Archive for the ‘Healthcare System’ Category

April 3, 2012

Health Benefits: What Women Won, and May Lose, in the Supreme Court’s Dark, Dark, Place

President Obama on Monday said he was “confident” the Supreme Court will uphold the Affordable Care Act, adding that overturning it would be an “unprecedented, extraordinary step.”

I think it’s important — because I watched some of the commentary last week — to remind people that this is not an abstract argument. People’s lives are affected by the lack of availability of healthcare, the inaffordability of healthcare, their inability to get healthcare because of preexisting conditions.

The law that’s already in place has already given 2.5 million young people healthcare that wouldn’t otherwise have it. There are tens of thousands of adults with preexisting conditions who have healthcare right now because of this law. Parents don’t have to worry about their children not being able to get healthcare because they can’t be prevented from getting healthcare as a consequence of a preexisting condition. That is part of this law.

And, as of 2014, adults would also be protected. Women could no longer be denied coverage based on pre-existing conditions such as pregnancy or domestic violence. The law would also eliminate gender rating, in which women end up paying more than men for insurance coverage.

And there’s more, via Raising Women’s Voices: A top 10 list of benefits for women under health care reform; specifics on how the law is already helping young women; and more details on how it supports women of color.

Back to Obama’s remarks:

Millions of seniors are paying less for prescription drugs because of this law. Americans all across the country have greater rights and protections with respect to the insurance companies, and are getting preventive care because of this law.

So, that’s just the part that’s already been implemented. That doesn’t speak to the 30 million people who stand to gain coverage once it’s fully implemented in 2014.

And I think it’s important, I think the American people understand and I think the justices should understand that in the absence of an individual mandate, you cannot have a mechanism to ensure that people with preexisting conditions can actually get healthcare.

ThinkProgress healthcare infographic We have to wait until sometime in June to find out if Obama is right, but there’s been no shortage of guess work underway to determine 1.) whether the Supreme Court will uphold the individual mandate requiring almost every American to buy health insurance; and 2.) what will become if health care reform if it does not.

Writing in The New Yorker, Jeffrey Toobin notes that the “heavy burden” of justification for the mandate — which Justice Anthony M. Kennedy asked Donald Verrilli, the solicitor general, to address — should instead be placed on the law’s challengers.

“The involvement of the federal government in the health-care market is not unprecedented; it dates back nearly fifty years, to the passage of Medicare and Medicaid,” writes Toobin. “The forty million uninsured Americans whose chances for coverage are riding on the outcome of the case are already entered ‘into commerce,’ because others are likely to pay their health-care costs.”

“Acts of Congress, like the health-care law, are presumed to be constitutional,” he later adds, “and it is—or should be—a grave and unusual step for unelected, unaccountable, life-tenured judges to overrule the work of the democratically elected branches of government.” Toobin then demonstrates how the justices’ questions reflected a troublesome meddling in policies set by Congress.

The Individual Mandate – A Not-So-Brief History
The individual mandate, as explained in this NPR story, has Republican roots dating back to 1989. Rachel Maddow discussed the party-line history during a recent segment, summed up as: “When Republicans proposed it — great idea, a conservative solution. When a Democrat has the idea, it’s socialism, tyranny and unconstitutional.”

Though Republicans circa 2012 would like Americans to believe the individual mandate is indeed “unprecedented,” Linda Greenhouse, who covered the Supreme Court for The New York Times for 30 years and who now writes a column on legal issues, applies the description to the politics of this debate:

What’s unprecedented is the singular determination of the Republicans both on Capitol Hill and in the statehouses to deprive President Obama of his major domestic achievement. Republican officeholders in all 26 states joined together in the case now known as United States Department of Health and Human Services v. State of Florida. In 22 of those states, the officeholder was the attorney general. In four states with Democratic attorneys general (Nevada, Wyoming, Iowa and Mississippi), Republican governors filed in their own names. If any of them noted any irony in the fact that not so long ago, the individual mandate was an idea cooked up by conservative policy wonks to counter more fundamental reform sought by the Clinton administration, they offer no sign.

The countless unprecedented things that Congress has done over the centuries were not, for that reason, unconstitutional. Social Security, Medicare, the Employee Retirement Income Security Act (Erisa), and the Emergency Medical Treatment and Labor Act, the 1986 law passed to prevent hospitals from refusing to care for uninsured patients in acute distress, all come to mind. (From the perspective of today’s toxic politics, it’s a miracle that any of these laws actually got passed, but that’s a separate issue.) So there must be some problem with the Affordable Care Act other than “never before.”

There are other federal mandates involving health care already on the books, including the Medicare payroll tax on workers and employers, and the 1996 Newborns’ and Mothers’ Health Protection Act, which requires plans offering maternity coverage to pay for at least a 48-hour hospital stay (96 hours following a c-section).

Isn’t It Ironic (Don’t You Think)
Some Republicans who can’t help but fly into an apoplectic rage upon hearing the term “mandate” in the context of health care reform remain surprisingly calm when mandating medical procedures for women.

Yes, I’m referring to government-mandated ultrasounds. Currently, seven states — most recently Virginia — mandate that an abortion provider perform an ultrasound on a woman seeking to have an abortion. These states, along with more than a dozen others, also require the provider to ask the woman if she’d like to view the image.

The Guttmacher Institute notes: “Since routine ultrasound is not considered medically necessary as a component of first-trimester abortion, the requirements appear to be a veiled attempt to personify the fetus and dissuade a woman from obtaining an abortion. Moreover, an ultrasound can add significantly to the cost of the procedure.”

Once again, Maddow breaks down the Republican hypocrisy:

The Road Ahead
The question of whether other parts of the Affordable Care Act can proceed without the individual mandate will continue to be debated until June. If the mandate alone is struck, insurance premiums would likely increase because insurance companies won’t have the built-in benefit of a broader insurance pool.

“Republicans would blame Obama for making health insurance more expensive. Democrats would blame insurers for the higher premiums. In other words: Déjà vu and total gridlock,” writes Jennifer Haberkorn of Politico. Her story explains what’s likely to happen if the Supreme Court strikes just the mandate, or the mandate and insurance reforms, along with the political fall-out if most of the law falls or is upheld.

Josh Gerstein, also of Politico, looks at the effects beyond health care reform: “If the justices knock out key parts of the law or bring down the whole thing, the reverberations could be felt across the legal landscape for generations to come, radically reining in the scope of federal power, according to supporters of the law and others who closely track the high court. And if the justices decide the individual mandate is a constitutional overreach, these observers say, federal labor and environmental laws could be the next on the firing line.”

If you think that seems too dire a prediction, consider Dahlia Lithwick’s reaction to comments made by the court’s conservative justice’s last week: “[A]s the justices pondered whether the individual mandate—that part of the Affordable Care Act that requires most Americans to purchase health insurance or pay a penalty—is constitutional, we got a window into the freedom some of the justices long for. And it is a dark, dark place.”

Those who would welcome the disintegration of health care reform include The Cato Institute’s Michael Cannon. He told NPR that if the entire law were to go away, “we would have just dodged this whole nasty debate over religious freedom and abortion.”

Meaning: There would be no increased access to preventive health care such as contraception, breastfeeding support, and screening for breast and cervical cancers and HIV. But hey, women’s health is so darn offensive when you get down to it, better to just cast it off. Thanks, but we’ve been there.

On the other hand, maybe a defeat at the hands of the Supreme Court will open new doors, for everyone.

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Additional Resources
- The National Women’s Law Center posted a short video explaining the legal challenges, why it thinks the law is constitutional, and what women could lose if the law is struck down.
- Jessica Gonzales-Rojas of the National Latina Institute for Reproductive Health explains more here.
Kaiser Health News coverage of the two-year anniversary of health care reform, from all angles. Plus, a timeline of major implementation milestones and the legal questions involved in the Supreme Court’s review.
Audio excerpts of arguments challenging the constitutionality of the 2010 health care law are posted on the NYT website, along with reporters’ analysis.

January 13, 2012

Ending Cervical Cancer Requires Ending Disparities in Access to Pap Tests and HPV Vaccines

Every year in the United States alone, more than 12,000 women are diagnosed and more than 4,000 women die of cervical cancer, a preventable disease that disproportionately affects women of color.

January is Cervical Cancer Awareness Month, and the National Latina Institute for Reproductive Health (NLIRH) is launching “¡Acábalo Ya! Working Together to End Cervical Cancer.” The campaign is aimed at educating Latinas about this disease and how to protect their health; raising the profile of cervical cancer prevention as a national reproductive justice and women’s health priority; and advocating for greater access to the tools and care needed to prevent, detect, and eventually end cervical cancer.

The NLIRH is hosting a blog carnival this week on the topic: What will it take to end cervical cancer? Read more on Why Cervical Cancer is a LGBT Issue by Verónica Bayetti-Flores, NLIRH policy research specialist; Cervical Cancer Awareness Month: Trans Men and Genderqueer/Gender Nonconforming People by the National Center for Transgender EqualityScreen More Women for Cervical Cancer – Not the Same Women More Often! by Kate Ryan, program coordinator, National Women’s Health Network; and Thank YOU Affordable Care Act for Helping Cervixes Stay Healthy by Keely Monroe, program coordinator, National Women’s Health Network.

The following text on disparities in access to Pap tests and HPV vaccines has been adapted from the 2011 edition of “Our Bodies, Ourselves.”

* * * * * * *

Most women who die of cervical cancer never had regular Pap tests, had false-negative results, or did not receive proper follow-up.

In the United States, socioeconomic and racial disparities are evident in statistics for cervical cancer. Vietnamese immigrants are five times more likely to be diagnosed with cervical cancer than white women. African-American and Native-American women are twice as likely to die of the disease as are white women. In one study, Hispanic women had about twice the cervical cancer incidence of non-Hispanic women in border counties near Mexico, and Hispanic women are 1.5 times more likely to die from cervical cancer as compared to non-Hispanic white women.

Disparities are due, at least in part, to women of color having less access to Pap screening and regular health care. It is quite possible that those women with the highest rates of cervical cancer will also have less access not only to Pap screening but also to the HPV vaccine. Until our health care system addresses such disparities in access, girls and women likely to benefit the most from this vaccine may well not be able to choose it.

To ensure more equal access to any adolescent vaccine, adequate infrastructure and resources must be made available. Some recommend implementation of school-based adolescent immunization programs similar to those formerly in place for delivery of hepatitis B vaccines. The United Kingdom and Australia have volunteer, nationally supported school-based campaigns that have resulted in high HPV vaccine coverage for about 70 percent of girls.

Currently, school-based health programs and routine preventive care visits for adolescents are limited in the United States, making it highly difficult to provide good access to HPV vaccines, especially the type of access needed to ensure all three required vaccine doses are administered. Available data suggest HPV vaccine coverage in the United States is low (less than 50 percent), and the proportion of girls receiving all three doses of the HPV vaccine is even lower (less than 25 percent).

Pap Tests Essential for Prevention and Treatment

HPV vaccines do not protect against all types of HPV associated with cervical cancer, and it is currently unclear how long they remain effective or whether booster shots will be needed to maintain protection throughout adulthood. Thus, regular Pap tests among sexually active women remain essential for cervical cancer prevention. Resources should not be diverted away from Pap screening programs to pay for the unusually expensive cervical cancer vaccine. Because Merck marketed Gardasil with a campaign that unnecessarily frightened girls, young women, and parents, many people now have a distorted view of this disease, the vaccine, and the continued importance of Pap screening.

There is no question that HPV vaccines represent an important scientific advance in the field of vaccine research, but exaggerating their potential benefit in places such as North America will not serve us well. In countries where there is little or no access to Pap screening, current HPV vaccines might have much more potential for saving lives if their costs were reduced considerably and if adequate infrastructure to prove them responsibly were securely in place.

The District of Columbia and dozens of states — many of which have been lobbied by vaccine makers to expand vaccination requirements — have introduced legislation to require, fund, or educate the public about the HPV vaccine. However, since 30 percent of infections are now caused by virus types for which the HPV vaccines do not provide protection, universal access to Pap tests remains critically important. Unfortunately, many girls in underserved communities (where HPV infection rates are often high) have less access to both the Pap test and the HPV vaccine.

For example, as of September 2009, when the CDC released its first state-level statistics for Gardasil, only 15.8 percent of girls in the relatively poor state of Mississippi had received the vaccine, compared with 54.7 percent of girls in the relatively wealthy state of Rhode Island. Partly because of greater access to Pap testing, the cervical cancer mortality rate in Rhode Island was already 50 percent lower than in Mississippi — which means the girls in Rhode Island are at much lower risk of contracting HPV to start with.

To reduce disparities for Latinas and other under-served women, we will need to make systemic changes in our health care system to increase access to screening and vaccinations for those who need it most.

August 30, 2011

Exploring the Health Needs of Incarcerated Women

The July/August issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing includes a series of articles on the health care needs of women in prison, including the need to address inequalities, provide thorough care for complex health conditions, and to attend to the end-of-life needs of female prisoners.

In End-of-Life Care and Barriers for Female Inmates, the authors explore a little-discussed topic. For background, they explain that “end-of-life” in prisons does not typically occur they way we might think, and so health care, and especially end-of-life care, for incarcerated women is much more complex than we might be aware:

Stereotypical images in the popular media promote a perception that prison death is due to suicide or homicide by fellow inmates. In reality, execution, homicide, and suicide combined account for less than one fourth of all prison deaths. The vast majority of deaths in U.S. prisons are a result of natural causes, and the leading causes are chronic, debilitating diseases, with heart disease, cancer, and liver disease the top three for women, followed by AIDS, suicide, septicemia, respiratory diseases, cerebrovascular diseases, influenza/pneumonia, and digestive diseases.

The authors explore the current problems with end-of-life care, such as inmates being removed to infirmaries that create social isolation and lack visiting hours, adequate facilities, or comfort care. They put it bluntly: “Within the current, prevalent public climate of ‘let ‘em rot,’ incarcerated women with EOL (end-of-life) needs are highly vulnerable.”

The authors then come to the following conclusion in response, one that we can certainly get behind: “The time has come to set aside the question ‘why provide humane care to dying female inmates?’ and to provide better EOL to all people.”

Another piece in the series advocates for prison health care providers to consider how past traumas might inform a female inmate’s health needs, encouraging providers to develop greater understanding of trauma in order to provide better care.

Finally, Barbara Guthrie writes a compelling piece, Toward a Gender-Responsive Restorative Correctional Health Care Model, which argues for institutions to completely rework their model of providing health care to female inmates. She calls for the explicit addressing of women’s specific health care needs and disparities, development of health action plans, free access to children and.or their caregivers, inclusion of educational and vocational training, and identification of health resources (such as community clinics) for women to access after release.

Guthrie writes about the need to address health and other inequities women experience prior to becoming incarcerated, and the ways in which confinement can make these inequalities worse. She writes:

At the time of confinement, female inmates are sicker than their male counterparts and are in dire need of health care….Specifically, female inmates, irrespective of their ethnicity or race, are more likely than their male counterparts to enter the correctional system with very serious and long-standing comorbidities as well as preexisting infectious diseases (HIV/AIDS, STIs, TB), chronic illness (diabetes, hypertension, cardiac disease, asthma), cancer (cervical and breast), substance use and abuse, and mental health issues/disorders (bipolar, depression, abuse, posttraumatic stress disorder…

Female inmates also report long-standing reproductive issues, such as intermittent bleeding and pelvic pain/discomfort that require screening and/or follow-up tests (Pap smears and or breast exams) or treatment during and after their confinement. Unfortunately, most correctional health care systems are unable to address the existing physical, mental, and social needs of female inmates, which exacerbates their already poor health.

Related to Guthrie’s work, this piece on gender-responsive strategies in jails may be of interest and covers some of the same principles.

August 4, 2011

The Effects of Using Birth Control, Right-Wing Version

As previously reported, women with health insurance will soon have access to a host of preventive health care services, including contraception, without having to pay out-of-pocket costs such as co-payments, co-insurance and deductibles.

Not surprisingly, the news rankled some conservatives who refuse to acknowledge the long-term economic or health benefits.

Take, for instance, Sandy Rios, a FOX News contributor and vice president of the Family-PAC Federal, a conservative political action committee, who likened women’s health needs to beauty services: ”We’re $14 trillion in debt and now we’re going to cover birth control, breast pumps, counseling for abuse? Are we going to do pedicures and manicures as well?”

Once again, we turn to Stephen Colbert to explain the outrage. And he does so beautifully, noting, for instance, that “a woman’s health decisions are a private matter between her priest and her husband,” and insurance companies should be in the business of covering only “necessary medical expenses — like boner pills.”

Plus, learn what happens when U.S. women get their hands on birth control pills …

The Colbert Report Mon – Thurs 11:30pm / 10:30c
Women’s Health-Nazi Plan
Colbert Report Full Episodes Political Humor & Satire Blog Video Archive

August 1, 2011

Yes! HHS Approves IOM Recommendations for Preventive Care for Women

Today, the U.S. Department of Health and Human Services announced that it is adopting the Institute of Medicine’s recommendations for preventive care services for women. This will ensure that women have access to the following services under health insurance plans without having to pay a co-payment, co-insurance or deductible:

  • well-woman visits
  • screening for gestational diabetes
  • HPV testing
  • STI counseling
  • HIV screening and counseling
  • contraception methods and counseling
  • breastfeeding support, supplies, and counseling
  • screening and counseling for domestic and interpersonal violence

Coverage for these services is expected to begin Aug. 1, 2012.

There is one caveat for some women regarding access to contraception without a co-pay — a provision that “Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.”

An announcement at the site indicates that public comment is welcome on this provision. Although I haven’t yet been able to locate it on, instructions for comment and more detail about the exemption is provided in this document.

July 28, 2011

IOM Recommendations Also Support Screening/Counseling for Violence

Last week, we highlighted the Institute of Medicine’s recommendation that birth control be covered without co-pays as a preventive service under health care reform.

Several other aspects of women’s health were also covered by the Institute’s recommendations, including “screening and counseling for interpersonal and domestic violence.” While the birth control prevention got a lot of attention online, we’ve seen less discussion of this and other recommendations, so thought we’d highlight it.

An email we received from Futures Without Violence called it a “historic victory,” and explained, “This is not a requirement for screening for domestic violence. It does however, break down significant barriers to integrating comprehensive responses to domestic violence and we believe it will create new opportunities to train providers how to identify and help patients in abusive relationships.”

Seen any good discussion of this violence screening/counseling recommendation? Let us know in the comments.

As a reminder, you can view the Institute’s press release, recommendations, report brief, and full report, “Clinical Preventive Services for Women: Closing the Gap,” online. The Department of Health and Human Services will still need to adopt this list of recommendations for the care to be covered under the Affordable Care Act.

Somewhat relatedly, the Department of Health and Human Services (which will decide whether to accept the Institute’s recommendations), is holding an “Apps Against Abuse” challenge, inviting people to develop applications that “provide young adults with tools to help prevent sexual assault and dating violence.” More information on entering the challenge is available here.

July 14, 2011

Speak Up Against Threats to Medicare

We received the following letter from Physicians for a National Health Program yesterday regarding political negotiations that range from raising the eligibility age for Medicare and increasing costs for participants to dismantling the program altogether. It’s an important issue and we hope you’ll take the time to learn more :

With the 46th anniversary of Medicare only a few weeks away (July 30), the program is in serious danger. … You may have seen the Washington Post story last week that said, “President Obama is pressing congressional leaders to consider a far-reaching debt-reduction plan that would force Democrats to accept major changes to Social Security and Medicare in exchange for Republican support for fresh tax revenue,” and as that part of his pitch he’s proposing “significant reductions in Medicare spending.”

Yesterday’s New York Times reports that the president has “agreed to consider a change in Medicare, which would have pushed up the eligibility requirement for recipients from the age of 65 to 67.” Others, such as Sen. Joseph Lieberman, I-Conn., have made similar proposals and are also pushing for increased cost-sharing by Medicare beneficiaries, e.g. much higher deductibles for doctors’ visits.

Such measures would unquestionably reduce access to health care by our nation’s elderly and severely disabled, worsen their health outcomes and increase financial hardship.

Still worse, others such as Rep. Paul Ryan, R-Wis., would dismantle the Medicare program altogether, replacing it with vouchers to buy private insurance.

As you know, PNHP has joined with others in calling for the protection of the Medicare and Medicaid programs, even as we have pointed out their limitations and advocated for a single-payer national health insurance program, an improved Medicare for all, as the best way to assure truly universal coverage and control costs.

We urge you to speak out on this issue and to submit a letter to the editor or an opinion piece to your local newspaper along these lines. You can find tips on how to do so here. Already a number of PNHP activists had their comments published, as illustrated by this op-ed by Dr. Jim Recht in Massachusetts and this letter by Ann Molison in Colorado.

This Thursday night, July 14, PNHP is hosting a special conference call on the status of Medicare featuring Bruce Vladeck, Ph.D., at 9 p.m. Eastern time. Vladeck, the former top administrator of the Medicare and Medicaid programs, will be followed by several PNHP national board members who will lead a discussion on “Medicare and single payer.” Dr. Claudia Fegan, past president of PNHP, will moderate the call. RSVP today and get call-in details by clicking here!

Garrett Adams, M.D., M.P.H.

July 6, 2011

Join the National Women’s Law Center for a Birth Control Blog Carnival

On July 21, the National Women’s Law Center is hosting a “Birth Control: We’ve Got You Covered” blog carnival to talk about the importance of access to birth control and to encourage the U.S. government to include birth control in a list of services that will be available without a co-pay.

The Affordable Care Act requires coverage – without a co-pay – for preventive services. Decisions about which services will be included are expected sometime this summer. Advocates, including the NWLC, have been working to encourage the Institute of Medicine and Department of Health and Human Services to include birth control as one of the preventive services to be covered.

If you’re unfamiliar with the “blog carnival” concept, it’s when lots of people post on the same topic or theme, and links to the posts are usually collected somewhere online – in this case by the NWLC. If you plan to participate with your own blog post on why birth control should be included as a key preventive care services for women, sign up online.

May 27, 2011

Vermont Passes Law Providing for Insurance Coverage of Home Births and Midwives, Birth Certificate Changes for Transgender Individuals

Last week, Vermont Governor Peter Shumlin signed into law a bill requiring that any health insurance and health benefit plans that provide maternity benefits (including Medicaid and public health care assistance plans) must provide coverage for midwifery services in hospitals, other health care facilities, and at home.

As I read the legislation, it includes coverage for both certified professional midwives and certified nurse-midwives.

The Governor remarked, “Access to midwifery care and home birth should not be limited only to those who can afford those services out of pocket. This law will ensure that all expectant mothers get the coverage and care they want and deserve.”

The legislation establishes a maternal mortality review board made up of an obstetrician, maternal-fetal medicine specialist, neonatologist, CNM, CPM, and other relevant specialists, along with a member of the public. This board will review maternal deaths in Vermont for factors associated with the deaths, and will make recommendations for systemic changes and legislation to address those factors.

Although it seems to have received less media attention, the law also includes a provision to allow transgender individuals to acquire new birth certificates reflecting their gender rather than the one assigned at birth. This will require a doctor’s note submitted to a court “stating that the individual has undergone surgical, hormonal, or other treatment appropriate for that individual for the purpose of gender transition.”

This reportedly makes Vermont the only state with a law that explicitly specifies that surgery is not required in order to obtain a new birth certificate. The law also provides that the original birth certificates will not be available for public inspection in order to protect individual privacy.

May 17, 2011

Health Literacy Resources for Providers

Earlier this month, I had the opportunity to attend the IHA health literacy conference, where many experts spoke about ways to make health information more understandable to more people.

Health literacy is a complex topic that I’m still learning about, but it encompasses more than just reading skills. According to a common definition, health literacy is “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Encompassed in that definition are basic reading skills, but also more complex skills such as those required to read a prescription bottle and figure out how and when to take a drug, number skills, listening skills, and other abilities needed to navigate the healthcare system.

In 2003, it was estimated that more than one in three U.S. adults had limited health literacy skills.

Beyond those basic statistics, though, are the stories of real patients who are not able to be full participants in their health care because the information they need is not explained in an accessible way. The video below features many of those stories, and is a powerful introduction to the barriers faced by patients with low health literacy.

It includes Toni Cordell-Seiple’s recollection of being told by a gynecologist that a “simple repair” was needed for the problems she was experiencing. Toni didn’t understand what the doctor told her or the forms she was required to sign at the hospital, and was naturally reluctant to reveal her lack of understanding. It was only in her follow-up visit when a nurse asked how she was feeling since her hysterectomy that Toni understood what had been done.

In addition to this introductory video, several resources were suggested by conference speakers that are good starting points for readers who want to learn more:

I’d also love to hear from any of you about what you’re doing to make sure patients get the information they need in a way they can use.

March 21, 2011

Medical Journal Editorial on U.S. Maternal Mortality as a Human Rights Failure

The March editorial for the journal Contraception frames rates of maternal mortality in the United States “not just a matter of public health, but a human rights failure.” The authors, from WomanCare Global, AWHONN, and Amnesty International, explain the problem:

The rise of maternal deaths in the United States is historic and worrisome. In 1987, maternal death ratios hit the all-time low of 6.6 deaths per 100,000 live birth. These ratios were essentially maintained for more than a decade. Around 2000, the ratio began to increase and has since nearly doubled, hovering between 12 and 15 deaths per 100,000 live births between 2003 and 2007…’near misses’ (maternal complications so severe the woman nearly died) have also increased by 27% between 1998 and 2005, now affecting approximately 34,000 women a year; and appalling disparities in maternal health outcomes exist between racial and ethnic groups, and among women living in different parts of the United States.

The authors draw attention to troublesome disparities, noting that “for the last 50 years, black women who give birth in the United States have been approximately four times as likely to die as white women,” although they do not seem to have higher rates of medical complications that are common causes of maternal death and hemorrhage. They also note that 25% of white women, 32% of black women and 41% of American Indian and Alaska Native women do not receive adequate prenatal care.

Authors Francine Coeytaux, Debra Bingham, and Nan Strauss explore possible reasons for the increase in maternal mortality, including lack of access to prenatal care, primary care, and insurance, inadequate or poor quality intrapartum care, limited postpartum care, overuse of medical interventions, and a lack of data collection and accountability.

They conclude with a call to action focused on systemic change, rather than smaller interventions in the health of individual women, arguing that “system-level improvements ensuring a uniformly high quality of care are also needed, and these improvements are beyond the control of the individual woman or an individual provider.” Action steps outlined in the piece include initiating, supporting and advancing legislation to reduce maternal mortality through improving care and reducing disparities, expanding data collection and analysis, and investigating more thoroughly why maternal deaths and injuries happen in the U.S. and taking steps to reduce those causes.

This and other editorials from Contraception are freely available online.

January 5, 2011

The New Year in Health Care Reform: Good News and Bad for Older Americans

The new, more Republican Congress is now in session, and we’re already seeing talk of repealing last year’s health care reform legislation. For now, older Americans can benefit from some of last year’s changes that are now becoming active, including:

  • The effect of the “doughnut hole” in Medicare Part D coverage should be reduced through a 50% discount on brand-name prescription drugs in the coverage gap. Senate Democrats are focusing on this benefit as one that should not be repealed by the new House and are vowing to block any such repeal.
  • Free preventive services, such as cancer screenings and annual wellness exams, will be available for seniors on Medicare.

Another expected benefit looks like it will be reversed:

  • The New York Times reports that Medicare regulations are being revised “to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday.” This is the provision which would have paid for the visits for Medicare recipients to talk to their physicians about their end-of-life wishes, which was distorted into political talk about “death panels.” The administration is citing a lack of public comment opportunity on the provision for its reversal.

An overview of other newly available healthcare benefits is available here.

December 3, 2010

New Recognition for Nurses Dedicated to Evidence-Based Model of Care

by Nekose Wills | OBOS program assistant

The Coalition for Improving Maternity Services (CIMS) has started the Mother-Friendly Nurse Recognition Initiative, which aims to recognize nurses who are dedicated to using an evidence-based model of care to improve health outcomes of birthing women and their babies.

CIMS will confer recognition to nurses who provide maternity care services consistent with the 10 Steps of the Mother-Friendly Childbirth Initiative (pdf). These nurses keep the best interest of women and babies at the forefront while embracing the MCFI as their guiding philosophical approach to the care of birthing women.

This handy FAQ page explains the program’s goals and application process. The application is available here.

Given the vital role nurses play in patient care and satisfaction, we are glad that CIMS recognizes their importance as well as the purpose of evidence-based care, even when it is not the popular choice.

July 7, 2010 Provides Tools for Understanding Health Care Options

Last month, Christine posted some resources for shopping for health insurance in light of the Patient Protection and Affordable Care Act, which institutes a number of changes in health insurance availability and coverage.

This month, one of the provisions of that Act was enacted to further aid in insurance shopping. The government is now offering a website where residents of any state can identify affordable health insurance coverage options in their state.

The website,, provides an online tool individuals and families can use to search for insurance and healthcare options. Under the “Find Insurance Options” section, you can put in information about your state, status (healthy individual, senior, young adult, etc.), age, and other non-personal details to find information about available plans in your area for individuals and families, including those considered “high risk” because they have a pre-existing health condition.

You can also find out if there are health care facilities near you that provide free or low-cost care.

The “Understand the New Law” section provides information on the Act and a timeline of when the various provisions will be implemented, and the “Information for You” section provides details specifically for families with children, individuals, people with disabilities, seniors, young adults, and employers.

The site also links to other federal sources of information, like Hospital Compare for healthcare quality data by hospital/location, and healthfinder for disease prevention information.

June 25, 2010

Proposed Rule Change Would Improve Hospital Visitation Rights

The U.S. Department of Health and Human Services this week announced a proposed rule change intended to make hospital visitation much easier for LGBTQ patients and their partners. The rule “would protect patients’ rights to choose their own visitors during a hospital stay, including visitors who are same-sex domestic partners.”

The proposed rule change follows up on an April 15 presidential memorandum requesting, in part, that critical access hospitals and hospitals participating in Medicaid or Medicare allow patients to designate visitors who would receive the same access as “immediate family members.” These participating hospitals “may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.”

As the memorandum explains:

[E]very day, all across America, patients are denied the kindnesses and caring of a loved one at their sides — whether in a sudden medical emergency or a prolonged hospital stay. Often, a widow or widower with no children is denied the support and comfort of a good friend. Members of religious orders are sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf. Also uniquely affected are gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives — unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated.

Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services (CMS), called the rule “an important step forward in the rights of all Americans to expect equal rights and privileges from the health care system, regardless of their personal and familial situations.”

The proposed rule will be available for public comment for 60 days, after which CMS will review the comments before finalizing the rule. It does not seem to be posted for comment yet at, but we’ll update this post with the link when it is.