An Oklahoma state Senate committee rejected a measure that “would have repealed a 1987 law that prevents cities and towns from enacting tobacco use restrictions stricter than that of the state” by a 2-6 vote on Monday — drawing sharp rebukes from public health advocates who see the legislation’s failure as a political concession to Big Tobacco, and even drawing the ire of the state’s GOP Gov. Mary Fallin, who has called on lawmakers to pass legislation aimed at curbing Oklahoma’s smoking-related public health care costs.

“This is a victory for tobacco lobbyists and the tobacco industry,” said Alex Weintz, Fallin’s communications director. “It’s a defeat for the state of Oklahoma and anyone who cares about improving our health.”

As OKNews reports, the debate over SB 36 revealed a clear correlation between the state senators’ votes and the amount of money they received from the tobacco lobby:

The debate on the measure turned into a showdown between Sen. Frank Simpson, R-Ardmore, the only senator to sign a pledge to refuse all contributions, meals and gifts from the tobacco industry, and Sen. Rob Johnson, who is listed as the No. 1 recipient on a website that tracks legislators receiving money from tobacco lobbyists.

Johnson, R-Yukon, received about $11,295 in campaign contributions and gifts from those who were identified as tobacco lobbyists since 2006, according to the website tobaccomoney.com, which was started last year by Doug Matheny, the former director of tobacco prevention at the state Health Department. [...]

“From the tobacco companies themselves, I don’t think I’ve received that much comparatively to other interests,” he said. “It has absolutely nothing to do with it. I’ve taken max contributions from somebody and completely have been opposed to an idea they’ve had.”

Johnson and his fellow reform opponents implied that SB 36 would be a burden on businesses, since it would discourage Oklahoma residents from patronizing establishments that don’t allow smoking. But that logic completely ignores the very real — and very significant — costs of the state’s smoking epidemic. National smoking-related medical costs amount to $200 billion in preventable spending every year, and studies have confirmed that states making small investments in smoking cessation policies see massive economic returns. In Oklahoma specifically, where about 5,800 people die each year from smoking, every household pays an estimated $556 annually in state and federal taxes to cover smoking-caused medical costs.

Ultimately, the measure’s defeat is a reminder of the outsized influence that Big Tobacco continues to enjoy. Fallin has vowed to continue her fight to encourage anti-smoking efforts in Oklahoma, and will potentially call for a popular referendum on SB 36 — but if she does, the people of Oklahoma can expect a titanic statewide lobbying campaign by the tobacco industry.

Confirming similar studies that have found that mental health problems are not correlated with violence, a new National Bureau of Economic Research (NBER) paper concludes that there is no statistical link between violent crime and people who suffered from depression as teenagers.

While opponents of gun violence legislation have tried to shift the gun violence prevention debate to focus on the mentally ill, the reality is that the victims of mental illness-related violence tend to be the patients themselves. And depression specifically is one of the most widespread mental health concerns in the world. As the report states, “depression is the leading cause of disability and the fourth leading contributor to the global burden of disease,” and mental illnesses is prevalent among young Americans, with “8.1 percent of 2 million adolescents aged 12-17 experienced at least one major depressive episode in 2009.”

Although the NBER report found “little evidence that adolescent depression influences the likelihood of engaging in violent crime or the selling of illicit drugs,” it did conclude that such depression was a significant predictor for future property crimes, costing hundreds of millions of dollars per year in damages and underscoring the economic costs that exacerbate the social costs of mental illness on the public.

That makes early detection efforts and community support systems geared towards addressing mental health in children vital to public health and preventing certain future crimes — and some lawmakers are taking action to do just that. Sen. Al Franken (D-MN) recently introduced the Mental Health In Schools Act in an effort to “allow schools to collaborate with mental health providers, law enforcement, and other community-based organizations to provide expanded access to mental health care for their students” and “support schools in training staff and volunteers to spot warning signs in kids and to refer them to the appropriate services.”

(HT: Wonkblog)

Four-year-old Torrie Smith, a little girl in a low-income Colorado household, suffers from devastating dental health issues. Her plight could have been avoided with regular preventative dentist check ups, which would have been free for Torrie under Medicaid — but her mother Wendie didn’t know about the dental health benefits afforded to Torrie under the public insurance program until it was far too late.

Torrie’s issues underscore the considerable gaps in America’s dental health coverage system. Dental insurance remains elusive even for many who have employer-sponsored health coverage — some estimates peg the number of Americans forgoing dental care at over 100 million, with children and the poor being disproportionately affected. That’s particularly bad news considering that dental problems are lifelong problems, and poor dental health early on in life leads to a status quo in which over a quarter of elderly Americans over the age of 65 lose all of their teeth.

And as the Coloradoan reports, even Medicaid beneficiaries face a dearth of coverage due to low reimbursement rates for dentists accepting Medicaid patients:

State Medicaid data reported to the federal government show that less than half of the 453,000 Coloradans under age 21 who were eligible for benefits in federal fiscal year 2011 received some kind of dental service. Only a quarter of Colorado counties met a 2010 state goal of getting at least 44 percent of Medicaid-eligible residents under age 19 to visit a dentist, according to an I-News analysis of state records.

“Dental disease is not self-resolving,” says Diane Brunson, director of public health for the University of Colorado’s School of Dental Medicine. “It’s not like catching a cold and you put up with it for a week or 10 days and you’re fine. You have to get treatment. And it’s so much more beneficial all the way around — to the child, to their family, to taxpayers — if dental problems can be prevented.”

While the state appears to be making strides in improving its numbers, part of the problem is the paucity of dentists willing to see Medicaid children. Only 10 percent of Colorado’s 3,500 or so dentists are considered “significant” Medicaid providers, meaning that they are reimbursed for at least 100 visits per year. Moreover, 20 of Colorado’s 64 counties do not have a dentist who accepts Medicaid.

A large part of the problem has to do with a lack of knowledge regarding essential health care benefits, which leads to the vast majority of Americans not claiming preventative dental care that they are eligible for. “When she came along,” Wendie said of Torrie, “they gave me a (Medicaid) card and said it was for her doctor visits. They didn’t say dental or anything like that.” That’s nothing new when it comes to Americans and their preventative care benefits — only one in five Americans in high-deductible insurance plans know that much of their preventative care is free.

But as the Coloradoan’s article points out, it also has to do with Medicaid’s historically low reimbursements for doctors. Since states share a considerable amount of authority along with the federal government when it comes to determining Medicaid’s budget, the program is often an easy target for budget cuts. But those cuts carry with them a considerable human cost for some of America’s poorest residents. As ThinkProgress has consistently reported, that makes implementing Obamacare’s optional Medicaid expansion a medical imperative for the American poor — but as Torrie’s story shows, educating families about the care that they are eligible for is just as important.

During a Senate hearing on gun violence prevention on Wednesday, Sen. Al Franken (D-MN) issued a stark warning: don’t stigmatize Americans suffering from mental illnesses.

Since December’s mass shooting at Sandy Hook Elementary School, lawmakers have been engaged in a debate over the best ways to curb gun violence. Much of that debate has centered on America’s expensive and inaccessible mental health care system, since several perpetrators of mass shootings in recent years have also had mental illnesses. But the conversation has veered wildly off-course — stigmatizing Americans suffering from mental disorders as dangerous, and turning them into the scapegoats for gun violence, as the NRA’s Wayne LaPierre did during his bizarre press conference in reaction to the tragedy at Sandy Hook.

At today’s hearing, Franken tried to stop that train of thinking in its tracks. The senator acknowledged the need for a stronger mental health safety net while also pointing out that Americans with mental illness are not actually prone to violence:

FRANKEN: I have supported funding for law enforcement programs and I work every day to carry out the work Paul Wellstone does to repair our mental health system. Tomorrow I will introduce the Mental Health In Schools Act, which will improve access to mental health care for kids. Catching these issues at an early age is really important. I want to be careful here — that we don’t stigmatize mental illness. The vast majority of people with mental illness are no more violent than the rest of the population. In fact, they are more likely to be the victims of violence. These recent events have caused us as a nation to scrutinize our failed mental health care system and I’m glad we’re talking about this in a serious way.

The statistics clearly support Franken’s argument — over 92 percent of Americans with mental disorders do not engage in violent behavior. The ones who do tend to be violent towards themselves.

That’s also why mental health professionals are concerned that some of the mental health reporting provisions in new gun safety laws — such as the one recently signed by Gov. Andrew Cuomo (D-NY) — might discourage patients from seeking care or being honest with their doctors about violent thoughts for fear of being reported to the authorities. Such measures add even more stigma to a public health crisis that is already widely stigmatized in America. According to the latest data from the Substance Abuse and Mental Health Services Administration (SAMHSA), over 29 percent of Americans who do not receive mental health care cite social stigma or the fear of being institutionalized as the main barrier to their care.

The growth of the oil and gas industries in North Dakota has brought an economic boom to the state in recent years — job growth in the oil and gas industry has tripled since 2007, and North Dakota’s overall population has increased 44,000 since 2008. But, as the New York Times reports, it’s also placed a massive new burden on the state’s health care system.

The new jobs have predictably led to a surge in North Dakota’s population. Combined with the unusually dangerous nature of the oil and gas industries, the explosion of new residents to North Dakota is straining the state’s hospitals to their limits. Mackenzie County in North Dakota has shouldered much of the burden with its single, one-story, sixty-year-old hospital with one emergency room. In the last three years, the hospital’s average monthly emergency room visits ballooned from 100 per month to 400:

Over all, ambulance calls in the region increased by about 59 percent from 2006 to 2011, according to Thomas R. Nehring, the director of emergency medical services for the North Dakota Health Department. The number of traumatic injuries reported in the oil patch increased 200 percent from 2007 through the first half of last year, he said.

The 12 medical facilities in western North Dakota saw their combined debt rise by 46 percent over the course of the 2011 and 2012 fiscal years, according to Darrold Bertsch, the president of the state’s Rural Health Association.

Hospitals cannot simply refuse to treat people or raise their rates. Expenses at those 12 facilities increased by 15 percent, Mr. Bertsch added, and nine of them experienced operating losses.

According to the Times report, many of the new patients for the state’s health care system are transient workers who don’t have permanent addresses or health insurance coverage. One of the biggest drivers of hospital debt there is patients providing inaccurate contact information, and then disappearing when it comes time to collect. Average paychecks in the energy sector are growing faster than elsewhere, so it’s not clear if this is an income problem or just a failure of the state’s housing infrastructure to keep up with the massive influx of new residents. Ad-hoc housing has sprung up in camps and even in Walmart parking lots across the state to compensate.

Those infrastructure problems have also created second-order problems for North Dakota’s health care. Street signs and addresses are often nowhere to be found, and paramedics can have a difficult time locating patients. The cramped housing has brought its own health problems and pests, and — as can happen when lots of human beings are thrown into close quarters — sexually transmitted diseases are also on the rise.

And the problems accompanying North Dakota’s boom are a microcosm for the oil and gas industries as a whole: Their annual fatality rate between 2003 and 2008 was 29.1 deaths per 100,000 workers — seven times the rate for all U.S. workers. A single well can require 1,500 trips by semi-trucks, tankers and standard pickups to move oil, water, sand and chemicals, and a third of the industries’ fatalities are associated with the massive amounts of motor vehicle activity. On top of that, companies often pay out rewards for low injury rates, which encourages under-reporting of workers’ compensation claims. In North Dakota itself, companies are allowed to compensate injured workers directly, prompting one lawyer to describe the situation to Grist as “the wild fucking west.”

In Mackenzie County and elsewhere, there are attempts to convoke the local government to impose a new 1-cent sales tax to finance a $55 million expansion of the hospital facility. Gov. Jack Dalrymple (R) is moving to bulk up medical training in the state with a new $68 million medical school building at the University of North Dakota, and $6 million expansion of the nursing program. But for now, the small-town practitioners are largely on their own.

With comprehensive immigration reform in the national spotlight this week, one talking point already being parroted by reform critics is that any overhaul that incorporates a pathway to citizenship for undocumented immigrants will eventually make President Obama’s landmark health care law much more expensive by adding millions of low-income immigrants onto Medicaid rolls or making them eligible for Obamacare’s private insurance subsidies. But don’t buy the hype — having these prospective Americans insured and paying into America’s tax and health care systems will be good for public health, personal health care costs, and — consequently — overall spending on health care entitlements.

The fact is, undocumented immigrants already receive subsidized care under Medicaid — but only for life-saving emergency room procedures. Those treatments are much more expensive than the primary and preventative care services that undocumented immigrants tend not to seek due to a lack of coverage, and forgoing that preventative care leads to a snowball effect in which undocumented immigrants only pursue “sick care” rather than health care, which raises health care costs for everybody by producing a more unhealthy population whose care is actually subsidized by the rest of the country.

Studies have estimated that America’s 11 million undocumented immigrants cost federal and state governments $10.7 billion in annual health care expenditures. While there isn’t an abundance of solid data on how much those costs would be lowered by placing the immigrants onto actual insurance rolls with comprehensive coverage, chances are that it would mirror trends in general health care spending on the insured versus the uninsured. Public safety net hospitals have estimated that states that do not participate in Obamacare’s Medicaid expansion will cost them over $50 billion by 2019, since uninsured and under-insured Americans cannot afford to compensate hospitals for the care they receive — and that shortfall is ultimately shifted onto the American taxpayer. Having these consumers become legal residents would allow them to pay into the system and actually pay for the benefits that they receive.

Immigration reform and a pathway to citizenship would also bode well for Obamacare’s subsidies and future Medicare spending. Bringing undocumented immigrants into the legal tax system would raise about $5 billion in new revenue in just three years — and potions of those revenues would go towards funding immigrants’ Medicare, Social Security, and Obamacare’s insurance subsidies. Furthermore, there is overwhelming evidence that people who receive quality health care and preventative services early on in life enjoy greater health — and therefore lower health care costs — in their twilight years. That’s especially significant considering that the bulk of expensive medical spending occurs in the last years of a person’s life.

At the end of the day, adding more legal immigrants and — eventually — American citizens onto Medicare, Medicaid, and Obamacare’s insurance subsidies will temporarily expand health care spending. But it also addresses the actual roots of health care inflation — namely, that people do not pursue enough preventative care early on in their lives and thus raise their treatment costs later on, and that many poor and uninsured people cannot compensate doctors and hospitals for the emergency care that they receive. By patching those elements of the social safety net, comprehensive immigration reform would actually lower long-term health care costs in America, and strengthen the social safety net.

The U.S. Substance Abuse and Mental Health Services Administration (SAMSHA) has just released its annual report on drug use and mental health disorders in America, and its findings confirm: Americans cannot afford the cost of their mental health treatment — even if they have insurance.

The report estimates that 45.6 million American adults suffered from Any Mental Illness (AMI) in 2011, comprising 19.6 percent of the adult population. Of that 45.6 million, a meager 38.2 percent received any sort of mental health services — and this graph breaks down why:

While 15 percent of Americans suffering from AMI cited inadequate insurance coverage as their main obstacle to seeking care, a staggering 50 percent said that mental treatment costs are simply too high. And that number includes both insured and uninsured Americans, illustrating how expensive out-of-pocket costs for mental health care are relative to the available coverage.

The data also highlights the damage done by the cultural stigma associated with such care. Over 37 percent of Americans who should have received treatment didn’t believe that they needed any or that treatment wouldn’t help — a dangerous assumption that is likely to exacerbate mental illness — and an additional 35 percent were afraid of negative social consequences or being institutionalized.

That last statistic should weigh heavily on lawmakers’ minds as they craft comprehensive gun safety legislation that also addresses mental health services. Mental health professionals have already expressed concerns that New York’s sweeping new gun laws may end up reinforcing stigmas about mental health care and dissuade Americans from seeking the care they need.

Earl Martinez is a 28-year-old Oregonian suffering from Alport Syndrome, a genetic kidney disorder that has forced him to undergo dialysis treatments for the past year and a half. In order to survive, he needs a new kidney, but the hereditary nature of his disease makes it impossible for his family to provide it. So, after waiting on a transplant list for over a year, Martinez has taken a more active role in addressing his medical needs — by begging for a kidney donor on the side of an Oregon road, CBS News reports.

Money is no obstacle for Martinez, who has health insurance. “My insurance would cover all medical costs on my side and the donor’s side,” Martinez told local CBS affiliate KOIN. “The donor would have no medical costs at all.”

But coverage alone isn’t enough for the approximately 113,000 Americans on an organ transplant waiting list — 80 percent of whom need a new kidney. According to a 2009 Rutgers Law Review article, only 30,000 transplants are performed in America every year. That meets less than a third of the annual demand and leads to 20 American deaths every day due to the lack of organ donors, and 4,000 deaths annually from too few kidney transplants.

Studies suggest that America’s dearth of organ donors may have to do with public health policy. The U.S. relies primarily on an “opt-in” system when it comes to organ donation, meaning that potential donors must actively volunteer to donate, as many Americans do at the DMV after receiving a driver’s license. But other nations’ experiences with organ donation policy suggest that an “opt-out” system — which always presumes a person’s consent upon death, unless that person or his family refuses — could be more effective. Austria, an “opt-out” nation, has a staggering donation consent rate of 99.98 percent, for example.

Still, despite its donor shortage, the U.S. ranks third worldwide in overall organ donation rates after death. And even in states like Oregon, where 70 percent of residents over the age of 18 are registered donors, there are only 274 organ transplants performed annually — suggesting that a lack of registered donors isn’t the root of the problem. The answer to this dilemma may actually lie in the source of Americans’ demand for organs.

The vast majority of U.S. residents waiting for a transplant need a kidney, and the most common causes of chronic kidney disease are diabetes and high blood pressure. It follows that America’s diabetes and obesity epidemic is in large part responsible for the nation’s unsustainable demand for kidney transplants. Addressing the soaring rates of obesity in the U.S., and therefore improving the health of the general population, could help reduce America’s demand for organ transplants. And that could give Americans like Martinez — who has no control over his disease — a much-needed leg up on the waiting list.

This week, potential Republican presidential contender Gov. Bobby Jindal (R-LA) rolled out one of the country’s most regressive tax proposals, a plan that would shift Louisiana’s tax burden away from the wealthy by raising taxes on the bottom 80 percent of state residents. Apparently, the “austerity” measures don’t stop there.

According to New Orleans CBS affiliate WWLTV, Louisiana residents over the age of 21 who are on Medicaid — the public insurance program for disabled and poor Americans — will stop receiving hospice care benefits at the end of this month. That means that low-income Louisianans with terminal illnesses, debilitating disabilities, and chronic long-term medical problems will no longer have access to the essential home and medical care that they need.

And while the cuts are intended to help the state balance its budget, critics point out that it is more likely to increase health care costs by pushing previously-insured Americans with costly medical conditions into private hospitals and emergency rooms where they will not be able to afford their treatments:

The Louisiana Department of Health and Hospitals say the elimination of hospice care for Medicaid patients will mean nearly $3.3 million in savings this year alone. In 2014, it’ll mean $8.3 million in savings.

However, Burns believes the state will end up paying much more with terminally ill patients forced to turn to local hospitals.

“They’ll just go in and out of the hospitals, maybe go to ICUs, and they won’t be able to have their family around them with hospice care,” said Burns. [...]

DHH says there were 5,819 recipients of hospice services through Louisiana Medicaid in the previous fiscal year.

By the Louisiana DHH’s own estimates, the cuts to Medicaid hospice-care beneficiaries are only expected to reduce the state’s projected $900 million budget deficit by 0.92 percent in 2014. These cuts will be imposed on top of the already draconian cutbacks to public education and health care programs that Jindal has in the pipeline.

Battles over Medicaid funding, particularly for those in need of long-term, specialized care, are nothing new. State budget cuts to the Medicaid program have long left disabled and special-needs Americans by the wayside, even in progressive states such as California. But one of the easiest ways for states to address their perennial public health funding issues is for them to participate in Obamacare’s Medicaid expansion, which the federal government will fund for the first several years.

Jindal, however, has refused to participate in the expansion, calling it a “bad idea” that is “expensive for taxpayers.” Ironically, Louisiana already takes in considerably more tax revenue from the federal government than it pays out, and Jindal’s Medicaid cuts — coupled with his refusal to expand Medicaid — will likely exacerbate that dynamic by forcing Americans across the country to subsidize care for Louisianans who have fallen through the safety net.