In a report released Feb. 10, the Government Accountability Office found that an estimated 7.6 million Medicaid enrollees nationwide had private health insurance during 2012, as self-reported by individuals for the annual American Community Survey. As of 2012, approximately 130,000 New Mexicans on Medicaid — or 27 percent of those enrolled in Medicaid at that point — were among those with private and/or public health coverage. While having third-party health coverage in addition to Medicaid… Reported by bizjournals 7 hours ago.

Like the communist that he is, President Obama appropriated some land for the state, designating three new national monuments. Democrats have started a 2020 redistricting super PAC called "Advantage 2020," while the GOP is readying it’s counterpart, "John Boehner, The 91-Year-Old Speaker." And Rudy Giuliani thinks Obama doesn’t love America like he does, though he might just be jealous of the time he went to America’s apartment and, standing on the sidewalk drenched in rain, saw the president through the window. This is HUFFPOST HILL for Thursday, February 19th, 2015:

*RUDY GIULIANI NOUN/VERB/OBAMA'D SO HARD* - You mean to tell us that Rudy GIuliani still isn't embracing his fate and appearing in home security system commercials? ("I'm former New York City Mayor Rudolph Giuliani, if ISIS knows one thing, it's that it hates America. If it knows another thing, it's that it never messes with the Slomin Shield.") Igor Bobic: "Former New York City Mayor Rudy Giuliani (R) sparked a firestorm on Wednesday, when he proclaimed that President Barack Obama 'doesn't love' America. The backlash keeps rolling in. *'I do not believe, and I know this is a horrible thing to say, but I do not believe that the president loves America,' Giuliani reportedly said at a private New York fundraiser for Wisconsin Gov. Scott Walker*. 'He doesn't love you. And he doesn't love me. He wasn't brought up the way you were brought up and I was brought up through love of this country.' Asked about the matter during a flight aboard Air Force One to Chicago, a White House...'It was a horrible thing to say,' deputy press secretary Eric Schultz said, according to a pool report. Schultz further jabbed at the onetime presidential hopeful by noting that Giuliani had tested the line during his 'fleeting 2007 run for the presidency.' Democrats have also denounced Giuliani's comments as offensive and called on Walker and the rest of the potential 2016 GOP presidential field to do the same… Walker, who was in the room while Giuliani was speaking, responded Thursday morning. "The mayor can speak for himself. I'm not going to comment on what the president thinks or not," Walker said. "I'm in New York. I'm used to people saying things that are aggressive." [HuffPost]

Not that anyone asked, but Bobby Jindal released a statement refusing to condemn Giuliani's remarks. Thanks, Bobby!

*GROUNDHOG SEES SHADOW* - Every year we do this story. It's a tradition. Sam Stein: "The wave of progress on LGBT rights has yet to reach the halls of the unsuitably named Gaylord National Resort and Convention Center in National Harbor, Maryland. For yet another year, the Conservative Political Action Conference will exclude from its list of sponsors the Log Cabin Republicans, a conservative group that advocates for gay rights." [HuffPost]

*HuffPost Hill XTRA:* The American Conservative Union claimed to Sam that the Log Cabin Republicans hadn't actually asked to sponsor CPAC. The Log Cabin Republicans then forwarded a December email saying they'd be "honored" to sponsor the event. Oopsie.

*HuffPost Haircuts:* Kate Sheppard.

*DAILY DELANEY DOWNER* - Woop woop, da sound of da food police. Oregon state senator Chris Edwards (D-Eugene) wants to stop people from buying "junk food" with food stamps. "Edwards says he personally doesn’t think it’s good policy to let people use SNAP to buy things like Cheetos. He says since many people on the program are also enrolled in the Oregon Health Plan, it would be beneficial to direct consumers towards whole foods with higher nutritional content. 'EugeneWeekly.com]

*DOUBLE DOWNER* - Why do people always want to control other people's food stamp purchases? Bryce Covert has the answer.

Does somebody keep forwarding you this newsletter? Get your own copy. It's free! Sign up here. Send tips/stories/photos/events/fundraisers/job movement/juicy miscellanea to huffposthill@huffingtonpost.com. Follow us on Twitter - @HuffPostHill

*BUSINESSMAN IS SHREWD* - We're pretty sure "Ocean's 13" was the last time we watched this many famous men vie for the affection of an old Jewish dude in Las Vegas (Elliott Gould is a national treasure, BTW). Bloomberg: "*Republican megadonor Sheldon Adelson won't get involved in the presidential primary contest until 'well into 2016,'* his top political adviser said in an interview Thursday. 'Any support of a presidential candidate is at least a year away,' the adviser, Andy Abboud, said. What Adelson does matters. The 81-year-old billionaire casino owner spent more money on the 2012 presidential race than anyone else in the country, and his every move is being closely watched for signs that he has a favorite this time around. In 2012, Adelson and his family invested more than $15 million in former House Speaker Newt Gingrich's presidential aspirations through a super-PAC, keeping him competitive far longer than he would have been otherwise. The Adelsons backed Mitt Romney after he won the nominating contest. All told, the family put about $93 million into super-PACs and campaigns during the cycle. Abboud's remarks came in response to questions about Sheldon and his wife Miriam Adelson's participation in a March 3 fundraiser in Washington for South Carolina Senator Lindsey Graham's presidential exploratory group, Security Through Strength." [Bloomberg]

*DEMOCRATS WOULD LIKE TO CONTROL THE HOUSE BEFORE 2030* - Is it just us or does "Advantage 2020" sound less like a super PAC and more like a vision supplemental program for your health insurance? Samantha Lachman: "*Democrats launched a super PAC Thursday with the purpose of flipping state legislatures before the next round of redistricting, which will follow the 2020 elections. The PAC, called Advantage 2020, will be led by Mark Schauer, a former Democratic congressman and Michigan state Senate leader* who lost the state's gubernatorial race to Republican Gov. Rick Snyder last year. Advantage 2020 plans to spend about $70 million over the next three elections in an attempt to chip away at GOP majorities in key battleground states where Republicans established legislative districts after the 2010 elections. 'The coming round of congressional redistricting will shape the political landscape for the next decade, and Mark’s leadership of Advantage 2020 is crucial to empowering us to win the state legislative seats critical to that process,' said Michael Sargeant, the executive director of the Democratic Legislative Campaign Committee, which is funding the PAC, in a statement." [HuffPost]

Here is an incredibly uncomfortable video of Joe Biden touching women.

*Our proposal -- "spot where balloon boy landed" -- remains unconsecrated*: "President Barack Obama will designate three new national monuments on Thursday and announce a new initiative to increase the number of children who visit national parks. *Obama will formally name the three monuments this afternoon in remarks near Chicago's Pullman neighborhood, an industrial community known for its historic role in labor and civil rights organizing*. The Pullman neighborhood will be the first National Park Service-protected area in Chicago. Obama is also designating Honouliuli National Monument in Hawaii, which was the site of a Japanese internment camp during World War II, and Browns Canyon in Colorado. Under the Antiquities Act of 1906, presidents have the power to grant federal protection to certain areas due to their historic or natural significance. National monuments can be managed by several agencies, including the National Park Service." [HuffPost's Kate Sheppard]

*BECAUSE YOU'VE READ THIS FAR* - Here's a cat who isn't intimidated by snow.

*REALLY INTENSE CONGRESSMAN DIES* - If ever there were a Tom Wolfe character roaming the halls of Congress, it was Cass Ballenger. Roll Call: "Ballenger [R-NC] announced his retirement from Congress in 2004, facing a defamation lawsuit from the nation’s largest Islamic civil liberties group. *He was quoted calling the Council on American-Islamic Relations 'the fundraising arm for Hezbollah' and saying living near its Washington headquarters had contributed to the breakup of his marriage*. The lawsuit was thrown out by a federal appeals court in 2006... [Ballenger and his wife, Donna] went on missions to Central and South America. After hitting it off with Chavez on a trip to Venezuela, Ballenger invited the leftist president to visit his home in Hickory, N.C., as an effort to press him closer to the political center. Ballenger liked to tell a story that Chavez, who spoke little English, once walked up to Donna Ballenger and said, 'I love you very much.' ... Ballenger’s tongue got him into trouble in 2002...Ballenger told a local paper he had 'segregationist feelings' himself after run-ins with black Georgia Democratic Rep. Cynthia McKinney. He quickly apologized and rescinded the comments, but some groups called for him to resign. Back home, Ballenger tried to counter further fallout by having his yard’s 3 1/2-foot tall black lawn jockey statue painted white. The cast iron statue had been a thorn in Ballenger’s side during re-election campaigns." [Roll Call]

*COMFORT FOOD*

- A man bought an unused 1950s prefab home that had a untouched kitchen in it.

- Website plots a graph of IMDB episode ratings of any TV show.

- Gossip about the hunks and babes of international politics with "Hottest Heads Of State." We see u, Stephen Harper.

*TWITTERAMA*

@SimonMaloy: why is this not more embarrassing MT @realDonaldTrump: Gov. Scott Walker just left my office--we had a really wonderful talk.

- @SabrinaSiddiqui: I have the same dress as RBG and I'm totally ok with that. pic.twitter.com/RnXtsLuIuk

@GrahamDavidA: Remember Andrew Sullivan?

*Got something to add? Send tips/quotes/stories/photos/events/fundraisers/job movement/juicy miscellanea to Eliot Nelson (eliot@huffingtonpost.com) or Arthur Delaney (arthur@huffingtonpost.com). Follow us on Twitter @HuffPostHill (twitter.com/HuffPostHill). Sign up here: http://huff.to/an2k2e* Reported by Huffington Post 7 hours ago.

Dogged by glitches, Colorado's online exchange for health coverage has signed up about 140,000 people for private health insurance so far for 2015. That number is far below the lowest projection of 168,777 for all of 2015 and a high projection of 242,777 for the year. Of those who have signed up this year, 95,000 — or about 68 percent — were renewing customers. The remaining customers were new. The open enrollment season ended on Sunday. Officials of the exchange — known as Connect for Health… Reported by bizjournals 5 hours ago.

The state health insurance exchange signed up 139,652 Coloradans for commercial plans during the three-month open enrollment period that ended Sunday, officials reported Thursday. Reported by Denver Post 4 hours ago.

The Pentagon spent $84.2 million on Viagra and other erectile dysfunction drugs in 2014, according to a recent report from the Military Times

Erectile dysfunction medications like Viagra and Cialis are covered by TRICARE, the government-backed health insurance program for active duty personnel, military retirees, and eligible family members.

See also: That Fiat Viagra commercial is creeping everyone out

While $84.2 million may seem like a high number, it's dwarfed in comparison to the Department of Defense's $50 billion health budget. The total U.S. Defense budget requested for 2016 is $536 billion Read more...

More about Viagra, Us Politics, U.S. Military, Us World, and Politics Reported by Mashable 29 minutes ago.

Less than a week after the close of the open enrollment period for the second year of Obamacare health insurance, federal officials announced today a special six-week extension for uninsured people who say may just now understand they will be... Reported by NJ.com 14 hours ago.

The Obamacare website had another major stumble on Friday when the White House revealed it sent hundreds of thousands of customers bad tax information.

According to the Associated Press, the Obama administration said about 800,000 HealthCare.Gov customers were sent the wrong tax information. Those customers will now have to delay filing their 2014 tax forms. 

"California, which is running its own insurance market, just announced a similar problem affecting about 100,000 people in that state," the AP reported. "The errors mean that nearly 1 million people may have to wait longer to get their tax refunds this year. Another 50,000 or so who already filed may have to resubmit their returns."

HealthCare.gov, the online insurance exchange set up by the Affordable Care Act (also known as Obamacare), had an infamously rocky rollout when it launched in 2013. At the time, hundreds of thousands of consumers couldn't access the website and the White House struggled to fix its bugs.

Politico reported this week that HealthCare.gov is "still a mess."

"The 'back end' of the Obamacare website still isn’t properly wired to the health insurance companies," Rachana Pradhan and Brett Norman wrote. "Subsidy payments aren’t automated, so the insurers get payments based on estimates. And adding information like a marriage or the birth of a child is a convoluted, multi-step process."

Join the conversation about this story »

NOW WATCH: 11 Facts That Show How Different Russia Is From The Rest Of The World Reported by Business Insider 13 hours ago.

WASHINGTON –The Obama administration is giving a reprieve to up to 6 million Americans who faced fines for failing to sign up for health insurance, opening up enrollment again during... Reported by NY Post 13 hours ago.

The administration is offering a special enrollment period for people who didn't realize they would have to pay if they don't have health insurance. Reported by msnbc.com 13 hours ago.

About 800,000 people who purchased health insurance through HealthCare.gov received incorrect tax information, Obama administration health officials said Friday.Administration officials said they couldn't identify how the error occurred, but the mistake could delay tax refunds for many Americans who are for the first time navigating the intricate system of subsidies designed to help them afford coverage under the Affordable Care Act. Reported by Washington Post 13 hours ago.

Health insurance marketplaces have been reopened so that people won’t be shut out of coverage — and forced to pay a penalty — for a second year. Reported by NYTimes.com 13 hours ago.

The New York Times is reporting that 800,000 people who enrolled in health insurance policies through HealthCare.gov were issued incorrect tax information by the federal government and have been urged to delay filing their taxes until the issue is resolved. According to the report, the government will also offer a special enrollment period for individuals to buy health insurance from March 15 to April 30 so that they can avoid tax penalties. Consumers are expected to receive update tax information… Reported by bizjournals 13 hours ago.

Maryland health exchange leaders are considering establishing a special enrollment period for people who will face a tax penalty this year because they did not buy health insurance in 2014. Beginning in 2014, most people are required to buy health insurance or pay a penalty. The upcoming tax season is the first time people who opted against health insurance will face that penalty. The federal Centers for Medicare and Medicaid Services on Friday announced a special enrollment period, March 15 through… Reported by bizjournals 12 hours ago.

Dayton's two companies offering plans on the state's health insurance exchanges brought in thousands of Ohioans. About 67,000 of the 235,000 Ohiaons enrolled in the health insurance marketplace this year are getting their plans from CareSource and Premier Health. The numbers come as open enrollment for the year, which started last November, came to an end this week. The introduction of health insurance marked a significant growth business venture for each company. CareSource enrolled 65,000 Ohioans… Reported by bizjournals 11 hours ago.

Many Americans facing a new federal tax penalty for not having health insurance got more time to buy coverage from the Obama administration. Reported by NY Daily News 11 hours ago.

*The risks of C-sections: What hospitals don't want you to know*

Pregnant women put a lot of trust in their doctors and hospitals. But a Consumer Reports investigation of more than 1,500 hospitals in 22 states suggests that such trust may be misplaced. It found that in many hospitals, far too many babies enter this world through cesarean section.

While some C-sections are absolutely necessary for the health of the mother or baby, the high C-section rates in our low-scoring hospitals are “unsupportable by professional guidelines and studies of birth outcomes,” said Elliot Main, M.D., director of the California Maternal Quality Care Collaborative and former chairman of the department of obstetrics and gynecology at the California Pacific Medical Center in San Francisco, who reviewed our data.

Our Ratings reveal that C-section rates vary dramatically—even between neighboring hospitals. For example, almost 55 percent of pregnant women anticipating low-risk deliveries—that is, women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned—nonetheless undergo a C-section at Los Angeles Community Hospital. But at California Hospital Medical Center, also in Los Angeles, the rate of C-sections for low-risk deliveries is 15 percent; at Western Medical Center Anaheim, 28 miles away, it’s about 11 percent.

Or consider El Paso, Texas. At Sierra Medical Center, 37 percent of low-risk deliveries are C-sections; four miles away at University Medical Center of El Paso the rate is about 15 percent. It’s a similar story in Colorado. Denver Health Medical Center earned a top score with a C-section rate of about 8 percent, while nearby Presbyterian-St. Luke’s Medical Center got low marks for a rate of about 20 percent.

We found this startling scenario playing out over and over in communities large and small across the U.S. Because a hospital’s C-section rate can be hard to find, it’s likely that most families are unaware of the huge differences in medical practice.

And unfortunately, it’s usually much easier to find a hospital with a high C-section rate than a low one. Overall, 66 percent of the hospitals in our Ratings earned our lowest or second-lowest score, while only 12 percent got either of our top two marks.

“We think it’s time those hidden numbers are brought to light,” said John Santa, M.D., medical director of Consumer Reports Health. “How you deliver your baby should be determined by the safest delivery method, not which hospital you choose.”

Change is already afoot. Evidence on the fallout from too many C-sections has grown so alarming that numerous health organizations have made lowering rates a priority. In March 2014, two major women’s health organizations—the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (ACOG/SMFM)—teamed to publish groundbreaking new practice guidelines aimed at preventing unnecessary cesarean births.

But hospitals can be bureaucratic institutions where the wheels of change move slowly. We’ll look at why C-sections remain so overused. And our Ratings—the most comprehensive ever on C-sections for individual U.S. hospitals—can help families choose the right place to deliver their baby.

Find your hospital's C-section rate

We have rated more than 1,500 hospitals in 22 states on their C-section rates for low-risk deliveries—that is, women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned. Those states are: Arizona, California, Colorado, Florida, Iowa, Illinois, Kentucky, Massachusetts, Maryland, North Carolina, New Jersey, New York, Nevada, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Vermont, Washington, and Wisconsin. Click on the state you are interested, then sort by "Avoiding C-section." To see a hospital's specific C-section rate, click on its name, then scroll down the page until you see the heading "Avoiding C-sections." You can also download a PDF of the Avoiding C-section Ratings for all 22 states. 

Melek Speros of Austin, Texas, says her doctor warned her late in her first pregnancy that her pelvis might be too small to allow for a vaginal delivery. "I was really surprised because I'm 5'8" tall with a large frame," Speros said. Reluctantly, her doctor agreed to allow her to “try” a vaginal birth by inducing labor eight days before her due date at St. David’s South Austin Medical Center (which earned low marks in our Ratings.) When the induction didn’t quickly work, he recommended a C-section. "He said that a vaginal birth would be unsafe, that my baby could get stuck and suffer serious harm," Speros said.

She took him at his word, and delivered her first son by C-section as well as her second son two years later. That’s no surprise: Mothers who deliver a first baby by C-section are about 90 percent more likely to deliver subsequent babies that way, too. But with her third, in what she describes as "the culmination of my hopes and dreams about giving birth," Speros vaginally delivered a healthy 9-pound boy.

Speros’ experience—feeling pressured into a C-section without being informed about her birthing options—prompted her to change career plans, switching from lawyer to childbirth educator. And indeed getting reliable information about how hospitals approach childbirth can be  difficult. For example, while hospitals often target expectant mothers with ads featuring cherubic infants and cozy birthing rooms, they seldom publicize their rates for surgical deliveries.

There are times when a surgical birth is the safest option. For example, C-sections can be lifesaving when the outlet from the womb is blocked by the placenta (a condition called placenta previa) or the baby isn’t properly positioned for birth by, for example, lying sideways in the uterus instead of head down. And with modern obstetrical care, C-sections are quite safe.

But a C-section—the second most commonly performed surgical procedure in the country, requiring a 6-inch incision in the abdomen and a second through the uterus—is major surgery, and thus takes longer to recover from than a vaginal delivery and also carries additional risks.

“C-sections increase the risk of mortality and complications,” says Kent Heyborne, M.D., chief of obstetrics at Denver Health Medical Center, which had the lowest C-section rate of any hospital in our Ratings with at least 5,000 low-risk deliveries over the two-year period included in our analysis. “But we’re just now becoming aware of the down stream effects.”

Carol Sakala, Ph.D., director of Childbirth Connection programs at the National Partnership for Women & Families, agrees. “Unless there is a definitive need for a C-section, vaginal birth has major benefits for moms and babies, both in the short term and throughout the course of their lives,” she said.

To begin with, although having a C-section may sound like a shortcut, it’s not. Speros says that although her C-sections went smoothly, it still took much longer to recover from them than it did from the vaginal birth of her third son.

And like others who've had abdominal surgery, she has lingering numbness at the site of the incision. Nineteen percent of women who’ve had a C-section report pain at the incision site being a major problem in the two months following delivery. That’s according to Listening to Mothers III, a national survey conducted by Harris Interactive for the Childbirth Connection of 2,400 mothers who gave birth to single babies in a hospital from July 2011 through June 2012. That compares with 11 percent of women who gave birth vaginally who cited a painful perineum (the area between the vagina and anus) as a major problem. And women with C-sections were more likely to say that the pain lasted six months or longer, too.

Life-threatening complications are rare whether babies are born vaginally or by C-section. But compared with women giving birth vaginally, healthy, low-risk women undergoing their first C-section were three times more likely to suffer serious complications—such as severe bleeding, blood clots, heart attack, kidney failure, and major infections—according to a 14-year analysis of more than 2 million women in Canada published in 2007 and cited by the new ACOG/SMFM guidelines.

And the risk of complications increases with each subsequent cesarean delivery. “Once you’ve had a C-section, there’s a big chance that all future births will also be by cesarean," Main said. "And that’s when the risks really start to rise.”

Vaginal delivery for uncomplicated births is also better for babies. They are less likely to suffer breathing problems and more likely to be breastfed, perhaps because it’s easier to get breastfeeding going when mothers are not recovering from major surgery. Some research suggests that over the long-term, babies born vaginally may be slightly less prone to chronic ailments such as asthma, allergies, or obesity, perhaps due in part to a protective effect from beneficial bacteria transferred from the mother during birth.

The number of C-sections performed in the U.S. has leveled off in the last few years, but is still up 500 percent since 1970. All those C-sections have not translated into substantially better outcomes for mothers and babies. The infant death rate in the U.S., while low, is higher than that of most other industrialized nations. And the maternal death rate actually increased slightly from 1990 to 2013, according to an analysis published May 2, 2014, online in The Lancet medical journal.

In part those grim statistics reflect the fact that American women today tend to be older and heavier going into pregnancy. But experts say that the main problem is a health care system that no longer values normal birth and focuses on scheduling labor, in part for patient and doctor convenience.

In the U.S. far fewer babies are born on holidays such as the Fourth of July or days around Thanksgiving or Christmas, we found when we examined three year's worth of data on births compiled for us by the Centers for Disease Control and Prevention. That could be because hospitals tend to schedule C-sections for times when they are well staffed—or because doctors, and even some mothers, may not want deliveries to interrupt their holidays.

That level of control requires increased use of interventions such as inducing, or starting, labor before a woman’s due date, which might increase the risk of cesarean delivery, or just scheduling a C-section from the start.

Another major problem is that many doctors intervene because they think that labor is moving too slowly and that longer labors lead to complications. But those assumptions are based on outdated information, says Aaron Caughey, M.D., Ph.D., chair of the department of obstetrics and gynecology and associate dean for women’s health research and policy at Oregon Health and Science University in Portland, Ore., and lead author on the new ACOG/SMFM guidelines.

The new guidelines help clear up when providers should act and when they have to be patient and let nature take its course. The absence of solid, up-to-date guidelines might have allowed other factors, including concerns about malpractice suits, to drive up the number of C-sections, Caughey says.

In addition, hospitals keeping watch on their financial bottom lines may turn a blind eye to high C-section rates. Medicaid and private health insurance pay about 50 percent more for C-sections than for vaginal births. Halving the total number of C-sections performed in the U.S. would save about $5 billion yearly, according to the Center for Healthcare Quality & Payment Reform, which advocates for higher-quality, lower-cost health care.

Our Ratings are based on the C-section rates for mothers who anticipate low-risk deliveries—that is, for women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned. While complications such as problems with the baby’s heartbeat could happen during labor and require intervening surgically, experts say that the vast majority of women in that low-risk category should be able to have a vaginal birth.

The average C-section rate for low-risk deliveries among the hospitals we looked at was about 18 percent—much higher than the national average of 12.6 percent in 2000, a benchmark we used to develop our Ratings. (Note that the average total C-section rate, which includes all cesarean deliveries not just low-risk ones, is 33 percent.)

And some hospitals performed much better—or worse—than average. C-section rates ranged from less than 5 percent at Saint Croix Regional Medical Center in Saint Croix Falls, Wis., to a high of almost 57 percent at Three Rivers Medical Center in Louisa, Ky.

So why do some hospitals have higher rates than others?

Unfortunately, we found no simple answers. Prospect Medical Holdings, the company that owns Los Angeles Community Hospital, says it treats “a significantly higher percentage of low-income and transient patients, many of whom have had little or no prenatal or primary care prior to delivery.” Those women may be at higher risk because of gestational diabetes or high blood pressure, a representative told us.

Our analysis did find slightly higher rates at hospitals in large urban areas compared with hospitals in smaller cities, perhaps because they see more women with risk factors not accounted for in our data or they have a larger proportion of first-time moms. But many similar hospitals serving similar populations manage to keep C-section rates low. For example, Saint Anthony Hospital in Chicago treats many low-income patients but still earned a high Rating, with a C-section rate of 9 percent of babies.

Our Ratings also confirm findings from other research showing significant regional differences. The lowest rates were in mountain states, the West coast, and the upper Midwest. For-profit hospitals also tended to have higher C-section rates.

But none of those factors come close to explaining the wide variation we found, the experts we consulted say.

Too often the medical establishment blames mothers. “They must be older, fatter, sicker, or they must be requesting C-sections,” Main said. “But that’s completely bogus. As a doctor I can convince almost any woman in labor to have a C-section.” Even after you account for things such as mothers’ age and weight, according to Main, you are still left with huge discrepancies of care.

Almost two-thirds of women in the Listening to Mothers survey who had their first C-section said their doctor was the decision maker, and more than one-quarter said they felt pressured to have the surgery.

“What it boils down to is culture,” Main said. “Culture of the hospital, the nursing staff, even the patients.” He points out that hospitals with a culture of facilitating vaginal birth—those that allow vaginal birth after cesarean, for example, or those where 10 percent or more of births are attended by nurse midwives—have far lower rates of C-sections.

A culture such as the one you find at Denver Health Medical Center, where Heyborne works. Lots of places say they have an “institutional philosophy” against too many C-sections, says Heyborne, but, “It's how we’ve translated that into action that makes a difference.” He says that as a teaching hospital, Denver Health is fully staffed with health care providers 24/7. “A lot of C-sections are done at 5 or 6 in the evening," Heyborne said. "We don’t have those pressures here. No one is trying to get home to dinner or the golf course.”

In addition he says that the hospital has firm policies against using interventions that might lead to cesareans, such as inducing labor without a medical reason. And Heyborne credits an active midwifery service. “About one-third of our births are managed by midwives and that helps keep the emphasis on natural birth processes.”

The Ratings are based on the C-section rates for mothers who anticipate a low-risk delivery—that is, women who haven’t had a C-section before, don’t deliver prematurely, ​and are pregnant with a single baby who is the proper position for delivery. The Ratings include all mothers, not just first-time mothers. ​The data the Ratings are based on do not include information on factors that may increase the risk for a C-section, such as heart problems in the mother or fetus, pregnancy-related high blood pressure, diabetes, obesity, or any other chronic disease.

The data come from the 22 states that had data available for us to analyze: Arizona, California, Colorado, Florida, Iowa, Illinois, Kentucky, Massachusetts, Maryland, North Carolina, New Jersey, New York, Nevada, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Vermont, Washington, and Wisconsin. 

It covers births during a two-year period between 2009 and 2012, depending on the state. We include hospitals with a minimum of 100 low-risk deliveries over that two-year period. 

For more details, read more on how we rate hospitals and our technical report on hospital Ratings.*Hospitals with high or low C-section rates
*

The table below shows the 10 hospitals in our Ratings with the lowest C-section rates that had at least 5,000 low-risk deliveries over two years.Hospitals with low C-section rates

-*Name and location *-

-*C-section rate (%)*-

(lower is better)Denver Health Medical Center, Denver 7.9

Utah Valley Regional Medical Center, Provo, Utah 8.3

McKay-Dee Hospital Center, Ogden, Utah 9.2

Intermountain Medical Center, Murray, Utah 9.6

Monmouth Medical Center, Long Branch, N.J. 10.0

JPS Health Network, Fort Worth, Texas 10.3

Bakersfield Memorial Hospital, Bakersfield, Calif. 10.5

University Medical Center, Las Vegas 10.9

Columbia St. Mary's Hospital Milwaukee, Milwaukee 11.4

WakeMed Raleigh Campus, Raleigh, N.C. 11.6

The table below shows the 10 hospitals in our Ratings with the highest C-section rates that at least 5,000 low-risk deliveries over two years.  

Hospitals with high C-section rates

Name and location

-C-section rate (%)-

(lower is better)

Virginia Hospital Center – Arlington, Arlington, Va. 27.1

Lenox Hill Hospital, New York City 27.2

Las Palmas Medical Center, El Paso, Texas 28.1

Inova Fairfax Hospital, Falls Church, Va. 28.4

Baptist Hospital of Miami, Miami 28.8

Providence Memorial Hospital, El Paso, Texas 29.2

The Woman's Hospital of Texas, Houston 29.2

Jackson Health System, Miami 29.7

Hackensack University Medical Center, Hackensack, N.J. 31.5

South Miami Hospital, Miami 44.9

What you can do to avoid C-sections

To lower your risk of a C-section, take the following steps.

*• Find out your hospital’s C-section rate.* Start with our hospital Ratings. If your hospital is not included, ask the person who will deliver your baby about the hospital’s rates. Remember: lower is usually better. The average national C-section rate for low-risk deliveries, the measure used in our Ratings, is about 18 percent, a rate we consider too high. A more reasonable figure is 12.6 percent, the national average in 2000 and a benchmark we used to develop our Ratings. (Note that the average total C-section rate, which includes all cesarean deliveries not just low-risk ones, is 33 percent.)

*• Choose your provider carefully. *It’s good to know the C-section rates for your doctor, too, so ask whether his or her practice tracks their C-sections. “Even if they don’t know the exact percent, providers should be able to articulate their philosophy about supporting vaginal birth,” Caughey said. Also ask how the new ACOG/SMFM guidelines may affect the practice’s approach to labor and delivery. If your provider is unaware of the new standards, or is dismissive of them, you may want to find a different one.

*• Watch your weight. *If you are overweight, strive to shed excess pounds before becoming pregnant. Overweight and obese women have a much higher risk of C-section than normal weight women. And once you’re pregnant, talk with your provider about the healthy weight gain for you. Women who are overweight should plan to gain less than those who are not.

*• Stay fit.* Women who take part in structured exercise during pregnancy are less likely to need a C-section, research suggests. Talk to your health care provider about appropriate forms of exercise, such as walking, swimming, and aerobic or yoga classes for pregnant women.

*• Don’t rush things*. Doctors should not try to induce labor unless there’s a good medical reason—for example, if a woman’s membranes rupture (her “water breaks”) and labor doesn’t start on its own or she is two weeks overdue. Trying to induce labor before a woman’s body is ready can lead to surgical delivery if labor doesn’t progress.

*• Don’t worry too much about big babies. *The possibility of a large baby is frequently used to justify a cesarean delivery, but that’s not warranted, according to the new ACOG/SMFM guidelines. To begin with, methods used to assess the baby’s weight toward the end of the pregnancy are not very accurate. Also, babies typically have to be 11 pounds or larger to justify a C-section, according to Caughey.

*• Get support during labor.* Consider hiring a doula, a trained birth assistant who can provide physical and emotional support throughout labor and delivery. Women who have continuous support from someone who is not a friend, family member, or a member of the hospital staff labor for shorter periods and are less likely to need interventions, research shows. Ask your insurer if it will cover doula care.

*• Ignore the clock. *The new ACOG/SMFM guidelines call for allowing more time in each phase of labor and delivery. In general, decisions on whether to intervene should be based on how well mothers and babies are doing, not how much time has passed.

For additional steps you can take before and during pregnancy to help ensure the best possible outcomes, see our report "What to Reject When You’re Expecting."

-And see these additional resources-

American College of Obstetricians and Gynecologists Patient Resources

American College of Nurse Midwives Patient Resources

Childbirth Connection

March of Dimes Pregnancy

March of Dimes Nacer Sano

Office of Women's Health Pregnancy Resources

What to do if you need a C-section

Sometimes a planned C-section is the safest option for you and your baby. And even if you’ve planned for a vaginal birth, complications may arise that necessitate a surgical delivery. All expectant families should discuss cesarean deliveries with their provider so that they understand what’s involved and are not caught off guard. The following steps can help ensure a safe, satisfying birth experience for you and your family.

*• Be wary of early C-sections.* Babies’ delivered before 39 weeks are more apt to have breathing problems or other issues. C-sections should not be scheduled before that point unless there’s a valid medical reason.

*• Discuss your preferences.* Ask if a birthing partner can be with you in the surgery room and recovery area. When will you be able to hold and breastfeed your baby? Skin-to-skin contact between moms and babies right after delivery facilitates bonding and breastfeeding.

*• Ask for antibiotics at the time of surgery.* That reduces the risk of infection. You don’t need them afterward unless you develop an infection.

*• Ask that your uterus be closed with two layers of stitching.* If you decide to have another baby vaginally, so called double-layering stitching will hold more securely during labor and delivery.

*• Request measures to prevent blood clots.* That might include wearing inflatable devices on your legs until you can walk on your own or taking a prescription blood thinner. Ask the nursing staff to help you get up and move around as soon as you are able to do so.

*• Ask for help breastfeeding.* Getting started breastfeeding as you recover poses extra challenges. A lactation consultant can provide invaluable support and advice.

*• Marshal support.* Plan to have extra support at home so you can focus on recovering and getting to know your new baby.

Find your hospital's C-section rate

We have rated more than 1,500 hospitals in 22 states on their C-section rates for low-risk deliveries—that is, women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned. Those states are: Arizona, California, Colorado, Florida, Iowa, Illinois, Kentucky, Massachusetts, Maryland, North Carolina, New Jersey, New York, Nevada, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Vermont, Washington, and Wisconsin. Click on the state you are interested, then sort by "Avoiding C-section." To see a hospital's specific C-section rate, click on its name then scroll down the page until you see the heading "Avoiding C-sections." You can also download a PDF of the Avoiding C-section Ratings for all 22 states.*Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2015 Consumers Union of U.S.*

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As if Oregon's politics couldn't get any crazier, what with with the strange resignation of its governor this month, add this to the mix: its attorney general has launched a second ugly lawsuit against huge Silicon Valley tech company, Oracle.

This one is also related to the infamously botched Obamacare health exchange Oracle was supposed to provide for the state. Oracle and Oregon are suing each other for millions about that failed site.

Now Oracle is refusing to host the one part of the system that both parties agreed worked fine: enrollment for Medicaid, which provides health coverage for the poor. Oregon's new lawsuit claims Oracle backed out of a promise to renew its contract.

When Oregon's contract with Oracle for Medicaid enrollment expires at the end of February, Oracle says it will not renew it. The system will go offline unless the state can figure out how to quickly move it (not likely) or get a judge to force Oracle to keep hosting it. This system is used to process new Medicaid applications and renew existing ones. All told, the system processes 26,000 low-income people each week, according to the state’s suit.

Oracle, naturally, says it made no such promise, and it blames the state for failing to "anticipate and plan" for the end of the contract — especially since the two parties were already in litigation.

As part of that litigation, Oregon is contemplating forever banning Oracle from all future contracts with the state.

Here's how the dispute began. Oracle was supposed to build a state system that lets people buy health insurance that would be the envy of all the other states.

Instead, the state spent about $200 million on the system, and paid Oracle more than $130 million before pulling the plug and filing a lawsuit over supposed problems with the site, the Oregonian reports.

Oracle — which says the state still owes it about $25 million — filed a counter suit saying the site worked fine, and that Oregon pulled the plug for political reasons. However, after missing deadline after deadline, the site was limping along, requiring people to use paper forms for at least part of the application process.In a letter responding to the second lawsuit, Oracle attorney Dorian Daley points out the irony in suing Oracle while also trying to force it to continue working for the state.

"After accusing Oracle of fraud and racketeering, and asking the court to protect the public from this alleged malfeasance by preventing Oracle from doing business with the State in the future, you are insisting that Oracle sign a new contract to continue working for the State for another year," she writes.

Indeed, Oracle has point: The state was trying to ban Oracle while making no plans to hire an alternative.

This healthcare exchange was supposed to be a point of pride for the state and the company. Business Insider has talked to Oracle employees who tell us they feel ashamed of the whole debacle and their company's role in it, whoever is ultimately to blame.

Here's the full scathing letter Oracle sent to the state and also sent to us when we asked Oracle for comment.

 

Oracle letter to Oregon over Medicaid lawsuit

*SEE ALSO: The 25 highest-paying jobs with the most openings right now*

Join the conversation about this story »

NOW WATCH: 14 things you didn't know your iPhone headphones could do Reported by Business Insider 11 hours ago.

If you went without health insurance during 2014, you’re now facing a modest financial penalty of $95 or 1% of your income. Next year, that penalty will increase. All of this is news to some uninsured people. That’s why, as predicted, the federal government and some state exchanges are creating an extra open enrollment period to help these people out.… [More] Reported by The Consumerist 11 hours ago.

Filed under: Taxes, U.S. Government, Barack Obama, Health Insurance, Income Tax

*Don Ryan/AP*

By RICARDO ALONSO-ZALDIVAR

WASHINGTON -- In a new setback for the health care law and the people it's supposed to help, the government said Friday it made a tax-reporting error that's fouling up the filings of nearly a million Americans.

After a successful sign-up season, the latest goof could signal new problems with the complex links between President Barack Obama's health care overhaul and the nation's income tax system.

Officials said the government sent the wrong tax information to about 800,000 HealthCare.gov customers, and they're asking those affected to delay filing their 2014 returns. The issue involves a new government form called a 1095-A, which is like a W-2 form for health care for people who got subsidized private coverage under Obama's law.
It's just another black mark on the administration's handling of the health care act. They were hoping for a clean season.

People can find out whether they're affected by logging in to their accounts at HealthCare.gov, where they should find a message indicating whether they were affected or not. They also can check by phoning the federal customer service center at 800-318-2596.

Separately, California announced earlier that it had sent out inaccurate tax forms affecting about 100,000 households. The state isn't part of the federal market but runs its own insurance exchange.

HealthCare.gov said in a blog post that the federal mistake happened when information on this year's premiums was substituted for what should been 2014 numbers. The website had a technology meltdown when it was launched back in 2013, but seemed to have overcome its problems this enrollment season.

"It's just another black mark on the administration's handling of the health care act," said Roberton Williams, a senior fellow at the nonpartisan Tax Policy Center in Washington. "They were hoping for a clean season."

*'Told to Wait'*

"For many of these impacted taxpayers, the tax refund could be the single largest financial payout of the year," said Mark Ciaramitaro, H&R Block's vice president for health care. Many people due a refund file well before the April 15 deadline. "They are being told to wait," he added, "further delaying access to their tax refund."

On another matter, the administration also announced a special sign-up extension for uninsured people who would face the health care law's tax penalties for the first time this year.

Several million households could benefit from that grace period, which had been sought by Democratic lawmakers.

Uninsured people who go to file their taxes and learn they're facing a penalty will have between March 15 and April 30 to sign up through HealthCare.gov. Otherwise, they would not have had an opportunity until the fall. Fines for being uninsured are going up significantly in 2015.

*Self-Inflicted Wound *

The tax-document mistake was a self-inflicted wound after what Obama had personally touted as a successful open-enrollment season, with about 11.4 million people signed up.

On Capitol Hill, Democrats were frustrated, but they gave the administration some credit for disclosing the error early instead of letting the problem compound as tax season advances.

The White House downplayed the consequences. "It's a small percentage of overall tax filers," said spokesman Josh Earnest. "You're talking about less than 1 percent of people who file taxes."

At the Health and Human Services department, Andy Slavitt, who oversees health insurance programs, said consumers affected by the problem will be notified starting immediately via phone calls and emails. They represent about 1 of every 5 HealthCare.gov customers who got subsidies in 2014.

An estimated 50,000 people who have already filed their taxes will receive special instructions from the Treasury Department, he said. All corrected forms should be available by early March.

*Complicated Links*

Slavitt said the error involved a "benchmark" premium that is used to help determine the subsidies that individuals receive. It's unclear whether the impact would favor the government or individual policyholders. Slavitt said it's a mix.

The tax error highlights the complicated links between Obama's health care law and taxes, connections that consumers are experiencing for the first time this year. The law subsidizes private health insurance for people who don't have access to job-based coverage. Those subsidies are mainly based on income.

By packaging the benefit as a tax credit, the law's supporters were able to promote it as a tax cut. But that also introduced new wrinkles to an already-complicated tax system at a time when Republicans have put the squeeze on the IRS budget.

Other issues could emerge later this spring. Consumers filing their taxes have to verify to the IRS that they got the amount of subsidy they were legally entitled to. If they received too much, their refunds will get dinged. Too little, and the government repays them. Some experts suspect that many consumers may have underestimated their 2014 incomes and gotten too big a subsidy.

"This is very complicated, and we've got all these different pieces coming together that will be prone to error," said Williams, the tax policy expert.

 

Permalink | Email this | Linking Blogs | Comments Reported by DailyFinance 9 hours ago.

Drug Company Charges $84,000 For Drug That Costs Less Than $200 To Make
Drug Company Charges $84,000 For Drug That Costs Less Than $200 To Make
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It's no surprise that American drug companies routinely mark up prices of medications way above the real cost, but the price of a new life-saving medication is dizzying.

The pharmaceutical company Gilead Sciences sells sofosbuvir, marketed as Sovaldi, as a new cure for the hepatitis C virus (HCV). The results have reportedly lived up to the clinical testing.

According to The Huffington Post, the FDA gave its approval for sofosbuvir in December 2013. Gilead Sciences sells a 12-week treatment of the medication for $84,000, which comes out to $1,000 per pill.

However, researchers at Liverpool University wrote in the Oxford Journals that Gilead Sciences' cost to produce a 12-week treatment of sofosbuvir is actually $68-$136 and added, "Within the next 15 years, large-scale manufacture of 2 or 3 drug combinations of HCV DAAs is feasible, with minimum target prices of $100–$250 per 12-week treatment course. These low prices could make widespread access to HCV treatment in low- and middle-income countries a realistic goal."

This theory appears to be correct as Gilead Sciences sells the same 12-week treatment in India for $300 because that country refused to allow Gilead Sciences to patent the drug and hold a monopoly, as it does in the U.S.

Back in the U.S., many federal and state health insurance programs will pay the $84,000 and so will some private insurance companies, but many Americans will die if they have to pay cash, unless they were to travel to India.

Gilead Sciences has the U.S. patent on sofosbuvir until 2028, which guarantees enormous profits for 13 more years.

While drug companies claim that they have to make these profits to cover their research and development, the U.S. government originally funded (via grants) the early research and development of sofosbuvir by Prof. Raymond Schinazi at Emory University.

Prof. Schinazi later set up Pharmasset Inc. to develop sofosbuvir and get patents for the drug. Pharmasset raised about $45 million via IPO in 2007 when it became a publicly traded company. Pharmasset Inc. was sold to Gilead Sciences in 2012 for $11.2 billion and Prof. Schinazi reportedly earned $440 million.

In total, The Huffington Post reports that an estimated $300 million of non-government money was spent for the actual research and development for the drug.

According to The New York Times, Gilead Sciences made $10.3 billion on Sovaldi in 2014, making it one of the bestselling drugs in the world.

Sources: The New York Times, The Huffington Post, Oxford Journals
Image Credit: Solvaldi Product Image

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OV in Depth:  Reported by Opposing Views 8 hours ago.