'OBAMACARE' READY TO LAUNCH--Health and Human Services Secretary Kathleen Sebelius gestures while speaking during a news conference at the Treasury Department in Washington in April, 2012. (AP Photo/Susan Walsh, File)

by Ricardo Alonso-Zaldivar

Associated Press Writer
WASHINGTON (AP) — President Barack Obama's health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds?

SOUTHERN FRIED FAVORITE--This Wednesday, Feb. 6, 2013 photo shows fried chicken, foreground, with hush puppies at a restaurant in Charlotte, N.C. (AP Photo/Chuck Burton)

by Mariyn Marchione

Deep-fried foods may be causing trouble in the Deep South. People whose diets are heavy on them and sugary drinks like sweet tea and soda were more likely to suffer a stroke, a new study finds.

It's the first big look at diet and strokes, and researchers say it might help explain why blacks in the Southeast — the nation's "stroke belt" — suffer more of them.

Blacks were five times more likely than whites to have the Southern dietary pattern linked with the highest stroke risk. And blacks and whites who live in the South were more likely to eat this way than people in other parts of the country were. Diet might explain as much as two-thirds of the excess stroke risk seen in blacks versus whites, researchers concluded.

"We're talking about fried foods, french fries, hamburgers, processed meats, hot dogs," bacon, ham, liver, gizzards and sugary drinks, said the study's leader, Suzanne Judd of the University of Alabama in Birmingham.

People who ate about six meals a week featuring these sorts of foods had a 41 percent higher stroke risk than people who ate that way about once a month, researchers found.

In contrast, people whose diets were high in fruits, vegetables, whole grains and fish had a 29 percent lower stroke risk.

"It's a very big difference," Judd said. "The message for people in the middle is there's a graded risk" — the likelihood of suffering a stroke rises in proportion to each Southern meal in a week.

Results were reported Thursday at an American Stroke Association conference in Honolulu.

The federally funded study was launched in 2002 to explore regional variations in stroke risks and reasons for them. More than 20,000 people 45 or older — half of them black — from all 48 mainland states filled out food surveys and were sorted into one of five diet styles:

—Southern: Fried foods, processed meats (lunchmeat, jerky), red meat, eggs, sweet drinks and whole milk.

—Convenience: Mexican and Chinese food, pizza, pasta.

—Plant-based: Fruits, vegetables, juice, cereal, fish, poultry, yogurt, nuts and whole-grain bread.

—Sweets: Added fats, breads, chocolate, desserts, sweet breakfast foods.

—Alcohol: Beer, wine, liquor, green leafy vegetables, salad dressings, nuts and seeds, coffee.

"They're not mutually exclusive" — for example, hamburgers fall into both convenience and Southern diets, Judd said. Each person got a score for each diet, depending on how many meals leaned that way.

Over more than five years of follow-up, nearly 500 strokes occurred. Researchers saw clear patterns with the Southern and plant-based diets; the other three didn't seem to affect stroke risk.

There were 138 strokes among the 4,977 who ate the most Southern food, compared to 109 strokes among the 5,156 people eating the least of it.

There were 122 strokes among the 5,076 who ate the most plant-based meals, compared to 135 strokes among the 5,056 people who seldom ate that way.

The trends held up after researchers took into account other factors such as age, income, smoking, education, exercise and total calories consumed.

Fried foods tend to be eaten with lots of salt, which raises blood pressure — a known stroke risk factor, Judd said. And sweet drinks can contribute to diabetes, the disease that celebrity chef Paula Deen — the queen of Southern cuisine — revealed she had a year ago.

The National Institute of Neurological Disorders and Stroke, drugmaker Amgen Inc. and General Mills Inc. funded the study.

"This study does strongly suggest that food does have an influence and people should be trying to avoid these kinds of fatty foods and high sugar content," said an independent expert, Dr. Brian Silver, a Brown University neurologist and stroke center director at Rhode Island Hospital.

"I don't mean to sound like an ogre. I know when I'm in New Orleans I certainly enjoy the food there. But you don't have to make a regular habit of eating all this stuff."

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

HEALTH SCARE--Michael Lee talks to a reporter about his recent heart surgery and follow-up care at Montefiore Medical Center in New York. (AP Photo/Seth Wenig)

by Lauran Neergaard

AP Medical Writer

WASHINGTON (AP) — Michael Lee knew he was still in bad shape when he left the hospital five days after emergency heart surgery. But he was so eager to escape the constant prodding and the roommate's loud TV that he tuned out the nurses' care instructions.

BACKS MEDICAID EXPANSION--Ohio Gov. John Kasich presents the fiscal year 2014-15 executive budget proposal during a news conference Monday, Feb. 4, in Columbus, Ohio. (AP Photo/Jay LaPrete)

Ohio GOP governor backs federal Medicaid expansion

by Ann Sanner

Associated Press Writer

COLUMBUS, Ohio (AP) — Ohio's Republican governor announced Monday he will push for expanding Medicaid under the federal health care law, a move that would give many more poor people access to government care.

It also sets up a potential fight among the governor and Republicans who control the state Legislature and are strongly against President Barack Obama's health care law.

The state anticipates more than 365,000 Ohioans will be eligible for coverage beginning in 2014 by expanding Medicaid, the health program for the poor that already provides care for one of every five residents in the state.

A broad group of Ohio's doctors, hospitals and health providers back the idea, as does the Ohio AARP.

Gov. John Kasich, who last summer called the federal health overhaul a "massive new tax on the middle class," proposed the Medicaid expansion in his two-year budget plan released Monday. He now must persuade Republican state lawmakers to back the plan despite the fact that many dislike the law's mandated coverage and campaigned against it just a few months ago.

Kasich reiterated his opposition to what he called "Obamacare," saying "I don't believe in the individual mandate."

"But I think that this makes great sense for the state of Ohio," he added.

If Ohio doesn't extend Medicaid, his administration said, federal tax dollars will be used to expand health coverage in other states and give businesses elsewhere a competitive advantage by creating a healthier workforce.

The leader of the Ohio House has said his fellow Republicans have concerns about the expense of expanding Medicaid. House Speaker William Batchelder told reporters the idea also poses philosophical questions for lawmakers who oppose the law's mandate that almost everyone obtain health insurance.

Kasich said he views the Medicaid expansion decision separately from the law's mandate, and he was hopeful that lawmakers would set their ideology aside.

"This is not an endorsement of Obamacare," he said.

Still, he acknowledged that debate on extending Medicaid coverage wouldn't be without its legislative fireworks.

"You're going to have a lot of fun stories to write over the course of the next several months," Kasich told reporters at his budget briefing.

The federal government will pay the entire cost of the Medicaid expansion for the first three years, gradually phasing down to 90 percent — still well above the current level of 64 percent. Even at those generous rates, however, some GOP governors and state legislatures say they fear being stuck with long-term costs.

Ohio will see an influx of $2.4 billion in federal funds over the next two years beginning in July to cover those who are newly eligible, the administration said.

Separate changes to eligibility for Medicaid will mean that almost 91,000 who are covered by Medicaid will be dropped from the program.

The state also expects to net $235 million because of a boost in tax revenue, plus additional savings from proposed Medicaid eligibility changes and savings on medical care for prisoners.

Kasich proposal also calls for an automatic "opt-out" trigger. Under his plan, if the federal government doesn't pick up its share of expanded coverage, the program for newly eligible Ohioans would shut down and state taxpayers wouldn't be stuck with the bill.

Kasich's decision is significant not only because Ohio is a political bellwether, but also because of his previous service is Congress, where as chairman of the House Budget Committee in the late 1990s he helped pass major legislation to reduce federal debt.

That gives his decision Monday added weight, and could undercut arguments from some conservatives that Washington cannot be trusted to honor its financial commitments for the latest Medicaid expansion.

Ohio was among 26 states that sued to overturn the federal law. The U.S. Supreme Court upheld the heart of the overhaul last year but allowed states to decide whether to expand Medicaid.

Washington, D.C., and 17 states have opted to expand their Medicaid rolls.

Kasich joined Arizona Republican Gov. Jan Brewer in calling for expansion. Several other GOP governors have said they will not go forward, including Rick Perry in Texas, Bobby Jindal in Louisiana and Nikki Haley in South Carolina.

Kasich said he will continue to press federal officials for flexibility on the expansion, perhaps allowing some lower-income Ohioans to get private coverage subsidized by Washington. It's unclear how far he will get. The governor said talks with the Obama administration were in the early stages.

The Medicaid expansion is intended to cover about half of the 30 million uninsured people expected to eventually gain coverage under the health care overhaul. The law expanded Medicaid to cover low-income people making up to 138 percent of the federal poverty level, or about $15,400 a year for an individual. That provision will mainly benefit low-income adults who do not have children and currently can't get Medicaid in most states. Separately, the overhaul provides subsidized private insurance for middle-class households.

Associated Press writers John Seewer in Toledo and Ricardo Alonso-Zaldivar in Washington contributed to this report.