The Daily Oklahoman from Oklahoma City, Oklahoma • 8

THE 0KLAH0MAN NEWS0K.COM 8A WEDNESDAY, AUGUST 8, 2012 NEWS Health exchange likely dead in state population would be left in the cold. A partial Medicaid expansion also would shift the cost of health insurance coverage for the poor to the federal government. Instead of the states eventually picking up 10 percent of the cost, the federal government would pay all of the subsidy under the exchange. The Crippen letter also suggests the possibility of states gradually phasing in expanded Medicaid coverage after 2014. Krista Zaharias, senior press secretary for the National Governors Association, said the association hasn't received a response from Sebelius, but the group understands Sebelius' department is working to provide a timely answer.

Alex Weintz, spokesman for Fallin, said she did not have a hand in preparing the letter, but her office is reviewing all options. for a family of four now is $23,050. The high court ruling made the Medicaid expansion essentially optional, and several Republican governors have announced their states will not be accepting the money. Fallin has put off a Medicaid decision until after November's election. Fallin voted against the Affordable Care Act while she was in Congress.

She has said she hopes Mitt Romney is elected president and the law is repealed, but a combination of political forces has prevailed on her to put off any final decision on Medicaid expansion. As an incentive to get states to accept Medicaid expansion, the federal law offers heavy federal subsidies. Federal tax money would fund 100 percent of the expansion the first three years. Subsequently, states would gradually pay a higher portion of the cost, capping at 10 percent in 2020. In existing Medicaid programs, Oklahoma now pays about 36 percent of Medicaid costs.

Other possibilities Meanwhile, the National Governors Association has proposed a new possibility that might change the politics and the financing of the situation. In a July 2 letter to Health and Human Services Secretary Kathleen Sebelius, association Executive Director Dan Crip-pen asked whether the enhanced federal Medicaid BY WAYNE GREENE Tulsa World wayne.greenec3tulsaworld.com Plans for state health insurance exchanges a centerpiece of the Obama administration's Affordable Care Act appear mortally ill if not completely dead in 29 states, including Oklahoma. A health insurance exchange is an electronic marketplace where uninsured people can compare and purchase health insur -ance and, under the health care act, receive federal subsidies for the cost. According to a tally kept by the Center on Budget and Policy Priorities, a Washington think tank that favors the federal health care law, 14 states and the District of Columbia have established exchange mechanisms that are compliant with the law's requirements. Three of those states established exchanges through executive orders.

The others were established through the legislative process. In seven other states, legislation to establish exchanges is pending, but time is getting short for states to join the effort. Under the law, exchanges have to be fully operational by Jan. 1, 2014, but there are other deadlines along the way. Experts say any state that isn't well into the process of developing its plans at this point will find meeting the deadlines difficult.

Early in her administration, Oklahoma Gov. Mary Fallin accepted a $54 million federal grant to establish an exchange, but later, under political pressure from tea party elements in her own Republican party, she rejected the grant. Six other states also rejected grants after first accepting them, according to the center's tally. The Oklahoma Legislature considered exchange plans the past two years, but the idea foundered under tea party pressure. Key parts of act The federal law mandates that if a state does not establish an exchange, the U.S.

Department of Health and Human Services will create one for it. After the U.S. Supreme Court found the Affordable Care Act is largely constitutional, much of the debate in state Capitols turned from exchanges to plans to expand Medicaid under terms of the law. Exchanges and Medicaid expansion are two key elements of reducing the number of uninsured Americans, under the law. Medicaid would cover the poorest people up to 133 percent of the federal poverty level.

People in the middle up to 400 percent of the poverty level -would either get insurance through their employers or buy insurance through an exchange and receive federal subsidies. Wealthier people would be responsible for their own health insurance or get it from their employers. The federal poverty level subsidies would be available if states expand Medicaid but not to the 133 percent of poverty level. Under such a scenario, more poor people would flow into health insurance exchanges and receive federal subsidies for purchasing private insurance instead of Medicaid. Under one scenario mentioned in Crippen's letter, a state could expand its Medicaid program up to 100 percent of the poverty level, allowing it to enjoy many of the benefits of the law and reduce future costs to the states.

No one below 100 percent of the poverty level is allowed to purchase insurance through an exchange, under the law. One possibility under discussion would be for health providers hospitals and physicians to fund the poor patients' share of insurance cost, which would still leave the providers money ahead. The federal government has previously allowed a similar arrangement under a separate program, a high-risk pool that provides coverage for people with pre-existing conditions at normal insurance premium levels. A partial Medicaid expansion would avoid one of the potential perversions of the Affordable Care Act if a state did not expand Medicaid at all, that would mean uninsured middle-class Americans would be able to get coverage through an exchange while the poorest ANY AC SERVICE CALL 0 Reduced trans fats credited with lowering kids' cholesterol ill lit MD FACS piastic reconstructive surgery creating a beautiful reflection of you Jl 405.751.L0VE (5683) drtimlove.com loveyourhairtransplant.com Dr. Sarah de Ferranti, director of preventive cardiology at Boston Children's Hospital, left, meets Tuesday with patient Quinn Voccio, 14, of Newton, in Walth-am, Mass.

A government study shows, in the past decade, the proportion of children who have high cholesterol has fallen. AP PH0T0 Despite the good news, experts remain worried: 17 percent of U.S. children are obese. Eating lots of carbohydrates and sugar, along with little exercise, can lead to diabetes and heart disease. BY MIKE STOBBE AP Medical Writer ATLANTA Finally some good news about cholesterol and kids: A big government study shows that, in the past decade, the proportion of children who have high cholesterol has fallen.

The results are surprising, given that the childhood obesity rate didn't budge. How can that be? Some experts think that while most kids may not be eating less or exercising more, they may be getting fewer trans fats. That's because the artery-clogging ingredient has been removed or reduced in many processed or fried foods such as doughnuts, cookies and french fries. "That's my leading theory," said Dr. Sarah de Fer-ranti, director of preventive cardiology at Boston Children's Hospital.

She wrote an editorial that accompanies the study. The study did not look at the reasons for the decline, but its lead author, Dr. Brian Kit of the Centers for Disease Control and Prevention, said the theory makes sense. The research, released online Tuesday by the Journal of the American Medical Association, also showed that children's average overall cholesterol levels declined slightly. Too much cholesterol in the blood raises the risk of heart disease.

It isn't usually an immediate threat for most children, but those who have the problem often grow into adults with a high risk. Kit and his colleagues drew data from an intensive national study over three periods 1988-94, 1999-2002 and 2007-10. During the most recent period studied, the number of children ages 6 through 19 with high cholesterol was 1 in E. That was down from 1 in 9 in each of the earlier periods. The average overall cholesterol level fell from 165 to 160.

In children, 200 is considered too high. The study was the first in almost 20 years to show trans fats might be responsible" for the new study's results, Marion Nestle, a New York University professor of nutrition, food studies and public health, said. "If so and as usual it's clear that more research is needed it would mean that public health measures like the trans fat ban in New York City are actually doing enough good to be measureable." such a decline. The researchers detected modest improvements in children's levels of so-called good cholesterol, which can protect the heart. That may be partly due to declines in teen smoking and childhood exposure to secondhand smoke over the last decade.

Studies have found that chemicals in cigarette smoke can lower good cholesterol. The bigger news was what happened with bad cholesterol and triglycerides. They went down by small but significant amounts. Artificial trans fats are known to decrease good cholesterol and increase bad cholesterol. In 2006, the federal government began requiring that packaged foods list the amount of trans fat per serving.

Meanwhile, a push to take trans fats out of foods gained momentum. New York City banned artificial trans fats in restaurant food in 2008. California in 2010 became the first state to adopt such a ban. Even Crisco, the goopy shortening that was trans fat incarnate, was reformulated to take it out. "I love the idea that reduced use of hydrogenated IS $300 Off A Complete System! Turn Ui llv I'.