As the obesity epidemic expands throughout the country, the availability of living kidney donors may be shrinking. A study at the North Shore-LIJ Health System Transplant Center in New York found that about 1 in 4 donors willing to give a kidney for a person in need were initially denied because they weighed too much.

Amongst that group, only a small percentage of the overweight donors were successful in losing enough weight to become eligible for a kidney donation. Despite a lack of national criteria for organ donation, the majority of centers reject donors with a body mass index (BMI) of 35 or more, due to previous data showing lackluster results for the donors and recipients in such cases.

Out of 104 potential donors involved in the study, 22% were denied for consideration due to a BMI greater than 35. Within that group, a mere 13% were able to drop enough weight to become eligible to donate.

There are approximately 92,000 people currently awaiting a kidney transplant.

In a statement about the study, Dr. Lynda Szczech, president of the National Kidney Foundation said, “As the kidney transplant waiting list grows, there is a great need for living donors. As a community, we need to identify ways to overcome this barrier so that we can increase our donor pool and end the wait for transplant.”

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Last week New Jersey Governor Chris Christie vetoed a bill to establish a state-run health care exchange where consumers would be able to compare insurance plans and rates from different carriers.

However, if President Obama’s 2010 health care reform bill is upheld by the Supreme Court, every state will be required to create an exchange. In cases where states refuse to set up an exchange, the federal government will step in and create them.

Christie, a Republican, waited until the last possible day to issue the veto, but said he may reconsider if the Patient Protection and Affordable Care Act is upheld by the court. Despite his rejection of a state-run health exchange, New Jersey is not among the 23 states challenging the health care reform bill in court.

“I intend to fully oversee New Jersey’s compliance in a responsible and cost-effective manner should its constitutionality ultimately be upheld,” said Christie.

New Jersey joins New Mexico as the second state with a Republican governor to veto the state health exchange, while Republican governors in other states have refused to create them. In New York, democratic Governor Andrew Cuomo, recently issued an executive order to create an exchange, bringing the total to 14 states who have approved them.

It’s clear to see that much of the nation is divided over the need for both state-run health exchanges and national health care reform. The fact remains that there are 50 million Americans living without health insurance today, along with millions more who have coverage that’s not meeting their needs.

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More employers are offering their employees health insurance plans with low premiums and high deductibles as a way of curbing the ever-increasing costs of health care that are outpacing economic growth and inflation.

A study published by the Rand Corporation in the May edition of the Health Affairs concluded that if half of all employer-sponsored coverage used these models, health care costs for the nonelderly would be reduced by approximately $57 billion per year.

It’s common for these plans to include a minimum of a  $1,000 annual deductible per person, paired with a health savings account. According to statistician Amelia Haviland who led the study, “Continued pressures to cut costs, combined with incentives in the Affordable Care Act, make the 50 percent enrollment level plausible over the coming decade.”

The study tracked 59 large corporations from 2003 to 2007 and concluded that families who participated in these consumer-directed plans elected to use more generic drugs, paired with  fewer visits to specialists and less elective admissions into hospitals, compared to consumers covered under traditional insurance plans.

However, consumer driven plans also eliminated the choice for some patients to undergo highly recommended services like cancer screenings and tests to measure blood sugar for diabetics.

While there are benefits associated with consumer-driven health plans, the deductibles can still be costly for some, but there are still viable options for affordable health insurance that aren’t employer-sponsored.

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Obtaining regular and affordable access to health care is becoming harder for Americans, even for those who have health insurance. A study by the Urban Institute found that the situation will only become more dire if the health care reform law is struck down or scaled back.

The report, published in the journal Health Affairs, found that between 2000 and 2010, an unprecedented number of Americans reported not having a regular source of medical care, hadn’t visited a doctor or dentist within a year and had unresolved medical and dental needs and decided against receiving health care due to the cost.

The Patient Protection and Affordable Care Act was signed into law by President Obama in March 2010 and although it can’t solve all of the nation’s health care woes, it can expand coverage to an additional 30 million Americans through subsidized private health insurance plans or Medicaid.

“If the key coverage provisions in the bill are ruled unconstitutional or repealed, projections indicate that the numbers of uninsured people will grow. Given what we observed over the past decade, we would be likely to see further deterioration in access to care for all adults — uninsured and insured alike,” wrote the authors of the Urban Institute’s report.

As the report demonstrates, people are increasingly neglecting their own health because they can’t justify the cost of doing so.

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Amber Young wasn’t feeling well and like 50 million other Americans, she was living without health insurance. So, she logged onto a website run by NowClinic online care, owned by UnitedHealthGroup and had a virtual meeting with a doctor in Texas. Young and the doctor communicated by instant message and then telephone before he diagnosed her with an upper respiratory infection and prescribed her with an antibiotic.

The cost of the visit was $45. According to Young, “I was as suspicious as anyone about getting treated over the computer. But I could not have been happier with the service.” NowClinic was formed in 2010 and has since spread to 22 states throughout the country. As a result, more consumers are able to take advantage of doctor “visits” from the comfort of their homes.

Not only are these appointments typically less expensive than a traditional doctor’s office visit, but many experts believe this new method of treatment could help to ease a shortage of doctors in the United States.

Some physicians and consumer groups are not as optimistic about this trend. “Getting medical advice over a computer or telephone is appropriate only when patients already know their doctors. “Even for a minor illness, I think people are going to be shortchanged. Getting medical advice over a computer or telephone is appropriate only when patients already know their doctors,” said Glen Stream of the American Academy of Family Physicians.

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