The Takeaway: States Can Decide On Covered Health Benefits; Obesity Epidemic Rooted In 1950s Moms?

By Elizabeth Nolan Brown, December 19, 2011 09:36 AM

Respecting States' Rights Or Playing Hot Potato? Last Friday, the Obama administration announced that it would leave defining the " essential health benefits" that must be provided by insurance plans under the new health care law up to the states, instead of specifying some national standard of benefits. It's a move aimed at deflecting criticism that the health care overhaul is too centrally-controlled and usurps state authority to regulate the health insurance industry. The 2010 Affordable Care Act designated 10 categories of essential health benefits that must be provided by individual and small-group insurance plans beginning in 2014 (including preventative care, emergency services and prescription drugs), and it was expected that the Department of Health and Human Services would define the particular services that fall within each category. But leaving this decision up to the states gives them "the flexibility to design coverage options that meet their unique needs," HHS Secretary Kathleen Sebelius said.

Some say, however, that the plan's real aim was shifting what could be extensive lobbying and debate over covered benefits away from the White House and into the statehouses.

Obama has taken all the grief he can stand over health care," Erik Gordon, a business professor at the University of Michigan, told Bloomberg news. "He doesn't want it to give the Republicans any more political ammunition. He is passing the hot potato to the states."

Under the new guidelines, states must set coverage levels in line with either popular small-business plans in their communities, the state employees' health plan, federal employee plans or the largest commercial managed- care plan in the state.

Obesity Epidemic's Roots: When folks talk about tracing today's obesity epidemic to the 1950s, most of us begin by thinking of the typical culprits-fast food, convenience food, microwaves, automobiles. 'Pregnant women' is likely low on that list. Yet the mothers-to-be of the 1950s could be at the root of today's high obesity rate in the U.S., according to fitness and nutrition expert Melinda Sothern.

The idea that obesity is 'programmed' in the womb is one that's been gaining scientific traction lately. Sothern, 51, believes obesity rates in America began soaring when they did-around the 1980s-because a generation of young mothers smoked, eschewed breast feeding and restricted weight gain during pregnancy, all of which can contribute to higher-weight kids (who turn into higher-weight adults). As the Los Angeles Times notes:

Women in the 1950s and 1960s - think Betty Draper on the hit TV show "Mad Men" - were generally advised to restrict weight gain in pregnancy to as little as 10 pounds. Inadequate nutrition in some of these women could easily have programmed their babies to catch up on growth during infancy - and studies suggest such growth spurts increase the risk of later obesity.

In 1963, the average 10-year-old boy weighed 74 pounds and the average 10-year-old girl 77 pounds-compared with 85 pounds and 88 pounds in 2002. "It is stunning, looking at pictures of kids in the '50s," says Dr. Matthew Gillman, a nutrition professor at Harvard. "They look scrawny."

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