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Anti-Abortion Forces Regroup In Wake Of Supreme Court Decision

Kaiser Health News - Wed, 07/20/2016 - 5:00am

Delegates at the Republican convention in Cleveland have approved the strongest anti-abortion platform in the party’s history. But groups that oppose abortion — and that lobbied for the strong language — are far from unified.

In fact, in the wake of last month’s Supreme Court decision reaffirming a woman’s right to abortion, leaders of a movement known for speaking largely with one voice are showing some surprising disagreement.

For the past several years, anti-abortion groups have pushed an agenda aimed at imposing much stricter regulation on abortion facilities. The groups said it was to promote the health and safety of women; abortion-rights supporters said it was an effort to regulate the clinics out of existence.

At least for now, the Supreme Court is siding with abortion-rights backers. Neither of the portions of Texas’ omnibus abortion law that were up for review “offers medical benefits sufficient to justify the burdens upon access that each imposes,” wrote Justice Stephen Breyer in the majority opinion.

The provisions that were struck down required abortion clinics in the state to meet the much higher safety standards for facilities that do much more advanced surgical procedures and required doctors who perform abortions to have admitting privileges at a hospital within 30 miles of the clinic.

This KHN story also ran on NPR. It can be republished for free (details).

In hindsight, “maybe it was a mistake for us to champion safeguards for women,” said Marjorie Dannenfelser, president of the Susan B. Anthony List, whose goal is to elect more anti-abortion candidates to public office. “Maybe we shouldn’t have done that.”

At a media briefing, Dannenfelser said her group will instead rally around legislation that has passed in more than a dozen states to ban abortion at roughly 20 weeks of pregnancy. Similar legislation passed the U.S. House but not the Senate.

The 20-week ban is “our top priority,” she said.

But Clarke Forsythe, acting president and senior counsel for Americans United for Life, said his group plans no fundamental change in strategy.

“It is more important than ever to focus on the risks to women and negative consequences,” he said in an interview. “The justices can’t sweep away the public health vacuum that they created with a few pen strokes.”

Forsythe said that while the court’s ruling has “put some roadblocks in the way, and we will have to take those into consideration,” there are still plenty of opportunities to regulate abortion providers that could pass constitutional muster, particularly if they are more narrowly targeted than the Texas law was.

The nation’s oldest anti-abortion group, the National Right to Life Committee, has never embraced the push for health and safety regulations aimed at women.

“Our focus has always been on the humanity of the unborn,” said its president, Carol Tobias, rather than potential risks to women seeking abortions.

Her group has instead been pushing state and federal bills to ban abortions after 20 weeks and ban “dilation and evacuation” abortions, which are the most common procedure performed after the first trimester of pregnancy.

“I don’t think the Texas decision is necessarily going to impact those types of legislation, and I know it’s not going to affect us,” she said.

But there is one thing they all seem to agree on: The future makeup of the Supreme Court, and with it the future of abortion rights, hangs in the balance with the upcoming election.

Because of the vacancy left by the death of Justice Antonin Scalia last winter, “it is so obvious, so simple to make the case” about the importance of who controls the White House and Senate when it comes to Supreme Court appointments, said Dannenfelser.

“We say the court’s always important,” said Tobias. “But this time we have solid proof.”

The groups also agree on something else — that despite the victory at the Supreme Court, abortion-rights forces are not winning the fight.

“The pro-life cause has never been stronger,” said Dannenfelser. “And our opponents’ position has never been weaker.”

Immediately after the court’s ruling, said Tobias, “Planned Parenthood came out and said they were going to pass pro-abortion legislation and repeal pro-life legislation.”

That is true. “Today’s victory means we can fight state by state, legislature by legislature, law by law, and restore women’s access to reproductive health care,” said Planned Parenthood Action Fund Executive Vice President Dawn Laguens in a statement.

But in fact, said Tobias, “they haven’t been able to do that in 40 years. The only way they make advances is through the courts. They don’t have the people” on their side.

In an interview, Laguens agreed that her side has more work to do. “We’ve got to change hearts and minds,” she said. But Laguens insists it is abortion opponents who are “out of sync with America and out of sync with the new generation.”

With a more “social justice minded” generation of millennials now coming of age, she said, it is abortion foes on the defensive. “They’re in a last gasp moment,” she said. “They feel it slipping away.”

Categories: Health Care

What Do Covered California’s Big Rate Hikes Mean For You?

Kaiser Health News - Tue, 07/19/2016 - 5:42pm

Covered California, the state’s Obamacare health insurance exchange, said Tuesday that its premiums will balloon by a statewide average of 13.2 percent next year — more than triple the roughly 4 percent increases in each of the previous two years.

But the average rate hike doesn’t tell the full story for individual consumers. Health plan prices vary across the state, and within regions. How much you’ll pay depends on a variety of factors: where you live, how much money you make, what level of coverage you want and which insurer you choose.

Keep in mind that these premium increases affect only a fraction of insured Californians — not the majority, who get their coverage through work or a government program such as Medicare or Medi-Cal.

Here are some key questions and answers to help you better understand what today’s announcement means for you.

Q: When do these premium hikes take effect?

They start in January for 2017 policies.

Q: Are all Covered California plans going up 13.2 percent?

No. California is divided into 19 pricing regions, and not all 11 plans that participate in the exchange are offered in each region. Your options will depend partly on where you live and what plans are available in your area.

In some regions, the rate increase is higher than the statewide average. In others, it’s lower.

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Within regions, rate hikes vary by insurer. For instance, in the greater Sacramento area, rates will rise an average of 13.4 percent overall. However, rate increases within the region range from an average 5.8 percent for a Kaiser Permanente plan to 23.1 percent for a Blue Shield of California plan.

Anthem Blue Cross and Blue Shield of California account for the highest rate increases statewide, said Covered California Executive Director Peter Lee. Blue Shield said its average hike was 19.9 percent, the biggest among all insurers participating in the exchange. Anthem Inc. said its average increase in California was 17.2 percent, the second biggest.

Q: Where are the biggest increases and what accounts for them?

The biggest rate hike will be in the region that includes Monterey, San Benito and Santa Cruz Counties, coming in at a whopping 28.6 percent. Covered California premiums in Northeast Los Angeles County will rise an average of 16.4 percent. Exchange enrollees in San Luis Obispo, Santa Barbara and Ventura Counties will see a 15.8 percent average increase. San Francisco rates are increasing an average of 14.8 percent.

Lee attributed the increases to several factors, including the rising cost of health care —in particular the steep jump in specialty drug prices.

Q: Will I be able to keep the same plan I have this year?

It depends on where you live. United HealthCare, after just one year of limited participation in Covered California, is pulling out in 2017.

Other plans, including Oscar, Molina and Kaiser Permanente, are expanding into some regions.

But even if you can keep your plan, a rate hike could put it out of your financial reach.

To find a better price, more Covered California enrollees will have to switch plans, which means they could lose their current doctors. According to Lee, about 80 percent of Covered California consumers will be able to pay less than they do now or cap their rate increases at 5 percent if they shop around and buy the lowest-cost plan at their current benefit level.

Q: If the premium on my plan rises by 10 percent, does that mean I’m going to have to pay 10 percent more out of my pocket than I did this year?

Not necessarily.

About 90 percent of Covered California enrollees receive tax credits that help defray the cost of their premiums.

As premiums rise, so do tax credits, which means that, all things being equal, the tax credits will absorb at least some of the rate hike.

Consumers are eligible for sliding-scale tax credits if they make between 138 percent and 400 percent of the Federal Poverty Level. This year, that’s between $16,394 and $47,520 for an individual and $27,820 and $80,460 for a family of three. The more money you make, the smaller the tax credit you receive.

Remember, the size of the tax credit you receive may vary from year to year as a result of changes in your income, age or family size.

“It is a complex calculation based on a lot of factors,” said Amy Palmer, director of communications at Covered California.

Q: When can I shop for my 2017 coverage?

Open enrollment for individual and family plans begins Nov. 1 and ends Jan. 31, 2017. These dates apply to plans purchased through Covered California or the open market.

But you won’t be able to research your specific situation until the fall. Because Covered California is revamping its online shopping tool, which offers personalized searches, it won’t be available and updated for 2017 health plans until early October, Palmer said.

If you already have a Covered California plan, you will receive a notice from Covered California in October explaining how much your current plan’s premium will change and what your tax credits — if any — will be for next year. If your plan is being offered again next year, you can keep the same plan at the new rate or switch plans during open enrollment.

If you want to get a general idea of average rate increases across the state, check out Covered California’s 2017 rate plan booklet.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Categories: Health Care

Medicaid Works: A Critical and Evolving Pillar of U.S. Health Care

Center on Budget and Policy Priorities - Tue, 07/19/2016 - 1:37pm

Medicaid is in the news, with Louisiana this month becoming the latest state to implement health reform’s Medicaid expansion even as, in Washington, House Republican leaders propose radical structural changes that would likely mean deep Medicaid cuts.

Categories: Benefits, Poverty

Covered California Health Plan Rates To Jump 13.2 Percent In 2017

Kaiser Health News - Tue, 07/19/2016 - 1:09pm

California’s Obamacare premiums will jump 13.2 percent on average next year, a sharp increase that is likely to reverberate nationwide in an election year.

The increase, announced by the Covered California exchange Tuesday, ends the state’s two-year respite from double-digit rate hikes.

The announcement comes as major insurers around the country seek even bigger rate increases for open enrollment this fall, and the presidential candidates clash over the future of President Obama’s landmark health law.

California won plaudits by negotiating 4 percent average rate increases the past two years for its 1.4 million enrollees. But that feat couldn’t be repeated for 2017, as overall medical costs continue to climb and two federal programs that help insurers with expensive claims are set to expire this year.

Health policy experts said California is rejoining the pack after outpacing much of the country during the launch of Obamacare.

“This puts a chink in the armor of the California story,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. “It’s still a more stable market than other states, and by most measures the Affordable Care Act is working quite well in California.” (California Healthline, an editorially independent program of the California Health Care Foundation, is produced by Kaiser Health News, which is part of the Kaiser Family Foundation)

Critics of the health law, including Republican presidential candidate Donald Trump, have been quick to seize on these rising costs as further proof that the Affordable Care Act is failing the average consumer and warrants repeal.

The Obama administration counters that federal subsidies spare most consumers from the full impact of the premium increases and the health law enables people to shop around for a better deal.

Last week, consulting firm Avalere Health found that the average rate increase being sought for widely sold silver plans was 11 percent across 14 states. But consumers could limit the increase by choosing one of the lower-cost silver plans, which are set to go up only 8 percent.

These rate increases apply to people who purchase their own coverage in the individual market, not the majority of Americans who get their health insurance through work or government programs such as Medicare and Medicaid.

Use Our Content This story can be republished for free (details).

Peter Lee, executive director of Covered California, said prices for 2017 reflect some one-time adjustments and don’t necessarily portend similar increases in the years ahead. “2017 will be a transitional year for premium rates across the nation,” Lee told a Congressional committee last week.

Two federal programs that have helped health insurers offset costly medical claims and cover sick patients in general end this year. They were intended as a temporary cushion for insurers who are now required to accept all applicants regardless of their medical histories.

Health insurers and Covered California said rates also reflect the ever-increasing cost of care, particularly for expensive specialty drugs.

“The rising trend of health-care costs remains a constant driving factor in health-care premiums,” Lee said.

Insurers have also complained about lax rules for special enrollment outside the designated signup period that have allowed some people to game the system by waiting until they need care to enroll . Those people tend to generate more claims and higher costs, insurers say. Federal and state officials say they have tightened the rules to address these complaints.

To press their case for higher rates, health insurers said they had the benefit of detailed data on exchange customers and their medical claims for the first time since these marketplaces opened in 2014.

Many consumer advocates in California had hoped that UnitedHealth Group Inc. would become another formidable competitor on the state-run exchange. But the nation’s largest health insurer is leaving Covered California after just one year of minimal participation — part of a broader pullback nationwide after the company posted heavy losses on individual plans.

The top four insurers in Covered California, led by Blue Shield of California and Anthem Inc., control more than 90 percent of enrollment.

The premium increases in California will vary widely by region and by insurance company, and could pinch the pocketbooks of cost-conscious consumers like David Arnson.

Arnson, 57, of Los Angeles, qualifies for a federal subsidy and pays just $32 each month for a Molina Healthcare policy he purchased through Covered California. He relies on the coverage to help pay for treatment for ankle and knee problems.

Arnson, who works at a record store and plays in a band, said he worries about his monthly premium increasing next year.

“I make a marginal living. Like anything, you want to pay as little as possible,” he said. “I need healthcare — it is at the top of my pyramid of necessities.”

The higher rates in California may spur more consumers to switch health plans. Only 14 percent of Covered California enrollees who returned this year chose a different insurer. On the federal exchange, 43 percent of people switched plans for 2016.

However, the proliferation of narrow networks can make shopping complicated since certain doctors and hospitals may only be available through one or two insurers, and provider directories are often inaccurate.

Since 2014, California has benefitted from having a healthier mix of enrollees compared to other states. One reason for that is state officials defied the Obama administration by requiring insurers participating in Covered California to cancel existing individual policies at the end of 2013.

That unpopular decision quickly moved people into coverage that fully complied with the health law and created one giant risk pool for rating purposes. Those previously insured customers were generally thought to be healthier, since at the time insurers could deny coverage to people with pre-existing conditions.

But that positive effect may be wearing off as people get sick over time or leave the individual market for coverage elsewhere, experts say.

The expansion of coverage under the Affordable Care Act has driven the percentage of uninsured Californians to a record low.

The share of Californians lacking health insurance was 8.1 percent at the end of last year, down from 17 percent in 2013, federal data show.

The expansion of Medi-Cal, the state’s Medicaid program for lower-income residents, accounts for a significant part of that reduction. Since January 2014, nearly 5 million people have joined the Medi-Cal rolls, bringing total enrollment to 13.4 million — about one-third of the state’s population.

Anna Gorman contributed to this report.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

This story will be updated.

Categories: Health Care

An Interview with Cynthia Chen, Foreign Law Intern

In Custodia Legis - Tue, 07/19/2016 - 10:33am

Today’s interview is with Cynthia Chen, a foreign law intern currently working with Tariq Ahmad on research related to the laws of Canada.

Describe your background.

Photo by Tariq Ahmad

I was born in Regina, Saskatchewan, a city in the west of Canada. I moved to Montreal, Quebec when I was five years old and I have been living there ever since. I recently completed the second year of my civil law (LLB) degree at the University of Montreal. I have previously interned at a law firm in Beijing, China, in the field of antitrust/competition law, as well as in a non-profit organization in Montreal for the defense of tenants’ rights. Next semester, I will be studying abroad at University of College Cork in Ireland.

How would you describe your job to other people?

As an intern in the Global Legal Research Directorate, I conduct research and assist in the writing of reports on various aspects of Canadian law in response to requests from the U.S. Congress, federal courts and agencies, as well as the general public. I also assist with matters concerning other francophone jurisdictions, such as France and Belgium. In addition, I write articles about recent legal developments in Canada for this blog and for the Global Legal Monitor.

Why did you want to work at the Law Library of Congress?

I was extremely eager to work at the Law Library of Congress, because it is such a unique and enriching experience. In addition to offering an unrivaled wealth of resources with the largest legal collection in the world, the Law Library is staffed by a diverse and highly qualified team of legal specialists from around the globe. I knew that it would be very stimulating to be surrounded by people with so many different backgrounds and perspectives and that such an environment would allow me to learn enormously. The experience of living in Washington, DC was definitely another plus, especially during the elections!

What is the most interesting fact you have learned about the Law Library of Congress?

Although I already knew that the Law Library has the largest legal collection in the world, it was only when I walked through the stacks in the sub-basement that I realized just how many books were in the Library’s collection. Also, I was very pleasantly surprised to discover that the working environment is extremely friendly and collegial.

What is something most of your co-workers do not know about you?

I am a competitive badminton player. I compete for my University team, les Carabins de Montreal, and I have also represented my province on numerous occasions at the national level.

Categories: Research & Litigation

First Edition: July 19, 2016

Kaiser Health News - Tue, 07/19/2016 - 6:49am
Categories: Health Care

‘Don’t Cut Me!’: Discouraged By Experts, Episiotomies Still Common In Some Hospitals

Kaiser Health News - Tue, 07/19/2016 - 5:00am

Since it was uploaded to YouTube, the video of Kimberly Turbin’s 2013 episiotomy has been viewed more than 430,000 times. In the video, Turbin lies on her back in a hospital bed. Her knees are bent, her legs and feet are elevated above her in stirrups. She is trying to push the baby out.

“Push, push, push. Go, go, go,” the nurse says.

A doctor walks into her room in Providence Tarzana Medical Center in California’s San Fernando Valley. He pulls out a pair of sharp scissors.

“What are you doing?” Turbin asks, breathless, between contractions.

He tells her he is going to cut her perineum, a procedure known as an episiotomy.

“What? Why? We haven’t even tried,” Turbin cries. “No, don’t cut me!”

This story also ran on NPR. It can be republished for free (details).

“What do you mean, ‘Why?’” the doctor responds, sounding increasingly irritated as Turbin continues to protest. “That’s my reason. Listen: I am the expert here.”

“You cannot fight with the doctor,” Turbin’s mother tells her daughter. “Just do it, doctor. Don’t worry.”

Then comes the audible sound of him snipping Turbin’s flesh.

Episiotomy, a once-common childbirth procedure that involves cutting tissue between the vagina and anus to enlarge the vaginal opening, has been officially discouraged in most cases for a decade. Yet it is still being performed at much higher than recommended rates in certain hospitals and by certain doctors.

In 2006, the American College of Obstetricians and Gynecologists released a recommendation against routine use of episiotomy, finding that it benefited neither mothers nor babies. In 2008, the National Quality Forum also endorsed limiting the routine use of episiotomies. The procedure is still supported for use in certain emergency situations.

Nationally, and throughout California, the use of episiotomies has dropped significantly since the official recommendations came out — from 21 percent of all vaginal births in the state in 2005 to less than 12 percent in 2014.

That overall drop masks some giant disparities. A majority of the state’s hospitals now have rates under 10 percent, according to state data. But a few, including Whittier Hospital Medical Center and Beverly Hospital, in Los Angeles, are performing the procedure in more than 60 percent of vaginal births. Neither hospital returned calls for comment.

“If you perform an episiotomy, you’re more likely than not going to cause more postpartum pain and discomfort,” said Dr. Alexander Friedman, an assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center.

Friedman was the lead author of a 2015 JAMA report about the variation in episiotomy rates among hospitals nationally. While it’s difficult to determine precisely what that rate should be, he said, it should likely be less than 10 percent.

As recently as the late 1970s, episiotomy was used in more than 60 percent of vaginal deliveries because doctors believed a clean incision made it easier to stitch up a woman and prevented overstretching of the muscles surrounding the vagina. In the past few decades, though, research began showing that the cuts were sometimes causing serious pain and injuries, including third and fourth degree lacerations, incontinence and sexual dysfunction. The cuts often proved slower to heal than a natural tear.

Armed with this information, many pregnant women started refusing the procedure, and most obstetricians stopped doing it routinely.

But some doctors are going against that trend.

Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health’s California Hospital Medical Center in Los Angeles, lists three main reasons why he suspects some providers continue to perform routine episiotomies: They’ve always done them, they lack awareness of best practices or they want to speed up deliveries.

“Certain segments of the obstetric community are very slow to modernize the practice,” he said. “They’re very slow to abandon procedures that are not a benefit and, in fact, may be harmful. And it’s really disappointing.”

Such variation exists not only among providers, but among hospitals. Case in point: The Los Angeles hospital chain, AHMC Healthcare Inc. Each of its six hospitals have continued to do episiotomies in more than 29 percent of vaginal births, according to state data. Two of them — Garfield Medical Center and Whittier Hospital Medical Center — have episiotomy rates close to 60 percent. Representatives of the chain and its hospitals did not return repeated calls and emails requesting comment.

By contrast, Kaiser hospitals have seen huge reductions in use of the procedure since the Oakland-based managed care organization undertook an intentional effort to address overuse.

Dr. Tracy Flanagan, director of women’s health and maternity at Kaiser Permanente in Northern California, said her office began examining episiotomy rates at different hospitals four or five years ago. They first looked at rates at the hospital level, then at the physician level, she said.

“When we generated the data, we saw a lot of the variation and got to work on it,” she said.

They sent the data to the individual hospitals. Then, doctors at each hospital who rarely performed episiotomies educated their colleagues about the appropriate use and risks.

Physicians tend to respond best if other physicians present them with a compelling argument to change their practices, Flanagan said. Reliable data, transparency and peer-to-peer education is a good recipe for narrowing variation, she said.

The average episiotomy rate for the Northern California Kaiser hospitals is now about 3 percent, she said. Zero percent would be too low, she added, since there are some cases where the procedure’s use is indicated — if a baby’s shoulder is stuck, if a baby’s heart rate drops, or if the mother is exhausted and wants an episiotomy, for instance.

Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative at Stanford University, says the episiotomy data offers a lesson on how quickly practices can change. It also highlights the hospitals where doctors refuse to alter their ways, he said.

In the case of C-sections, doctors may be motivated to perform the procedures because they allow for faster deliveries or better pay, he said. But the main reason most doctors still perform episiotomies is because they always have done so, he said.

“It is always hard for people to relearn,” Main said.

His organization is leading an effort to provide doctors and hospitals with data on certain childbirth practices to show them how they compare with their peers around the state. Beginning in 2010, they partnered with the March of Dimes to educate providers about the dangers of elective delivery prior to 39 weeks. Within three years, that practice had dropped off rapidly, he said. They are currently undertaking similar efforts related to C-sections.

Chavira, the maternal and fetal medicine specialist at California Hospital in Los Angeles, said he would like to see similar transparency with episiotomies.

“If you have a hospital where people are doing 5 percent episiotomies and one guy is doing 60 percent episiotomies, all of a sudden he sticks out like a sore thumb,” he said.

A lot of women don’t want the procedure, he noted, and doctors are supposed to honor their patients’ wishes.

Turbin, a 29-year-old dental assistant who now lives in Stockton, is suing her former doctor, Alex Abassi, for assault and battery. In June, a judge ruled that the case could go to trial this fall. Citing cognitive impairment, Abassi surrendered his medical license last year. The executive director of the attorney’s office representing Abassi declined to comment.

Since the episiotomy, Turbin said, “I had major, major, major, major pain.”

She’s afraid to go to the doctor now, she said, and she’s terrified of getting pregnant again.

“If I go back to that day, there’s nothing I could have done,” she said. “That doctor was going to cut me no matter what.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Categories: Health Care

Soda Taxes: Gaining Steam Or Getting Steamrolled?

Kaiser Health News - Tue, 07/19/2016 - 5:00am

A sip of soda will become more expensive next year in Philadelphia, which recently became the second city in the United States to pass a tax on sugary beverages — after Berkeley voters passed one in 2014.

The Philadelphia measure, approved by the City Council in June, could lend momentum to efforts by public health advocates to get similar taxes enacted elsewhere around the nation.

Voters in three Northern California cities — San Francisco, Oakland and Albany — will decide in November whether to approve such taxes. A soda tax initiative in San Francisco in 2014 failed to get the two-thirds vote needed to pass.

Several states also have tried and failed to pass soda taxes. In California, a bill to do so died this spring.

Use Our Content This KHN story can be republished for free (details).

Outside of the United States, Mexico, England and France also tax sugar-laden beverages.

Advocates of taxing these drinks say that they contribute to high rates of obesity and diabetes, and that putting a bigger price tag on them can reduce consumption and improve people’s health. Critics argue the taxes are unpopular and that it is discriminatory to single out one item in the grocery cart.

The American Beverage Association, one of the staunchest opponents of soda taxes, has funded successful opposition campaigns throughout the United States, including in California.

The association has spent $64.6 million since 2009 fighting such initiatives — including more than $9 million just to defeat the proposed San Francisco tax in 2014, according to a report last year by the Center for Science in the Public Interest, a Washington, D.C.-based advocacy group. Coca-Cola and Pepsi have also been big contributors to the opposition.

Lauren Kane, a spokeswoman for the beverage trade group, said there is no evidence that soda taxes make anyone healthier. “Obesity has been rising … while soft drink consumption has been declining,” she said. “It would defy logic to say that soft drink consumption is driving obesity.”

Overall, soda sales dropped 1.2 percent in 2015, according to Beverage Digest, which tracks the industry, continuing a downward trend.

Kane added that taxing any grocery item is a “slippery slope” that makes other groceries vulnerable to taxation.

Harold Goldstein is the executive director of California-based Public Health Advocates. (Courtesy of Harold Goldstein)

To hear more about the campaigns for soda taxes, we spoke with Harold Goldstein, executive director of California-based Public Health Advocates, who has played an active role in some of these efforts. A transcript of the conversation below has been edited for clarity and space.

Q: What are the health and medical effects of drinking too many sugar-sweetened beverages?

It is now proven that sugary beverages are a leading contributor to obesity, diabetes and heart disease. When we consume liquid sugar, the body converts much of that sugar to fat in the liver, causing fatty liver disease. We now have an epidemic in this country of fatty liver disease.

There are studies showing, for example, if you drink two sodas a day for just two weeks, that your unhealthy cholesterol, your LDL cholesterol, will go up 20 percent and that your triglycerides will go up 20 percent. If you drink that amount for six months, the amount of fat in your liver will go up 150 percent. This is a dramatic impact in a short period of time because our bodies are not designed to consume liquid sugar.

Q: How big is the problem of obesity and diabetes in the U.S.?

The obesity and diabetes epidemics are among the most fundamental public health problems facing our country today. They impact every demographic group. At the same time, they are a particular problem in low-income communities and communities of color, in large part because it’s in those communities where there is the least access to healthy food and the least access to opportunities to be physically active.

We know that diabetes rates are going to increase by 80 percent in the next five years, costing the state $15 billion more in direct health care costs. With that kind of money on the table … it is imperative that we invest in diabetes prevention. Whether it is through a soda tax, through the state legislature or state general funds, it is time to establish a major statewide diabetes prevention campaign in California.

Q: A recent report by your organization and the UCLA Center for Health Policy Research found that more than half of Californians have either diabetes or prediabetes. Aside from sugar-sweetened beverages, what else is causing this?

We have created a world that is designed for diabetes. We have fast food outlets on every corner. We have staggering portion sizes of sugary beverages and restaurant meals and everything from bagels to burgers. We have gotten rid of [physical education] in schools. We allow unregulated advertising of unhealthy products to children.

Q: Why target sugary beverages and not other junk food?

A: If you eat a candy bar, it takes hours to digest it. The liquid sugar is just floating sugar molecules and we absorb that sugar in as little as 30 minutes. The research is continuing to show that sugar itself is a particular problem, and perhaps the biggest problem. We know that the body turns sugar into fat. [Soda] is the right place to start. It represents half of the sugar in the food supply, it is the largest source of sugar and our body treats it differently.

Q: In Philadelphia, the mayor argued for the new tax based on the revenue it would bring in, rather than the health risks of soda. Do you think that helped get it approved?

I think different communities are going to support soda taxes for different reasons, in large part based on what the funds are going to be used for. In Berkeley, the revenues go into the general fund. City council members wanted that money to be dedicated to obesity and diabetes prevention efforts, as they have done. That was something clearly important to voters in Berkeley. In Philadelphia, the funds are dedicated to a variety of things, especially pre-K [education] in low-income communities and parks and rec programs. It is important that through this democratic process, residents get to decide how they want to use the revenues raised by such a tax.

Q: The effort to pass a soda tax in California died in committee this spring. Can you explain what the bill would have done and what happened to it?

The bill would have established a 2 penny-per-ounce fee on sugary beverages. As a fee, it would have required that all the revenues raised be dedicated to mitigating harm caused by those products. As has happened now five times in the state legislature, the beverage industry put their corporate might behind their lobbying efforts and successfully killed the bill.

Q: How difficult is it to overcome opposition by the soda industry?

What we are learning is that it’s far easier to enact soda taxes at the local level than at the state level in California. The beverage industry has enormous power in the state Legislature. And getting it passed in California requires a two-thirds vote in the legislature, which is a big hurdle. Other states don’t have that hurdle. There are a number of states that are currently working on it in one way or another.

Q: Critics say that soda taxes won’t reduce obesity rates and give government too much control over consumer choice. What do you think about the argument that this might not be the best way to address diabetes and obesity?

Soda taxes are one way to address the diabetes and obesity epidemic. What has been shown in Berkeley and Mexico, where the tax has now been in effect for quite some time, is that those taxes reduce consumption of sugary beverages, which we know are a leading contributor to the epidemic.

At the same time, those taxes provide funds to pay for much needed programs in communities. Soda taxes aren’t the end-all and be-all of obesity and diabetes prevention. There is a lot more that can and needs to be done to address the epidemic.

Q: As public health advocates like yourself work to reduce access to these beverages, what sort of alternatives are you promoting?

The biggest solution is to encourage and support people to drink water instead of sugar. It is the simplest, easiest change that any of us can make to reduce our chance of getting diabetes. Sixteen teaspoons of sugar in every 20-ounce beverage is way more than our body can handle and still be healthy.

Q: Will there be another try to get a statewide tax in California?

I am sure there will be, with Philadelphia passing theirs. One or more of the soda taxes in the Bay Area are likely to pass. I think that in the coming years, states around the country will also establish soda taxes.

Blue Shield of California Foundation helps fund KHN coverage in California.

Categories: Health Care


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