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Las nuevas inscripciones bajo la Ley de Cuidado de Salud a Bajo Precio (ACA) parecen ser hasta un millón menos que el  número récord del año pasado, especialmente por problemas con el programa que enfrenta la saliente administración Biden.

La reelección de Donald Trump para un segundo mandato ha generado incertidumbre sobre el futuro de la ley de salud. Además, el gobierno implementó normas complejas para reducir las inscripciones fraudulentas y está combatiendo una demanda que busca evitar que un grupo de inmigrantes sin residencia legal adquieran cobertura en los mercados de seguros de salud.

Hasta ahora, el número de nuevos inscritos y reinscritos que utilizan cuidadodesalud.gov, el sitio del mercado federal que usan 31 estados, está por debajo del año pasado. A principios de diciembre, las nuevas inscripciones apenas superaban las 730,000, en comparación con 1.5 millones en el mismo período de 2023.

Para dar más tiempo a los consumidores de los estados del mercado federal para inscribirse, los Centros de Servicios de Medicare y Medicaid (CMS) extendieron hasta el 18 de diciembre el plazo para adquirir cobertura que comienza el 1 de enero. (El plazo del 15 de enero es para la que comenzaría el 1 de febrero).

También está en juego una regla emitida por la administración Biden que permite, por primera vez, que los Dreamers, las personas traídas al país de niños sin papeles, puedan inscribirse en los mercados y obtener subsidios.

El 9 de diciembre, un juez federal de Dakota del Norte falló a favor de 19 estados que buscaban bloquear esta directiva de la administración Biden.

El 16, el equipo de Biden obtuvo una suspensión temporal, pero el destino de esta opción todavía está por verse.

De prevalecer, la decisión en este caso, Kansas vs Estados Unidos, efectivamente prohíbiría a quienes han calificado para el programa de Acción Diferida para los Llegados en la Infancia (DACA) inscribirse o recibir subsidios para los planes de ACA en los 19 estados. Según los abogados que siguen el caso, no parece afectar la inscripción o la cobertura en otros estados.

Se espera una decisión final sobre la suspensión temporal en cualquier momento. Si se concede, podría permitir que los Dreamers sigan inscribiéndose mientras se escucha la apelación del gobierno a la decisión del tribunal de distrito, lo cual es poco probable que ocurra antes de que Trump asuma el cargo.

En sus documentos judiciales, la administración Biden argumenta que no conceder una suspensión sería muy disruptivo en medio del período de inscripción abierta, lo que causaría que el gobierno federal incurra en costos para reajustar su mercado para reflejar el cambio y notificar a aquellos que ya se han inscrito que sus planes han sido cancelados.

El caso original fue presentado en agosto en el Tribunal de Distrito de los Estados Unidos para el Distrito de Dakota del Norte y está siendo escuchado por el juez de distrito Daniel Traynor, nominado en 2019 por el entonces presidente Trump.

Previamente, el gobierno federal estimó que alrededor de 100,000 personas sin seguro de un total de medio millón de beneficiarios de DACA podrían inscribirse para tener cobertura de 2025. En su nuevo escrito, el gobierno dice que 2,700 se han inscrito en los estados que presentaron la demanda y que usan el mercado federal.

La regla de la administración Biden, finalizada en mayo, aclaró que quienes califican para DACA serían considerados “legalmente presentes” para los propósitos de inscribirse en planes bajo ACA, los cuales están abiertos a ciudadanos y aquellos denominados inmigrantes “legalmente presentes”.

Los abogados federales argumentan que Dakota del Norte no ha demostrado que sería perjudicado por la regla, por lo que no tiene legitimidad para presentar el caso. El estado argumentó que incurre en costos para aproximadamente 130 beneficiarios de DACA que viven allí, y que no tendría esos gastos si se les prohibiera inscribirse en ACA y, por lo tanto, decidieran abandonar el país.

Por su parte, el gobierno federal argumentó que un éxodo es poco probable. El escrito legal también cuestionó el cálculo de Dakota del Norte de que incurre en costos de $585 para emitir licencias de conducir a los beneficiarios de DACA y alrededor de $14,000 anuales para educar al menos a un miembro o dependiente de DACA.

Todos los estados que impugnan esta regla argumentan que causará cargas administrativas y económicas a medida que más individuos se inscriban, y que alentará a más personas a permanecer en Estados Unidos sin documentos.

Los estados demandantes son: Alabama, Arkansas, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Missouri, Montana, Nebraska, New Hampshire, Dakota del Norte, Ohio, Carolina del Sur, Dakota del Sur, Tennessee, Texas y Virginia.

Definition

A gluten-free diet is an eating plan that cuts out foods that have a protein in them called gluten. Gluten helps foods keep their shape. It’s found in grains such as wheat, barley and rye. It’s also found in crosses of these grains, such as a mix of wheat and rye called triticale.

Some people have health conditions such as celiac disease that cause problems when they eat gluten. If your healthcare professional recommends a gluten-free diet to manage your condition, you’ll have plenty of foods to choose from. Some foods that are made with gluten are available in gluten-free versions. And many foods are naturally gluten-free. These include meats, seafood, fruit, vegetables and some grains.

Purpose

People who have celiac disease need to follow a gluten-free diet for life to manage the condition. With celiac disease, eating gluten causes the immune system to mistakenly damage the small intestine over time.

People who have other conditions linked with gluten also may need to limit or stay away from gluten. Talk with your healthcare professional to find out what type of eating plan is right for you.

Celiac disease

Celiac disease is a type of autoimmune condition. That means the immune system mistakenly attacks healthy tissues and organs. With celiac disease, gluten triggers an immune system reaction that damages the lining of the small intestine. This condition can cause digestive symptoms such as stomach pain, bloating and diarrhea. It also can lead to ongoing extreme tiredness, headaches, depression, and bone or joint pain. Over time, damage to the small intestine prevents this organ from absorbing nutrients in food.

Gluten intolerance

This condition also is known as non-celiac gluten sensitivity. It means that you don’t have celiac disease, but you get some of the same symptoms after you eat gluten. Gluten intolerance does not cause the same type of damage to the small intestine as does celiac disease. A gluten intolerance might not even be caused by gluten itself. Carbohydrates called FODMAPs that are in some foods with gluten may play a role. But more research is needed. Still, a gluten-free diet seems to improve symptoms.

Gluten ataxia

This autoimmune condition sometimes happens along with celiac disease in those who eat gluten. Gluten ataxia affects some nerve tissues. It causes trouble controlling muscles that help you move around well and maintain balance or coordination. Research suggests that a gluten-free diet can help relieve gluten ataxia.

Wheat allergy

A wheat allergy happens when the immune system mistakes gluten or some other protein found in wheat for germs. The immune system reaction that follows may cause some of the same digestive symptoms as celiac disease or gluten intolerance. Sometimes a wheat allergy also can cause other symptoms such as itchy welts called hives.If you have a wheat allergy, you likely will benefit from gluten-free foods because they’re not made with wheat. But you don’t need to cut out other grains with gluten, such as barley and rye.

A gluten-free diet also is popular among people who don’t have a gluten-related health condition. The claimed benefits of the diet are improved health, weight loss and more energy. But more research is needed.

Diet details

If you follow a gluten-free diet, you’ll likely learn to be extra mindful of what you eat. It’s important to pay close attention to your food choices, the ingredients found in foods and how much nutrition they have.

Allowed fresh foods

Many naturally gluten-free foods can be a part of a healthy diet:

• Fresh fruits and vegetables are gluten free, but dried, frozen and canned versions may have ingredients with gluten in them, including those in sauces.
• Beans, seeds, legumes and nuts in their natural, unprocessed forms.
• Eggs.
• Lean, nonprocessed meats, fish and poultry without seasoning.
• Most low-fat dairy products including plain milk, plain yogurt and unprocessed cheese.

Grains, starches or flours that can be part of a gluten-free diet include:

• Amaranth.
• Arrowroot.
• Buckwheat.
• Corn, including cornmeal, grits and polenta labeled gluten-free.
• Flax.
• Gluten-free flours such as rice, soy, corn, potato and bean flours.
• Hominy (corn).
• Millet.
• Quinoa.
• Rice, including wild rice.
• Sorghum.
• Soy.
• Tapioca (cassava root).
• Teff.

Grains not allowed

Do not eat foods and drinks that contain the following:

• Wheat.
• Barley.
• Rye.
• Triticale.
• Oats, unless the label says they’re gluten-free.

Oats are naturally gluten-free. But they may become tainted during production with wheat, barley or rye. This is known as cross-contamination. Oats and oat products labeled gluten-free have not been cross-contaminated. But some people with celiac disease may have a reaction to another protein in oats called avenin. Ask your healthcare professional if it’s OK to include gluten-free-labeled oats in your diet.

Wheat terms to know

There are different varieties of wheat, all of which contain wheat gluten:

• Couscous.
• Durum.
• Einkorn.
• Emmer.
• Farro.
• Graham.
• Kamut.
• Spelt.
• Wheat germ.
• Wheat bran.

Wheat flours have different names based on how the wheat is milled or the flour is processed. All of the following flours have gluten:

• Enriched flour with added vitamins and minerals.
• Farina, milled wheat usually used in hot cereals.
• Graham flour, a coarse whole-wheat flour.
• Self-rising flour, also called phosphate flour.
• Semolina, the part of milled wheat used in pasta and couscous.

Gluten-free food labels

When you buy processed foods, you need to read labels to find out if they have gluten in them. Processed foods are foods that have been changed from their natural state. They’re often prepared or packaged. Check the ingredients list on a package’s label. See if the list includes wheat, barley, rye or a cross of these grains such as triticale. Some packages list wheat as a possible allergen in a statement at the bottom of the label.

In the United States, foods that are labeled gluten-free must have fewer than 20 parts per million of gluten. Foods with these labels may include:

• Naturally gluten-free food.
• A prepared food that doesn’t have an ingredient that contains gluten.
• Food that has not been cross-contaminated with ingredients that have gluten during production.
• Food with a gluten-containing ingredient that has been processed to remove gluten. The food needs to have less than 20 parts per million of gluten after the removal process.

Alcoholic drinks made from naturally gluten-free ingredients, such as grapes or juniper berries, can be labeled gluten-free. Wine, distilled liquor and fruit cider that’s made without barley malt are examples of drinks that don’t have gluten.

Beer, ale and other malted drinks made with barley have gluten in them. They’re not safe to drink if you’re on a gluten-free diet. Some mixed alcoholic drinks have gluten in them as well. So it’s important to find out what ingredients they’re made with before drinking. Alcoholic drinks that are labeled gluten-free are OK to drink. But those labeled “gluten removed” or “processed to remove gluten” are not safe for people with celiac disease.

Processed foods that often have gluten in them

If you follow a gluten-free diet, it’s important to read labels of processed foods. This helps you find out if the foods have wheat, barley or rye in them.

In general, be careful of the following processed foods if you’re on a gluten-free diet. Keep in mind that foods labeled as gluten-free or made with gluten-free grain are OK to eat.

Starchy foods that often have gluten in them include:

• Breads.
• Bulgur wheat.
• Cereals.
• Communion wafers.
• Croutons.
• Matzo.
• Pastas.
• Seasoned rice mixes and pilafs.

Processed sweets and snacks that often have gluten in them include:

• Cakes and pies.
• Candies.
• Cookies and crackers.
• French fries.
• Seasoned snack foods, such as potato and tortilla chips.
• Soups, soup bases, broth, bouillon or soup mixes.

Alcoholic drinks and related processed items that often have gluten in them include:

• Beer, ale, porter, stout.
• Malt, malt flavoring and other malt products.

Processed meats that may have gluten in them include:

• Burgers.
• Hot dogs.
• Imitation seafood.
• Meat loaf.
• Processed lunchmeats.
• Sausage.

Condiments that may have gluten in them include:

• Gravies.
• Salad dressings.
• Sauces, including soy sauce.

Medicines and supplements

Medicines may use wheat gluten as a binding agent. Talk with your healthcare professional or pharmacist about the medicines you’re taking. Dietary supplements that contain wheat gluten must have “wheat” stated on the label.

Eating gluten-free at home and in restaurants

For people with celiac disease, in particular, it’s important not to eat gluten or use medicines with gluten in them. The following tips can help you keep gluten from accidentally getting into the food you make at home:

• Store gluten-free foods in a different place from where you store foods that have gluten.
• Keep cooking surfaces and food storage areas clean to remove any ingredient that has gluten in it.
• Wash dishes and cooking equipment thoroughly.
• Use separate cutting boards, cooking equipment and utensils for gluten-free foods. For instance, you could think about buying a separate toaster or toasting bread in the oven. This lowers the risk of cross-contamination from crumbs that could have gluten in them.

You also can take steps to lower your chances of being exposed to gluten when you eat out. Use these tips:

• Read restaurant menus online ahead of time if you can to be sure there are options for you.
• Eat out early or late when a restaurant is less busy and better able to address your needs.
• Ask your server what seasonings will be used and how the food will be prepared and handled. Also ask if your food can be made with separate, well-cleaned equipment and surfaces.

Results

If you have celiac disease, it’s important to follow a strict gluten-free diet for life. People who follow the diet and prevent cross-contamination have fewer symptoms of the disease. They’re also less likely to have health problems that stem from damage to the small intestine.

It’s not clear if non-celiac gluten sensitivity is a life-long condition. Some research suggests that you may follow the diet for 1 to 2 years. Then you get tested again to see if you’re still sensitive to gluten.

Some studies have looked at the benefits that people without celiac disease or non-celiac gluten sensitivity think they get from the gluten-free diet. More research is needed to find out whether science can support any of the following claims about the diet’s results:

• Weight loss.
• Overall improved health.
• Better gut health.
• Improved athletic performance.

Risks

The foods not included in a gluten-free diet provide important vitamins and other nutrients. For example, whole-grain breads and other products are natural or enriched sources of the following:

• Iron.
• Calcium.
• Fiber.
• Thiamin.
• Riboflavin.
• Niacin.
• Folate.

So, following a gluten-free diet likely will change the nutrients you get from food. Gluten-free breads and cereals have varied nutrient levels compared with the products they are replacing.

Some gluten-free foods also have higher fat and sugar contents than the gluten-rich food being replaced. It’s important to read labels, not only for gluten content but also for overall nutrient levels, sodium, and calories from fats and sugars.

You can talk with your healthcare professional or dietitian about what nutrients you may need more of. Then ask what foods are good sources of the nutrients you need.

Costs

The costs of prepared gluten-free foods tend to be higher than the cost of the foods being replaced. The expense of following a gluten-free diet can be large, especially if your diet includes foods that aren’t naturally gluten-free.

Vijayashree Natarajan is senior vice president and head of technology at Omega Healthcare, which produces financial, administrative and clinical systems for healthcare organizations.

Given her well-rounded expertise in healthcare information technology, we asked her recently to look ahead to 2025 and describe three key trends and imperatives she’ll be watching that will also be of keen interest to health system C-suite executives and other health IT experts. Cybersecurity, cancer informatics and agentic artificial intelligence were the three she chose.

Q. Why do you feel it is imperative to stress data security in 2025?

A. As healthcare continues its digital transformation, we will see the convergence of clinical data, revenue cycle operations and patient care becoming increasingly interconnected. Organizations that can effectively harness these data streams while maintaining data security will be best positioned to thrive as healthcare continues morphing and becoming more patient-centric.

The journey toward this future will require ongoing collaboration, innovation, and a steadfast commitment to patient safety and data security.

As the health IT industry increasingly embraces AI and other digital technologies, the importance of robust cybersecurity measures cannot be overstated. The healthcare industry faces unique challenges due to the sensitivity of the data – from personally identifiable information to electronic health records to electronic protected health information.

Healthcare organizations need pervasive micro-segmentation coverage for applications, server workloads and users across all asset types.

Q. Cancer informatics is an interesting selection you make for 2025. Why this area of HIT?

A. There will be an escalating need for cancer informatics as the CDC says the total number of cancer cases is projected to increase by 50% by 2050.

As cancer rates continue to climb, there will be a heightened emphasis on the need for high-quality data, or “cancer informatics,” to support cancer-related public health initiatives.

However, the exponential rise and increasing complexity of cancer data present considerable hurdles for management. Data comes from a variety of sources, including clinical records, pathology reports, imaging studies and genomic data.

Skilled professionals must take a comprehensive approach to accurately integrate these different data sets and extract valuable information. This information then influences crucial downstream activities such as precision medicine techniques, public health surveillance, new treatment guidelines and policy recommendations, clinical trial enrollment, and clinical research ideas.

The increasing importance of robust clinical data cannot be emphasized enough. As we advance, the focus will be on developing solutions that not only streamline data processes but also unlock new insights that drive clinical and operational excellence.

By integrating innovative technologies with deep industry expertise, keeping humans in the loop, we can set the stage for a new era in healthcare – one where data-driven decisions pave the way for enhanced patient outcomes and more efficient, accessible healthcare services.

Q. And finally you suggest agentic AI will be key in 2025. How so?

A. For providers and payers, artificial intelligence is becoming key to minimizing fraud, advancing value-based care, and creating insights for risk assessment and identifying care gaps. The rise of generative AI is expanding these capabilities, enhancing everything from patient interactions to clinician documentation, and even improving the AI algorithms themselves.

Moving forward, we anticipate technologies like agentic AI to play a crucial role in boosting efficiency, tailoring treatments and enhancing patient results.

When adopting AI systems, healthcare organizations should prioritize:

• Creating a dedicated AI oversight team
• Developing contingency plans for potential system disruptions
• Providing comprehensive staff training and support
• Implementing timely monitoring and reporting tools
• Establishing robust data governance policies
• Using predictive analytics to foresee potential issues

As exciting as these developments are, implementing AI in healthcare comes with its own set of challenges and considerations. Organizations must carefully manage risks associated with data privacy, security and the integration of AI into existing workflows.

Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication

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