr/May).
Sun is very bright (due to altitude), and the humidity is low. Nice green grass requires either irrigation or rainy days. There is no dedicated line for irrigation, so you would need to use the “drinking” water, and a lot of it.
A note about “drinking” water - its quality definitely worse than in Vancouver (it's quite hard and has other chemicals). While they allow us to drink it from the tap, we don't risk it, plus we don't like having stains on every glass surface we have in the house. Fortunately, it's possible to avoid it with softener (plus we have a reverse osmosis system for actual drinking). It’s not cheap though, but it’s a long term investment that could be worth thinking about (we’ve installed the systems from https://www.jugfree.com/ and they have prices there for reference).
Short summers don't always bring warmth and sun only, but also heavy rains, hail and tornado. Hail damages houses and cars, and the last storm in Calgary (June 2020) has the estimation in damages nearly $1 billion: https://calgaryherald.com/news/local-news/cost-of-damage-from-weekend-storm-could-total-1-billion-nenshi
Winter is not so harsh though due to Chinook. Visually it looks like huge dark clouds cover the city and the temperature is rising. Even without it, the winter is mild enough, but it's not always good. As the day/night temperature could differ in 20C, the ice (usual or black) is the real issue here, and winter tires are strongly recommended.
My recommendations: South Calgary has a better climate and usually hail is not so bad here (we live in South East). It’s better to avoid the north (besides that, North East has a high crime rate).
Real Estate
The houses are cheaper in Vancouver, definitely. Medium income families can afford decent living conditions here. Surely, nothing fancy, the same overpriced wood frame houses as in North America overall, as the construction lobby is very strong here, and having sound-proof, properly thermal insulated houses, preferably from bricks, is a luxury.
Please note though that the taxes are increasing. As Calgary (and Alberta overall) in a financial crisis (they put in motion a lot of expensive projects when the oil/gas industry boomed, and still couldn’t recover after its collapse), so they burden their problems on residents.
Also, they have tons of other cash grabs there (carbon tax, some administrative fees nobody can explain), so the utilities are not cheap either. Insurance is also one of the highest in Canada (the official excuse is they are losing money because of hail storms and other disasters).
My recommendations: Towns near Calgary could be worth researching (like Okotoks or Chestermere). Surely, there are some disadvantages living there (for example, I’m literally 5 minutes drive from both major highways, so don’t have to deal with the slow traffic), but it’s definitely cheaper. https://www.realtor.ca/ is a Canada-wide database, you can look up the property ahead.
Geography
Calgary has quite a good location if you like nature. It has the unique position to provide access to several big natural areas at once, so if you have bad weather in one region, you can drive to the opposite direction and still find something nice. Please note that Calgary has the international airport with the decent choice of direct flights too.
On the west:
Banff National Park. It's a two hour drive (depending on traffic jams, usually they have some esp. on weekends). Please note that you don’t necessarily need to visit Banff and the park, and can find nice places near Canmore and Kananaskis (K-country).
East K-country, has several provincial parks. More accessible, shorter (1+ hour) drive (not necessary Hwy 1, but also Hwy 22), almost no traffic jams. A lot of ATV options, lakes and mountain hikes.
On the east:
Badlands. Surely, the most famous is Drumheller region (1.5+ hour drive), but they have much more than that as the badlands are presented in many places in Southeast Alberta, like Dinosaur Provincial Park (2h drive).
A lot of lakes with kayaking, fishing and jet skis options. The examples are Lake McGregor (a little over an hour drive) and Lake Newell (2 hours drive).
On the south:
Waterton Lakes National Park, 2.5 hours drive, a lot of activities there, but due to recent forest fires not everything is open.
US border (the traffic is much lighter compared with Vancouver, almost no waits). The prominent examples are Glacier National Park, Montana (3 hours drive) and Yellowstone National Park, Wyoming (10 hours drive).
On the north:
Shortcut to Jasper. While driving through Banff in theory faster (5 hours), in reality due to constructions, traffic jams and two-lane Icefield Parkway it could be faster to drive through Rocky Mountain House (6 hours).
There are a lot of parks there too, we just never got a chance to explore them yet. I guess Big Hill Springs Provincial Park could be an example of those (1 hour drive).
Shopping
It’s easier to shop here due to easy commuting and close availability of the big stores: Costco, Walmart, Superstore, Save-on-Foods, Home Depot, Lowes etc. Definitely, there are big malls (i.e. Chinook Center, CF Market Mall), outlets (i.e. CrossIron Mills) and big specialized stores (i.e. Cabela’s) too.
Diversity is not so good though - mostly North America merchandise. We found only one decent store for Asian products: T&T Supermarket. There are some small Asian stores too (mostly in the North), but they usually don’t have anything extra special compared with T&T.
Seafood options are not so great too (both in restaurants and in stores). Oysters and lobsters are quite uncommon for Calgary. I guess T&T has the best selection, but still less than in Vancouver.
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Detox Centers In Pecos New Mexico 87552
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Post Office in Pecos, New Mexico on S Main St. Operating hours, phone number, services information, and other locations near you. Pecos Post Office. 63 S Main St, Pecos, NM 87552.
Postal Code: 87552. Locality: Pecos. State: New Mexico (NM). Country: United States. Write a review. Similar Places in Pecos. Pecos Mental Health Center. Bronco Lane, Pecos, NM 87552 +1 505-757-6112.
Garcia Auto Works PO Box 199 Pecos, NM 87552 Phone: (505) 757-6779 This email address is being protected from spambots. He focuses on all types of surveys near Pecos, New Mexico and large acreage surveys in the region. Getting around swiftly in the backcountry is his specialty.
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Address: PO Box 710 Pecos, NM 87552 view map The Pecos Valley Medical Center (PVMC) is a Federally Qualified Health Center (FQHC) located in Pecos New Mexico. PVMC has immediate openings for our bupenorhpine/suboxone program. PVMC currently provides comprehensive primary and dental care. PVMC also offers Behavioral Health Services including…
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The most common substances abused in the city of Pecos, New Mexico, are: meth, heroin, cocaine, alcohol, marijuana, opana, fentanyl, inhalants, spice, restoril, librium, and methadone. There are just over 25 different types of addiction treatment facilities available to addicts in the Pecos area.
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Pecos Valley Medical Center, Inc. (PVMC) is a not-for-profit community health center serving western San Miguel and eastern Santa Fe County residents and visitors. Email: [email protected]. Mailing Address: PO BOX 710, Pecos, NM 87552.
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Address: PO Box 710 Pecos, NM 87552 view map The Pecos Valley Medical Center (PVMC) is a Federally Qualified Health Center (FQHC) located in Pecos New Mexico. PVMC has immediate openings for our bupenorhpine/suboxone program. PVMC currently provides comprehensive primary and dental care. PVMC also offers Behavioral Health Services including…
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Pecos is a village in San Miguel County, New Mexico, United States. The population was 1,441 at the 2000 census, growing much faster than in other parts of San Miguel County, partly because Pecos is within commuting distance of Santa Fe.
Pecos National Historical Park. United States. New Mexico (NM). Things to Do in Pecos. Pecos National Historical Park. For more information about camping and other permits from the Forest Service, contact: Pecos District Ranger Station, Box 429, Pecos, NM 87552 or call (505) 757-6121.
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Address: PO Box 710 Pecos, NM 87552 view map The Pecos Valley Medical Center (PVMC) is a Federally Qualified Health Center (FQHC) located in Pecos New Mexico. PVMC has immediate openings for our bupenorhpine/suboxone program. PVMC currently provides comprehensive primary and dental care. PVMC also offers Behavioral Health Services including…
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Obamacare Co-Ops Down From 23 to Final ‘3 Little Miracles’
New Mexico Health Connections’ decision to close at year’s end will leave just three of the 23 nonprofit health insurance co-ops that sprang from the Affordable Care Act.
One co-op serves customers in Maine, another in Wisconsin, and the third operates in Idaho and Montana and will move into Wyoming next year. All made money in 2019 after having survived several rocky years, according to data filed with the National Association of Insurance Commissioners.
They are also all in line to receive tens of millions of dollars from the federal government under an April Supreme Court ruling that said the government inappropriately withheld billions from insurers meant to help cushion losses from 2014 through 2016, the first three years of the ACA marketplaces. While those payments were intended to help any insurers losing money, it was vitally important to the co-ops because they had the least financial backing.
Lauded as a way to boost competition among insurers and hold down prices on the Obamacare exchanges, the co-ops had more than 1 million people enrolled in 26 states at their peak in 2015. Today, they cover about 128,000 people, just 1% of the 11 million Obamacare enrollees who get coverage through the exchanges.
The nonprofit organizations were a last-minute addition to the 2010 health law to satisfy Democratic lawmakers who had failed to secure a public option health plan — one set up and run by the government — on the marketplaces. Congress provided $2 billion in startup loans. But nearly all the co-ops struggled to compete with established carriers, which already had more money and recognized brands.
State insurance officials and health experts are hopeful the last three co-ops will survive.
“These are the three little miracles,” said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University, in Washington, D.C.
Maine Aided in Supreme Court Victory
The Maine co-op, Community Health Options, helped bring competition to the state’s market, which has had trouble at times attracting insurance carriers, said Eric Cioppa, who heads the state’s bureau of insurance.
“The plan has added a level of stability and has been a positive for Maine,” he said.
The co-op has about 28,000 members — down from about 75,000 in 2015 — and is building up its financial reserves, Cioppa said. Community Health Options is one of three insurers in the Obamacare marketplace in Maine, the minimum number experts say is needed to ensure vibrant competition.
Kevin Lewis, CEO of the plan, attributed its survival to several factors, including an initial profit in 2014, the year the ACA marketplaces opened, that put the plan on a secure footing before several years of losses. He also credited bringing most functions of the health plan in-house rather than contracting out, diversifying to sell plans to small and large employers, and securing lower rates from two health systems during a couple of difficult years.
Jay Gould, 60, a member who offers the plan to workers at his small grocery in Clinton, has been happy with the plan. “They have great customer service, and it’s good to know when I am talking to someone that they are from Maine,” he said.
Central Aroostook Association, a Presque Isle nonprofit that helps children with intellectual disabilities, switched to the co-op last year to save 20% on its health premiums, said administrator Tammi Easler. Having a Maine insurer means any issues can be dealt with quickly, she said. “They are readily available, and I never have to wait on hold for an hour.”
The co-op, which made a $25 million profit each of the past two years, has proposed dropping its average premiums by about 14% in 2021, Lewis said.
Community Health was one of the lead plaintiffs in the case before the Supreme Court and expects to get $59 million in back payments from the settlement.
The federal decision to suspend those so-called risk corridor payments — designed to help health plans recover some of their losses — was one of the factors that caused many of the co-ops to fail, Corlette said. Republican critics of the ACA, however, blame poor management by the plans and lack of oversight by the Obama administration.
Insurers are in talks with the Trump administration about whether the $13 billion due the carriers must be added to their 2020 balance sheet or could be counted toward operations from prior years. This year, insurers are generally banking large profits since many people have delayed non-urgent care because of the COVID-19 pandemic. Since the ACA limits insurers’ profit margins, adding that federal windfall to this year’s ledger might mean many insurers would have to pay out most of the money to their consumers. If the money is applied to earlier years, the insurers could likely keep more of it to add to their reserves.
Too Much Competition in New Mexico
The Supreme Court ruling came too late for New Mexico Health Connections, which lost nearly $60 million from 2015 to 2017. The co-op would have received $43 million in overdue payments, but, in an effort to raise needed cash, it sold that debt to another insurer in 2017 for a much smaller amount.
Marlene Baca, CEO of the co-op, which made a $439,000 profit in 2019, said its goal of bringing competition into the market was achieved, since five other companies will be enrolling customers this fall for 2021. Yet, that competition eventually led to the plan’s decision to end operations, announced last month.
With only 14,000 members, it made no sense to continue operating due to high fixed administrative costs, she said. Her plan was also hurt by the slumping economy this year, which pushed many state residents out of work and made more than 3,000 members eligible for Medicaid, the state-federal health program for the poor.
“We did our very best,” Baca said, noting that her company is closing with enough money to pay its outstanding health claims. Many other co-ops that shuttered were closed out by their states and unable to meet all their debts to health providers, she said.
Montana’s Co-Op Is Expanding
The Mountain Health Co-Op, with about 32,000 members, has just two competitors in its home state of Montana and four in Idaho.
A big factor behind its survival was that the plan received a $15 million loan in 2016 from St. Luke’s Health System, Idaho’s largest hospital provider, said CEO Richard Miltenberger. Although he wasn’t working for the co-op at that time, Miltenberger said, it is his understanding that the hospital wanted to help maintain competition in that marketplace.
The co-op is expecting $57 million from the Supreme Court victory.
“We are in excellent shape,” Miltenberger said. The plan, which paid back the St. Luke’s loan and made a $15 million profit in 2019, added vision benefits this year and is offering a dental exam benefit for next year. It’s also providing most insulin and medications for asthma and chronic obstructive pulmonary disease to members without any copayment to help ensure compliance.
The insurer is moving into Wyoming for 2021, which will end the Blue Cross plan monopoly in that state’s Obamacare marketplace, he said.
Wisconsin’s Mystery Donor
Wisconsin’s Common Ground Healthcare Cooperative was on the verge of ending operations in 2016 when it received a lifesaving $30 million loan, said CEO Cathy Mahaffey. The insurer has refused to identify the benefactor other than to say it was not a person or company doing business with the plan.
In 2018, Common Ground was the only health plan in seven northeastern Wisconsin counties, she said. Today, the co-op has about 54,000 members and faces competition from two to five carriers in the 20 counties where it operates.
Common Ground, which recorded a $73 million profit last year, expects to receive about $95 million from the Supreme Court case victory.
Wisconsin’s decision not to expand Medicaid under the health law has benefited the co-op because people with incomes from 100% to 138% of the federal poverty level ($12,760 to $17,609 for an individual) are ineligible for Medicaid and must stay with marketplace plans for coverage. In states that expanded Medicaid, everyone with incomes under 138% of the poverty level is eligible.
Another factor was its decision in 2016 to eliminate the broad provider network offering and sell a plan offering only a narrow network of doctors and hospitals, allowing it to benefit from lower rates from its providers, according to Mahaffey.
“We are very strong financially,” she said.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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Obamacare Co-Ops Down From 23 to Final ‘3 Little Miracles’ published first on https://nootropicspowdersupplier.tumblr.com/
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Obamacare Co-Ops Down From 23 to Final ‘3 Little Miracles’
New Mexico Health Connections’ decision to close at year’s end will leave just three of the 23 nonprofit health insurance co-ops that sprang from the Affordable Care Act.
One co-op serves customers in Maine, another in Wisconsin, and the third operates in Idaho and Montana and will move into Wyoming next year. All made money in 2019 after having survived several rocky years, according to data filed with the National Association of Insurance Commissioners.
They are also all in line to receive tens of millions of dollars from the federal government under an April Supreme Court ruling that said the government inappropriately withheld billions from insurers meant to help cushion losses from 2014 through 2016, the first three years of the ACA marketplaces. While those payments were intended to help any insurers losing money, it was vitally important to the co-ops because they had the least financial backing.
Lauded as a way to boost competition among insurers and hold down prices on the Obamacare exchanges, the co-ops had more than 1 million people enrolled in 26 states at their peak in 2015. Today, they cover about 128,000 people, just 1% of the 11 million Obamacare enrollees who get coverage through the exchanges.
The nonprofit organizations were a last-minute addition to the 2010 health law to satisfy Democratic lawmakers who had failed to secure a public option health plan — one set up and run by the government — on the marketplaces. Congress provided $2 billion in startup loans. But nearly all the co-ops struggled to compete with established carriers, which already had more money and recognized brands.
State insurance officials and health experts are hopeful the last three co-ops will survive.
“These are the three little miracles,” said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University, in Washington, D.C.
Maine Aided in Supreme Court Victory
The Maine co-op, Community Health Options, helped bring competition to the state’s market, which has had trouble at times attracting insurance carriers, said Eric Cioppa, who heads the state’s bureau of insurance.
“The plan has added a level of stability and has been a positive for Maine,” he said.
The co-op has about 28,000 members — down from about 75,000 in 2015 — and is building up its financial reserves, Cioppa said. Community Health Options is one of three insurers in the Obamacare marketplace in Maine, the minimum number experts say is needed to ensure vibrant competition.
Kevin Lewis, CEO of the plan, attributed its survival to several factors, including an initial profit in 2014, the year the ACA marketplaces opened, that put the plan on a secure footing before several years of losses. He also credited bringing most functions of the health plan in-house rather than contracting out, diversifying to sell plans to small and large employers, and securing lower rates from two health systems during a couple of difficult years.
Jay Gould, 60, a member who offers the plan to workers at his small grocery in Clinton, has been happy with the plan. “They have great customer service, and it’s good to know when I am talking to someone that they are from Maine,” he said.
Central Aroostook Association, a Presque Isle nonprofit that helps children with intellectual disabilities, switched to the co-op last year to save 20% on its health premiums, said administrator Tammi Easler. Having a Maine insurer means any issues can be dealt with quickly, she said. “They are readily available, and I never have to wait on hold for an hour.”
The co-op, which made a $25 million profit each of the past two years, has proposed dropping its average premiums by about 14% in 2021, Lewis said.
Community Health was one of the lead plaintiffs in the case before the Supreme Court and expects to get $59 million in back payments from the settlement.
The federal decision to suspend those so-called risk corridor payments — designed to help health plans recover some of their losses — was one of the factors that caused many of the co-ops to fail, Corlette said. Republican critics of the ACA, however, blame poor management by the plans and lack of oversight by the Obama administration.
Insurers are in talks with the Trump administration about whether the $13 billion due the carriers must be added to their 2020 balance sheet or could be counted toward operations from prior years. This year, insurers are generally banking large profits since many people have delayed non-urgent care because of the COVID-19 pandemic. Since the ACA limits insurers’ profit margins, adding that federal windfall to this year’s ledger might mean many insurers would have to pay out most of the money to their consumers. If the money is applied to earlier years, the insurers could likely keep more of it to add to their reserves.
Too Much Competition in New Mexico
The Supreme Court ruling came too late for New Mexico Health Connections, which lost nearly $60 million from 2015 to 2017. The co-op would have received $43 million in overdue payments, but, in an effort to raise needed cash, it sold that debt to another insurer in 2017 for a much smaller amount.
Marlene Baca, CEO of the co-op, which made a $439,000 profit in 2019, said its goal of bringing competition into the market was achieved, since five other companies will be enrolling customers this fall for 2021. Yet, that competition eventually led to the plan’s decision to end operations, announced last month.
With only 14,000 members, it made no sense to continue operating due to high fixed administrative costs, she said. Her plan was also hurt by the slumping economy this year, which pushed many state residents out of work and made more than 3,000 members eligible for Medicaid, the state-federal health program for the poor.
“We did our very best,” Baca said, noting that her company is closing with enough money to pay its outstanding health claims. Many other co-ops that shuttered were closed out by their states and unable to meet all their debts to health providers, she said.
Montana’s Co-Op Is Expanding
The Mountain Health Co-Op, with about 32,000 members, has just two competitors in its home state of Montana and four in Idaho.
A big factor behind its survival was that the plan received a $15 million loan in 2016 from St. Luke’s Health System, Idaho’s largest hospital provider, said CEO Richard Miltenberger. Although he wasn’t working for the co-op at that time, Miltenberger said, it is his understanding that the hospital wanted to help maintain competition in that marketplace.
The co-op is expecting $57 million from the Supreme Court victory.
“We are in excellent shape,” Miltenberger said. The plan, which paid back the St. Luke’s loan and made a $15 million profit in 2019, added vision benefits this year and is offering a dental exam benefit for next year. It’s also providing most insulin and medications for asthma and chronic obstructive pulmonary disease to members without any copayment to help ensure compliance.
The insurer is moving into Wyoming for 2021, which will end the Blue Cross plan monopoly in that state’s Obamacare marketplace, he said.
Wisconsin’s Mystery Donor
Wisconsin’s Common Ground Healthcare Cooperative was on the verge of ending operations in 2016 when it received a lifesaving $30 million loan, said CEO Cathy Mahaffey. The insurer has refused to identify the benefactor other than to say it was not a person or company doing business with the plan.
In 2018, Common Ground was the only health plan in seven northeastern Wisconsin counties, she said. Today, the co-op has about 54,000 members and faces competition from two to five carriers in the 20 counties where it operates.
Common Ground, which recorded a $73 million profit last year, expects to receive about $95 million from the Supreme Court case victory.
Wisconsin’s decision not to expand Medicaid under the health law has benefited the co-op because people with incomes from 100% to 138% of the federal poverty level ($12,760 to $17,609 for an individual) are ineligible for Medicaid and must stay with marketplace plans for coverage. In states that expanded Medicaid, everyone with incomes under 138% of the poverty level is eligible.
Another factor was its decision in 2016 to eliminate the broad provider network offering and sell a plan offering only a narrow network of doctors and hospitals, allowing it to benefit from lower rates from its providers, according to Mahaffey.
“We are very strong financially,” she said.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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from Updates By Dina https://khn.org/news/obamacare-co-ops-down-from-23-to-final-3-little-miracles/
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Mountainview Dental Centre: Exceptional Dental Services in Rocky Mountain House
Mountainview Dental Centre offers comprehensive dental care. our team provides various services, including routine check-ups, treatments, and cosmetic procedures. Patient comfort is a priority, and the latest dental technology ensures high-quality results. For exceptional dental services in Rocky Mountain House, visit Mountainview Dental Centre. Your smile is our top priority.
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Orthodontic Services Rocky Mountain House
Mountain View Dental in Rocky Mountain House! We are proud to offer comprehensive orthodontic services to our patients of all ages. Our experienced and skilled orthodontists are dedicated to helping you achieve a straight and healthy smile. At Mountain View Dental, we understand that a straight smile not only enhances your appearance but also improves your oral health. Our orthodontic services are designed to address a wide range of orthodontic issues, including crowded or misaligned teeth, overbites, underbites, crossbites, and more. For more information contact us.
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Emergency orthodontists are not only specialists in emergency treatment, but their doors are also open to patients with regular visits for miscellaneous treatments from cosmetic to general dentistry and injectables that will have you feeling amazing and smiling proudly. Usually, reputable dental clinics in Mountain View serve all facets of the dental world. They give their patients access to all assistance to guarantee an end-to-end dental experience. Read on for some of the most prevalent therapies that they usually perform regularly.
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Obamacare Co-Ops Down From 23 to Final ‘3 Little Miracles’
New Mexico Health Connections’ decision to close at year’s end will leave just three of the 23 nonprofit health insurance co-ops that sprang from the Affordable Care Act.
One co-op serves customers in Maine, another in Wisconsin, and the third operates in Idaho and Montana and will move into Wyoming next year. All made money in 2019 after having survived several rocky years, according to data filed with the National Association of Insurance Commissioners.
They are also all in line to receive tens of millions of dollars from the federal government under an April Supreme Court ruling that said the government inappropriately withheld billions from insurers meant to help cushion losses from 2014 through 2016, the first three years of the ACA marketplaces. While those payments were intended to help any insurers losing money, it was vitally important to the co-ops because they had the least financial backing.
Lauded as a way to boost competition among insurers and hold down prices on the Obamacare exchanges, the co-ops had more than 1 million people enrolled in 26 states at their peak in 2015. Today, they cover about 128,000 people, just 1% of the 11 million Obamacare enrollees who get coverage through the exchanges.
The nonprofit organizations were a last-minute addition to the 2010 health law to satisfy Democratic lawmakers who had failed to secure a public option health plan — one set up and run by the government — on the marketplaces. Congress provided $2 billion in startup loans. But nearly all the co-ops struggled to compete with established carriers, which already had more money and recognized brands.
State insurance officials and health experts are hopeful the last three co-ops will survive.
“These are the three little miracles,” said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University, in Washington, D.C.
Maine Aided in Supreme Court Victory
The Maine co-op, Community Health Options, helped bring competition to the state’s market, which has had trouble at times attracting insurance carriers, said Eric Cioppa, who heads the state’s bureau of insurance.
“The plan has added a level of stability and has been a positive for Maine,” he said.
The co-op has about 28,000 members — down from about 75,000 in 2015 — and is building up its financial reserves, Cioppa said. Community Health Options is one of three insurers in the Obamacare marketplace in Maine, the minimum number experts say is needed to ensure vibrant competition.
Kevin Lewis, CEO of the plan, attributed its survival to several factors, including an initial profit in 2014, the year the ACA marketplaces opened, that put the plan on a secure footing before several years of losses. He also credited bringing most functions of the health plan in-house rather than contracting out, diversifying to sell plans to small and large employers, and securing lower rates from two health systems during a couple of difficult years.
Jay Gould, 60, a member who offers the plan to workers at his small grocery in Clinton, has been happy with the plan. “They have great customer service, and it’s good to know when I am talking to someone that they are from Maine,” he said.
Central Aroostook Association, a Presque Isle nonprofit that helps children with intellectual disabilities, switched to the co-op last year to save 20% on its health premiums, said administrator Tammi Easler. Having a Maine insurer means any issues can be dealt with quickly, she said. “They are readily available, and I never have to wait on hold for an hour.”
The co-op, which made a $25 million profit each of the past two years, has proposed dropping its average premiums by about 14% in 2021, Lewis said.
Community Health was one of the lead plaintiffs in the case before the Supreme Court and expects to get $59 million in back payments from the settlement.
The federal decision to suspend those so-called risk corridor payments — designed to help health plans recover some of their losses — was one of the factors that caused many of the co-ops to fail, Corlette said. Republican critics of the ACA, however, blame poor management by the plans and lack of oversight by the Obama administration.
Insurers are in talks with the Trump administration about whether the $13 billion due the carriers must be added to their 2020 balance sheet or could be counted toward operations from prior years. This year, insurers are generally banking large profits since many people have delayed non-urgent care because of the COVID-19 pandemic. Since the ACA limits insurers’ profit margins, adding that federal windfall to this year’s ledger might mean many insurers would have to pay out most of the money to their consumers. If the money is applied to earlier years, the insurers could likely keep more of it to add to their reserves.
Too Much Competition in New Mexico
The Supreme Court ruling came too late for New Mexico Health Connections, which lost nearly $60 million from 2015 to 2017. The co-op would have received $43 million in overdue payments, but, in an effort to raise needed cash, it sold that debt to another insurer in 2017 for a much smaller amount.
Marlene Baca, CEO of the co-op, which made a $439,000 profit in 2019, said its goal of bringing competition into the market was achieved, since five other companies will be enrolling customers this fall for 2021. Yet, that competition eventually led to the plan’s decision to end operations, announced last month.
With only 14,000 members, it made no sense to continue operating due to high fixed administrative costs, she said. Her plan was also hurt by the slumping economy this year, which pushed many state residents out of work and made more than 3,000 members eligible for Medicaid, the state-federal health program for the poor.
“We did our very best,” Baca said, noting that her company is closing with enough money to pay its outstanding health claims. Many other co-ops that shuttered were closed out by their states and unable to meet all their debts to health providers, she said.
Montana’s Co-Op Is Expanding
The Mountain Health Co-Op, with about 32,000 members, has just two competitors in its home state of Montana and four in Idaho.
A big factor behind its survival was that the plan received a $15 million loan in 2016 from St. Luke’s Health System, Idaho’s largest hospital provider, said CEO Richard Miltenberger. Although he wasn’t working for the co-op at that time, Miltenberger said, it is his understanding that the hospital wanted to help maintain competition in that marketplace.
The co-op is expecting $57 million from the Supreme Court victory.
“We are in excellent shape,” Miltenberger said. The plan, which paid back the St. Luke’s loan and made a $15 million profit in 2019, added vision benefits this year and is offering a dental exam benefit for next year. It’s also providing most insulin and medications for asthma and chronic obstructive pulmonary disease to members without any copayment to help ensure compliance.
The insurer is moving into Wyoming for 2021, which will end the Blue Cross plan monopoly in that state’s Obamacare marketplace, he said.
Wisconsin’s Mystery Donor
Wisconsin’s Common Ground Healthcare Cooperative was on the verge of ending operations in 2016 when it received a lifesaving $30 million loan, said CEO Cathy Mahaffey. The insurer has refused to identify the benefactor other than to say it was not a person or company doing business with the plan.
In 2018, Common Ground was the only health plan in seven northeastern Wisconsin counties, she said. Today, the co-op has about 54,000 members and faces competition from two to five carriers in the 20 counties where it operates.
Common Ground, which recorded a $73 million profit last year, expects to receive about $95 million from the Supreme Court case victory.
Wisconsin’s decision not to expand Medicaid under the health law has benefited the co-op because people with incomes from 100% to 138% of the federal poverty level ($12,760 to $17,609 for an individual) are ineligible for Medicaid and must stay with marketplace plans for coverage. In states that expanded Medicaid, everyone with incomes under 138% of the poverty level is eligible.
Another factor was its decision in 2016 to eliminate the broad provider network offering and sell a plan offering only a narrow network of doctors and hospitals, allowing it to benefit from lower rates from its providers, according to Mahaffey.
“We are very strong financially,” she said.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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Orthodontics Market Growth, Trends, Insights, Revenue Status & Forecast
A fresh report titled “Orthodontics Market” has been presented by KD market insights. It evaluates the key market trends, advantages, and factors that are pushing the overall growth of the market. The report also analyzes the different segments along with major geographies that have more demand for Orthodontics Market. The competition analysis is also a major part of the report.
Orthodontics is a branch of dentistry, which involves treatment of patients with improper positioning of teeth, teeth movement, straightening, appearance, and aesthetics of teeth. The correction of improperly positioned teeth and jaws are included in orthodontics. The global orthodontics market was valued at $1,493 million in 2016, and is estimated to reach at $2,597 million by 2023, registering a CAGR of 8.2% from 2017 to 2023.
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Factors such as rise in prevalence of dental diseases & conditions and increase in geriatric population who are more prone to dental disorders significantly drive the growth of the global orthodontics market. Moreover, rise in awareness towards dental aesthetics & oral hygiene and increase in dental tourism supplement the market growth. However, risks associated with orthodontic treatment and limited reimbursement policies restrain the market growth. Conversely, huge untapped market potential in the emerging countries, such as China and India, and upsurge in the demand for orthodontic procedures are expected to provide lucrative opportunities to the market players.
The orthodontics market is segmented based on type, age group, and region. Depending on type, the market is divided into brackets, anchorage appliances, ligatures, and archwires. The brackets segment is further bifurcated into fixed and removable brackets. Likewise, the anchorage appliances segment is classified into bands and buccal tubes. Furthermore, the ligatures segment is fragmented into elastomeric ligatures and wire ligatures. By age group, the orthodontics market is categorized into adults and children. As per region, the orthodontics market is analyzed across North America, Europe, Asia-Pacific, and LAMEA.
KEY BENEFITS FOR STAKEHOLDERS
- This report entails a detailed quantitative analysis of the current market trends from 2016 to 2023 to identify the prevailing opportunities.
- Orthodontics market size and market estimations are based on comprehensive analysis of the key developments in the industry.
- In-depth analysis based on region assists to understand the regional market and the strategic business planning.
- The development strategies adopted by key manufacturers are enlisted to understand the competitive scenario of the market.
KEY MARKET SEGMENTS
By Type
- Brackets
- - - Fixed
- - - Removable
- Anchorage Appliances
- - - Bands & Buccal Tubes
- - - Miniscrews
- Ligatures
- - - Elastomeric Ligatures
- - - Wire Ligatures
- Archwires
By Age Group
- Adults
- Children
By Region
North America
- U.S.
- Canada
- Mexico
Europe
- Germany
- France
- UK
- Italy
- Spain
- Rest of Europe
Asia-Pacific
- Japan
- China
- Australia
- India
- South Korea
- Taiwan
- Rest of Asia-Pacific
LAMEA
- Brazil
- Saudi Arabia
- South Africa
- Rest of LAMEA
The list of key players operating in this market includes:
- 3M Company
- Align Technology, Inc.
- American Orthodontics
- Danaher Corporation
- Dentaurum GmbH & Co. KG
- DENTSPLY International, Inc.
- G&H Orthodontics, Inc.
- Henry Schein, Inc.
- Rocky Mountain Orthodontics, Inc.
- TP Orthodontics, Inc.
Browse Full Report With TOC@ https://www.kdmarketinsights.com/product/orthodontics-market-amr
Table of Content
CHAPTER 1: INTRODUCTION
1.1. Report description 1.2. Key benefits for stakeholders 1.3. Key market segments
1.3.1. List of key players profiled in the report
1.4. Research methodology
1.4.1. Secondary research 1.4.2. Primary research 1.4.3. Analyst tools and models
CHAPTER 2: EXECUTIVE SUMMARY
2.1.1. CXO perspective
CHAPTER 3: MARKET OVERVIEW
3.1. Market definition and scope 3.2. Key findings
3.2.1. Top investment pockets 3.2.2. Top winning strategies
3.3. Top Player Positioning, 2016 3.4. Porters Five Forces Analysis 3.5. Regulation and reimbursement scenario
3.5.1. U.S. 3.5.2. Europe 3.5.3. Japan
3.6. Market dynamics
3.6.1. Drivers
3.6.1.1. Growth in awareness towards dental hygiene 3.6.1.2. Increase in geriatric population 3.6.1.3. Advantages of orthodontics treatment 3.6.1.4. Growth in dental tourism
3.6.2. Restraints
3.6.2.1. Risks and adverse effects associated with orthodontics treatment 3.6.2.2. Limited reimbursement
3.6.3. Opportunity
3.6.3.1. Upsurge in demand for dental cosmetic procedures 3.6.3.2. Rise in disposable income and lucrative opportunities in the emerging economies
CHAPTER 4: ORTHODONTICS MARKET, BY TYPE
4.1. Overview
4.1.1. Market size and forecast
4.2. Brackets
4.2.1. Key market trends, growth factors & opportunities 4.2.2. Market size and forecast, by product type
4.2.2.1. Fixed brackets
4.2.2.1.1. Market size and forecast
4.2.2.2. Removable brackets
4.2.2.2.1. Market size and forecast
4.2.3. Market size and forecast, by region 4.2.4. Market analysis, by country
4.3. Anchorage Appliances.
4.3.1. Key market trends, growth factors & opportunities 4.3.2. Market size and forecast, by product type
4.3.2.1. Bands and buccal tubes
4.3.2.1.1. Market size and forecast
4.3.2.2. Miniscrews
4.3.2.2.1. Market size and forecast
4.3.3. Market size and forecast, by region 4.3.4. Market analysis, by country
4.4. Ligatures
4.4.1. Key market trends, growth factors & opportunities 4.4.2. Market size and forecast, by product type
4.4.2.1. Elastomeric ligatures
4.4.2.1.1. Market size and forecast
4.4.2.2. Wire ligatures
4.4.2.2.1. Market size and forecast
4.4.3. Market size and forecast, by region 4.4.4. Market analysis, by country
4.5. Archwires
4.5.1. Key market trends, growth factors & opportunities 4.5.2. Market size and forecast, by region 4.5.3. Market analysis, by country
Continue…
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KD Market Insights offers a comprehensive database of syndicated research studies, customized reports, and consulting services. These reports are created to help in making smart, instant and crucial decisions based on extensive and in-depth quantitative information, supported by extensive analysis and industry insights.
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On the day the state of Colorado voted for Hillary Clinton over Donald Trump by about 5 points, voters there also rejected a ballot measure to enact a state-based single-payer system by an astounding margin of 79 percent to 21 percent.
Amendment 69, the Colorado Creation of ColoradoCare System Initiative, would have created a system in which all Coloradans would gain insurance through a tax-funded government insurance program. Private health insurers would have been rendered obsolete.
The Colorado initiative bears a resemblance to the Medicare-for-all legislation released by Sen. Bernie Sanders (I-VT) this week and endorsed by leading Democrats like Sens. Kamala Harris (D-CA), Elizabeth Warren (D-MA), Cory Booker (D-NJ), and Kirsten Gillibrand (D-NY), and to HR 676, Rep. John Conyers’s (D-MI) single-payer proposal which has the support of a large majority of House Democrats.
Colorado’s initiative, in other words, matched the 2017 health care platform of the Democratic party. And it failed — really, really, really badly.
“The proposal came too soon and too fast for where voters were,” Joel Dyar, who worked as state field director for the ColoradoCare Yes campaign, says.
Some of that failure is attributable to the unique challenges of adopting single-payer through a ballot initiative, and at the state level. Because Colorado’s constitution bans public funding for abortions, ColoradoCare would’ve taken away access to abortion from the hundreds of thousands of women currently in private health plans that cover the procedure. That earned the amendment the opposition of NARAL Pro-Choice Colorado and Planned Parenthood of the Rocky Mountains, two leading progressive groups in the state. “They didn’t check in advance to see if this was a problem,” Karen Middleton, the executive director of NARAL Pro-Choice Colorado, recalls. “By the time anyone had seen the language, it was already locked in.”
And because the proposal had to be set in stone in order to appear on the ballot, advocates didn’t have time to negotiate with key stakeholders on details of the plan, meaning few stakeholders bought in. Many progressive think tanks like the Colorado Fiscal Institute and the Bell Policy Center, unions like the United Food and Commercial Workers, and advocacy groups like ProgressNow Colorado wound up opposing the plan. “A poorly thought-through initiative like Amendment 69 does violence to the future of single-payer in Colorado,” Ian Silverii, ProgressNow Colorado’s executive director, says.
But other obstacles will be just as present in a federal fight. Entrenched interest groups, particularly insurers, spent millions opposing the measure. Moderate Democrats like Gov. John Hickenlooper, Sen. Michael Bennet, and former Gov. Bill Ritter came out against it. And, ultimately, Colorado voters were just not persuaded.
The ColoradoCare plan
Colorado Health Institute
ColoradoCare, the single-payer system to be created by Amendment 69, was vague in specifying what benefits it would cover, listing 11 categories like "ambulatory patients services, including primary and specialty care," "prescription drugs and medical equipment," and "preventive and wellness services." The plan would include no deductible and no copayments for preventive and primary care services; copayments for all other services were to be waived for financial hardship.
This isn’t quite as sweeping as many single-payer plans. For example, HR 676, the Conyers bill supported by most House Democrats, covers "the full scope of dental services," "basic vision care," "long-term care," and even "chiropractic services." Bernie Sanders’s bill is similarly comprehensive, as is California’s proposal. ColoradoCare, by contrast, didn’t guarantee long-term care or vision care or dental care, at least to adults.
But the abolition of deductibles and copayments and traditional premiums, and inclusion of prescription drugs as part of the core benefit, makes ColoradoCare quite a bit more generous than Medicare or most foreign universal health care systems.
The plan was to be funded by a new 10 percent tax on basically everything:
A 6.67 percent employer-side payroll tax plus a 3.33 percent employee-side payroll tax; most economists think the former tax would be reflected in lower take-home pay for employees
A 10 percent tax on all nonwage income, like capital gains, self-employment, Social Security benefits, etc.
That’s on the low side of estimates of what a single-payer system would cost. California’s State Senate Appropriations Committee estimates that a (more generous) single-payer system there would require a 15 percent employer payroll tax, while Vermont abandoned its single-payer effort after it concluded a 11.5 percent payroll tax hike and an income tax hike of up to 9.5 percent was necessary.
Advocates note that these taxes would be replacing current employer and employee spending on health care. Health insurance currently makes up about 7.5 percent of private employers’ compensation to employees, according to the Bureau of Labor Statistics, and the average household spends 6.2 percent of pretax income on health care. With major exceptions, like adult dental and vision and purely elective procedures like cosmetic surgery, ColoradoCare would’ve replaced all those expenses for Coloradans and their employers. Though payroll and income taxes would rise, advocates argued, households and businesses would be held harmless or even made better off once you take that removed burden into account.
Colorado Health Institute
Independent analysis cast doubt on some of the details here. The respected, nonpartisan Colorado Health Institute prepared an analysis of the proposal that concluded that while it would roughly break even in its first year, it would have a quite large deficit by year 10: $7.8 billion, or 13.9 percent of revenue.
Understandably, the proposition's supporters disputed this, with Colorado State economist Anders Fremstad arguing that the analysis underestimated how much the system could restrain health spending and how much it'd continue to bring in in federal funds. And CHI’s Joe Hanel says that the group also estimated the tax rate needed to break even over 10 years, and found that a 12 percent rate would work (a pretty modest bump from 10 percent in the ballot initiative language).
ColoradoCare would have run into trouble if it came up short on cash. It would have been governed by an elected board of 21 trustees — three each from seven different geographic regions of Colorado — who'd have the power to raise copayments, eliminate coverage of some services, and even shut down the entire program if the finances weren't working out. (Cutting compensation to providers is another obvious option, but as CHI notes, "Amendment 69 is silent on compensation to providers.")
ColoradoCare's board could also vote to put a tax increase on the ballot to fund the program, but voters would have to assent to it. "Colorado voters tend not to approve tax increases, so approval for higher premium taxes for ColoradoCare would have proven difficult," Natalie O'Donnell Wood, a senior policy analyst at the progressive Bell Policy Center in Denver, says.
The voting process was also weirdly designed. “ColoradoCare," CHI notes, "would create a separate voting system for itself. [It] would create two distinct classes of voters: the current registered voters of the state and members of ColoradoCare. Most adults would be in both groups, but some would be included in one group but not the other."
For instance, ColoradoCare's elections — for board of trustees, and on tax increases the board proposes — would be open to noncitizens, including undocumented immigrants, but it would require voters to live in Colorado for at least a year before the election, while normal Colorado elections only have a 22-day residency requirement.
This governance aspect generated concern among progressive activists — not the noncitizen voting part, but the elected board existing on its own off to the side of Colorado’s regular political structure. Wood notes that it could have invited legal challenges. One analysis noted that the rest of the Colorado Constitution requires US citizenship to vote, and that because "Amendment 69 does not explicitly repeal the Constitution's voter criteria," that requirement could still be binding, meaning the different rules for voting on ColoradoCare could be struck down.
The new board could also be vulnerable to cooption, especially if elections to it were low-turnout. “If I'm the Koch brothers,” Silverii, the head of ProgressNow Colorado, says, “the only thing I do in Colorado for the foreseeable future is attempt to rig that system to gerrymander the districts, get the most anti-universal health care, anti-progressive people on the planet elected to those positions to intentionally run the thing into the ground and then say, ‘See, it doesn't work!’”
Why progressives rejected ColoradoCare
A lot of the opposition to ColoradoCare was predictable. The opposition raised more than $4 million in total — largely from health insurance companies — compared to about $900,000 for supporters. According to the Colorado Secretary of State's office and Ballotpedia, the health insurer Anthem donated $1 million to the anti-ColoradoCare campaign, Kaiser Permanente gave $500,000, UnitedHealthcare gave $450,000, and the hospital chains Centura and HealthOne each gave $250,000.
“The citizens supporting single-payer in Colorado were vastly outspent by status quo health care powers,” Dyar, the ballot measure’s field director, says. “There were millions of dollars put into television to run ads against it and millions of dollars put into misinformation and fear tactics.”
Worse still, Dyar says, “the national progressive interests didn’t come to the rescue.”
So why is that? For one thing, at the time, backing single-payer represented a political risk. Colorado was a purple state in the presidential race, and Democratic Sen. Michael Bennet was up for reelection. While he didn’t attract a top-tier opponent, the state’s tilt makes him inherently vulnerable. “The party felt like it was very risky and that candidates were vulnerable to being tied to the initiative,” Dyar recalls.
But a number of progressive activists in Colorado also thought the measure could actively make things worse. A major issue was the governance challenge posed by putting the program in the state constitution, where tweaking it could be more difficult. A report by the left-leaning Colorado Fiscal Institute focusing on Hispanic families noted that, while many and likely most low-income Hispanic families would pay less under ColoradoCare (not counting the employer side of the payroll tax), poor Medicaid enrollees would be faced with new taxes without new health benefits to offset them. That’s the kind of thing that could be fixed ahead of time if the proposal had gone through a legislative process — but it didn’t.
Many, like Silverii, were also skeptical of trusting its supervision to a new board that could be elected in low-turnout elections and that could thus be subject to manipulation and capture.
Perhaps the biggest issue of contention, however, was abortion.
In 1984, Colorado narrowly passed Initiative 3, the Colorado Abortion Funding Prohibition Amendment, which barred all public funding for abortion except if needed to save the life of the mother. And ColoradoCare wouldn’t have changed that. It couldn’t have: The state constitution has a “single subject” rule requiring ballot measures to stick to one topic, meaning the ColoradoCare initiative couldn’t simultaneously repeal the abortion funding ban.
ColoradoCare would have thus taken away abortion access from women whose private insurance covers the procedure — a group totaling more than 550,000, per NARAL’s Middleton. It didn’t just fail to expand access to abortion to poorer women, it actively made access worse. And while some advocates for the policy argued that it was still worth supporting for the “greater good” of expanded health care coverage for other procedures, reproductive rights advocates were understandably not having it.
“I’m sure there are still hurt feelings, and I’m sure there are still people who are upset about it,” Middleton says. “It was also a proxy around the Bernie-Hillary break. You had people supporting Bernie in the primary who supported Amendment 69 who saw that alignment, and it heightened that tension that you saw around the country in the primary.”
Advocates for the act disputed this interpretation, arguing that ColoradoCare actually overrode the abortion ban, and that the board of trustees could choose to cover abortion if it wanted to do so. NARAL wasn't persuaded, noting that the ColoradoCare ballot measure didn't mention abortion at all, and so courts could easily conclude that it did not conflict with or supersede the abortion ban.
What federal single-payer advocates can learn from Colorado
In some ways, the federal situation is more promising than that in Colorado. While major Democrats in the state resisted the single-payer push, more and more national Democrats and 2020 presidential contenders are endorsing Medicare-for-all. “It came too soon and came without an open dialogue with the Democratic Party and candidates up and down ballot,” Dyar, the ColoradoCare field director, says. “Had this initiative had Democratic Party support in Colorado, it could’ve gone much further.”
The federal effort also doesn’t involve a ballot initiative changing the Constitution. If a real push happens for single-payer the next time a Democrat is in the White House and the party controls Congress, there will be time to negotiate particulars and work out the kinds of problems that emerged with the ColoradoCare language. “It’s important that many progressive and centrist groups have a role from the start in writing single-payer legislation,” Dyar says. “Without that buy-in and without that compromise that comes with that process, there’s always something to make someone unhappy.”
"Colorado may not be the best case study in looking to successes and failures on single-payer," Wood concludes, given ColoradoCare’s unique set of challenges.
But at the same time, the ColoradoCare debate offered some warnings as to issues a federal single-payer push will have to address.
Abortion is a big one. While the US Constitution doesn’t ban federal funding for abortion, the Hyde Amendment does statutorily ban funds from going to abortions (with exceptions for rape, incest, and life of the mother). That’s just a legislative provision regularly included in federal appropriations bills, and it could be repealed as part of a single-payer push.
But as the 2009 to 2010 fight for Obamacare showed, there are some Democrats who might be on board to raise taxes and expand health coverage, but not if that coverage includes abortion. Former Rep. Bart Stupak (D-MI) nearly scuttled the effort by offering an amendment barring federal funds from being used to subsidize insurance plans covering abortions. He and other anti-abortion Congressmen threatened to oppose the bill without the amendment, and abortion rights groups threatened to oppose any bill that included it. Eventually President Barack Obama was forced to issue an executive order limiting funding for abortions through the insurance marketplaces to satisfy Stupak.
It’ll be hard enough to get 218 House votes and 51 (or even 60) Senate votes for single-payer. If even one or two members of either House take Stupak’s position, Democrats could be forced to choose between single-payer with no abortion coverage (which would greatly restrict abortion access and enrage abortion rights groups) and a system in which literally every abortion is paid for by the federal government, enraging anti-abortion groups and likely greatly increasing the number of abortions performed.
Another obstacle is the tax shock. Bernie Sanders has been fairly vague about how he’d fund his single-payer proposal, and past funding plans he’s put out have raised far too little money to cover the benefits. But when Congress actually debates a single-payer bill, that bill will have to specify pay-fors, or else its advocates will need to persuade colleagues to access a massive increase in deficits and debt.
That will be tough. Running against big tax increases and a “government takeover of our healthcare” is, as ColoradoCare’s opponents demonstrated, very easy:
“It took the opposition three seconds to call it a tax and supporters three minutes to explain how it was simply a different way of payment that would save them a whole lot of money,” Dyar recalls.
This stuff matters. Public opinion on specific issues like single-payer is quite malleable, and as Vox’s Dylan Scott notes, support for single-payer falls in polls after respondents are informed of common criticisms of it. Before any counterarguments, 55 percent of respondents to a Kaiser Family Foundation poll supported single-payer, but after being asked, "What if you hear that opponents say guaranteed universal coverage through such a plan would give the government too much control over health care," only 40 percent still support it, and 62 percent oppose it.
Kaiser Family Foundation
Hearing supportive arguments (like that it would make health insurance a basic right) turns public opinion in the opposite direction. Which is exactly the point: The public is really suggestible on the topic. And when insurers and spending millions to oppose the proposals, it’s likely people will hear more arguments against the idea and respond by turning away from it.
Bernie Sanders is, of course, hardly a naif about the immense power of corporate interest groups. But even if there were no corporate opposition, winning the public over would be tough. While the current system clearly doesn't work for people without coverage, most people with employer-based insurance like it. They like it a lot, in fact. And they tend to be very skeptical of big disruptive efforts to change it, as Princeton sociologist Paul Starr argues in Remedy and Reaction: The Peculiar American Struggle over Health Care Reform.
There’s a reason Obama spent months assuring people that if they liked their health plan, they could keep it. When you tell people you’re going to take away what they have now, they usually tell you to go fuck yourself.
This is why many health reform advocates, starting with UC Berkeley economist Helen Halpin and Yale political scientist Jacob Hacker, have argued for transitioning to single-payer by offering a public option available to employers and individuals alike. If such a plan paid the same rates to doctors and providers as Medicare (rates lower than private insurance), that would translate into lower premiums, which would lead employers to gradually shift into the public plan of their own accord, without a huge super-visible tax increase.
This is the approach that former Rep. Peter Stark (D-CA) offered in his AmeriCare Health Care Act in 2006, and Sen. Chris Murphy (D-CT) is offering similar legislation this year. The Colorado experience suggests that such an approach could avoid the problems that dog more ambitious single-payer plans — particularly if employers could choose between a public plan that covers abortion and a public plan that doesn’t.
Disclosure: My partner served as NARAL Pro-Choice America’s research director during the 2016 campaign. She did not work on ColoradoCare in any capacity.
via Vox - All
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