Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.

Input: Consider Input: Paragraph: In its latest “report card,” the American College of Emergency Physicians said such reduced access earned the nation a “D+” — that’s down from the overall “C-“ grade from the group’s last report in 2009. Shortages and reduced hospital capacity make it more difficult to access emergency care, the group said. It also warned about the impact on disaster preparedness. While the report does not measure the actual quality of care provided, it does offer a snapshot of national and state policies affecting emergency medicine as seen by providers. Washington, D.C., was ranked the highest in the report, earning a “B-“ grade, while Wyoming ranked last and was the only state to earn an overall failing grade of “F.”  The group’s task force looked at scores of measure in five major categories — access to care, quality and patient safety, liability, injury prevention and disaster preparedness — and relied on data from the Centers for Disease Control and the Centers for Medicare and Medicaid Services, among others. The report comes just as the Affordable Care Act, known as Obamacare, comes into full effect this year. The 2010 law aims to expand access to health insurance and reduce the nation’s healthcare costs, but it has become a political flashpoint amid a troubled rollout of the federal insurance exchange website. While the physician’s report does not factor in all of the effects of the law — its grades are based on data from early 2013 — emergency rooms could be used even more as more Americans gain insurance coverage under Obamacare, it said. Some health experts have predicted that increasing the number of insured patients should reduce pressure on hospital emergency rooms because access to regular doctor care will improve, something that is hoped would prevent chronic conditions from spiraling out of control or help catch other problems before they worsen. But insurance coverage could also lead those who might have held off going to the emergency room to seek care, said Jon Mark Hirshon, an emergency medicine doctor and researcher at the University of Maryland who oversaw the group’s report card. Newly insured people also may have a hard time finding a regular doctor who accepts their plan, he said. “On top of that, emergency departments are open 24 hours a day, seven days a week. If I have a primary care provider but it’s 9 o’clock at night on a Friday and they’re closed, then people come to the emergency department,” Hirshon told Reuters. The group is asking for congressional hearings to probe whether the law puts “additional strains” on emergency rooms. Already, beds for patients have fallen from a rate of 358 per 100,000 people four years ago to about 330 beds per 100,000 people now, the report said. Wait times have increased to a median of 4.5 hours compared to four hours in 2009. Despite the dismal U.S. grade given by the group, it noted that policies and infrastructure varied widely by state. States with the best emergency care include Massachusetts, Maine, Nebraska and Colorado, while Kentucky, Montana, New Mexico and Arizona rounded out the bottom, just above Wyoming. States are also still grappling with the uninsured. By law, hospitals must provide emergency care regardless of patients’ ability to pay. Under Obamacare, states can expand access to Medicaid, the federal-state health insurance plan for the poor. Data shows that Medicaid patients use emergency rooms as much as other insured patients, but several recent studies have shown that Medicaid patients utilize them more than the uninsured. One study this month showed Oregon patients given Medicaid through a lottery increased their emergency room use by 40 percent compared to those not offered Medicaid. “We have to be leaner and more efficient, but it just becomes more and more challenging,” Hirshon said. Claim: Doctors say pressure on ERs may rise, give U.S. failing grade.

Output: People seeking urgent medical could face longer wait times and other challenges as demand increases under Obamacare, U.S. emergency doctors said in a report on Thursday that gives the nation’s emergency infrastructure a near failing grade.


Input: Consider Input: Paragraph: Ravalli County District Judge Jennifer Lint signed a temporary restraining order Friday that prohibits Gov. Steve Bullock and state health officials from enforcing emergency rules on flavored vaping products. They were set to take effect Tuesday. Lint was acting in response to a lawsuit filed Thursday by three vape shops and an industry group. They claim the 120-day ban is an overly restrictive reaction to a national outbreak of vaping-related illnesses and deaths they say is caused by illegal black-market products. Bullock’s press secretary, Erin Loranger, told the Ravalli Republic that officials are reviewing the judge’s ruling. The lawsuit was brought by the Montana Smoke Free Association, Freedom Vapes, Liberty Smoke and uBlaze Vapor said the ban could force more than 20 Montana businesses to close. The business owners said the pulmonary illnesses could be the result of the “illicit addition” of THC or marijuana products into legal vaping products. THC and marijuana are not included as ingredients in any of the products sold by the businesses involved in the lawsuit, according to the plaintiffs. The ban would not only harm the businesses, but also people who use e-cigarettes to quit tobacco products, the lawsuit said. In an affidavit filed in the lawsuit, Freedom Vapes owner Ron Marshall said that flavored vape juices comprise 95% of the products sold in his three stores and his business would not be able to survive without them. On Friday, he said that the lawsuit was about freedom and liberty. “If the governor can take away those liberties with a swipe of a pen, then what’s next? If it’s us today, who will it be tomorrow?” he said. Lint scheduled an Oct. 30 hearing to consider arguments about the future of the temporary ban. ___ Information from: Ravalli Republic , http://www.ravallirepublic.com Claim: Montana judge halts temporary flavored vaping ban.

Output: A temporary ban on the sale of flavored electronic cigarettes due to take effect next week in Montana has been blocked for now by a judge.


Input: Consider Input: Paragraph: The company declined to discuss details in the so-called  not approvable letter from the Food and Drug Administration. It  would not comment on whether the agency had asked for further  data or new clinical trials. The drug, which was expected to be called Cordaptive,  combines long-acting niacin with a new drug that prevents the  flushing side effect common to niacin — an uncomfortable  sensation of burning in the face and neck that leads many  patients to discontinue taking it. Analysts widely expected the drug to be approved,  especially after a committee of European regulators last week  recommended it be cleared for sale there. The rejection was another blow for Merck, whose share price  has fallen about 30 percent this year amid a controversy and  debate over the effectiveness of the cholesterol drugs its  sells in a joint venture with Schering-Plough Corp. The FDA decision should be a boon to Abbott Laboratories,  whose franchise of niacin-based cholesterol drugs would have  been in direct competition with Merck’s proposed new entry into  the lucrative market. Abbott shares rose 2.7 percent following the Merck news. Deutsche Bank analyst Barbara Ryan called the news a  disappointment. “We expected the drug to get approved,” she said. “It’s not  going to have any impact on the earnings outlook for this year,  but certainly as we go out in time they could have had an  important contribution from the drug.”    Merck said it would meet with the FDA to submit additional  information to enable the agency to further evaluate the  benefit/risk profile of the drug, which it has gone back to  calling MK-0524A after the FDA also rejected the prospective  brand name Cordaptive. “We firmly believe that MK-0524A provides physicians with  an important option to manage their patients’ cholesterol,”  Merck’s research chief Peter Kim said in a statement. The company said it did not yet know when a meeting with  FDA officials might take place. In clinical trials, the laropiprant component of the drug  demonstrated an ability to significantly reduce the flushing  effect of niacin. It had been hoped the combination would  enable patients to tolerate niacin at a dose that provides the  most therapeutic benefit. Despite the setback, Merck reaffirmed the 2008 forecast it  issued last week and reiterated confidence in meeting its goal  of double-digit annual earnings per share growth through 2010,  excluding certain items. Some analysts believed that Cordaptive and a planned  follow-up combination drug that also includes Merck’s bad  cholesterol lowering Zocor could eventually garner $1 billion  to $2 billion in annual sales. Merck shares fell to $39.40 in extended trading from their  New York Stock Exchange close at $41.44, while Abbott shares  climbed to $53 from the NYSE close at $51.61. Claim: Merck says FDA rejects its new cholesterol drug.


Output: U.S. health regulators have rejected  Merck & Co Inc’s new drug designed to raise the level of HDL,  or “good” cholesterol, the company said on Monday, sending its  shares down 5 percent.