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04/20/12

  04:17:30 pm, by MedBen5   , 147 words,  
Categories: News, Wellness

Daily Exercise May Help Smokers Kick The Habit

Nicotine gum and patches may or may not aid cigarette smokers in kicking the habit, but a major study suggests that exercise may be an effective route to quitting once and for all.

According to NPR, researchers in Taiwan tracked the health and habits of 434,190 people in Taiwan from 1996 to 2008. They found that smokers who exercised for as little as 15 minutes a day were 55% more likely to quit than inactive people. And by staying active, ex-smokers were 43% less likely to relapse later.

Not only did a daily workout help smokers give up cigarettes, it also counteracted the negative effects of the habit. Just 30 minutes of exercise a day increased the life of ex-smokers by 5.6 years, while reducing their risk of death by 43%.

And even smokers who haven’t successfully quit benefit from keeping active. The study found that a daily 30-minute walk increased their life expectancy by 3.7 years.

04/19/12

  05:07:13 pm, by MedBen5   , 458 words,  
Categories: News, Health Plan Management

New Employer Tax to Fund Patient-Centered Outcomes Research

Last week, the Internal Revenue Service released its pre-Federal Register draft of proposed rules on how self-funded plan sponsors and insurance carriers will pay the federal government to support the Patient-Centered Research Outcomes Institute. The Affordable Care Act (ACA) amended the Internal Revenue Code to create the Patient-Centered Outcomes Research Institute Trust Fund and the taxes collected will fund the Trust between 2012 and 2019. The Institute is tasked with conducting research to evaluate the clinical effectiveness of certain medical treatments, services and supplies, as well as reviewing strategies to treat, diagnose and manage illness and injury.

Unlike the discussions during the Supreme Court hearings as to whether the fee charged for not purchasing coverage under the ACA’s Individual Mandate is really a “tax” or a “penalty”, the IRS considers this Trust Fund payment a “tax” and treats it as such under the proposed regulations. You might also have heard this tax called the “Comparative Effectiveness Fee”.

The proposed regulations are based on comments received after the IRS released Notice 2011-35 in June, 2011 regarding implementation of the tax. The Trust Fund tax remains in effect for plan/policy years beginning after September 30, 2012 and continues through the 2018 plan/policy year. The proposed regulations require that the first payments be made in July, 2013 and require submission of IRS Form 720 (Quarterly Federal Excise Tax Return) along with the payment. For the Trust Fund Tax payments only, Form 720 must be filed annually – although Form 720 may need to be filed by a company quarterly for other purposes.

Full story »

04/18/12

  05:31:55 pm, by MedBen5   , 195 words,  
Categories: News, Wellness, Health Plan Management

Eye Screening May Reveal Onset of Parkinson's

Considering that vision exams can detect diabetes, high blood pressure, high cholesterol, glaucoma, multiple sclerosis and even potential memory loss, it would not be hyperbole to say that our eyes can serve as a treasure trove of medical information. MedPage Today reports on still another condition that a more advanced eye screening may uncover: Parkinson’s disease.

According to a study of 112 Parkinson’s patients, including newly diagnosed cases not yet on medication, all tested showed constant small rhythmic movements of their eyes when attempting to fix their gaze on an object. By comparison, the same instability was seen in just two of 60 age-matched controls.

Co-researcher Mark S. Baron, MD, of the VA Medical Center in Richmond, Va. says that while specialty equipment is needed to measure the eye tremors, the screening could be nearly 100% accurate.

Studies like this demonstrate the usefulness of regular eye checkups. That’s why MedBen VisionPlus promotes regular exams and early detection and treatment of visual impairments. Our group vision plan also provide the highest quality glasses and contact lenses at extremely affordable prices.

To learn more about MedBen’s vision care programs, contact Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.

  04:11:44 pm, by MedBen5   , 189 words,  
Categories: News, Health Plan Management

Labor Department Updates Online Employer Health Benefit Advisor

The U.S. Department of Labor (DOL) has released an updated version of its Health Benefits Advisor for Employers. This online resource outlines the federal laws that can affect health benefit coverage provided by group health plans. The Advisor explains the legislation, statutes and regulations in Parts 6 and 7 of Title I of the Employee Retirement Income Security Act of 1974 (ERISA). These laws include:

  • Consolidated Omnibus Budget Reconciliation Act (COBRA)
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Mental Health Parity Act (MHPA) and Mental Health Parity and Addiction Equity Act (MHPAEA)
  • Newborns’ and Mothers’ Health Protection Act (Newborns’ Act)
  • Women’s Health and Cancer Rights Act (WHCRA)
  • Genetic Information Nondiscrimination Act (GINA)
  • Michelle’s Law

You may access the updated Health Benefits Advisor for Employers from the DOL web site at http://www.dol.gov/elaws/ebsa/health/employer/.

The Health Benefits Advisor for Employers is one of a series of elaws (Employment Laws Assistance for Workers and Small Businesses) Advisors developed by DOL to help employers and employees understand federal employment laws and resources. To access all of the elaws advisors, visit the elaws Web site at www.dol.gov/elaws.

04/17/12

  04:47:27 pm, by MedBen5   , 144 words,  
Categories: News, Wellness

Study: Obesity Accounts For One-Fifth Of U.S. Health Spending

Carrying around excess weight is a financial burden in addition to a physical one, a new study says.

According to HealthDay News, researchers from Cornell University found that an obese person’s medical costs are $2,741 a year higher (in 2005 dollars) than if they were not obese. That additional money adds up to $190.2 billion a year nationally – nearly 21% of total U.S. health spending.

The study’s numbers far exceed previous estimates that put the cost of obesity at $85.7 billion a year. “Historically, we’ve been underestimating the benefit of preventing and reducing obesity,” study author John Cawley said in a university news release.

“Obesity raises the risk of cancer, stroke, heart attack and diabetes,” Cawley said. “For any type of surgery, there are complications [for the obese] with anesthesia, with healing. Obesity raises the costs of treating almost any medical condition. It adds up very quickly.”

04/13/12

  04:54:40 pm, by MedBen5   , 205 words,  
Categories: News, Wellness

Working The Late Shift May Raise Diabetes Risk

More evidence that irregular sleep habits can adversely affect one’s health: A new study by Brigham and Women’s Hospital in Boston found the fighting the body’s natural sleep patterns can increase the risk of type 2 diabetes.

According to MSNBC, researchers deliberately disrupted the normal sleep patterns of volunteers. Within a few days, their bodies began to respond differently to standard meals – so much so that three of the volunteers became pre-diabetic. Fortunately, symptoms disappeared when regular sleep resumed.

“Glucose levels went much higher and stayed that way for several hours,” said neuroscientist Orfeu Buxton, Ph. D., the study’s lead author. “This was because of decreased insulin released from the pancreas. Together these reflect an increased risk of diabetes.”

More than 21 million Americans who labor evening or nighttime hours have a righer risk of obesity and heart disease, in addtion to diabetes. The advice from the scientists for those who perform “shift work” – either out of necessity or choice:

  • Try to make your daily clock as normal as possible.
  • Get good sleep during the day – finding, if you can, a quiet, very dark room.
  • Don’t eat big meals at a time when you feel your body clock is out of whack.

04/11/12

  04:42:13 pm, by MedBen5   , 176 words,  
Categories: News, Health Plan Management

Support For Health Care Reform Law Continues To Fall

Public support of the health care reform law has reached a new low, according to the latest ABC News/Washington Post poll.

ABC News reports that 53% now disapprove of the Affordable Care Act, while only 39% support it – the smallest vote of confidence in more than a dozen such polls since August 2009. “Strong” opposition outnumbers strong advocacy by over a 2-to-1 margin.

Moreover, a combined two-thirds of respondents believe that the Supreme Court should strike down the entire law (38%) or at least the individual mandate (29%), the requirement that most Americans carry health insurance or pay a penalty.

As for how people think the high court will vote on the ACA, over half think the justices will allow partisan political views to influence their ruling, while 40% say the decision will be impartial. Along party lines, 41% of Republicans say the vote will be partisan, compared to 55% of Democrats and 52% of independents.

A bit of good news for President Obama, however: 48% of reposdents trust his handling of health care policy, compared to just 38% for presumptive GOP nominee Mitt Romney.

  10:43:07 am, by MedBen5   , 212 words,  
Categories: News, Wellness

Cancer Headlines: Higher Costs, Higher Survival Rates

Lots of cancer-related news this week… here’s a sampling:

  • According to Kaiser Health News, a new study suggests that higher American costs for cancer care compared to Europe is offset by better U.S. survival rates – almost two years longer on average. “We found that the value of the survival gains greatly outweighed the costs, which suggests that the costs of cancer care were indeed ‘worth it,’” the researchers wrote.
  • The U.S. Preventive Services Task Force has renewed its 2004 recommendation that women at average risk for ovarian cancer not get screened for the disease, Medical Xpress reports. The panel says that the currently used blood test and transvaginal ultrasound isn’t very accurate, and as such may cause more harm than benefit for patients.
  • Reuters reports that people are more likely to get screened for colorectal cancer when their doctors recommend they get a stool test instead of a colonoscopy, or when doctors leave it up to patients to choose which test to have. A new study suggests that doctors should take their patients’ preferences into consideration before recommending one test or the other.
  • And via USA Today: The American Cancer Society reminds people that proper diet and other healthy lifestyle habits can greatly reduce the odds of developing the disease.
  09:54:42 am, by MedBen5   , 177 words,  
Categories: News, Wellness

Tried-and-True Weight Loss Methods Work Best, Study Finds

Every now and then, the scientific community takes a few moments out of their busy schedule to confirm something that we all already know… but hey, a gentle reminder never hurts. In this case, a new study determined that time-tested ways of losing weight – exercise, eating less fatty food and so on – work better than fad diets and “miracle” weight-loss pills.

WebMD reports that researchers analyzed surveys from over 4,000 obese people to determine how those who successfully lost weight did so. They found that those who exercised more and ate less fat lost more weight.

“People actually are losing 5% to 10% of their body weight or more using tried-and-true methods,” says study author Jacinda M. Nicklas, MD, MPH of Beth Israel Deaconess Medical Center in Boston.

The study also showed that people who joined commercial weight loss programs, such as Weight Watchers or Jenny Craig, were more likely to lose 10% or more of their body weight. And while only a small portion of those surveyed used prescription weight loss drugs, most did report some weight loss.

04/10/12

  05:38:00 pm, by MedBen5   , 213 words,  
Categories: News, Health Plan Management

New Medical Codes Delayed Until 2014

The Department of Health and Human Services (HHS) has announced that an upgrade to the medical-coding standard will be postponed for a year, The Wall Street Journal Health Blog reports.

Originally set for implementation in 2013, the coding set known as will now go into effect on October 1, 2014. In a press release, HHS said the delay will give doctor and health insurers “more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.”

When the ICD-10 update is completed, the number of diagnosis and procedure codes used in medical billing will expand greatly, from around 18,000 in the current ICD-9 code set to about 140,000. Not surprisingly, the American Medical Association doesn’t favor the change, saying that the increase in codes will further burden doctors without improving care.

HHS said that the proposed coding changes – which would also establish a unique health plan identifier that could be used in billing – “would save health care providers and health plans up to $4.6 billion over the next ten years.”

To get some idea of the scope of the 120,000+ new codes, take a look at this Wall Street Journal article from September 2011. Suffice it to say, if you’re ever burned by flaming waterskis, there’s a code for that.

  01:02:59 pm, by MedBen5   , 295 words,  
Categories: Wellness, Health Plan Management

Doctors Differ In Opinion Of "Choosing Wisely" Campaign

Last week, nine medical societies jointly announced “Choosing Wisely” – a doctor-focused campaign to promote more selective use of medical tests. The groups compled a list of 45 tests and procedures they considered to be overused.

On the KevinMD.com blog, two physicians share their opinions of Choosing Wisely – one approving, the other more qualified in his support:

John Mandrola, MD, cardiologist: “Doctors must design and implement healthcare changes and reforms. Call us what you will, but we are the experts in medical diagnosis and treatments. We know what works and what doesn’t. We must be allowed to practice Medicine – not just follow protocols, or test and treat just to cover our butts. The corollary here, of course, is that we must be allowed to be human…

“That our thought leaders are now proclaiming – and social media is amplifying – the values of clinical judgment and targeted thoughtful diagnostic and therapeutic interventions represents a monumental sea change.”

Mike Sevilla, MD, family physician: “With these reports today, patients are challenging me even harder about the testing and treatments that I am recommending. I don’t have a problem with this. However, I do have a problem how this story has been framed in that ‘I’ am the reason why unnecessary tests are done, and my patients are more than happy to remind me of that…”

“Now, don’t get me wrong. I agree with everything that happened today. 30 billion dollars annually of unnecessary tests are a real problem. However, will this effort really change the behavior of physicians? Probably not. Will this effort really try to educate patients not to ask for unnecessary tests? Probably not. Will this campaign hope to score political points with Congress and the White House? Some believe yes…”

  11:22:15 am, by MedBen5   , 219 words,  
Categories: Announcements, News, Health Plan Management

Report: Health Care Reform Law Would Raise Deficit

The Affordable Care Act will add more that $340 billion to the deficit, according to a new study of the health care reform law by a Republican member of the board that oversees Medicare financing.

The Washington Post reports that conservative policy analyst Charles Blahous predicts that much of the savings and revenue ACA gains – from lower Medicare payments and higher taxes – will be more than offset by additional benefits to individuals already insured, paid through the Medicare hospitalization trust fund. That means those savings would not be available to pay for expanding coverage for the uninsured.

“If one asserts that this law extends the solvency of Medicare, then one is affirming that this law adds to the deficit,” said Blahous, who President Obama approved in 2010 as the GOP trustee for Medicare and Social Security. “Because the expansion of the Medicare trust fund and the creation of the new subsidies together create more spending than existed under prior law.”

The Obama administration countered that Blahous used faulty and selective math to reach his conclusions. “The fact of the matter is, the Congressional Budget Office and independent experts concluded that the health-reform law will reduce the deficit,” a White House budget official said, speaking to the Post on the condition of anonymity because the report was not publicly available.

04/09/12

  12:16:07 pm, by MedBen5   , 209 words,  
Categories: News, Wellness

Study Suggests False-Positives Can Predict Breast Cancer Risk

An oft-cited concern by those in support of reduced mammogramy screening is the greater potential of a “false-positive” – a result that indicates that a cancer is present when it is not. And indeed, 61% of women in the U.S. who do receive annual mammograms have at least one such incorrect result within a ten-year period.

New research suggests, however, that even false-positives may provide some hint for a future risk of breast cancer. Women in a Danish study who had at least one false-positive mammogram had a 67% greater likelihood of eventually being diagnosed with the disease, WebMD reports. The analysis included 58,000 women who had mammograms in Denmark between 1991 and 2005.

Breast cancer specialist Stephanie Bernik, MD doesn’t wholly support the study’s findings. “There has long been a suggestion that women who have more activity in their breasts that lead to false-positive mammograms may also have an increased risk for breast cancer, but I don’t think this study proves this,” she told WebMD.

Bernik (who was not involved in the research) also noted that innovations in mammography screening since 2000 have led to better detection of breast cancer and fewer false-positives, and the analysis reflects the greater test accuracy. “This study could be interpreted as reassuring for women being screened today.”

  11:23:55 am, by MedBen5   , 277 words,  
Categories: Health Plan Management

Health Care Woes In 1933 Sound Very Familiar

The more health care changes, the more it stays the same… at least, that’s the conclusion one might reach when reviewing a list of U.S. health care problems from 1933.

C.E.A. Winslow, a Professor of Public Health at Yale University, wrote “A Program of Medical Care for the United States” for the January 27, 1933 edition of Science magazine. His observations about the state of health care back then should strike a familiar chord with you. We’ve highlighted several here – you can read Winslow’s complete list at John Goodman’s Health Policy Blog.

  • Unwise expenditures for medical care: “Of the total of $3,656,000,000 a year now spent by the American people for medical care, 360 million dollars go for “patent medicines” and 125 million dollars for the services of cultists and irregular practitioners who have never studied the human body and do not understand its working.”
  • Economic burden of emergency illness: “in the group of families with incomes under $2,000 a year (about half the population of the United States) one per[cent]…of the families spent over $500 in one year for medical care…[this] constitutes the critical economic problem in the field of medical care.”
  • Inadequate care of the sick: “The second result of economic maladjustment is that a shocking large amount of illness is now actually uncared for (in spite of the potential adequacy of the resources at our disposal).”
  • Lack of preventive services: “…there is everywhere a grave lack of the applications of modern medical science to the prevention of disease…[A]s long as preventive services are immediately contingent on the payment of a fee for such services…they will not be sought by the patient.”

04/06/12

  05:16:15 pm, by MedBen5   , 313 words,  
Categories: News, Health Plan Management

While Health Law's Fate Is Weighed, MedBen Stays Proactive

In the leadup to, and aftermath from, Supreme Court hearings over the Affordable Care Act, the Internet has been rife with speculation as to what would happen if the individual mandate, or even the entire health care reform law, was struck down. The New York Times recently focused on how reversing two years of policy would affect a specific industry – health insurers.

Based on the comments of the articles’s interviewees, there’s a fair amount of hand-wringing going on:

  • “Many of us did not get the bill we wanted, but I think having to start over is worse than having to fix this.” – Health care industry consultant
  • “The risk of repeal and starting from zero frightens [insurers] infinitely more” than having to comply with the law as written. – Former insurance executive
  • The law, “while imperfect in a number of ways, was a step forward.” – Insurer CEO

And here at MedBen? While we’re certainly keeping an eye on judicial developments, whatever the outcome should be, it’s essentially business as usual. As nothing in the law acts to reduce the cost of care, we continue to do precisely what we’ve always done: Find ways to provide leading-edge administrative services that increase efficiency while reducing client costs.

MedBen has never been a company to take a wait-and-see attitude. So rather than sit idly by, we remain at all times proactive. For instance, in 2010 we developed Partners Community Health Plan – a unique benefits package in which local hospitals and providers play an equal role in its management. Partners is currently available for fully-insured and self-funded businesses in Southeastern Ohio and Southwestern Kentucky, with more regions soon to come.

“Business as usual” really means that MedBen is constantly looking out for your best interests – through varied benefit offerings, innovative cost controls, on-line and in-house technologies, and outstanding customer service – regardless of circumstances.

  04:02:53 pm, by MedBen5   , 178 words,  
Categories: Announcements

Preventive Care Costs Can Differ Greatly

As more preventive services are covered in full by health insurance, the range of treatment costs from one provider to another has received increased scrunity. USA Today reports that a new study demonstrates just how great the difference can be.

According to research group Change HealthCare, costs for some preventive services can vary as much as 700%. A review of 15,000 consumers found cost differences of hundreds of dollars charged for the same tests. Colonoscopy costs, for example, ranged from $786 to $1,819.

The U.S. Department of Health and Human Services has developed a list of preventive services covered under the Affordable Care Act, and predicts a 1.5% increase in insurance premiums to cover the costs. But whether that’s a conservative estimate or not ultimately depends on the consumer’s choice of medical provider.

Bottom line: Even when you ensue no direct out-of-pocket expenses, it’s a good idea to know how much you’re spending for preventive care, and how it compares to average costs in your area. Such websites as myMedicalCosts.com, Outofpocket.com and Pricedoc.com can help you with your research.

  12:18:10 pm, by MedBen5   , 262 words,  
Categories: Wellness

Don't Ignore The Signs Of Sleep Deprivation

Many of us are so conditioned to getting by with less than seven hours of sleep a night that we ignore the warning signs our body sends when it wants more rest. But failure to take notice can lead to a myriad of health problems, including high blood pressure, obesity, depression, and decreased concentration and reaction times.

Men’s Health highlights six signs that you need to turn in earlier. We summarize them below, but you can check out the complete list at their website.

  1. You’re not hungry for lunch. A lack of sleep throws off your internal clock resulting in abnormal feelings – which is why so many people lose or gain weight during periods of sleeplessness.
  2. You’ve looked at three other Web sites in the last 5 minutes – and checked your email twice. A lack of sleep can make focusing seem impossible.
  3. You can’t remember where you put the car keys. Your brain needs sleep to refresh and regenerate. Without it, your short-term memory may be impaired.
  4. You can’t carry on a conversation. Come Saturday night, coming up with witty – or even coherent – one-liners is out of the question.
  5. You’re drowsy at the wheel. If you struggle to stay awake while driving – or doing any task that puts your life at risk – you’re not just bored. You need more sleep.
  6. You feel sick – and you never get sick. Your immune system repairs and strengthens while you sleep. So in addition to eating flu-fighting foods, log at least seven hours a night to stay healthy all season.
  11:12:17 am, by MedBen5   , 163 words,  
Categories: News, Prescription

FDA Warns About Fake Cancer Drugs

Avastin users may want to take extra precautions to ensure that their physicians and pharmacists are giving them the proper version. For the second time this year, the Food and Drug Administration has uncovered counterfeits of the injectable cancer drug.

AFP reports that the latest counterfeits are labeled by the name under which Avastin is approved in Turkey, Altuzan, but contain no active ingredient. Genentech, a subsidiary of the Swiss pharmaceutical giant Roche, markets the only FDA-approved version of Avastin in the United States.

The agency “is alerting healthcare professionals that another cancer drug, originating from a foreign source and purchased by US medical practices, has been determined to be counterfeit,” said the FDA in a statement.

In February, the FDA warned that as many as 19 US medical practices had potentially purchased and used counterfeit Avastin from Quality Specialty Products (QSP), a foreign supplier also known as Montana Health Care Solutions.

Avastin is used to treat colorectal, lung, kidney, breast and ovarian cancer.

04/04/12

  05:13:08 pm, by MedBen5   , 212 words,  
Categories: News, Wellness, Health Plan Management

"Choosing Wisely" Campaign Promotes Smarter Medical Testing

In an effort to reduce wasteful spending without harming patients, nine medical societies have compiled a list of tests and treatments their members should no longer automatically order. MSNBC reports that the groups, which include the American Academy of Family Physicians, the American Society of Clinical Oncology and the American College of Cardiology, represent nearly 375,000 physicians.

Each of the specialty societies created a list of “Five Things Physicians and Patients Should Question". The 45 tests and procedures considered to be overused include:

  • Repeat colonoscopies within 10 years of a first test
  • Early imaging for most back pain
  • Brain scans for patients who fainted but didn’t have seizures
  • Antibiotics for mild- to-moderate sinusitis unless symptoms last for seven or more days or worsen
  • Stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present
  • PAP smears on women younger than 21 or who have had a hysterectomy for a non-cancer disease
  • Advanced imaging or bone scans in patients with early-stage breast or low-grade prostate cancer
  • Bone scan screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors
  • Routine cancer screening on dialysis patients with limited life expectancies
    Chemotherapy for sickest cancer patients

Complete lists are available at the “Choosing Wisely” website.

  01:40:49 pm, by MedBen5   , 354 words,  
Categories: News, Health Plan Management

President's Confident Comments Ruffle Feathers

In spite of rumblings that the Supreme Court could strike down the entirety of the Affordable Care Act, President Obama is confident that the health care reform law will stand, the New York Times reports. On Monday, he said that it would be an “unprecedented, extraordinary” step to overturn legislation passed by the “strong majority of a democratically elected Congress.”

Obama defended his signature legislative achievement, and cautioned right-leaning justices not to practice partisan politics from the bench:

“I’d just remind conservative commentators that for years what we’ve heard is the biggest problem on the bench is judicial activism or a lack of judicial restraint – that an unelected group of people would somehow overturn a duly constituted and passed law. Well, here’s a good example. And I’m pretty confident that this court will recognize that, and not take that step.”

The severity of the President’s comments rubbed some politicians and pundits the wrong way – even those who support the law. In The Washington Post, op-ed columnist Ruth Marcus called his words “unsettling“:

“To be clear, I believe the individual mandate is both good policy and sound law, well within Congress’ powers under the Commerce Clause… And yet, Obama’s assault on ‘an unelected group of people’ stopped me cold. Because, as the former constitutional law professor certainly understands, it is the essence of our governmental system to vest in the court the ultimate power to decide the meaning of the constitution. Even if, as the president said, it means overturning ‘a duly constituted and passed law.’”

No doubt aware of how his remarks had been received, Obama gave a more measured critique at a press luncheon on Tuesday:

“[T]he point I was making is that the Supreme Court is the final say on our Constitution and our laws, and all of us have to respect it, but it’s precisely because of that extraordinary power that the Court has traditionally exercised significant restraint and deference to our duly elected legislature, our Congress. And so the burden is on those who would overturn a law like this.”

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