New research suggests that patients who need to be admitted to the ER when the hospital’s emergency department is at its busiest could suffer more than just long waits. In fact, they may be more likely to stay in the hospital longer, rack up expensive medical bills, and potentially even have a greater chance of dying.

Wonkblog’s Sarah Kliff flags a new study that tracked people who were admitted to California hospitals in 2007, both during times that the emergency departments were “saturated” with patients and the times that they were less busy. The researchers found that patients who visited the ER while it was crowded with other increased their odds of dying by five percent:

There aren’t many differences in the types of patients who visit the emergency department when its crowded or when its empty. Of those who came in to a saturated emergency room, 10.3 percent had congestive heart failure, compared to 10.4 percent of those arriving during less crowded hours. About half of the patients in each condition were white and just under a third were African-American.

The one big difference, this paper finds, is in the morality rate: Patients who came into a saturated emergency department had a 5 percent higher chance of dying in the hospital after their admission.

Researchers, who noted that “emergency department (ED) crowding has become an international health delivery problem,” attributed the jump in mortality rates to patients facing strained staff resources and extra delays.

This could be especially bad news for residents of New York City, where damage in the wake of Hurricane Sandy has left a lasting impact on the hospital network. After flooding and power outages forced four of the city’s hospitals to close — including the premier high trauma center in Manhattan — the hospitals that remain open are struggling under the increased weight of additional patients flooding into their emergency departments. ER visits have jumped by 25 percent in some New York City hospitals. The hospitals that remain closed do not expect to be able to resume full operations for several months.

The IRS today released final rules on a 2.3 percent tax on medical devices passed as part of President Obama’s landmark health care reform law, Reuters reports. The tax, which will help fund Obamacare’s coverage expansion and insurance subsidies for Americans, is estimated to raise $29 billion over the next ten years according to Congressional Budget Office (CBO) estimates.

But despite the IRS rules, the tax’s future remains shaky, as manufacturing firms, Republicans, and some Democrats are considering delaying or even repealing the tax as part of negotiations regarding the so-called “fiscal cliff.” The trepidation over the revenue source stems from fears that the tax could be applied too broadly, potentially stifling manufacturers or driving up the cost of everyday medical tools.

But officials contend that there are enough exemptions to the tax for more common, over-the-counter devices, and that the flurry of new customers coming into the health care market after Obamacare’s insurance expansion will counteract any added costs to manufacturers:

“The excise tax is on the medical device manufacturers and importers (who) will now have access to 30 million new customers due to the health care law,” Treasury Department spokeswoman Sabrina Siddiqui said in a statement.

Many medical devices that are sold over-the-counter – such eyeglasses, contact lenses and hearing aids – are exempt from the tax, as are prosthetics, the IRS said. [...]

Some medical device companies are hoping to delay the tax’s start date as part of a resolution of the “fiscal cliff” deadline at the end of the year involving many tax and spending measures, said Steve Ferguson, chairman of Cook Group Inc.

“We would like to be part of the punt,” Ferguson said, referring to an extension of current tax policy into 2013.

ThinkProgress reported that repealing the tax would be a top priority for congressional Republicans in the wake of President Obama’s reelection. In June, House Republicans successfully repealed the tax, but the measure has not been taken up in the Senate. However, if a sufficient number of Democratic lawmakers feel pressured enough by industry interests to include a device tax repeal in “fiscal cliff” talks, that may change.

While it is certainly important for health care officials and lawmakers to make sure that the tax is applied in a way that doesn’t unnecessarily or negatively burden hospitals and device manufacturers, efforts to repeal or delay the tax risk leading down a slippery slope where Obamacare’s other funding mechanisms — such as the tax on premium health plans and wealthier Americans — are delayed, scaled back, or repealed in the face of persistent interest group lobbying.

As with any social program, Obamacare’s consumer protections, coverage expansions, and insurance subsidies can only be implemented effectively if they are responsibly paid for. The temptation to preserve popular consumer protections while shying away from the more painful costs of providing those protections might make for good politics, but it’s bad policy, and it could end up hurting more Americans in the long-term by making Obamacare unsustainable.

Women’s health advocates confirm that Michigan lawmakers are likely to revive on Thursday an omnibus anti-abortion bill that sparked widespread protests after it passed the House this summer, in addition to a host of other restrictive abortion legislation they hope to force through the current lame duck session.

As Michigan’s current attempt to pass anti-union legislation dominates the coverage surrounding the state legislature, lawmakers are using the opportunity to revisit anti-abortion measures they hope to slip through before this session ends. Since five anti-choice state legislators lost their seats in last month’s election, this may be the best time for the legislature to advance their far-right agenda — despite the fact that the majority of Michigan residents support legal access to abortion. On Thursday afternoon, the state senate may consider multiple anti-abortion bills that aim to:

1) Regulate abortion clinics out of existence. HB 5711, the massive 45-page legislation that sparked a massive outcry when the House considered it in June, contains additional and unnecessary regulations for abortion providers. HB 5711 would subject any facilities that perform 6 or more abortions per month to burdensome regulations that could be so costly that they force clinics to close their doors, an indirect method of targeting abortion providers.

2) Limit abortion access for women in rural areas. HB 5711 would also place restrictions on telemedical abortions, which provide essential health services to women in rural areas who often lack any access to nearby abortion doctors. Even though telemedical procedures have been proven to be safe and effective, Michigan lawmakers seek to require doctors to be physically present to administer abortion services.

3) Impose further guidelines for the disposal of fetal remains. Michigan already has regulations in place to instruct medical professions about how they must dispose of fetal remains, but HB 5711 wants to go a step further, requiring fetal remains to be treated in the exact same manner as dead bodies. Doctors would be forced to fill out death forms and make arrangements for the fetal remains’ cremation or burial, imposing an emotional burden on the women whose pregnancies end through a medical miscarriage. No other state handles fetal remains at 10 weeks in the same way as it handles dead bodies.

4) Prevent private insurance companies from covering any abortion services. A trio of companion bills — SBs 612, 613, and 614 — would work together to ban the health insurance exchange that Michigan will set up under Obamacare from covering abortion, as well as ban private insurers from covering any abortion services under their general insurance plans. Currently, 87 percent of Michigan’s insurance plans include abortion care in their benefits packages. If private insurers elect to cover abortions, they have to do it as a separate rider, which often ends up being more costly for women.

5) Allow doctors to refuse to perform abortion services because of their personal beliefs. SB 975, which passed the Michigan Senate’s Health Policy committee earlier this week and is now up for a full vote, is a sweeping “license to discriminate” bill that would allow medical professionals to deny health services based on their personal beliefs. It would allow doctors to refuse to provide HIV treatment, vaccinations, or abortions to any of their patients simply based on their “conscience.”

Preliminary reports from women’s health advocates on the ground in Michigan suggest that the Senate has already passed SB 975, and is likely to pass SBs 612, 613, and 614 this afternoon. But Thursday’s push doesn’t represent the only step that Michigan lawmakers have taken during this year’s lame duck session to push through anti-choice legislation. Just a few weeks ago, state legislators also considered establishing a tax credit for fetuses past 12 weeks’ gestation, a dangerous step toward endowing fetuses with the same rights as U.S. citizens.

An open letter from Irish and American activists is calling on Secretary of State Hillary Clinton to address Ireland’s abortion laws during her visit today and tomorrow.

The renewed look at Ireland’s abortion laws come in the aftermath of the tragic death of an Indian citizen living in Ireland, Savita Halappanavar, due to complications from her pregnancy and the refusal of her hospital to perform an abortion. Ireland maintains some of the strictest abortion laws in the world, but has pledged to reexamine them following global interest in Halappanavar’s story.

Hoping to keep the pressure up on Ireland, a group called Savita’s Laws has issued the letter, open for signature to all on the Internet, lobbying Clinton to speak out:

Otherwise, Ireland will continue to be in clear violation of its international obligations on human rights, despite having committed, during its recent successful campaign for membership of the UN Human Rights Council, to the full promotion of such rights in its domestic policy. Deeming this to be a matter of urgent concern both on an Irish and international scale, we would ask, Madam Secretary, that you might consider addressing this very real and present danger to the lives and health of pregnant women during your visit to Ireland this week. The Irish government must take the right decision to protect the rights of women in Ireland, and it should do so without further delay.

Clinton has spent a large portion of her time at Foggy Bottom crusading for enhancing the rights of girls and women globally. In 2011, Clinton told Newsweek, “I believe that the rights of women and girls is the unfinished business of the 21st century.” Even before her stint as Secretary of State, Clinton was well-known for her declaration that “women’s rights are human rights” during her time as First Lady.

Clinton, who will be leaving the State Department shortly, maintains a stable of goodwill in Ireland, due to her husband’s role in negotiating a peace treaty ending violent struggle in the north. Whether she will use this position to speak out while in Dublin remains to be seen.

States have spent less money on anti-tobacco programs over the past two years than at any point since 1998, when a large settlement with the tobacco industry awarded states billions of dollars to put toward their public health campaigns, a new report from the Campaign for Tobacco-Free Kids finds.

The report notes that even though states expect to collect a record $25.7 billion from tobacco taxes and settlement money in this fiscal year, they’re planning to spend less than 2 percent of those funds on anti-smoking campaigns and tobacco prevention programs. And the authors told the New York Times that the lack of funding for public health resources is especially problematic now that tobacco has become divided along economic lines, and is now imposing a serious strain on low-income smokers who can end up spending up to a quarter of their income on cigarettes:

“Smoking used to be the rich man’s habit,” said Danny McGoldrick, the vice president for research at the Campaign for Tobacco-Free Kids, “and now it’s decidedly a poor person’s behavior.”

Aggressive antismoking programs are the main tools that cities and states have to reach the demographic groups in which smoking rates are the highest, making money to finance them even more critical, Mr. McGoldrick said.

The decline in spending comes amid growing certainty among public health officials that antismoking programs, like help lines and counseling, actually work. California went from having a smoking rate above the national average 20 years ago to having the second-lowest rate in the country after modest but consistent spending on programs that help people quit and prevent children from starting, Dr. McAfee said.

Even aside from the positive public health implications, investing in tobacco prevention is also incredibly cost-effective for states. One study estimated that states’ returns on their anti-smoking programs can be as high as $50 saved for every $1 spent. That study projected an annual $200 billion loss from preventable health problems caused by tobacco — mostly thanks to decreased workplace productivity and increased health care costs — so states like California that are investing in strong anti-tobacco programming have significantly lowered their health care expenditures, and those savings far surpass the cost of the programs themselves.

Nevertheless, recent budget cuts have forced many effective tobacco programs to contract or even cease altogether. North Carolina eliminated funding for its program this year, and Ohio didn’t allocate any money for what used to be a successful program in the state in the past. Anti-tobacco programs have been cut by more than 90 percent in Washington State, by more than 75 percent in Maryland, and by more than half in Maine, Massachusetts, New York and Wisconsin.

A deadly meningitis outbreak in October that led to the deaths of 36 Americans due to lax regulatory standards at a Massachusetts compounding pharmacy has prompted lawmakers in House of Representatives to introduce a bill imposing tighter regulations on the industry.

According to a press release issued by the two lawmakers who introduced the bill — Rep. Rosa DeLauro (D-Conn.) and Rep. Nita Lowey (D-NY) — the Supporting Access to Formulated and Effective (SAFE) Compounded Drugs Act would require, among other things, drug compounders to register with a national Food and Drug Administration (FDA) database, patients to be informed whether or not they are receiving treatment with a compounded drug, a minimum level of FDA-sanctioned production standards for such drugs, and training opportunities for more vigorous state oversight of compounding pharmacies:

“I wish this legislation were not necessary, but recent, tragic events have proven that it is,” DeLauro said. “The actions of the New England Compounding Center have made clear that strong Federal authority is necessary to ensure patients know they are receiving safe compounded drugs. It has also become clear that federal and state regulators must better communicate to identify trouble facilities and leverage their resources to protect patients.”

“Yesterday’s announcement that multiple NECC products were contaminated simply underscore that this was not an isolated incident. We must end the current regulatory morass so that no more lives are placed at risk.”

Lowey said: “As recent events have made clear, it is critical to ensure compounding pharmacies are operating safely and the products consumers receive will improve – not jeopardize – their health. Federal oversight is critical to identify and correct potential problems and keep consumers safe.”

The congressional effort comes on the heels of Massachusetts separately cracking down on unregulated pharmacies in the state. After the initial outbreak, the FDA pleaded for Congress to set up clearer oversight standards on the compounding industry.

In the long political battle over President Obama’s landmark health care reform, Obamacare opponents have argued that an overhaul to the nation’s health care system isn’t necessary because Americans don’t struggle or die due to a lack of access to insurance. But public opinion says otherwise, as Americans continue to rate health care access and the high cost of insurance as their top medical concerns.

According to Gallup’s annual Health and Healthcare Survey, four in ten Americans cite either healthcare access or cost as the most urgent health problem currently facing the country. And the Americans who responded to Gallup with some critique of the health care system surpasses the number of Americans who named a specific illness, like cancer or diabetes, as their top medical concern. Americans have ranked their worries about being able to get coverage under a health insurance plan at the top of their list of concerns since 2007:

Since the Affordable Care Act won’t be fully in effect until 2014, it may take another few years before the health law helps ease American’s concerns about losing their health insurance. If Obamacare isn’t blocked from taking effect in Republican-controlled states, it will extend coverage to 30 million previously uninsured Americans by expanding the Medicaid program for additional low-income beneficiaries and creating state-run health exchange markets.

But Gallup notes there’s one other health concern that may soon surpass Americans’ worries about insurance access and cost: the national obesity epidemic. Gallup first started including obesity in their annual health survey in 1999, when only about one percent of Americans rated it as a health concern — but as obesity and diabetes rates have soared across the country, that number has steadily risen to its current peak of 16 percent. Most residents in all 50 states are now considered either overweight or obese, and the number of kids with type 2 diabetes is projected to increase by 50 percent by 2050.