• DISB Approves Decreases in Workers’ Compensation Rates
• National Insurance Act of 2007 Pending
• HSA Plans are Covering Preventive Care on a First-Dollar Basis
• Life Insurance Premiums Expected to Decline by 4 Percent in 2007
• Employer Health Benefit Costs Continue to Rise at Twice the Rate of Inflation, Mercer Survey Finds
• Health Benefit Costs Rise at Twice Inflation Rate
• Can the private market handle long-term care?
• Chasing Drugs - Many Take Drastic Steps to Get Prescription Medicine
• Exercise Corner: Boost Your Metabolism
• Recipe Corner: Tree-Shaped Crescent Veggie Appetizers

DISB recently approved the 2008 workers’ compensation rate filings by the National Council on Compensation Insurance (NCCI), which includes a decrease of 7.6 percent for the industrial classes in the voluntary market, and a decrease of 10.6 percent for the industrial classes in the residual market (those in the assigned risk category). In the District of Columbia, workers’ compensation insurance is mandatory for employers on all employees. According to DISB Commissioner Thomas E. Hampton, the rate decreases were a result of an overall decline in claim frequency, and less severity in the claims amount.

These decreases are in addition to the voluntary decrease of 7.9 percent and assigned risk decrease of 5.6 percent for 2007. The 2006 decrease in claim frequency extended a trend that started in the 1990s, according to the NCCI, a statistical company that compiles information from insurance companies, analyzes trends, prepares workers’ compensation rate recommendations, and provides a variety of services and tools to maintain a healthy workers’ compensation system. The decline seems to have become just as prominent among the medium and large claims, as it is for the small claims. Commissioner Hampton noted that while most of the insurance companies will use the NCCI-recommended rates, additional expenses might add to the rates that each company sets.

Source: Industry News, October 22, 2007

There are two pending bills for the federal regulation of the insurance industry. Both bills—one in the Senate and one in the House of Representatives—would authorize the establishment of a comprehensive system of federal chartering, licensing, regulation and supervision of insurers and insurance producers that is independent of the state system of insurance licensing, regulation and supervision. It will require federally chartered and licensed insurers and producers to comply with certain state laws, including state tax laws; and to provide for the creation of an Office of National Insurance within the Department of Treasury that is funded by assessments imposed upon federally chartered and licensed insurers and insurance producers. If the proposals become law, insurers will be allowed to choose whether to be governed by a state or federal regulator, which is similar to the banking industry.

Source: Industry News, October 22, 2007

"HSA plans have been a valuable new coverage option -- especially for those who had been uninsured previously -- and are providing consumers with access to important preventive health care services," said Karen Ignagni, President and CEO of AHIP.

AHIP surveyed its members to examine the preventive benefits provided by high-deductible health plan (HDHP) policies that are compatible with a health savings account (HSA). The survey found that most HSA/HDHP policies cover recommended preventive benefits on a "first dollar" basis -- that is, without regard to whether the deductible is met.

Among HSA/HDHP policies offering first-dollar coverage for preventive care, 100 percent cover adult and child immunizations; well-baby and well-child care; mammography; Pap tests; and annual physical exams and screenings. Nearly 90 percent provide first-dollar coverage for prostate cancer screenings and 83 percent offer this coverage for colonoscopies.
Virtually all HSA/HDHP policies purchased in the large-group market (99 percent) and small-group market (96 percent) provide first-dollar coverage for preventive care.

Additionally, 59 percent of policies purchased in the individual market cover preventive care on a first-dollar basis. First-dollar coverage for preventive benefits is less frequent in the individual market because premiums for individual coverage are not tax deductible, as they are with employment-based coverage. This gives consumers an incentive to purchase preventive benefits through a tax-free HSA rather than through higher premiums. AHIP supports full tax deductibility for all health insurance premiums to create a level playing field for consumers purchasing health care coverage on their own without an employer sponsor.

Source: InsuranceNewsNet.com, November 27, 2007 

Premiums for individual life insurance—both term life and “permanent” insurance—will drop, on average, by 4 percent in 2007, according to the Insurance Information Institute (I.I.I.).
“This continues a generally downward trend in life insurance premiums, which began several decades ago,” said I.I.I. economist and life insurance spokesperson Dr. Steven Weisbart. “The 4 percent drop projected for 2007 is in line with the average 5 percent per year drop beginning in 2000,” added Dr. Weisbart. “The result is that, in 2006, premiums are less than half of what they were over a decade ago.”

The I.I.I. estimates that, for example, the annual premium for a 40-year-old male nonsmoker buying a $500,000 20-year level term life insurance policy in 2007 will be $615 if he qualifies as a “standard” risk and $340 if he meets the more stringent requirements of a “preferred” risk. Rates for women, younger people and for larger amounts of insurance would be lower.

Premium rates for traditional whole life, universal life, and variable universal life insurance are also expected to be lower in 2007. The premiums for these products—which are designed to pay a death benefit no matter when the insured person dies—are driven by expected investment returns as well as by the same forces that affect term rates, Dr. Weisbart said.

“Life insurance rates are dropping because death rates for the 25-44 age group—the primary age range for purchasing life insurance—have decreased significantly over the past 10 years,” Dr. Weisbart pointed out. In 1996 the death rate per 100,000 for the 25-44 age group was 177.8; by 2004 it had dropped to 161.8 (preliminary data, National Vital Statistics Reports). That is nearly a 10 percent drop in the death rate in less than a decade for the prime insurance-buying ages.

“The drop in life insurance rates couldn’t come at a better time for families with young children,” said Dr. Weisbart. “It’s important that they have life insurance to protect the income their dependents rely on.” Most parents with young children buy term life insurance: A study by LIMRA International (an insurance marketing research organization owned by over 850 financial services organizations) showed that, of those who bought life insurance in 2003, 72 percent of married couples and 66 percent of single parents bought term policies. Each premium dollar for term insurance provides several times the amount of death benefit available from whole life policies.

With rates lower than they have ever been, parents should re-assess the amount of life insurance they carry on their own lives, and many should consider purchasing more. For example, it takes a $500,000 death benefit to pay a widow $2,500 a month for 17 years(1). Yet in 2004, according to LIMRA International, the average adult with life insurance age 25-34 had only $145,000, and the average adult age 35-44 had only $323,000 of insurance on his or her life. As the term “average” implies, many people had smaller amounts of insurance—and one in four adults have no life insurance at all. Furthermore, even a monthly income of $2,500 is less than meets the eye since a portion of it of it is taxable income, and it does not include a retirement program or other employer-paid benefits that the income earner may have had during life.

Those in certain nontraditional family situations also should consider purchasing additional life insurance. The 2000 U.S. Census counted 2.4 million grandparents who say they are responsible for the basic needs of grandchildren living with them. About one-third of these grandparents are raising their grandchildren with no parent present in the home. Nearly one in five of these grandparents are living in poverty; 71 percent are under age 60. Many of them are still working, or have gone back to work to support their family. For the security of the children in their care, these grandparents should learn how their grandchildren can qualify to receive Social Security survivor benefits. And, if they can afford it, they may want to consider individual life insurance as well. For information on grandparents and Social Security, see http://www.ssa.gov/kids/parent5.htm.

Whatever your family situation, if you buy more life insurance, consider buying enough to replace any existing individual life insurance you have. Buying one larger policy—rather than keeping the smaller one and starting a second policy—will further lower your premium rate, since most life insurance companies charge lower rates for larger amounts of insurance. Typical amounts that qualify for lower rates are $250,000, $500,000, and $1,000,000. Be sure to note on the application that you plan to replace an existing policy, and don’t drop the existing policy until the new one is in place.

The I.I.I.’s forecast for life insurance rates in 2007 coincides with an industry-wide campaign to promote September as Life Insurance Awareness Month. The campaign is being coordinated by the Life and Health Insurance Foundation for Education (LIFE); for more information on the campaign, see http://www.life-line.org/LIAM.

Source: Insurance Information Institute, November 27, 2007 

Total health benefit costs rose by 6.1 percent in 2007, the same pace as last year, to an average of $7,983 per employee, according to the National Survey of Employer-Sponsored Health Plans, conducted annually by Mercer and released today. The survey included private and public employers with 10 or more employees and nearly 3,000 employers participated.

The good news is that cost increases have held steady for three years (after spiking to nearly 15 percent in 2002) and are likely to slow a bit further in 2008, to 5.7 percent. The bad news is that' s still more than twice the rate of inflation. Health cost growth is outpacing wages and material costs and eroding business profitability.

There are consequences for working Americans as well: In the absence of a mandate to provide coverage, some small employers are simply dropping their plans, adding their employees to the growing rolls of the uninsured. Among employers with fewer than 200 employees, health coverage prevalence fell from 63 percent to 61 percent in 2007 - and that' s down from 66 percent five years ago. This drop-off is continuing despite the new availability of relatively low-cost consumer-directed health plans (CDHPs), which may be a concern for state and federal policymakers currently debating the future of US health insurance.

After the out-of-control growth of benefit costs in the early part of this decade, a fourth year of single-digit increases begs the question, why isn' t it worse? Shifting costs is one reason. Among large employers (those with 500 or more employees), average in-network PPO deductibles rose by about 11 percent, from $426 to $473 for individuals and from $1,022 to $1,134 for families.
But even if employers made no benefit cuts at all, the rate of increase still appears to be slowing. Employers estimated that the cost of their largest medical plan would increase 8 percent in 2008 "before changes." That' s down from 9 percent in 2007 and 10 percent in 2006.

"The slowdown in the underlying trend reflects slowing utilization," said Mr. Bos. "And that is very likely tied to the proliferation of health management activities and other consumerism strategies."

The survey found that 80 percent of large employers use health management programs as a way to control costs and improve productivity, while 52 percent are actively promoting employee consumerism. The majority of employers using these strategies say they have been successful (63 percent for health management and 62 percent for consumerism). Large employers, which tend to be more proactive in managing benefit costs, experienced a somewhat lower average cost increase than small employers in 2007 (5.1 percent compared to 6.6 percent).

Another factor that may have served to slow increasing benefit costs was the growth in enrollment in consumer-directed health plans, the type of medical plan with the lowest cost by far. In 2007, the percentage of employees enrolled in a CDHP (based on either a Health Savings Account or a Health Reimbursement Account) rose from 3 percent to 5 percent of all covered employees.

"As employees shift from more expensive plans into less expensive ones, employers' overall cost per employee drops," said Mr. Bos. "This is what we saw happen in a big way when employees moved out of traditional indemnity plans into managed care plans in the mid-1990s."
Evidence that the plans are cost-effective is accumulating. CDHPs delivered substantially lower cost per employee than either PPOs or HMOs in 2007. CDHP cost averaged $5,970 per employee, compared to $7,120 for HMOs and $7,352 for PPOs. In addition, when Mercer asked about the reaction of employees enrolled in the plan, about three-fifths of the large sponsors with an HSA-based CDHP (61 percent) said it was either "strongly positive" or "more positive than negative."

The early advocates of CDHPs promised these plans would provide an option for small employer health plan sponsors contemplating terminating their plans because of cost. However, as noted earlier, health plan offerings by small employers continued to erode despite the widespread availability of CDHPs in 2007.

"While the average costs of an HSA-based CDHP is about 20 percent lower than the average medical plan, that doesn' t make it affordable to all employers. Solving the problem of the uninsured will mean addressing the question of affordability," said Mr. Bos.

So how do employers view the state and federal reform efforts that are aimed at increasing access for the uninsured? The Mercer survey asked whether employers favored or opposed "pay or play" laws: requiring employers to offer a health plan or pay into a fund to provide coverage to the uninsured and mandating that individuals buy insurance. Fewer than a fourth of all employers support pay or play (23 percent), and the larger they are the less likely they are to approve: among those with 20,000 or more employees, only 13 percent approve, while 49 percent disapprove.

"Most large, multi-state employers want to retain flexibility and control over their benefit plans and avoid the burdens and complications of complying with numerous state mandates," said Mr. Bos.

Source: Business Wire, November 19, 2007

Total health benefit costs have risen 6.1% percent this year, to an average of $7,983 per employee, according to Mercer Inc.

Researchers at Mercer, a unit of Marsh & McLennan Companies Inc., New York, have based the results from a survey of about 3,000 public and private employers with 10 or more employees.
The 2007 percentage increase is about the same as the 2006 increase, and cost increases have held steady for 3 years after spiking to nearly 15% percent in 2002, Mercer researchers report.
Increases are likely to slow a bit further in 2008, to 5.7%, but, even at that lower rate, health benefits would still be rising at more than twice the rate of inflation, the researchers say.

The percentage of employers with 10 to 200 employees offering health coverage has fallen to 61% this year, from 66% in 2002, and employers with 500 or more employees are sharing the burden by increasing deductibles and other out-of-pocket costs, researchers say.

The percentage of employees enrolled in plans incorporating health savings accounts or other personal health accounts increased to 5% of all covered employees, from 3%, the researchers found.

The average cost per employee was $7,352 at preferred provider organization plans, $7,120 at health maintenance organization plans and $5,970 at health account plans.

Source: NU Online News Service, Nov. 20, 2007

As families gather for the holidays, many will face tough decisions about their loved ones growing old and frail. For most, it will be the first real look at long-term care insurance. But few will actually purchase
policies. Most older Americans don't because the premiums are too high and the market is too confusing and fraught with fraud. Besides, most already have Medicare.

The trouble is, since its inception in 1965, Medicare has notoriously excluded long-term care. By covering acute care for conditions from which people are expected to recover, and excluding coverage of chronic
conditions from which people aren't expected to heal, Medicare has left a huge hole in older people's pockets. Seniors' out-of-pocket medical expenses have risen from 15 percent of annual income in 1965 to nearly 25 percent today. They are expected to hit 30 percent by 2025.

The private insurance market responded to the exclusion of long-term care benefits by creating policies that cover long-term care in the home, the community and nursing homes. By the mid-1990s, hundreds of such options were available. But selecting a plan proved difficult, because costs and benefits vary dramatically by the type of coverage, the insureds' age and health and hometown. Despite growing levels of government regulation, the plans have proven fairly unstable. Put off by high premiums, fraud, overcharges and general mismanagement, many people simply don't buy them. The Congressional Budget Office and the Government Accountability Office estimate that as many as 40 percent of U.S. seniors could afford long-term care policies, but fewer than 10 percent have them.

Meanwhile, complaints of improperly denied claims have risen sharply. In 2005, California reported that 1 of 4 long-term care insurance claims were denied. In 2007, the National Association of Insurance Commissioners reported a 92 percent jump in long-term care complaints nationally from 2001 to 2006, much of the increase linked to complaints about claim denials. While some fight to obtain benefits they've already paid for, others battle to get long-term care insurance coverage at all. In many states, people can and are being denied long-term care plans for melanoma, obesity, smoking or drinking. In its underwriting statement, the insurance firm Term Life America lists 49 conditions considered uninsurable for long-term care insurance, including hepatitis, Alzheimer's, AIDS, diabetes and multiple sclerosis.

Sen. Hillary Clinton, D-N.Y., has called for the GAO to investigate the long-term care industry. Under the Health Insurance Portability and Accountability Act of 1996, the industry got tax breaks in exchange for
consumer protection standards. The law prohibits them from excluding coverage of most treatments or conditions and from canceling policies except when clients don't pay premiums.

Accountability and enforcement of existing laws would be an important first step. But soon, aging Baby Boomers will exponentially increase the need for such services. The problem with private, for-profit, long-term care insurance is that insurers aren't in the business of ensuring that all older Americans have fair and timely access to services. Insurers need healthy quarterly reports for investors. Claims denials and drops in
coverage in the long-term care sector should not surprise us; they are widespread throughout the entire health insurance industry. The next step, then, must be to move from a purely for-profit market provision of
long-term care insurance toward a federal universal plan.

The easiest route would be to expand Medicare coverage of nursing homes and community-based long-term care. Medicare covers just the first 100 days of nursing home care. The co-pay for days 21 through 100 is more than $100 a day. Few seniors or their families can afford this. Because most
nursing home stays are relatively brief, eliminating the co-pay and providing full coverage of the first 100 days would be an enormous step in the right direction.

An alternative would be to create a Medicare Part E that provides mandatory universal long-term insurance coverage, funded through the payroll tax. While more cumbersome to develop, this would have the
advantage of encouraging more home and community-based care rather than favoring institutions.

We have experimented long enough with providing much needed long-term care insurance via the private market. It's time to move beyond yet another investigation of how industry fraud and mismanagement harm older people's lives, to act on the realization that the profit-driven private market simply can not handle long-term care insurance alone.

Source: SF Chronicle, November 16, 2007

A widow recently sold her wedding ring to pay for medicine. Another sometimes begs for prescription drugs left by friends who've died. Another on occasion uses pills prescribed for her dog.

These examples—and many more—of what people actually do to get medications provide a timely reality check for lawmakers in Congress as they wrangle over a Medicare prescription drug benefit: This is how older and disabled Americans are struggling while they wait. Right now a congressional committee, hampered by deep ideological disagreements, is trying to produce a final drug benefit out of two very different bills passed in the Senate and the House in June.

But while the political infighting and nickel-and-diming continue in Washington, millions of people across the country remain in need, sometimes desperately so. "I wish some of these politicians could live on an income like ours just for a month and see where it goes," says Linda Watkins, 58, of Williamston, S.C., who sometimes takes antibiotics meant for her dog. "They have so much drug coverage, I think they forget how much medicines cost nowadays and how tough it is for ordinary folks."

Watkins is one of more than 10,000 readers who responded to a Sound Off questionnaire in the June AARP Bulletin asking them to tell us the methods they use to reduce the cost of their medications.

The Bulletin examined a group of 2,000 replies. Because they were sent in voluntarily, they do not amount to a scientific survey and should not be interpreted as such. Nevertheless, the replies—half from people with drug coverage, half from those with none—reveal a mosaic of deprivations. In particular, they show the extent to which many people are: cutting costs to the detriment of their own health, even among those who have private insurance; willing to flout the law to buy their medicines from Canada and Mexico, where they cost less; falling through the cracks in a system so badly patched together that it doesn't merit being called a "system" at all.

Many people checked off at least nine ways they cut drug costs, out of 13 possibilities listed in the questionnaire—trying almost anything to save money.

Most people, of course, are not driven to the lengths of the three women cited above. Our group, which included people ages 44 to 96, with some still working and not in Medicare, showed out-of-pocket expenses ranging from zero to $14,000 a year. Savings from cost cutting ranged from "very little" to $2,500 a month.

Some methods of cutting costs are just prudent consumerism—for example, using lower-cost generics instead of brand-name drugs (mentioned by 82 percent) and getting discounts (47 percent) and even, in some cases, splitting pills (30 percent). Some pills of different strengths, such as 20 mg and 40 mg, are sold for the same price, so splitting them halves the cost. Splitting pills to skip doses, though, is dangerous. (See our web-exclusive guide to the Do's and Don'ts of Splitting Pills.)

But you have to be feeling the pinch badly to fail deliberately to take medicines you need in the full knowledge that it can harm your health.

Yet 40 percent of people without coverage say they skip doses or don't fill all their prescriptions, and 18 percent do both. More surprisingly, the equivalent numbers for people who have any type of coverage are 34 and 17 percent.

Why? The experience of Darlene Galvan, 66, a retired real estate broker in San Bernardino, Calif., is not uncommon. To cope with high blood pressure, thyroid problems and internal bleeding, she should be taking 14 medications. She has quit five, skipped doses on others and split pills to make them last longer.

Galvan is in a Medicare HMO—"the best one in this area"—but drug coverage is limited to $250 worth of medicines each 90 days. Her most expensive drug costs $360 for a 90-day supply. Even with a copay of $100, "I'm over my quarterly limit for just one prescription," she says.
In recent years many Medicare HMOs have raised premiums and reduced benefits to offset rising drug costs. So have many private insurance companies.

At 61, Frances Adkinson of Union City, Ga., is glad to be insured under her employer's plan. But though it covers many drugs, it refuses to pay for the two she needs most, rejecting her doctors' written pleas that one of them—an anti-allergenic that prevents her throat from swelling—is "a matter of life and death."

"I think insurance companies should be required to cover medications that are needed," she says, particularly when, as with her costliest medication, "there is no generic available."

Adkinson, too, skips doses and doesn't always fill prescriptions. In our group, in fact, more than one in four (27 percent) of those who receive employee or retiree insurance from companies or unions—a type of coverage envied by the uninsured—resorts to these measures.

Ironically, many people with drug coverage find themselves paying more out of pocket than many without it. That is because those who need multiple medications also have multiple copays. Someone who needs 10 drugs with a copay of $25-$60 each could be paying $250-$600 a month on top of the premiums and copays for visiting the doctor. For some, this is a real Catch-22.

A retired couple from upstate New York (who prefer not to be named) have an income of $2,200 a month, out of which they pay a $500 insurance premium and copays of over $200 for 11 drugs between them. They can't consider dropping the insurance because, following a liver transplant last year, just the two anti-rejection drugs she takes to stay alive cost $2,300 a month. Choosing another plan is not an option because, with her pre-existing condition, the premium would double.

Like several others in our group, this woman didn't want her name published for a specific reason. "I'm so afraid the insurance company will dump me," she says. "I'm paranoid."
To be sure, many readers do not have such difficulties and a few are exceptionally fortunate. The drug plans for military retirees and many veterans require only low copays. Under some union plans, retirees pay nothing out of pocket. But at the other end of the spectrum are those whose cost-cutting methods only emphasize the disparities.

Returning to work is one. Patricia King of Los Gatos, Calif., at age 70 decided "just to find a job with health benefits." She succeeded—and now, turning 77, pays $30 for a 90-day supply of the costliest of her five medicines, instead of the $107 a month she used to pay without insurance, a saving of over 90 percent. "I enjoy the job," says King, who is very aware that being able to afford all her medicines is also keeping her well enough to work.

One retiree (who does not wish to be identified) lives in a Florida condominium where many neighbors are in their 80s and 90s. Sometimes, she says, "I ask for the drugs of people who've died," most often a blood pressure medicine that many older Americans rely on.
Others say they "buy less food," "use home remedies," "stay away from doc," "share with Mother," "trade with friends," "use others' leftovers," "rely on relatives' help," "stay healthy" and—most frequently—"do without" prescribed drugs.

Only a minority of our group is enrolled in low-income drug assistance programs provided by states and communities or by drug companies, although these can save enrollees a lot of money.
Sadly, many people do not realize they are eligible for such programs. This was the case with a 72-year-old widow living in Pennsylvania, which has the PACE drug assistance program, one of the best in the country. With an income of less than $600 a month, she has sold off many of her possessions to pay for medicine, including her wedding ring—"the most heartbreaking thing I've done"—not knowing she qualified for help.

Far more people (a surprising 74 percent) say they've been given—and often asked for—free samples of drugs from their doctors. Drug companies provide samples to promote new products. Doctors often give a month's supply to see how a patient fares on a new drug. But many also use them to subsidize patients who can't afford the price. An Arizona retiree says his doctor once gave him a whole year's supply for that reason.

Without question, the fastest-growing cost saver is buying drugs from abroad. Nobody is sure how many people are doing it, though estimates hover around 2 million. (See More Americans Go North for Drugs from our April 2003 issue.)

Among our respondents, more than one in three (37 percent) with no drug coverage are buying drugs from Canada—33 percent by mail order and 4 percent by crossing the border. Even among those with coverage, 11 percent are buying from Canada to reduce costs. Fewer buy drugs in Mexico—5 percent with coverage and 8 percent without.

These numbers are far higher than three years ago, when Canadian mail order had barely begun. In a 2000 Bulletin Sound Off, only 9 percent of respondents said they bought drugs from Canada or Mexico.

To Dale and Marjorie Brown, self-employed farmers in North Dakota, private insurance is unaffordable. In poor health, they say medicines are their worst expense at up to $900 a month out of pocket. But they still save thousands by buying some in Mexico every winter when visiting relatives and getting the rest from Canada by mail order.

Many others report slashing their drug bills by more than half. Walter Wager, 79, a writer in New York City, pays the Canadian price of $286 a month for cancer pills that would cost him $600 here. "I've had a wonderful experience with the Canadians," he says.

Legal or safety concerns do not appear to bother these importers, but something else often does. "It's very embarrassing as a patriotic American to be driven to ordering my necessary drugs from another country," says Doris Greene of Jacksonville, Fla., whose late husband would never buy even a foreign car.

From these interviews and many more emerges a strong sense of disconnection with Washington. "There's a whole subculture out there," Linda Watkins says, in describing the long lines at a local clinic that dispenses limited supplies of free, donated medicines.

Are there lessons for Congress to learn here? One may be that private plans—on which Republicans place much faith and the current Medicare proposals largely rely—would need strong government oversight to ensure adequate and dependable benefits. Another may be that anger over U.S. drug prices—which push up insurance costs as well as drive people to buy from abroad—is rapidly hardening.

Many readers say they need a Medicare drug benefit that is affordable as quickly as possible, but most are skeptical of getting one any time soon.

"I'm 82," says June Henderson, a former missionary now in Colorado who has tried almost every means of cutting costs. "And at the rate it's going, I'll be dead by the time anything is passed in Congress."

Source: AARP Bulletin, December 5, 2007

Metabolism is a mystery. You may know that mastering it is the key to losing weight, but what is it? And where is it? Turns out it's the engine that drives every cell, and that means it's everywhere. Your metabolism helps you walk, talk, fight off illness, even read this article. Its fuel is calories. Each one you consume goes into the metabolic tank that powers the machine that is you. Keep that tank filled and you're good to go, right?

If only it were that simple. As you age, your body becomes less effective at burning calories, mostly because of a gradual decrease in activity and resulting loss of muscle. Your metabolism can dip as much as 25 to 30 percent over your adult life, says Miriam Nelson, Ph.D., director of the John Hancock Center for Physical Activity and Nutrition at Tufts University. As a result, your body tends to store excess calories in the form of -- you guessed it -- body fat, and that extra weight only slows you down more.

You don't, however, have to resign yourself to a life of forgiving jersey fabrics and shape-disguising tunics. For most women, strength-training can help boost metabolism by as much as 10 percent in 12 weeks by rebuilding muscle. You can increase it further by making small but targeted lifestyle changes. "Anything that energizes you -- a good night's sleep, fresh air, sunlight, a healthy diet, regular exercise -- ultimately helps drive metabolism," explains Nelson.

With that in mind, we've designed a round-the-clock plan that will tune up your fat-burning engine, boosting its efficiency and maximizing calorie burn morning, noon and night. By shifting your body into high gear, these timely tips will help you burn 200 to 300 more calories a day. (And that doesn't even take into account your regular exercise routine.) Can't do it all? Don't worry -- employing even a few of these steps will confer benefits. Now let's get going.

Morning
Eat a 300- to 400-calorie breakfast
In the AM, your energy stores are depleted by as much as 80 percent from the night before. Without food, your body shifts into starvation mode, which means it begins to conserve energy and burn fewer calories. (In other words: Your metabolic rate takes a nosedive.) That may be why, in one study, breakfast skippers were 4 1/2 times more likely to be obese than breakfast eaters. For more long-lasting energy, include whole grain complex carbohydrates like oatmeal.

Throw in a cup of halved strawberries
Research suggests that getting enough vitamin C -- 75 mg a day -- may be essential for optimal fat burning. The strawberries provide 90 mg.

Get a dose of sunlight
"Exposure to bright light decreases melatonin and increases serotonin, shifting your body from sleep to awake mode and, in turn, revving your metabolic furnace," says health and psychology researcher Robert K. Cooper, Ph.D., author of the metabolism book 'Flip the Switch.'

Take your multivitamin
Antioxidant nutrients help protect mitochondria, tiny structures found in every cell, from damage; they're the microscopic fat-burning furnaces that convert food into fuel.

Move at the office
"Moving throughout the day -- even if it's just walking to a colleague's office rather than sending an e-mail -- keeps your metabolism higher than doing a workout and then remaining sedentary," says James O. Hill, PhD, director of the Center for Human Nutrition at the University of Colorado at Denver.

Sip a cup of coffee or tea
Caffeine is a central nervous system stimulant that moderately boosts metabolism, helping you burn about 20 extra calories.

Have a midmorning snack
Good choices are a reduced-fat cheese stick or a cup of low-fat yogurt and a piece of fruit. Every time you eat, your body burns additional calories to digest the food. Take advantage of this automatic boost by eating something -- even if it's very small -- every 3 to 4 hours.

Your AM Routine: Energizing Yoga
Accelerate the natural metabolic boost that occurs when you wake up by doing these poses. Yoga can also help control levels of the stress hormone cortisol, which begins to rise after waking and can contribute to muscle loss and a resulting dip in metabolism.

Downward Facing Dog
Kneel with hands directly beneath shoulders, knees beneath hips, and toes tucked. Press palms into floor and lift tailbone toward ceiling, straightening legs so body forms an inverted V, as shown. Keep shoulders away from ears and relax head between arms. Hold for three to five breaths. Bend knees and relax down to floor.

Cobra
Lie face down with legs extended, toes pointed. Place hands on floor beneath shoulders, elbows close to torso. Press feet, thighs, hips, and pelvis firmly into floor and straighten arms, lifting chest as high as comfortably possible, as shown. Keep shoulders down and back, lifting through breastbone, opening chest, and lengthening spine. Hold for three to five breaths. Tuck toes under and push back into Downward Facing Dog. Repeat moves three to five times.

Afternoon
Eat a protein-packed lunch You'll burn more calories digesting your midday meal because protein is more difficult to break down than carbohydrates or fat.
Try: 
o roast turkey breast with sliced veggies and hummus wrapped in a whole wheat tortilla; add a piece of fruit 
o salmon salad (like tuna salad but with canned salmon) topped with lettuce and tomato on a whole wheat bun; carrot sticks and grapes on the side 
o chicken-vegetable soup with a whole wheat roll

Snack on nuts
As your blood sugar and energy levels hit the postlunch slump, your metabolism also takes a dip. The protein and fiber in a handful of nuts (about 20) can help stave off hunger and keep you energized until dinnertime. "Nuts also contain monounsaturated fats, which have been found in studies to stimulate fat burning," says Cooper.

Laugh it up
Laughing eases stress and boosts calorie burn up to 20 percent, reports a Vanderbilt University study of 90 men and women. Need a little inspiration? Check out The Onion, an irreverent -- and completely fake -- news site.

Take the stairs
Climbing stairs quickly elevates your heart rate for a metabolic jolt that burns 8 calories per minute -- twice as much as brisk walking. Try to accumulate 5 to 10 minutes during the afternoon.

Brew some green tea
Studies show that the polyphenol compounds in 2 to 4 cups may help raise metabolism by as much as 35 percent and encourage fat burning.

Commute -- with a CD
Relaxing music has been shown to reduce cortisol, a key metabolism-tempering hormone. Once tension has been tamed while on the highway, switch to more energizing music; upbeat tempos raise your heart and breathing rates and metabolism. And you'll be ready to tackle whatever awaits you when you arrive at home.

Stretch at your desk
Counter the metabolism-depressing effects of midday stress by boosting circulation and easing upper-body tension. And take deep breaths while you stretch to provide cells with the energy-producing oxygen they need to burn fat.

Chair reach and drop
A. Sit on edge of chair, feet flat, back straight. Extend arms overhead, palms facing each other, and gently arch back as far as comfortable. Hold 1 to 2 seconds, then sit back up and lower arms out to sides.

B. Clasp hands behind back and lean forward from hips, bringing chest toward thighs, arms toward ceiling. Hold 10 to 15 seconds. Release and repeat.

Source: Prevention, 2007

Veggie trays, move over! This colorful tree-shaped appetizer will add an interesting twist to your appetizer buffet

INGREDIENTS

2 cans (8 oz. each) Pillsbury refrigerated crescent dinner rolls
1 pkg (oz) cream cheese, softened
½ cup sour cream
1 teaspoon dried dill weed
1/8 teaspoon garlic powder
3 cups finely chopped assorted vegetables (bell peppers, broccoli, carrots, cucumbers and/or green onions)

DIRECTIONS

Heat oven to 375° F. Remove dough from cans in rolled sections (2 sections from each can); do not unroll. Cut each section into 8 slices (16 slices from each can).

Place slices, cut side down, on ungreased cookie sheets to form trees. To form each tree, start by placing 1 slice for top; arrange 2 slices just below, with sides touching. Continue arranging row of 3 slices, then row of 4 slices, ending with row of 5 slices. Use remaining slice for trunk. Refrigerate one tree.

Bake one tree at 375° F. for 11 to 13 minutes or until golden brown. Cool 1 minute; carefully loosen with pancake turner and slide onto wire rack to cool. Bake and cool second tree.

Place each tree on serving platter. In small bowl, combine cream cheese, sour cream, dill and garlic powder; blend until smooth. Spread mixture over both trees. Decorate trees with assorted vegetable pieces. Garnish as desired. Refrigerate until serving time. To serve, pull apart slices of tree.

Source: Pillsbury.com, December 5, 2007