Families, health advocates urge Obama to act on food safety

(Reuters) - Families, public health advocates and consumer groups called on the White House on Tuesday to implement delayed provisions in a food safety law they say would help prevent some of the nearly 3,000 deaths caused by food-borne illnesses each year.

Families of victims who have died from food-borne illnesses and consumer and health organizations wrote a letter to President Barack Obama calling on him push forward provisions of a food safety law signed last year that would regulate food imports, produce and packaged food against possible contamination.

The Food Safety Modernization Act was the first food safety overhaul in over 70 years, and without the implementation of these provisions most of the U.S. food system continues to operate under what public health advocates say are outdated laws.

These rules would help prevent food-borne outbreaks such as one last year when listeria-contaminated cantaloupe killed over 30 people, said Erik Olson, director for food programs at the Pew Health Group.

"With our current food system it only takes one part of that food system to contaminate a huge amount of food," Olson said. "We're concerned that the longer these rules take to get out we're just going to continue having these kinds of outbreaks."

The rules have remained at the White House's Office of Management and Budget since late 2011 when the Food and Drug Administration submitted proposed versions of the rules. The OMB is tasked with reviewing and releasing the rules to continue the rule-making process.

Over the past year the United States has had 10 cases of food-borne diseases where multiple states were affected and as many as 390 cases were reported in one outbreak, according to data from the U.S. Centers for Disease Control and Prevention aggregated by the Pew Health Group.

These outbreaks were from salmonella, E. coli and listeria in food like ground tuna, imported papaya and pine nuts.

The CDC estimates that about 3,000 deaths are caused by food-borne illnesses and about 48 million people, or one in six Americans, gets sick from food contamination every year. Because of underreporting, the number of sicknesses caused by contaminated food is greatly understated, Olson said.

The rules would establish standards for possible sources of contamination of fresh fruits and vegetables, and make importers responsible for the safety of food they import.

It would also force food companies to identify possible causes of contamination and specify actions to prevent them.

(This story is corrected in first paragraph to say the law is said to help prevent some of the deaths from food-borne illnesses, not all)

(Reporting by Lily Kuo; Editing by Eric Beech)

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Obama, Romney's flip-flops on health care reform

While Mitt Romney was in the hot seat this week, President Obama has been there before. Here's a look back at some pivots the presidential contenders have made when it comes to health care policy.

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President Obama Speaks on Health Reform

The Supreme Court's decision to uphold the Affordable Care Act ensures hard-working, middle class families will get the security they deserve and protects every American from the worst insurance company abuses. June 28, 2012.

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NY health plans continue as US court OKs Obama law

ALBANY, N.Y. (AP) — With state health officials advancing plans to help provide uninsured New Yorkers with health coverage under President Barack Obama's health care overhaul, Thursday's U.S. Supreme Court ruling upholding most of the law was being celebrated at places like a network of neighborhood medical clinics in New York City.

"It's really not melodramatic to say that lives are going to be profoundly affected for the better," said Dr. Daniel Baxter, top medical officer for the William F. Ryan Community Health Network. "This means that children are going to be able to get their immunizations, women are going to be able to get appropriate cancer screening, people with diabetes are going to be treated."

In April, Gov. Andrew Cuomo issued an executive order to establish a statewide exchange starting in 2014, a marketplace where individuals and small businesses could tap into as much as $2.6 billion in federal tax credits and subsidies under the overhaul law. It is meant to insure every American, mainly those who don't have employer health plans or don't qualify for Medicaid. The U.S. Supreme Court upheld the overhaul's main provisions Thursday.

Cuomo on Thursday praised the ruling and Obama's leadership for measures that will provide access to health care for more than a million New Yorkers. His administration will keep moving forward with implementing the exchange, which also will lower coverage costs for businesses, he said.

Outside the Capitol, two dozen advocates from Health Care For All New York rallied. Organizer Bob Cohen called the promised coverage "basic economic security" people need to survive in a tough economy.

Right now, between 20 to 30 percent of the Ryan Network's patients are uninsured, Baxter said. Not all are poor. In these lean economic times, Baxter said he has seen a growing number of patients who have lost their private health insurance when they lost good-paying jobs.

The uninsured still get care, he said, but many patients often forgo treatment or precautionary measures rather than risk getting a big bill. One uninsured patient skipped a recommended X-ray a year ago because she didn't have insurance. As a result, Baxter said, it took an extra year for doctors to discover that she had cancer.

The law will also be a financial boon for places like the Ryan Network. Baxter said the health centers have long received some government reimbursement for treating the uninsured, but he said it has never been close to covering costs. "Had the law been overturned, many community health centers would find their viability in jeopardy," he said.

In Buffalo, Liz and Tim Evans have health insurance now through Liz's employer, Medaille College, but have gone without it for periods of years while employed part-time. At nearly $1,000 a month, it was too expensive. "I didn't really know how I felt about (the law) until the ruling. I was relieved and pleased it was upheld," Liz Evans said.

"I'm glad my daughter is going to be covered until she's 26," said Evans, a college librarian whose daughter is 12. "We've been in the position before of having pre-existing conditions and having to wait for coverage so I'm glad that's gone."

Evans has a thyroid condition, and her husband, a laid-off carpenter, has diabetes.

State Attorney General Eric Schneiderman said his office stands ready to enforce the law to ensure New Yorkers benefit from its protections, calling the court's decision a "historic victory" for millions of Americans.

"This law will continue to provide a spectrum of key consumer protections including keeping young adults on their parents' plans, ending pre-existing condition restrictions and increasing consumer information about health care choices," he said.

Under Cuomo's order, issued after legislation to establish the exchange stalled in the Republican-controlled state Senate, health officials plan to show by January that the state is ready to participate in the federal program. The goal is to have the exchange operating on Jan. 1, 2014, Health Department spokesman Peter Constantakes said.

New York has about 11 million residents who are insured, mainly through employer health plans, and 5 million low-income residents enrolled in Medicaid. Census data from last year showed nearly 2.9 million New York residents, or about 15 percent, without insurance, although the state estimate is 2.7 million — mainly working poor who don't have employer-sponsored coverage and Medicaid-eligible residents who haven't registered.

The Business Council of New York State said employers already struggle with high coverage costs, taxes and surcharges, and the Supreme Court's ruling does nothing to "bend the cost curve." The group said it will work to assure the exchange has full participation by insurers, agents, brokers, chambers of commerce and employers in all stages of development for "as robust a health insurance market and health care delivery system as possible."

An assortment of tax increases, health industry fees and Medicare cuts are supposed to pay for the changes. Starting in 2014, almost everyone will be required to be insured, with some exceptions, or pay a yearly fine. That would be $695 per person up to $2,085 per household, or 2.5 percent of household income, whichever is greater.

"We disagree with the Supreme Court's decision to affirm a massive tax increase that people cannot afford right now," said Scott Reif, spokesman for the Senate Republican Conference.

____

Associated Press writer Carolyn Thompson in Buffalo contributed to this report.

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2008 Obama: Health Care Should "Never Be Purchased With Tax Increases On Middle Class Families."

At a Campaign rally in 2008, Obama said that health care should not purchased with a tax increase (October 4, 2008).

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President Obama Speaks on Health Reform

The Supreme Court's decision to uphold the Affordable Care Act ensures hard-working, middle class families will get the security they deserve and protects every American from the worst insurance company abuses. June 28, 2012.

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Health reform: What if Obama hadn’t tried it?

???initialComments:true! pubdate:06/07/2012 10:55 EDT! commentPeriod:3! commentEndDate:6/10/12 10:55 EDT! currentDate:6/7/12 8:0 EDT! allowComments:true! displayComments:true!Posted by Ezra Klein at 10:55 AM ET, 06/07/2012 TheWashingtonPost

When you see these conversations about whether Obama should have pursued health care reform rather than continuing to “focus on the economy,” it’s worth keeping a couple of things in mind.

Obama signs the health reform bill into law. But what if he hadn’t? (Marvin Joseph - The Washington Post)

1) The calendar: The stimulus bill passed in February 2009. Most of its spending was scheduled for 2010 and 2011. Health care reform passed in March 2010. That is to say, the bulk of the health care debate took place in 2009 — before the stimulus had really begun its work. If Obama hadn’t done health care, he would have needed to be doing something else between February 2009 and March 2010. Some people seem to think that “something else” could have been passing more stimulus bills. I find it very hard to believe that Congress would have greenlighted further stimulus before the $800 billion stimulus bill they’d just passed began spending out.

Remember, too, that the idea was to have health care passed not by March 2010, but August 2009. That didn’t happen, in large part due to Max Baucus and other centrist Democrats who said they wanted more time to negotiate with Republicans. But if it had worked out, it would have left seven more months in which Obama could have been seen “focusing on the economy,” whatever that means. So in some ways, the question might be whether the Obama administration should have abandoned health reform once it blew past the August deadline. I don’t see much of a case for that.

2) The recovery: The economy was in freefall through much of 2009. But as the year wore on, the job losses fell from 800,000 a month in January to 170,000 in December. And, in the beginning of 2010, the economy began growing again. We added 189,000 jobs in March — the very month the health care bill passed. We added 239,000 jobs in April. It appeared that the stimulus was working. Perhaps it had been enough. Then, later in 2010, we began shedding jobs again. In my reporting, that’s when a number of Obama’s economist staffers began seriously thinking we needed a second stimulus. But by that time, health care had passed.

3) The deficit: Another popular idea is Obama should have taken the moment to focus on long-term deficit reduction. Of course, as far as Obama is concerned, that’s exactly what he did.

Everyone agrees the crux of the long-term deficit problem is health care spending. It’s also one of the reasons wages for workers are rising so slowly. The key argument that convinced Obama to pursue a health care bill during the economic crisis was Peter Orszag’s belief that health reform was entitlement reform. In March 2009, Obama said health reform is “a fiscal imperative. If we want to create jobs, rebuild our economy, and get our federal budget under control, then we must address the crushing cost of health care this year.”

Obama and his team believe that the Affordable Care Act is the single largest legislative effort ever to reduce health care spending both in Medicare and in the rest of the system (here are five of the bill’s key cost controls). Republicans don’t believe that, which is fine. But that’s an argument over whether the Affordable Care Act will work. It’s not an argument over whether the Obama administration attempted to address the long-term drivers of the deficit.

If you think Obama shouldn’t have done the health care bill, you need to say what he should have been doing between February 2009 and March 2010 instead. He did, after all, have huge majorities in Congress, and a nation hungry for action. Further stimulus seems, for the reasons I outlined above, unlikely. David Brooks has suggested energy reform, but I see little reason to believe that would have proven more popular. Financial regulation makes more sense, but if you talk to people inside the White House, they say that the Treasury Department was understaffed and imposing massive regulatory uncertainty at the exact moment banks were weakest would have made it harder for the credit markets to recover. Tax reform and deficit reduction would both have involved tax increases, creating a similar Republican countermobilization. Housing has been a mess, but the Obama administration has actually had considerable power in that sector — it’s just that their policies haven’t worked very well.

That’s not to say health care couldn’t have been handled more adroitly, nor that one of these other options wouldn’t have been politically superior. But everything — health care included — looks better before you try and send it through Congress. And all this has to be balanced against the fact that health reform was, legislatively, a success, and the nation is certainly closer than it’s ever been in its history to extending insurance to every American. If the bill survives the next few years and goes into effect in 2014, my hunch is it will be remembered as the signal triumph of Obama’s presidency, not a key mistake. If it’s repealed or overturned, then, of course, history’s judgment will be different. And the irony of this is that far from anything Obama did in 2009 deciding the future of his health care bill and the legacy of his presidency, it’s the actions of German Chancellor Angela Merkel and European Central Bank head Mario Draghi that could end up making the difference.

For more on this subject, read Jon Alter.

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Blog Contributors

Ezra Klein is the editor of Wonkblog and a columnist at the Washington Post, as well as a contributor to MSNBC and Bloomberg. His work focuses on domestic and economic policymaking, as well as the political system that’s constantly screwing it up. He really likes graphs, and is on Twitter, Google+ and Facebook. E-mail him here.

Suzy Khimm covers the budget, economic policy, and financial regulatory reform. Before coming to Washington, she was based in Brazil and Southeast Asia, where she wrote for the Economist, Slate, and the Wall Street Journal Asia. Follow her on Twitter here, and email her here.

Sarah Kliff covers health policy, focusing on Medicare, Medicaid and the health reform law. She tries to fit in some reproductive health and education policy coverage, too, alongside an occasional hockey reference. Her work has appeared in Newsweek, Politico, and the BBC. She is on Twitter and Facebook.

Brad Plumer is a reporter focusing on energy and environmental issues. He was previously an associate editor at The New Republic. Follow him on Twitter. Email him here.

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Obama health reform law goes on trial amid deeply split public opinion

Whatever you call it – the Affordable Care Act, health-care reform, Obamacare – one aspect of President Obama’s signature health-care law is taken almost as if etched in stone: Americans “don’t like it, they think it’s unconstitutional, and they want it repealed,” as Senate minority leader Mitch McConnell put it in the GOP’s weekly television address last week.

As the US Supreme Court begins three days of argument over the 2010 health-care reform law, a close reading of several recent opinion polls shows that public sentiment may be more complex than that – and may complicate Republicans’ push to make health care a central part of their political agenda through November.

The crux of the matter? Americans see the individual mandate, the law’s requirement that almost every American buy health insurance or pay a penalty, as unconstitutional.

RECOMMENDED: Obama health care law at Supreme Court: mega case for the history books

At the same time, the overall law – with popular measures like the ability to keep children on a parent’s health-insurance policy through age 26 – either divides public opinion or tilts slightly toward Democrats' positions.  

Americans have consistently shown a constitutional concern with the health-care law. Earlier in Senator McConnell’s weekly remarks, for example, he cited a February poll conducted by Gallup/USA Today in which 72 percent of respondents said they believed that the individual mandate is unconstitutional. A poll released Monday by The Hill newspaper found half of voters believe Mr. Obama’s health-care law should be overturned, versus 42 percent who say it should be upheld. A March 14 poll by Pew Research shows similar results – 41 percent “approve” of the individual mandate, while 56 percent “disapprove.”

Those same polls, however, show that overall public opinion about the law is more evenly divided.

In the Gallup/USA Today survey, a slight 47 percent to 44 percent edge goes to those who would favor repealing the entire health-care law under a Republican president come 2013. The Pew poll, moreover, shows a majority of voters say the law should be either expanded (33 percent) or left as is (20 percent), compared with 38 percent who say it should be repealed.

Similarly, The Hill’s poll shows a majority of voters (52 percent) say health-care quality will be about the same or better if the health-care law survives. Forty-two percent predict it will be worse.

Democratic voters are much more likely to support the health-care law than are Republicans. Independent voters, who are key to deciding the 2012 election, tend to be more sanguine than Republicans about the health-care reform law.

Independents are more likely to oppose repeal (47 percent) than favor it (43 percent), according to the Gallup survey. In the Pew report, a plurality of independents favor repeal (40 percent), but a combined 51 percent said Congress should expand the law (33 percent) or leave it as is (18 percent).

Finally, whom does the public trust to handle health care? Far and away, the answer is Democrats.

Pew’s poll shows the public says Democrats are better able to handle health care than are Republicans, by a 14 percentage point margin. They are also deemed better able to handle Medicare (13 percentage points) and abortion (16 percentage points).

What does that add up to for this election season? While both parties have vowed to make health care a top issue going into November, Democrats are expected to hammer Republicans over proposed changes to Medicare contained in the House Republican budget plan, because the Democrats have a significant polling edge on that issue.

“The Affordable Care Act shows that Democrats remain firmly committed to Medicare,” said Rep. Steny Hoyer (D) of Maryland, the House Democratic whip, in a statement. “This law strengthened Medicare by improving benefits, extending its solvency, and laying the foundation for reforms that will constrain costs and improve quality.”

On the other hand, Republicans may have to fight the perception that the fight over the health reform law is much ado about little. Seventy percent of Americans told Gallup that the law has not affected them at all.  

The margin of error in the Gallup/USA Today poll is plus or minus 4 percentage points. It is 3 points for the Hill  and the Pew polls (but greater when the Pew poll results are broken down by party affiliation). 

RECOMMENDED: Obama health care law at Supreme Court: mega case for the history books

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Health Reform Debate Arrives in the Supreme Court: Why It's Not About Obama

Andrew Harrer / Bloomberg / Getty ImagesThe Supreme Court building stands in Washington, Nov. 7, 2011.

Listening to the heated rhetoric coming out of Washington, you may think the three days of health care arguments at the Supreme Court that begin Monday morning are about whether President Obama should have the power to force Americans to buy health insurance and order states to double the size of Medicaid through his 2010 overhaul of the health care industry. They’re not.

For all the focus on the Obama in “Obamacare,” the constitutional question before the court is not whether the executive branch has the power to remake the health care market in the United States, but whether Congress does. It was, after all, Congress that passed the law with a supermajority, enacting provisions that will eventually penalize Americans who don’t buy insurance and increase the size of the Medicaid program.

(SPECIAL: The Five Keys to Health Reform’s Success or Failure)

That’s why many conservative jurists find it difficult to challenge the health care reform law’s constitutionality. On paper, Congress has a lot of power when it comes to controlling commerce in America, and Republican appointees from the D.C. circuit’s Laurence Silberman to former clerk to Justice Antonin Scalia and 5th Circuit conservative Jeffrey Sutton have argued powerfully that Congress is well within its bounds in regulating health care, which represents 1/6th of the national economy.

Article 1, Section 8, Clause 3 of the Constitution, commonly known as the Commerce Clause, gives Congress the power “…to regulate commerce with foreign nations, and among the several states, and with the Indian tribes,” and over the years that power has been found to be very broad. The two most significant precedents for congressional commerce clause power are Wickard v. Filburn (1942) and Gonzales v. Raich (2005).

In Filburn, the New Deal court unanimously found that the government could penalize even the most private economic behavior. The court ruled that an Ohio farmer had to pay a penalty for growing wheat for his own use because not buying on the open market could affect grain prices nationwide. In Raich, Justice Scalia wrote as part of a 6-3 majority that Congress needed the expansive power to ensure that its regulation of drugs nationally wasn’t undermined by California’s permissive dope laws.

(LIST: 5 Ways to Get the Most Out of Health Reform)

But Congress can’t control every aspect of American life through its power over the economy. In two Rehnquist court precedents, US v. Lopez (1995) and US v. Morrison (2000), the conservative justices tried to rein in places where the Commerce Clause could be used by Congress. In Lopez, the court found activity to be regulated under the clause had to be economic in nature. In Morrison, Rehnquist argued that the Violence Against Women Act went too far in allowing rape victims to sue for civil damages in federal court because doing so would usurp state powers and “create a completely centralized government.”

Justice Anthony Kennedy is always a potential swing vote in close cases like health reform. Because Scalia ruled in favor of expanded commerce clause powers in Raich, the conservative stalwart is seen by some as a possible vote in favor of Obamacare, though his votes in Lopez and Morrison break the other way. Chief Justice John Roberts has been successful in finding large majorities on some controversial issues during his time atop the court. The easiest way to produce that in the case of Obamacare would be to find that a challenge to the individual mandate is premature, as no one has yet been forced to buy insurance, so the extent of any challenge to the law’s constitutionality remains unclear. That would allow both sides of the court to punt on the issue until 2014, when the law comes into full effect.

A ruling is not expected on Obama’s health care reforms until late June. But however the justices probe the case this week, only outside commentators and political activists will be talking about the question of Obama’s power to control the health care market.

MORE: Health Insurance Is for Everyone

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Obama mum on health care milestone?

Wolf Blitzer talks to a former White House domestic policy adviser about the anniversary of the health care reform law.

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On health care, Ore. picks up where Obama left off

SALEM, Ore. (AP) — Pregnant with her seventh child and desperate to kick a meth addiction, Madeline Hutchinson turned to a program from the local Medicaid provider that connected her with a mentor and other support that she said helped her get off drugs.

Emmanual, now 2, was born healthy.

"We need mentors. We need advocates," Hutchinson said. "We need someone that's going to come along and say, 'This baby needs to be clean. And we're going to show you how.'"

There's a smattering of preventative care programs like this around Oregon, and not just for addicted mothers. But there hasn't been a statewide push — until now.

Oregon Gov. John Kitzhaber last week signed a law that will create new regional entities, called coordinated care organizations, which will be able to spend money on programs like the one Hutchinson credits with turning around her life.

Kitzhaber says the plan will improve care, reduce costs and serve as a model for the rest of the nation.

But critics say that if the program works, more people will use health care benefits and costs will rise.

The coordinated care organizations will be responsible for looking after Medicaid patients in their area. Local organizations will determine their exact models.

But each will be a holistic approach that addresses every aspect of health — mental, medical and dental — with a focus in particular on people with mental illnesses, addictions or chronic conditions like diabetes, heart disease, asthma and kidney failure.

The idea is to target the costliest patients and provide up-front care that can prevent emergency room visits and other expensive interventions, and thus save Medicaid a lot of money.

Oregon has long been a pioneer in finding new approaches to health care, and Kitzhaber — a former emergency room doctor who is passionate about overhauling the system — believes the new law could solve several problems.

Officials say that if all 50 states adopted Oregon's changes, the federal budget would save more than $1.5 trillion over the next 10 years — more than Congress' failed "super committee" was trying to save over the same time period.

"I'm convinced ... the federal government is going to have to do something drastic about the cost of health care," Kitzhaber said. "And it's not going to be driven by how you keep people healthy. It's going to be driven by how do you keep from defaulting on the national debt, which is two completely different conversations."

Long before the Oregon Legislature passed the law in February, Kitzhaber took his idea to Washington, D.C., to present it to Obama administration officials, and he caught their attention.

"There are several states thinking about this kind of approach," said Cindy Mann, a deputy administrator at the federal Centers for Medicare and Medicaid Services. "This is definitely a time when everybody can be learning from each other."

In some ways, Oregon's effort is an attempt to pick up where Obama's health overhaul leaves off. While Obama expanded access to care, his Affordable Care Act leaves it largely up to the states to find a plan for lowering the cost and improving the quality.

But there is no guarantee the new Oregon law will do exactly what Kitzhaber wants.

A January report by the Congressional Budget Office found that previous projects experimenting with coordinated care for Medicare patients did not provide conclusive evidence of savings.

"On average, the 34 programs had no effect on hospital admissions or regular Medicare expenditures," according to the report.

And the ability to usher in widespread cost savings across the health care system will depend on whether the program can expand beyond Medicaid. Even if it works in Oregon, there's no guarantee that other states with different cultural and political environments would see the same results.

Oregon state Sen. Fred Girod, a conservative Republican and a dentist, said he doesn't think the plan would actually save money because he says it will increase consumption of health care.

"Are we going to get more for less?" Girod said in a committee hearing. "I've been in the Legislature for a long time, I've been promised that I don't know how many times and I have yet to see it."

Proponents dismiss the CBO report, saying their plans go far beyond the limited experiments that were studied, and point to data from projects in Oregon and elsewhere that more closely align with their plans.

A state-commissioned report found that significant savings were possible from eliminating duplicated tests, preventing hospitalizations and other techniques.

Oregon's changes will focus on the neediest, costliest patients. Many of them are on both Medicare, primarily for the elderly, and Medicaid, primary for the poor.

Various funding streams from all levels of government for mental, physical and dental care will be pooled into a global budget. Each coordinated care organization gets a share of that budget and will have broad authority to spend the money as it sees fit. Successful organizations will be rewarded with additional cash.

Local officials around Oregon have already begun setting up coordinated care organizations in various parts of the state, and some are expected to be up and running on July 1.

Supporters of the new law say a project in central Oregon shows that it can work.

After identifying 144 patients who were frequently visiting the emergency room — at least 10 times in a year — a group of health providers found that most had mental health conditions and more than half had no primary care provider who could treat simple disorders outside the ER.

By creating care plans, assigning case managers to help them navigate the health care system and embedding mental health providers at the doctor's office, emergency room visits were reduced by 49 percent in six months.

Robin Henderson, a psychologist who is director of behavioral health services for the hospital in Bend, Ore., says the program has promise, "It's an interesting shift in philosophy to start to look at how you care for the whole person."

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Obama health chief visits L.A. clinic, announces plan to help students

Kathleen Sebelius, secretary of Health and Human Services, fields questions at a panel discussion at the Eisner Pediatric and Family Medical Center in downtown Los Angeles. Earlier, she announced more than $9 million in funding to help medical students repay school loans if they agree to work in underserved areas. (Arkasha Stevenson / Los Angeles Times / February 13, 2012)

Health and Human Services Secretary Kathleen Sebelius visited a health clinic in downtown Los Angeles on Monday and announced more than $9 million in funding to help medical students repay school loans if they agree to work in underserved areas.

Sebelius said the program will encourage more students to pursue careers in family medicine and will help relieve a shortage of primary care doctors.

"Most Americans who live in underserved areas don't have access to basic care," she said during the visit to Eisner Pediatric and Family Medical Center. "It is not just a problem in some rural, isolated communities. It's a big problem in cities, like here in L.A."

Sebelius toured the Eisner clinic, which serves more than 26,000 patients each year, and took part in a panel discussion about community health clinics. Clinics nationwide received an influx of financial support from the federal health reform law, designed to improve quality of care and reduce costs.

In the past, Sebelius said that not enough attention was paid to workforce issues. But that has changed, and now there is more effort to expand that workforce, including training primary care doctors, nurse practitioners and physician assistants.

The loan repayment program, also funded by the federal law, is part of the National Health Service Corps and provides up to $120,000 to students who commit to spending three years as primary care doctors in underserved areas.

The National Health Service Corps, created in 1972, has tripled in size over the last three years. The program already provided loan repayment for medical residents, while the new effort reaches students who are still in medical school.

One of the recipients, Eric Schluederberg, a medical student at Western University of Health Sciences in Pomona, said he was originally interested in primary care because his father is a family physician. But he is also inspired by his fiancee, who has spina bifida, a birth defect believed to be preventable with proper prenatal care.

"It is part of the reason I want to be out there, helping women who just don't know," he said. "I want to be part of that."

Naomi Gordon-Walinksy, a doctor at the Eisner clinic, said the National Health Service Corps has helped her and other colleagues remain at the clinic.

"It's been a huge lift off my shoulders to be able to not worry about making the monthly loan payments," she said. "… It helps us stay committed to our work here."

anna.gorman@latimes.com

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Health insurers question Obama birth control plan

(Reuters) - Health insurers said on Friday they feared President Barack Obama had set a new precedent by making them responsible for providing free birth control to employees of religious groups as he sought to defuse an election-year landmine.

Obama on Friday announced the policy shift in an effort to accommodate religious organizations, such as Catholic hospitals and universities, whose leaders are outraged by a new rule that would have required them to offer free contraceptive coverage to employees.

Instead, the Obama administration ordered insurers to provide workers at religious-affiliated institutions with free family planning if they request it, without involving their employer at all. Insurance industry officials said the abrupt shift raised questions over how that requirement would be implemented.

"We are concerned about the precedent this proposed rule would set," said Robert Zirkelbach, spokesman for America's Health Insurance Plans, the industry's trade group. "As we learn more about how this rule would be operationalized, we will provide comments through the regulatory process."

Zirkelbach said insurers "have long offered contraceptive coverage to employers as part of comprehensive, preventive benefits that aim to improve patient health and reduce health care cost growth."

Employers who have signed on for such health plans in the past paid part of the cost of birth control prescriptions, while their employees also bore some of the expense through co-payments.

Aetna, the third-largest U.S. health insurer, said that it would comply with the policy but needed "to study the mechanics of this unprecedented decision before we can understand how it will be implemented and how it will impact our customers."

An Aetna spokeswoman said the company "did not have any direct input into the actual policy decisions that were made."

When asked about the insurer concerns, the White House cited a report from the U.S. Health and Human Services Department that estimates the costs of providing free birth control can be offset by reducing expenses associated with unintended pregnancies.

(Reporting by Lewis Krauskopf in New York, Additional reporting by Caren Bohan in Washington, Editing by Michele Gershberg, John Wallace and Matthew Lewis)

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