LEXINGTON, Ky.--While 27 states and the District of Columbia chose to expand Medicaid eligibility to 138 percent of the federal poverty level by the end of 2014, more states are likely to consider expansion in 2015.

Debra Miller, CSG's director of health policy, said states that expand this year are likely to follow the lead of Arkansas, Iowa, Michigan and Pennsylvania and design state-specific programs that will require a waiver from the federal government.

"The pressures on the states that have not already expanded Medicaid are growing," Miller said. "Providers, especially hospitals, worry about their revenues. Many in the dollars-and-cents crowd worry about the economic loss of leaving federal money on the table. Consumer advocates tout the advantages of health insurance coverage not just for those newly covered, but for employers and the overall economy."

The federal government will reimburse states 100 percent of the cost of expansion for calendar years 2014 through 2016, and at a reduced rate thereafter.

Miller listed Medicaid expansion as the top health care-related issue facing state policymakers in 2015. The Council of State Governments this week released its annual listing of top 5 issues legislators will face this year in education, energy and the environment, federal affairs, fiscal and economic development, health, international affairs, interstate compacts, transportation and workforce development.

The Medicaid expansion was a part of the Patient Protection and Affordable Care Act, which will again loom large in states. Twenty-seven states are served by a federally facilitated health insurance exchange, while 14 states opted to operate a state-run health insurance exchange. Three states have a federally supported marketplace and seven are served by a state-federal partnership marketplace. A case before the Supreme Court this term raises questions about the subsidies for insurance coverage under those federal exchanges.

"Depending upon the upcoming Supreme Court decision on the exchange and insurance subsidy question, states could be forced into another round of decisions around ACA implementation," Miller said.

Other health issues will compete for the attention of state policymakers, Miller said. Among the questions they'll need to consider, she said, are these: "How can states make sure there are enough health care providers to deliver the right services at the right time? How will aging baby boomers change demands on the health care system? Will parity between physical health and behavioral health be achieved? How can the scourge of heroin and prescription drug abuse be stopped?"

Health care costs account for one of every six dollars spent in the economy.

"The growing share of states' budgets spent on health care--not just Medicaid, but state employee benefits, state retiree health care, and health costs in corrections as well--dictates that each dollar be spent as efficiently and effectively as possible," Miller said.

She said states will look at integrating health and human services to "break down artificial funding and service silos." They also will increasingly apply evidence-based standards to guide programs and services, she said.

"State policymakers will look to tackle upstream factors such as poverty, racism and educational achievement in order to reduce downstream costs," said Miller.

People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check ? that means maintaining good blood sugar control ? and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these complications of diabetes.

Heart Attack

Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call 911 immediately:

• Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
• Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
• Shortness of breath
• Nausea or lightheadedness

Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.

Stroke

Stroke warning signs may include :

• Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
• Feeling confused
• Difficulty walking and talking and lacking coordination
• Developing a severe headache for no apparent reason

If you suddenly experience any of these stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death.

Nerve Damage

People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:

• Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.
• Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.

If you notice any of the following symptoms, see your doctor:

• Inflammation and tenderness anywhere on your body
• Red, itchy rash surrounded by small blisters or scales
• Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
• Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
• Sharp pain that gets worse at night
• Muscle weakness that makes walking difficult
• Bladder infections and problems with bladder control
• Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
• Erectile dysfunction in men and vaginal dryness in women

Kidney Disease

Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.

Typically, you won't notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:

• Swelling in your ankles and legs
• Leg cramps
• A need to go to the bathroom more often at night
• A reduction in your need for insulin
• Nausea and vomiting
• Weakness and paleness
• Itching

The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.

Eye Problems

People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.

Call your doctor if you notice any of these warning signs:

• Blurry vision that lasts for more than two days
• Sudden loss of vision in one or both eyes
• Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
• A sensation of seeing "flashing lights"
• Pain or pressure in one or both eyes

Hyperglycemia

Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include :

• Frequent urination
• Extreme thirst
• Feeling tired and weak
• Blurry vision
• Feeling hungry even after eating

If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.

The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.

Report any unusual symptoms to your doctor. Together you can work to prevent these diabetes-related health complications.

Cincinnati, OH (Jan. 8, 2015) - Nearly everyone is on some kind of diet. Losing weight isn't easy. And keeping it off can be even harder. That's why Mercy Health (formerly Catholic Health Partners) - a Catholic healthcare ministry serving Ohio and Kentucky - has devoted the second of its monthly Mercy Health: Helping You Be Well videos to weight management.

In a concise video on Mercy Health's YouTube channel, Drs. Mohamed I. Dahman of Mercy Health Physicians in Cincinnati and Stephanie Dunkle-Blatter of St. Rita's Weight Management in Lima answer questions such as: How do I know if I'm at an unhealthy weight? What is the healthiest way to lose weight? What kind of foods should I eat? How much should I exercise? Are there any fad diets that could work for me?

An infographic with weight management tips is available at INSERT LINK. And Mercy Health is sharing tips throughout the month on its social media channels.

Mercy Health: Helping You Be Well, which spotlights key health issues and tips for healthy living, debuted in December. The videos feature Mercy Health physician experts who are committed to making lives better - mind, body and spirit.

About Mercy Health

or connect with Mercy Health on Facebook, Google+, Pinterest and Twitter (@LivingMercyHlth).

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If you had told me a year ago that I'd be gluten- and dairy-free, I would have laughed and then served up a huge lasagna. This Italian American practically has pasta running through her veins ? which likely contributed to my current health dilemma.

After my type 2 diabetes diagnosis in January, I began to read everything I could get my hands on about reversing the disease through diet and exercise. I watched Forks Over Knives and omitted animal products, saw a nutritionist and counted carb grams, and through it all, I drank a lot of kale.

Then, I picked up Dr. Mark Hyman's book Blood Sugar Solution. In it, he explains how common allergens like gluten, dairy, alcohol, and caffeine affect our bodies, even if we're not technically allergic. Certain foods are more likely to cause inflammation, which is a stress response that the body produces when we are fighting off something. A little inflammation helps you heal and then goes away, a ton of it hurts you and becomes constant. Inflammation and insulin resistance go hand in hand, and one of the ways to combat diabetes is to remove the triggering foods.

Dr. Hyman's research made sense to me, so I thought I'd give his diet a try. With little less than a month until my follow-up doctor's appointment, I wanted to jumpstart my progress. I read his 10-Day Detox Diet, which cuts out not only the inflammation triggers of gluten, dairy, caffeine, and alcohol, but also all grains, most fruit, legumes, and starchy vegetables, to help maintain balanced blood sugar levels. I welcomed the return of humanely-produced lean protein and an almost laughable amount of healthy fats ? nearly 20 g per meal ? which was absolutely shocking to someone who grew up in the 1980s and 1990s, when fat was the enemy. Could this really produce results? I was about to find out.

While it felt like an undertaking to commit to such a change, I figured that I could do practically anything for 10 days, so why not give it a shot? As I prepared to make everything that passed my lips for the next week and a half, I filled my shopping cart with raw nuts and coconut oil, hemp and flax and chia seeds, a lot of avocados, and a farmers market's worth of leafy greens and cruciferous veggies. I was ready to detox.

Though it wasn't all about the food. Stress causes inflammation, so a big part of healing yourself is to actively work on relaxation techniques. Detoxifying baths, journaling, breathing, media fasting, and exercise were all part of the plan, too. It's also a lot easier to make better food choices after you've taken a few deep, calming breaths.

As with most detoxes, it gets worse before it gets better. I had intense gluten withdrawal, which caused headaches, irritability, and the craziest cravings I had ever experienced. I felt like I would die (or someone in my immediate vicinity might) if I didn't immediately eat a pizza-pasta-bread sandwich. Thankfully, it passed in a couple of days, and the other side saw a lifting of "brain fog" that I didn't even know I had. So much energy! Such clarity! It felt pretty great.

At the end of 10 days, I had lost 8 pounds, bringing my overall weight loss to 25 pounds. My lab results showed marked improvement, with improved cholesterol and a reduction in my A1c (average blood sugar over three months) from 9.8 to 6.5.

While I have dabbled in gluten and dairy since the detox, I've noticed that I have more energy and fewer cravings when I avoid them. Though it doesn't hurt to hit the reset button every once in a while, diet remains a balance, and making good choices most of the time is the way to get and stay healthy.

Tara Bellucci is a lifestyle writer and marketing consultant focused on helping entrepreneurs boost their small businesses. Her work has appeared on Apartment Therapy, The Kitchn, and Boston.com. A co-founder of the Boston Food Swap, she hosts monthly events where people swap homemade and homegrown food. She writes openly about her health journey at MindMouthMantra.com.