Judge Rules Against Birth Centers
May 2009 - A federal administrative judge has ruled that the federal Medicaid program may deny federal funds to state Medicaid plans that pay for birth center facility fees. The ruling comes in an appeal by the Texas Health & Human Services Commission in which the American Association of Birth Centers (AABC) filed an amicus brief on behalf of the 42 Texas birth centers that are now at risk to lose Medicaid payment of their costs. The decision leaves the federal Centers for Medicare and Medicaid Services ("CMS") free to shut down birth center facility reimbursement in the rest of the U.S.
The AABC has turned to Congress to rectify this situation. Legislation that would require payment to birth centers on the same basis that Medicaid currently pays hospitals, physicians, and nurse-midwives will be introdouced in the U.S. House of Representatives next week by Representative Susan Davis (D) of California and Representative Gus Bilirakis (R) of Florida. The bill, to be called the "Birth Center Medicaid Act," would ensure that Medicaid enrollees may continue to access the safe, woman-centered, cost-effective care that women with private insurance may choose.
For the past 30 years, birth centers have consistently demonstrated dramatic cost savings, compared to the cost of childbirth in hospitals. According to data from the U.S. Agency for Healthcare Research and Quality, and the recently-published Milbank report, "Evidence-based Maternity Care: What It Is and What It Can Achieve", the national average charge for an uncomplicated hospital birth is four times higher than for birth in a freestanding birth center. Birth centers provide high quality woman-centered care with outcomes as good if not better than hospital births, result in far fewer expensive interventions, and demonstrate much lower rates of cesarean sections.
Even though birth centers had been recognized as Medicaid providerss by CMS (and, earlier, by HCFA) since 1987, in the last three years CMS began to disallow federal matching funds to states that paid birth center facilitiy fees. As a result, state Medicaid Agencies in Alaska, South Carolina, and Washington State were forced to find alternative ways to compensate birth centers for Medicaid enrollees. The Texas Health & Human Services Commission has not yet indicated whether it intends to pursue a further appeal to the courts, but AABC is greatly concerned that the agency may be not continue to pay birth centers without federal matching funds.
The nationwide implications of this ruling, not only for women enrolled in Medicaid but also for birth centers, could be catastrophic. Birth centers serve a significant Medicaid population and, for some centers, as many as 50% to 95% of patients are Medicaid enrollees. Without reimbursement for the costs associated with these births, birth centers thoughout the nation will be pushed to the brink of closing. Some centers in Washington State have, in fact, been forced to close since the CMS crackdown. The loss of birth centers would be particularly ironic at the present time, as the nation considers how to deal with a flu pandemic that could make hospitals unsuitable sites for women in labor and their otherwise-healthy babies. Birth centers, in such a scenario, stand out as safe havens where women could give birth safely without exposure to hospital pathogens. If birth centers are forced to shut their doors because of this misguided CMS policy, this option may be foreclosed in many states.
For further information, and to learn how you can take action, please visit AABC's Legislative Alert pages on www.BirthCenters.org
Yost Pool will open this summer!
On April 21, the mayor of Edmonds declared that Yost pool would indeed open this year. The efforts of our citizens to bridge the budget shortfall that the city was experiencing has paid off, as the city will not have to put any funds into the running of the pool for summer 2009.
As part of a three part solution to save the pool, the citizens proposed a plan to increase pool fees to market rate, revise the pool schedule and staffing, and fund raise to make opening the pool a reality this summer.
About 1,000 citizens contributed donations to the save Yost pool effort, totaling over $53,000.
A big 'Thank You' to all who came together to save Yost Pool.
Yes We Can by artist Antar Dayal is the latest release from the Artists for Obama series. In Antar's words, “I am honored to support Barack Obama’s history-making presidential bid through one of his many visionary platforms, including recognizing the importance of art in America. My artwork is inspired by his words, wisdom, accomplishments, and expression of our hopes and dreams for a better America. Our world is facing seemingly insurmountable economic and environmental challenges. It is a rare occurrence to behold a leader like Barack Obama who understands what America must do in order to reclaim itself on the world stage. As a first generation immigrant, I have confidence that America can collectively overcome these challenges under Obama’s presidency. YES WE CAN!”
(profile)
(feet)Coffee and cholesterol
Does your daily morning jolt boost the risk of heart disease?
By Merritt McKinneySpecial to msnbc.comFor the millions of people who depend on coffee to jumpstart their day, cholesterol is probably the last thing on their mind as they wait for the morning jolt of caffeine to kick in. In the past few years, though, more and more evidence hints that coffee can increase cholesterol levels.
Experts say that the majority of coffee-drinking Americans do not need to worry about the impact of a cup of joe on cholesterol levels. That's because most Americans drink filtered coffee, which is believed to have much less of an effect on cholesterol than unfiltered coffee. Filters seem to remove most of the cholesterol-boosting substances found in coffee.
But a cholesterol check may be in order for people who use a French press or percolator to make their coffee or who prefer espresso or other varieties of unfiltered coffee, according to Dr. Michael J. Klag, the vice dean for clinical investigation at Johns Hopkins University School of Medicine in Baltimore.
In 2001, Klag and his colleagues reviewed more than a dozen studies that looked at the relationship between coffee consumption and cholesterol levels. They found that drinking an average of six cups of coffee a day was associated with increased total cholesterol and LDL, the harmful type of cholesterol. Nearly all of the rise in cholesterol was linked to unfiltered coffee.
The coffee culprit
Although caffeine is often cast as a villain, the stimulant is not to blame for unfiltered coffee's effect on cholesterol levels. According to Klag, the increase in cholesterol is believed to be caused by oils called terpenes that are found in coffee, but are mostly removed by filters."Persons who drink unfiltered coffee should get their cholesterol checked to make sure it is not elevated," says Klag.
The Johns Hopkins researcher notes that in a 1994 study he and his colleagues found an association between coffee consumption and an increased risk of heart disease. But most of the increased risk was linked to coffee drinking before 1975. It was during the mid-1970s, Klag points out, that drip coffee makers became widely used in the United States, making filtered coffee the norm.
Although Klag advises his patients who drink unfiltered coffee to switch to filtered brew, he says that not everyone needs to be overly concerned about the effect of unfiltered coffee on cholesterol. He notes that cholesterol levels are a "combination of how you live, what you eat and what genes you inherit." A healthy person with low cholesterol probably does not need to worry too much about the effect of coffee on cholesterol levels, he says.
A Dutch researcher who has also documented the cholesterol-boosting effect of unfiltered coffee agrees that the risks need to be seen in perspective.
"Unfiltered coffee has much less effect on your heart disease risk than smoking, high blood pressure or being overweight," says Dr. Martijn B. Katan, a professor at the Wageningen Center for Food Sciences and Wageningen University. "But if you want to optimize your cholesterol levels, you should avoid large daily amounts of unfiltered coffee."
Unfiltered coffee seems to boost cholesterol the most, although a handful of recent studies hint that filtered coffee may have an effect on cholesterol, too. In one study, researchers in Sweden found that people who normally drank filtered coffee experienced a small drop in cholesterol levels when they stopped drinking coffee for a few weeks. The results were "surprising," according to Dr. Elisabeth Strandhagen, of Sahlgrenska University Hospital(CK) in Goteborg, who led the study.
"We have done some tests on coffee filters, but we cannot explain why the filtered coffee had this effect on serum cholesterol," she says.
Despite the findings, filtered coffee seems to have a much smaller effect on cholesterol than unfiltered coffee. Strandhagen encourages people with high cholesterol or who are at high risk of heart disease to choose filtered coffee. They should also avoid coffee filters that have "aroma holes," which are very common in Sweden, she says.
Pieces of the puzzle
But filtered vs. unfiltered may not be the most important question to ask about coffee and cholesterol, according to a spokesperson for the American Dietetic Association.
"People try to pin a culprit" when it comes to coffee and cholesterol, "but people do not live in an isolated world," says Dr. Gail C. Frank, a professor of nutrition in the department of family and consumer sciences at California State University Long Beach. According to Frank, there are "several pieces to the coffee story," including not only whether people drink filtered or unfiltered coffee, but how much they drink and what they are doing besides drinking coffee‹such as smoking.While unfiltered coffee may contain substances that raise cholesterol levels, many popular coffee drinks sold at coffee houses seem more like desserts than beverages to Frank. The "bolts" of cream and sugary calories raise questions of their own about coffee's effect on cholesterol, she says.
When making decisions about coffee, Frank encourages people not to look for a yes or no answer. It's not a simple question of "do drink coffee" or "don't drink coffee," she says.
Instead, Frank encourages people to "filter through" their own lives and their own cardiovascular risk factors to make a decision about how much and what type of coffee to drink.
Merritt McKinney is a health writer based in Houston.
© 2008 MSNBC Interactive
*personal side note: We got my dad a stovetop coffeemaker for Christmas and 6 months later his cholesterol did got up...
