A package of stringent abortion restrictions is expected to hit North Dakota Gov. Jack Dalrymple’s (R) desk early this week — including a “heartbeat” measure that would outlaw abortion at just six weeks of pregnancy, legislation that would force the state’s last remaining abortion clinic to close its doors, and a first-of-its kind ban on abortions due to genetic abnormalities.

But North Dakota residents are fighting back against their lawmakers’ war on women’s health, urging Dalrymple to reject the proposed abortion restrictions. On Monday afternoon, approximately 300 people — including some Republican state lawmakers who oppose their colleagues’ recent anti-choice agenda, saying their fellow legislators have “stepped over the line” with the extreme abortion bans — gathered in Bismarck, ND for a “Stand Up For Women” rally. Protestors hoped to communicate that North Dakota will not condone more attacks on reproductive freedom.

Republican Rep. Kathy Hawken and Republican Sen. Judy Lee, who broke from their party this session to oppose the stringent abortion restrictions because they go too far to threaten women’s health care in the state, both attended the rally in Bismarck. Women’s health advocates flocked to the steps of the state capitol building, brandishing signs declaring “VETO,” “Trust Women,” and “Stop The War On Women” (all photos via Stand Up For Women):

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According to a new report from the Centers for Disease Control (CDC), over 70 million of America’s 79 million “prediabetic” residents — those with relatively high blood sugar but not high enough to qualify as diabetic — knew they were at risk of developing the disease in 2012.

As Everyday Health reports, that’s particularly bad news considering that prediabetic Americans can reverse their condition through diet and exercise, preventing their blood sugar from reaching diabetic levels and sparing them from the chronic illness and its associated health care costs:

While prediabetes is often reversible with a healthy diet and exercise, the CDC said in its report, those with the condition need to know they have it or they’re unlikely to make the needed lifestyle changes. And without those lifestyle changes, research has shown that within 10 years most prediabetics develop diabetes, which can lead to a variety of serious complications, from heart disease to kidney failure to blindness.

“If we can identify it early on, we can treat it,” said Scott Drab, PharmD, associate professor of pharmacy and therapeutics at the University of Pittsburgh School of Pharmacy. “We can prevent many of these patients from going on to get diabetes.”

In its report, the CDC noted that only 14 percent of Americans even know prediabetes exists — but the agency was also clear that the condition and therefore the risk of developing diabetes could be reversed or delayed in many cases by eating less, exercising and losing weight.

“Evidence-based lifestyle programs aimed at increasing physical activity, improving diet, and achieving moderate weight loss among those with prediabetes can prevent or delay type 2 diabetes,” the CDC said in the report. “Because the vast majority of persons with prediabetes are unaware of their condition, identification and improved awareness of prediabetes are critical first steps to encourage those with prediabetes to make healthy lifestyle changes.”

Some doctors recommend that all Americans get screened for prediabetes every year in order to bolster prevention efforts and stop the disease before it progresses to an unsustainable stage. That’s not surprising considering that excess sugar in diets leads to 180,000 annual deaths worldwide and that the rise in American diabetes rates is the main driver of ballooning U.S. health care costs.

The Obamacare provision that requires insurance companies to cover contraceptive services with no additional co-pay has broad public support, but has still remained one the most politically contentious aspects of the health reform law. Despite the fact that the Obama Administration provides an exemption for religiously-affiliated organizations that may object to covering birth control, religious organizations across the country have continued to resist Obamacare.

Those fights over birth control have been spearheaded by religious universities and for-profit organizations, despite the fact that those types of institutions may have hundreds of students or employees who don’t share the same objection to contraceptive services. Obamacare opponents have been going to extreme lengths to drag out the largely failed “religious liberty” fight.

In fact, one Roman Catholic university in Ohio, Franciscan University, actually dropped health coverage for its entire student body last year simply because its officials were afraid of “one day having to provide coverage for contraception.” A federal judge recently dismissed Franciscan University’s lawsuit against the federal government and blasted its decision to deny health insurance plans from its more than 2,500 students:

U.S. District Judge Algenon Marbley sided with the government, saying the groups couldn’t prove they would ever likely suffer the harm they allege. He noted that 15 other federal courts have already ruled similar lawsuits weren’t timely and most of those 15 decisions determined the groups filing the lawsuits lacked jurisdiction.

The judge also criticized Franciscan University over its decision in May to drop its student health insurance program out of fear of one day having to provide coverage for contraception.

Marbley said the university can’t argue harm based on “a phantom specter” created by its own fears, which the government has stated are unsubstantiated, Marbley said.

“It is gravely unfortunate that Franciscan’s students have lost the opportunity to receive health insurance coverage from the University,” the judge said.

Overall, the Catholic Church has actually been largely supportive of efforts to expand access to health care, which the Church considers to be a basic human right. During the political battle to pass the Affordable Care Act, Catholic nuns filed a brief in support of the health reform law, explaining that the government has a “moral imperative” to ensure care for people who cannot afford insurance. The Catholic bishops have obviously taken issue with some provisions of the reform law, but they also admit that they can “recognize the good present in the bill.”

However, rather than weigh the positive effects of health coverage against their opposition to birth control, Franciscan University simply decided to throw out its student health insurance plans altogether. And university officials show no signs of letting up, despite their defeat in court. As Father Terence Henry, Franciscan’s president, said in a statement, “We will not stop fighting this unjust mandate, and we are in this for the long haul.”

Women in Kansas may be the latest group to fall victim to the newest troubling trend in anti-choice legislation: Fetal heartbeat bills. These proposals seek to ban abortions as soon as a fetal heartbeat can be detected, which can be as early as six weeks — before many women even know they’re pregnant — and directly undermine the rights guaranteed by Roe v. Wade, which grants women’s right to an abortion until the point of viability at around 23 or 24 weeks of pregnancy.

The Kansas fetal heartbeat proposal, HB 2324, was introduced earlier in the legislative season, but had not seen much movement until today when the House Federal and State Affairs Committee announced it would conduct a hearing on the bill at 8:00 am tomorrow, hoping to rush the bill through in the final days of the session. Kansas NOW Lobbyist and State Co-Coordinator Elise Higgins expressed dismay at the tactic:

“Not only is House Bill 2324 clearly a way for Kansas legislators to challenge Roe on the taxpayer dime, notice of the hearing was given less than 24 hours in advance to the general public. We condemn this underhanded approach to legislation unprecedented in its extremity, and are committed to fighting it every step of the way.”

North Dakota passed a heartbeat bill earlier in March that is currently awaiting the governor’s signature, while Arkansas overrode a gubernatorial veto to implement a 12-week heartbeat bill that would ban all abortions after the heartbeat could be detected with an abdominal ultrasound. Mark Gietzen, the chairman of the Kansas Coalition for Life, the group behind HB 2324, boasted that the bill was more restrictive than the Arkansas law and claimed it was “likely to stand up in court” in an op-ed over the weekend.

The Kansas House has already advanced a 70-page omnibus anti-abortion bill that does everything from force doctors to warn about unsupported connections between breast cancer and abortions to restricting comprehensive sex ed resources in public schools.

McDonald’s will make its ‘McWrap’ a permanent menu item with the launch of a big ad campaign starting April 1, and it’s clear the company is working to make sure the new product looks like a ‘healthier option’ on the menu.

On Monday, a leaked internal memo showed that McDonald’s believes it would lose 22 percent of its 18-34 year old customers to what’s perceived as the healthier option, sandwich chain Subway, without adding the wrap onto its menu. McDonald’s is also looking to alter its unhealthy image with its green label. Just last week, researchers at Cornell University released a study showing that consumers view green labeling as a shorthand for healthier food:

People tend to think a candy bar with a green calorie label is healthier than ones with red or white labels, even when the number of calories is the same, a Cornell University researcher found.[...]

“Our research suggests that the color of calorie labels may have an effect on whether people perceive the food as healthy, over and above the actual nutritional information conveyed by the label, such as calorie content,” [a Cornell news release] said.

Of course, Subway uses green packaging, along with the tagline “Think Fresh” to convey nutrition. But its sandwiches are not significantly healthier by any means; they contain an average of 608 calories, and the highest calorie sandwich checks in at 570 calories for a six-inch, translating to about 1,140 for the chain’s signature ‘footlong.’ The sandwich chain does offer lower fat content options, however, and some of its options have “Heart Check” approval from the American Heart Association. That perception is paying off; Subway now has more stores in the U.S. than McDonald’s does.

High-calorie, high-salt, high-fat foods that fast food chains serve pose a huge health risk, causing damage to organs including the heart and liver, and obesity. The perception about fast food might be different when it comes to something like a wrap, but the effect is the same. The McWrap pictured above is 590 calories and contains 44 percent (PDF) of a person’s daily fat intake.

In addition to the high-profile cases on marriage equality that are slated for consideration this week, another crucial legal battle that begins on Monday could have huge implications for the future of the health care industry. Federal Trade Commission (FTC) v. Actavis could save consumers and the government hundreds of billions of dollars in health care spending, prompting one plaintiff to dub it “the health care reform case of 2013.”

The case centers on the widespread and arguably collusive practice of “reverse payment” settlements — commonly referred to as “pay for delay” — between brand name drug manufacturers and their cheaper generic drug counterparts. Such arrangements involve brand name drug makers paying off generic manufacturers to delay a generic drug’s release into the market, allowing the brand name producers to further profit off of their significantly more expensive drugs:

Congress saw the difference that generic drugs could make in health care spending when in 1984 it passed the Drug Price Competition and Patent Term Restoration Act, also known as the Hatch-Waxman Act.

That law, together with amendments passed roughly 20 years later, encouraged generic drug makers to challenge the patents protecting lucrative brand-name drugs.

But a loophole in the law has turned the theory of patent infringement on its head, allowing a brand-name company to pay the generic drug maker to keep its low-price version off the market for a given number of years. That is the opposite of how a patent-infringement case is usually settled, with the generic infringer paying the brand-name patent holder. Thus, the deals are known as “reverse payment” settlements.

These schemes cost American consumers as much as $3.5 billion every year by delaying access to relatively cheap generic drugs and keeping prescription drug costs unnecessarily high, despite recent drops in drug spending driven by the greater use of generics. In fact, brand name drugs only constituted “18 percent of the total prescriptions written by doctors in 2011 but 73 percent of consumer spending,” and Big Pharma companies use the massive profit margins produced by that dynamic to effectively silence their competitors by offering a deal that’s too good to refuse. Brand name and generic drug makers — who both have plenty to gain financially through the shoddy arrangements — argue that such deals are actually beneficial for the consumer, as expensive patent lawsuits between the two industries could end up delaying a generic drug’s release even further.

But that argument is a smokescreen that ignores Congress’ original intent in passing the Drug Price Competition Act. It is an unintended consequence — as confirmed by none other than bill author Rep. Henry Waxman (D-CA) himself. In an amicus brief filed with the Court urging the justices to side with the FTC, Waxman wrote, “The Hatch-Waxman Amendments’ intention was to promote competition by generic drug manufacturers. The possibility of agreements such as those involved in this case is an unintended consequence of the legislation. Hatch-Waxman was never intended to foster such agreements, still less to render the antitrust laws’ prohibition of anticompetitive agreements among competitors inapplicable to agreements allowing generic manufacturers to exact a potion of a brand-name manufacturer’s monopoly profits in return for withholding entry into the market.”

Twice a year, Tennessee holds a “health care lottery” that gives some hope to the uninsured residents in the state who can’t afford health coverage. Tennesseans who meet certain requirements — in addition to falling below a certain income threshold, they must be elderly, blind, disabled, or a caretaker of a child who qualifies for Medicaid — may call to request an application for the state’s public health insurance program, known as TennCare.

The lottery is part of TennCare’s “spend down” program, which allows a resident’s income to be calculated after subtracting their medical costs from their total earnings. That means that some Tennesseans who technically earn too much annual income to qualify for public insurance could still be eligible for TennCare if they successfully complete the application process. The New York Times notes that while other states have similar “spend down” initiatives, most don’t limit the lottery enrollment period to a narrow window of call-ins. The unique enrollment process in Tennessee highlights the overwhelming demand for affordable health services, as many low-income Americans fall into a gap between being able to qualify for Medicaid and being able to access private insurance coverage:

State residents who have high medical bills but would not normally qualify for Medicaid, the government health care program for the poor, can call a state phone line and request an application. But the window is tight — the line shuts down after 2,500 calls, typically within an hour — and the demand is so high that it is difficult to get through. [...]

“It’s like the Oklahoma land rush for an hour,” said Russell Overby, a lawyer with the Legal Aid Society in Nashville. “We encourage people to use multiple phones and to dial and dial and dial.”

The phone line opened at 6 p.m. on Thursday for the first time in six months. At 5:58, Ida Gordon of Nashville picked up her cordless phone and started dialing. Ms. Gordon, 63, had qualified for TennCare until her grandson, who had been in her custody, graduated from high school last spring. Now she is uninsured, with crippling arthritis and a few recent trips to the emergency room haunting her.

“I don’t ask for that much,” Ms. Gordon said as she got her first busy signal, hanging up and fruitlessly trying again, and then again. “I just want some insurance.”

If Tennessee Gov. Bill Haslan (R) opted to expand Medicaid under Obamacare, more than 180,000 people would be able to be added to the TennCare rolls by 2019. Obamacare’s Medicaid expansion would extend coverage to low-income Americans whose earnings are above the current cut-offs for public assistance — which would include many of the people like Ida Gordon, who are desperately dialing and redialing in the hopes of winning an elusive health care lottery. Haslan has not yet decided whether Tennessee will accept Obamacare’s optional expansion of the Medicaid program, although he has indicated that he may make his decision sometime this week.

A growing number of GOP governors across the country have begun to concede that expanding Medicaid makes sense for the low-income residents in their states. But many of their fellow Republicans still aren’t willing to cooperate with the health reform law whatsoever — even going so far as to suggest that Obamacare will “degrade” or “destroy” what is already the “best health care system the world has ever known.” As Tennessee’s health care lottery demonstrates, however, the low-income Americans who are resorting to desperate measures to access the care they need may not agree with that assessment.

In order to promote better sexual health around the globe, the Bill and Melinda Gates Foundation wants someone to create the next generation of safe — yet pleasure-enhancing — condoms. And the foundation is putting its money where its mouth is with its ongoing Grand Challenges Explorations grant competition. Successful applicants could win a $100,000 initial grant, as well as up to $1 million in continued funding, to put their new condom design into production.

The challenge was issued in light of the reality that, while condoms have been in use for the past four centuries, “they have undergone very little technological improvement in the past 50 years.” On its website, the global health advocacy organization specifies that stymied sexual pleasure is a significant factor contributing to inconsistent condom use, and condoms that heighten pleasure might help reverse the trend in at-risk communities:

The one major drawback to more universal use of male condoms is the lack of perceived incentive for consistent use. The primary drawback from the male perspective is that condoms decrease pleasure as compared to no condom, creating a trade-off that many men find unacceptable, particularly given that the decisions about use must be made just prior to intercourse. Is it possible to develop a product without this stigma, or better, one that is felt to enhance pleasure? If so, would such a product lead to substantial benefits for global health, both in terms of reducing the incidence of unplanned pregnancies and in prevention of infection with HIV or other STIs?

Likewise, female condoms can be an effective method for prevention of unplanned pregnancy or HIV infection, but suffer from some of the same liabilities as male condoms, require proper insertion training and are substantially more expensive than their male counterparts. While negotiating use of female condoms may be easier than male condoms, this need for negotiation precisely illustrates the barrier preventing greater use that we seek to address through this call. [...]

We are looking for a Next Generation Condom that significantly preserves or enhances pleasure, in order to improve uptake and regular use. Additional concepts that might increase uptake include attributes that increase ease-of-use for male and female condoms, for example better packaging or designs that are easier to properly apply. In addition, attributes that address and overcome cultural barriers are also desired.

While the idea that men don’t use condoms as a consequence of curtailed pleasure and satisfaction may induce some serious eye-rolling, study data on the subject shows that it is no laughing matter — particularly for low-income regions with medically vulnerable populations. In one qualitative study on inconsistent condom use among HIV-positive populations in India, interview participants cited a lack of “full satisfaction” and the desire for “greater sexual intimacy in the heat of the moment” as a major barrier to safe sex practices. And here in the U.S., another study of American men who have sex with men (MSM) — who are generally at much higher risk for HIV and syphilis transmission — found the trend to be even more pronounced, with the vast majority of respondents tying non-use of condoms to sensation and pleasure-related reasons.

Across the country, about 21 states have restricted access to abortion by preventing insurance companies from covering the cost of the legal medical procedure. But lawmakers in Washington State are currently considering the opposite approach: legislation to mandate that insurance companies pay for abortion services as part of their plans’ maternity care.

Washington has traditionally been a trailblazer when it comes to reproductive rights. In 1970, the state become the first to legalize abortion by a popular vote. Now, under the proposed Reproductive Parity Act, it may become the first to ensure that insurance companies aren’t permitted to segregate abortion care from the rest of the women’s health services covered under their plans:

The bill passed the state House earlier this month by a vote of 53-43, though it faces an uncertain future in the Senate. A similar bill in the New York state Assembly has been introduced each session for over a decade but has never received a public hearing.

“This is a core value for Washingtonians,” said Melanie Smith, a lobbyist for NARAL Pro-Choice Washington. “We should protect it while we still have it and not leave access to basic health care up to an insurance company.” [...]

Supporters of Washington state’s proposed abortion insurance mandate are careful to stress that it wouldn’t lead to a dramatic uptick in abortions or require carriers with a religious bent to cover the procedure. They also note that a pair of federal plans that will be sold on all 50 state exchanges will be barred from covering elective abortions.

“It’s not expanding abortion coverage,” said Democratic Rep. Eileen Cody of West Seattle, the bill’s primary sponsor. “It’s ensuring the rights of women to get what they’re paying for now and to continue their freedom of choice.”

The bill has been hotly contested, particularly as conservatives have argued it represents an affront to the religious liberty of individuals who oppose abortion and don’t want to purchase plans that cover it. But Obamacare already requires at least some plans in the state-level insurance marketplaces to exclude abortion coverage. And, as Rep. Cody notes, the legislation wouldn’t actually significantly change the current landscape in Washington because all of the state’s major insurers already cover abortion.

But it would prevent new insurers entering Washington’s insurance marketplace from adopting the same kind of anti-abortion policies that have been sweeping the nation over the past two years, as states across the country have rushed to block access to abortion coverage. Elizabeth Nash, the state issues manager for the Guttmacher Institute, told the New York Times that the bill’s passage would be a “watershed event” regardless of its immediate impact on the insurance market. “It would be a model for other states to follow,” Nash explained.

According to the Guttmacher Institute, only about 12 percent of the abortions across the country are paid for by insurance providers. But in states that have enacted roadblocks to abortion coverage, women who seek abortions are often forced to pay large out-of-pocket costs in order to make their own medical decisions. The average cost of a first-trimester abortion is about $470, and an estimated 42 percent of the women who seek abortions have incomes that fall below the federal poverty line.