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Daily Archives: November 5, 2014

Soda Tax Succeeds In Berkeley, Fizzles In San Francisco

Voters in Berkeley, Calif., have passed the nation’s first soda tax with a resounding 75 percent of the vote. The measure aims to reduce the effects of sugar consumption on health, especially increased rates of obesity and diabetes.

Across the bay in San Francisco, however, a similar proposal failed to get the two-thirds supermajority it needed.

More than 30 cities and states across the country have attempted but failed to enact such a tax, at least in part because of well-funded opposition from the soda industry.

Soda bottles are displayed in a food truck's cooler on July 2014 in San Francisco. A ballot measure to tax soda failed in San Francisco.  (Photo by Justin Sullivan/Getty Images)

Soda bottles are displayed in a food truck’s cooler on July 2014 in San Francisco. A ballot measure to tax soda failed in San Francisco, but a similar one passed in Berkeley, Calif. (Photo by Justin Sullivan/Getty Images)

Berkeley’s Measure D needed only a simple majority to pass. It will levy a penny-per-ounce tax on most sugar-sweetened beverages and is estimated to raise more than $1 million per year. Proceeds will go to the general fund; Measure D calls for the creation of a health panel to advise Berkeley’s City Council on appropriate health programs to receive funding.

Campaign Co-Chair Josh Daniels called Berkeley’s win a tipping point. “I think you will now see many, many other cities and communities around the country looking at this as a genuine public policy to address the diabetes and obesity crisis that we face,” he said.

While the San Francisco proposition did not pass, supporters there declared a victory of their own: More than half the voters approved the tax despite millions spent by the American Beverage Association to defeat it.

This story is part of a partnership that includes KQED, NPR and Kaiser Health News. It can be republished for free. (details)logo npr

“So the fact that we were able to overcome $10 million,” said Proposition E coauthor Scott Wiener, a member of the San Francisco Board of Supervisors, “and it looks like a majority of San Franciscans – despite that $10 million – will vote ‘yes,’ is pretty extraordinary.”

The opposition campaigns, funded primarily by the beverage association, argued that the measures were riddled with loopholes and wouldn’t accomplish their health goals. Roger Salazar, a spokesman for the campaigns, pointed to the 30 failed measures from around the country and called Berkeley “an anomaly.” He said that to expect to pass such a tax elsewhere in California was “foolhardy.”

Advocates are convinced he’s wrong. Harold Goldstein, executive director of the California Center for Public Health Advocacy, called the measure’s passage “remarkable.”

“What we learned here in Berkeley,” he said, “is that when voters learn the truth about sugary beverages, when they learn that they are one of the central causes of the growing diabetes epidemic, they want to tax it, they want to regulate these products.”

Sodas are the primary source of added sugar in the American diet and that added sugar is linked to increasing rates of diabetes.

Berkeley has a history of being first to a new cause that’s later embraced more broadly, said Lori Dorfman, executive director for the Berkeley Media Studies Group. “In the mid-70s, Berkeley made the first ‘curb cut,’ and now people in wheelchairs all over the country are not trapped in their homes anymore.” She noted that Berkeley was also the first city to pass a clean indoor air ordinance.

Mexico enacted a national soda tax on January 1, and by summer, consumption had dropped 10 percent.

Kelly Brownell, dean of Duke University’s school of public policy first proposed a soda tax in the early 1990s. He called the votes in both Berkeley and San Francisco “historic” and, like other advocates, predicted other cities will soon follow suit and that soda companies are bracing for that.

“My guess is that inside their boardrooms, they know very well these taxes are the beginning of the future,” he said. “This is a wave starting to crest.”

Brownell said that half the costs of diabetes and obesity are born by taxpayers, through government health insurance programs Medicare and Medicaid. Those public costs “justify the government getting involved, just like tobacco taxes,” he said.

This story is part of a reporting partnership that includes KQED, NPR and Kaiser Health News.

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Voters Provide Mixed Messages On Health Ballot Measures

The Affordable Care Act wasn’t directly on the ballot in any state, but voters did decide a host of health-related issues in Tuesday’s elections.  And there was no clear theme to what won and lost.

For example, voters in two states – North Dakota and Colorado – rejected so-called “personhood” amendments that would have recognized rights for unborn fetuses.

It was the third time since 2008 Colorado voters faced – and voted down – language to amend the state constitution to enshrine as a “person” those not yet born, sometimes from the moment of conception. This year’s version was slightly different. It would have written “unborn human beings” into the state’s criminal code and its Wrongful Death Act. As with the past two efforts, voters rejected this version 64 to 36 percent with 73 percent of the vote counted.

The North Dakota amendment, by contrast, would have added language to the state constitution stating, “The inalienable right to life of every human being at any stage of development must be recognized and protected.” It failed 64 to 36 percent.

Efforts to establish rights for the unborn have failed regularly even in very conservative places, as opponents have argued that such “personhood” measures could outlaw not only abortion, but some forms of birth control or in vitro fertilization.

Abortion opponents did not come away empty-handed, however. In Tennessee voters approved a measure that would effectively overturn a 2000 state Supreme Court decision that found the state’s constitution guaranteed a right to abortion and prohibited most state restrictions.

The amendment, stating that “Nothing in this Constitution secures or protects a right to abortion or requires the funding of an abortion,” was approved with 53 percent of the vote. It is expected to touch off a round of new restrictions when the Republican-dominated state legislature reconvenes next year.

In Arizona, voters, as expected, supported a “right to try” ballot measure that would allow, but not require, drug makers to provide not-yet-approved drugs to people with terminal illnesses. Colorado became the first state with a right-to-try law earlier this year.

The effort has been pushed by the Libertarian Goldwater Institute, based in Arizona. Critics have worried that the laws could give those with terminal illnesses false hope, particularly because drug makers are loathe to provide experimental drugs to those near death, since that could reflect badly on the drug.

Meanwhile, in California, two highly-publicized, health-related ballot measures went down to defeat.

One, Proposition 45, would have imposed the same public notice and transparency requirements for health insurance premium rates as voters approved for auto and homeowners insurance in 1988. It would also have given the state’s insurance commissioner the right to reject rate hikes deemed “excessive.”

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

The proposal was fiercely opposed by the health insurance industry, which raised more than $50 million to fight it. Opponents argued, among other things, that the proposal would have given too much power to the state’s elected insurance commissioner. With 95 percent of the votes counted, Proposition 45 was losing 60 to 40 percent.

California voters also turned back, 67 to ȁ percent, an effort to raise the caps on damage awards for non-economic “pain and suffering” in medical malpractice cases. The $250,ዀ maximum had not been raised since the California malpractice law was originally written in 1975.

But Proposition 46 would also have made California the first state to require random drug and alcohol testing for physicians. That part of the proposal prompted many newspaper editorial boards to turn against it.

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Republican Gubernatorial Victories Make Medicaid Expansion Unlikely In 5 States

Tuesday’s re-election of Republican governors in closely contested races in Florida, Georgia, Wisconsin, Maine and Kansas dims the chances of Medicaid expansion in those states.
Advocates hoping for Democratic victories in those states were disappointed by the outcomes, but Alaska, which also has a Republican incumbent, remains in play as an independent challenger holds a narrow lead going into a count of absentee ballots.

“No one would say it was a good night for the prospects of Medicaid expansion,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University.

GOP Governors election 570

Govs. Scott Walker, Nathan Deal, Rick Scott, Sam Brownback and Paul LePage

Still, Alker said the playing field for Medicaid expansion didn’t shift dramatically. “The debate continues to be within the Republican party — with more pragmatic Republicans saying yes and ideologues driving the opposition. So what happens next is a good test case to see how Republicans will resolve these internal tensions.”

Even if Democrats had been victorious in governor races, they still faced a long shot getting Medicaid expansion through Republican-controlled legislatures. The one exception was Maine, where Gov. Paul LePage, who was re-elected, has five times vetoed efforts by his state’s Democratic-controlled legislature to expand the program.

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

In Florida, Republican Gov. Rick Scott has supported Medicaid expansion, but has done little to persuade state lawmakers to extend the program to 850,000 residents.

If Democratic challenger Charlie Crist had won, he would have faced strong opposition in the Republican-dominated state House, said Sean Foreman, associate professor of political science at Barry University in Miami Shores. “Scott’s victory means Medicaid expansion is dead the next four years,” he said.

Meanwhile, the future of Arkansas’ “private option” Medicaid expansion could be in trouble with the election of Republican Asa Hutchinson as governor and GOP gains in the state House and Senate. Hutchinson replaces Democratic Gov. Mike Beebe, who had championed the state’s expansion plan and who was barred by term limits from running.

Hutchinson has not taken a position on the program, saying he will assess its costs and benefits to “determine whether the program should be terminated or continued.” Arkansas’ expansion is vulnerable because by law, the legislature must reauthorize it every year with a 75 percent majority.

In Alaska, Bill Walker, an independent candidate who favors expansion, holds a small lead over incumbent Gov. Sean Parnell, who opposes it. Should Walker prevail after absentee ballots are counted, he still must get the support of his Republican-controlled legislature. About Ǻ,000 Alaskans would gain coverage through expansion.

Since the Supreme Court made Medicaid expansion an optional part of the Affordable Care Act, 27 states and Washington, D.C. have extended the program to individuals with incomes under $16,100. While most of those states expanded eligibility at the beginning of 20Ǯ, Michigan and New Hampshire came on later this year and Pennsylvania’s expansion will start in January.

Nationally, Medicaid enrollment has increased by more than 8 million people since last October and has been seen as the biggest factor in reducing the number of uninsured Americans by about 25 percent this year.

State lawmakers have sometimes blocked Medicaid expansion even with a supportive executive. In 2013, Democrat Terry McAuliffe had campaigned on expanding Medicaid, but after he was elected Virginia governor he was unable to persuade state lawmakers who demanded the program be reformed first.

Carolyn Pearson, vice president of consulting firm Avalere Health, said expansion advocates will turn their attention to Utah, whose Republican governor hopes to take a plan to the GOP-controlled legislature, and Wyoming, where Gov. Matt Mead, also a Republican, has expressed interest in widening eligibility for Medicaid. Indiana is also negotiating with the Obama administration to expand Medicaid.

Pearson argued that Arkansas lawmakers are unlikely to unravel that state’s Medicaid expansion, which has helped more than 60,0Ǡ gain coverage. “It is incredibly difficult to take benefits away from state residents once they have been granted,” she said.

She said more Republican-led states could move ahead as the issue cools politically.

Sara Rosenbaum, professor of health policy at George Washington University, said it’s hard to tell how big an impact the election will have.

“One possibility is that now that a bitterly contested election is over, the governors may be open to discussion,” she said.

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Viewpoints: Obama’s ‘Shellacking'; States Benefiting From Health Law Turn Red

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Medicare Defers Request To Pay Doctors For End-Of-Life Counseling

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Some Consumers Could Be Double-Billed Due To Healthcare.gov Issues

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Feds Move To Close Health Law Loophole That Allows Large Employers To Offer Plans Without Hospitalization Benefits

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State Highlights: Emergency Responders Squeezed In Texas; Mental Health Costs In Kansas City

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Oklahoma Supreme Court Temporarily Blocks Abortion Laws

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Republican Shocks Democrat In Maryland Gov. Race

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