Information on popular complementary and alternative medical topics

A person who has been covered previously under a group plan, but who can no longer work, may have the option of continuing in the group plan for eighteen months under the Consolidated Omnibus Reconciliation Act of 1985 (COBRA). Under COBRA, the former employee would pay a premium that is 102 percent of the premium previously paid by the employer—the extra 2 percent is for administrative fees. Some states will pay these premiums for you, to delay Medicaid coverage. Requirements for coverage under COBRA are as follows: COBRA applies only to businesses with twenty or more employees; the former employee must pay the premiums; the former employee must be ineligible for Medicare; the employer must continue the group plan for continuing employees; and the former employee cannot join another plan.     People who are eligible for Social Security disability benefits when employment ends may obtain eleven months of additional coverage (for a total of twenty-nine months) with the same insurer, although the premium may now be 150 percent for the additional eleven months.     People who are not eligible for COBRA because they worked for a company with fewer than twenty employees may still be protected under the Continuation of Comprehensive Benefits laws in thirty-five states; the duration of coverage of the employer’s group policy varies with different states, and ranges from three to eighteen months.     The alternative to COBRA, if COBRA is not available or if it runs out, is a conversion policy: the former employee converts the group policy to a type of individual policy. Conversion policies cover less than group plans and cost more. Thirty-five states require employers to offer conversion policies to former employees when COBRA benefits run out. Premium rates tend to be high, since most people who buy conversion policies are in poor health. Nevertheless, the person with a serious disease might have few other options, and conversion policies are available regardless of health status or preexisting conditions. The remaining option is an individual plan, which costs even more than a conversion policy.*204\191\2*

This is a curious and poorly understood tumor of the blood vessels that got its name from the person who first described it over a century ago, Moricz Kaposi, a Hungarian dermatologist. At that time KS was generally a tumor of the leg occurring in elderly men of Ashkenazi Jewish or Mediterranean descent. A KS tumor is purple or black in color and painless. Over years or decades, KS tumors in these men grew slowly in size and number, but seldom caused serious consequences. KS in people with HIV infection behaves differently: the tumors grow more rapidly and appear in parts of the body other than the legs, including the internal organs.
These tumors can appear any place on the skin. They can also occur in the gastrointestinal tract, where they cause abdominal pain or diarrhea; in the lymph glands, where they occasionally cause painful swellings in the neck, under the arms, or in the groin; in the lungs, where they cause shortness of breath, coughing up sputum, or collections of fluid that reduce breathing capacity; in the brain, where they cause seizures; and in the liver. KS may also occur on the roof of the mouth. KS is unusual in that the tumors grow simultaneously at different places both on the skin and within internal organs.
KS is second only to PCP as the initial AIDS-defining diagnosis in people with HIV infection. Although KS occurs without HIV infection, it is approximately twenty thousand times more frequent in people with HIV than in those without. Probably between 20 and 25 percent of all people with AIDS have KS, but the frequency is substantially greater in gay men than in other groups with HIV infection. KS was also more common in people with AIDS in the early stages of the epidemic than it is now, for reasons no one knows. Some feel that the epidemiology of KS suggests that it is a sexually transmitted disease and that the safer sex practices widely adopted by gay men in the early 1980s in response to the HIV epidemic account for the reduction in cases.
The prognosis is actually quite good, possibly because people whose KS is their first
AIDS-defining condition have less severe immune suppression. Many people simply have tumors that persist or that increase in size and number. For this reason, treatment may not be necessary. Treatment is usually done for cosmetic reasons or for relief of any unpleasant symptoms.

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