Archive for the ‘Healthcare System’ Category

November 7, 2009

Is Your Representative On This List? Call Now to Preserve Abortion Coverage

We’ve received news that these Democrats are on the fence about the Stupak amendment that would restrict abortion coverage in the health reform bill (read this post for background).

If you live in any of these districts, or know someone who does, please call your representative *now* and let him know (yep, they’re all men) that women’s healthcare should not be negotiable.

Rep. Chris Carney (Pennsylvania – 10th district)

Rep. Ben Chandler (Kentucky – 6th district)

Rep. Jim Cooper (Tennessee – 5th district)

Rep. Henry Cuellar (Texas – 28th district)

Rep. Artur Davis (Alabama – 7th district)

Rep. Joe Donnelly (Indiana – 2nd district)

Rep. Richard Neal (Massachusetts – 2nd district)

Rep. Earl Pomeroy (North Dakota – at large)

Rep. Vic Snyder (Arkansas  - 2nd district)

Rep. John Tanner (Tennessee – 8th district)

Rep. Peter Visclosky (Indiana – 1st district)


November 7, 2009

So This is What It’s Come To: Abortion Amendment Limits Access for Women

The House is expected to vote today on a $1.055 trillion health care package that would expand coverage for up to 36 million people — but first there will be a vote on an amendment that severely limits abortion coverage in a new government-run insurance plan and through private insurance that is bought using government subsidies.

After a back-room fight last night, House Speaker Nancy Pelosi agreed to allow the amendment proposed by Rep. Bart Stupak (D-MI). It reads:

The amendment will prohibit federal funds for abortion services in the public option. It also prohibits individuals who receive affordability credits from purchasing a plan that provides elective abortions. However, it allows individuals, both who receive affordability credits and who do not, to separately purchase with their own funds plans that cover elective abortions. It also clarifies that private plans may still offer elective abortions.

If you are reading this on Saturday, stop. Call your representatives and tell them this amendment is unacceptable. Go, now. We’ll wait. [Update: See this list of 11 representatives who are on the fence. These members, in particular, need to hear from you.]

It looks likes the amendment has enough votes to pass may be a close vote, and lawmakers need to know that a health care bill that tosses out a legal medical procedure used by millions of women every year is unacceptable.

The Washington Post’s Ezra Klein writes:

The amendment is expected to pass with relative ease. Republicans will join with anti-choice Democrats to push it over the finish line. Once the amendment passes, the bill is cleared for a vote, and all parties expect that vote to succeed. Today looks likely to end with a historic, and important, vote. A vote that is a first step towards helping more than 30 million people secure health-care coverage, and making sure hundreds of millions are better protected from the vagaries of the insurance industry. But Stupak’s amendment is a bitter start. It is, however, not the end. Even if it muscles into the House bill, it will also have to pass in the Senate, and then survive conference, before it becomes law.

Illinois Democrat Jan Schakowsky told C-SPAN’s “Washington Journal” that she’ll vote for the bill’s passage today, even with the Stupak amendment, but would opposed the final bill if the amendment survives the conference committee.

“If that language were in the final final bill, I certainly couldn’t support it,” Schakowsky said.

Plus: This morning, members of the Democratic Women’s Caucus went to the microphone, one by one, to explain how the overall health care bill would benefit women. Republican Rep. Tom Price of Georgia responded with a stream of “I object. I object. I object.” It got ugly.

Here’s a five-minute video showing what went down; if you’re short for time, below is the “I object” mashup created by Media Matters.


October 28, 2009

Empowered Patients = ePatients

A new, freely available, open-access journal that launched this month reflects a position Our Bodies Ourselves has long held: Healthcare is better, and people are healthier and more empowered, when individuals are informed and can actively participate in their own care.

The Journal of Participatory Medicine, launched at last week’s Connected Health Symposium in Boston, will publish online peer-reviewed articles that “explore the extent to which shared decision-making in health care, and deep patient engagement, affect outcomes.” The inaugural issue includes articles from all stakeholders, including patients, healthcare providers, payers, and others.

The journal’s significance is underscored by the fact that current or former editors of three of the most prominent medical journals – JAMA, BMJ, and the Annals of Family Medicine – also contributed to the first issue. As Amy Romano at Science & Sensibility points out, even the journal’s peer review process is participatory and values the input of all stakeholders, especially patients themselves.

The journal is being published by the relatively new Society for Participatory Medicine. The organization also has a blog, e-patients.net, which focuses on and includes stories from patients becoming informed, connecting with other patients, finding support, and exploring potential treatments for their healthcare concerns.

The existence of this organization and its publications reflect a growing trend toward patient involvement in health care that has been inspired and enabled by the internet. The Pew Internet and American Life Project released a report earlier this year indicating that 61 percent of American adults look online for health information, and that “six in ten e-patients … say their most recent search had an impact, mostly minor, on their own health or the way they care for someone else.”

More than half said information they found online lead them to ask their physician new questions or to get a second opinion on their care.

The internet is also enabling access to personal health records and new ways of collecting and sharing health data. The Society and the Journal will promote efforts to encourage these developments while protecting patient confidentiality.

As one physician wrote of the e-patient phenomenon in 2008:

Patients want information, ideally tailored to their needs. They want to discuss this with their physicians without being shooed away, and would appreciate getting pointers. They even want access to their test results and medical records. Although many physicians feel threatened by all this, engaging the patient as a partner in her own care can be quite gratifying, improves patient satisfaction, and may even lead to better outcomes.

As an organization that has long held that women can become their own health experts and that women, as informed health consumers, are catalysts for social change, we agree.


October 28, 2009

The Definitive Breakdown of U.S. Health Care Myths and Facts

Those of you who are engaged in conversations with opponents to a public health insurance option might want to try pulling them away from Fox News for a moment and ask them to read Ellen Shaffer’s new piece, “U.S Health Care: Myths and Facts.”

Schaffer is co-director of the Center for Policy Analysis, which runs the EQUAL Health listserv (Equitable, Quality, Universal, Affordable Health). List members contributed to this comprehensive document, which answers such questions as:

  • Who’s More Efficient, Government or the Private Insurance Market?
  • Are We Spending Too Much on Health Care?
  • Do We Pay Too Much for Drugs?
  • Could Importing Drugs Reduce Prices?
  • Can Prevention Programs Reduce Health Care Costs?
  • Is Health Information Technology a Silver Bullet for Reducing Costs?
  • Are there really 46 Million Americans Who Can’t Get Health Care?
  • Can Universal Coverage Be Achieved by Mandating Everyone to Buy Insurance?
  • Do We Need More Government Programs to Cover Low-Income People?

Action Items:
- If you or your friends live in states where Democrats (or pretend-Democrats) are hesitating over the public option, call or write your elected officials and urge support.

- Starting Oct. 28 and running at least through Nov. 4, Healthcare-NOW is organizing Patients Not Profit Sit-Ins. Learn more at MobilizeForHealthcare.org.

Raising Women’s Voices has coverage of a teach-in on health reform held at Columbia University on Oct. 22. Sponsored by the Student Committee of the Public Health Association of NYC and the Black and Latino Caucus of the Mailman School of Public Health, the event drew nearly 60 students, faculty and members of the community.

If you want to sponsor a teach-in on a college campus, contact RWV: info [at] raisingwomensvoices [dot] org for sample materials and programs. And check RWV’s calendar for upcoming events and speak-outs.

- Organizing for America received around a thousand videos made by healthcare advocates; here are the 20 finalists for your vote. The winner’s video will air on national television.

20_healthcare_videos


October 22, 2009

A Doctor’s Disclosure: Crossing a Line to Offer Compassionate Care

The matter of how much personal information to share with patients comes up frequently for practitioners, and there are times when it can be most helpful. But it is a difficult decision.

In an essay online at WBUR public radio, Our Bodies Ourselves board member Anne Brewster, an internist who works at Massachusetts General Hospital, discusses her decision to disclose something about herself to a 30-year-old patient diagnosed with multiple sclerosis, an autoimmune disease of the central nervous system. When Brewster calls to give her the news, she shares that she has the same disease:

In revealing personal information, physician to patient, I had crossed a line. I did so intentionally, in an effort to bring compassion to our exchange, but still today, I cannot shake the slightly uneasy feeling that I have somehow breached medical etiquette.

When we enter medical school and don our white coats for the first time, the division between doctor and patient begins – “us” and “them.” We start our education by dissecting a human corpse, and in so doing, learn early on to separate the body from the person. We master the parts — the Ischial Tuberosity, the Latissimus Dorsi, the Sternocleidomastoid, the Flexor Digitorum Longus. We think about lymphatic drainage, muscle insertions, arterial supply, and nerve innervation. We divide the body into sections: distal and proximal, dorsal and ventral, lateral and medial.

We go on to study disease processes — so many that our heads spin. Eventually, we begin to take care of patients and are encouraged to remember the person behind the disease. We are instructed to make eye contact, to sit on the edge of the bed when we speak to a hospitalized patient, and to use touch when appropriate, by holding a hand or squeezing a shoulder. Empathy is cultivated, but at the same time, explicitly and implicitly, we are taught to keep an emotional distance. Sharing personal information is taboo.

Part of this is for survival. None of us could bear to feel all of the pain, the fear, the loss that we encounter daily in medical practice. If we allowed ourselves to realize that we are vulnerable to all of the diseases we treat, all the time, we could not function. And part of this is about being a good doctor. Emotions can cloud judgment, and the preservation of professional boundaries is essential to quality care.

But true objectivity is a myth.

Continue reading this excellent essay.


October 13, 2009

Olympia Snowe to Vote Yes on Senate Finance Committee Health Care Bill

Update (2:52 p.m.): Final vote — Senate Finance Committee passes health reform bill by a vote of 14-9, with Sen. Olympia Snowe the lone Republican voting in favor.

Update: Public option supporter Sen. Jay Rockefeller will also vote “yes.”

The Senate Finance Committee is expected to vote on health reform legislation proposed by Sen. Max Baucus (D-Mont.) this afternoon or evening. The bill is expected to make it out of committee, but one of the lingering questions had been whether it would pass with or without the support of Sen. Olympia Snowe (R-Maine). It’s no longer a question — Snowe announced she will break with her party and support the Finance Committee bill.

“Is this bill all that I want? Far from it,” Snowe said. “Is it all that it can be? Far from it. But when history calls, history calls.”

She noted that consequences of inaction “dictate the urgency of Congress to take every opportunity to demonstrate its capacity to solve the monumental issues of our time.” (Listen to Snowe’s full statement at NPR.)

There’s no guarantee Snowe will vote for future versions of the legislation, and it remains to be seen how much Democrats will have to bend to keep the Maine Republican on board.

For more from today’s committee vote, Katherine Q. Seelye is live blogging at The New York Times blog Prescriptions.

More healthcare reading:

- “As the manipulation, posturing and bickering over health reform led primarily by conservative male congressional leaders, pundits, anti-choice organization leaders and ‘anti-reform town hall’ groupies drones on, the Democratic women of the Senate stepped up,” writes Jodi Jacobson at RH Reality Check, describing the actions of eight female senators last week.

“The Senators’ obvious frustrations — and even anger — at the slow progress on health reform legislation, the fact that untold numbers of Americans continue to become ill or die due to lack of timely health care, and the political games being with played reproductive health services was refreshing, frank, and long overdue,” continues Jacobson.

- Clark Hoyt, The New York Times public editor, on Sunday provided a behind-the-scenes look at the newspaper’s approach to covering health care reform, and he explained new features created to help readers understand the policy debate. In addition to the Prescriptions blog mentioned above, OBOS readers may also be interested in a new online forum, Health Care Conversations, which invites readers to comment on 20 healthcare-related topics, including popular conversation starters such as the public option and single-payer healthcare. Less busy is the forum on women and healthcare.


October 8, 2009

Health Care Reform Update: Senate Finance Committee Sets Vote for Tuesday; Poll: 61 Percent of Voters Favor Public Option; Legislators Tackle Gender Gap …

The vote on the Senate Finance Committee health reform bill has a date: Tuesday, Oct. 13.

The decision comes one day after the Congressional Budget Office reported that the committee’s legislation would cover 29 million uninsured Americans but would still slow the growth of spending and would reduce deficits by a total of $81 billion over a decade.

“Despite the expansion of coverage at a cost of $829 billion over 10 years, the budget office said 25 million people — about one-third of them illegal immigrants — would still be uninsured in 2019,” reports The New York Times. “In all, it said, the proportion of nonelderly Americans with insurance would rise over the 10 years to 94 percent, from 83 percent today.”

Meanwhile, House Speaker Nancy Pelosi (D-Calif.) today said that she’s going to send the CBO multiple variations of a health care bill that combines legislation from three different House committees. Ben Pershing at the Washington Post writes:

Pelosi said Thursday that she would send one bill to the CBO with what she called a “robust public option,” that would reimburse health-care providers at 5 percent above Medicare rates. The other two versions would have rates negotiated between the government and providers. “There’s no question that the robust public option scores very well,” Pelosi said, emphasizing that the first version would cost less but acknowledging that it might not be able to garner the 218 votes needed for passage. (Democrats hold 256 seats in the House.) “It’s very close,” she said.

Despite that split in her caucus, Pelosi said she felt “we’re in a very good place, because we have many good options. … There will be the votes for a public option. Now it’s a question of which one.”

After Pelosi gets the CBO’s analysis back, Democratic leaders and the House Rules Committee will complete the job of assembling a bill for floor consideration. The leadership has already ruled out bringing a bill to the floor next week, so the week of Oct. 19 would be the earliest time a vote would occur.

Speaking of a government-run insurance option, a new Qunnipiac University poll shows public support is running 2-to-1, with 61 percent in favor and 34 percent opposed. Other findings: “By a 57-37 percent margin, voters say Congress should not approve a health care overhaul with only Democratic votes. Democrats are OK with a one-party bill 63-29 percent, but opposition is 88-9 percent from Republicans and 62-32 percent from independent voters.”

Plus:

* Domestic Abuse Victims Struggle with Another Blow: Difficulty Getting Health Insurance: Good story at Kaiser Health News. For background, see this report from the National Women’s Law Center on how the individual health insurance market fails women.

* Health Care Bills Tackle Gender Gap in Coverage: USA Today reports on efforts to include provisions in health care legislation that would ban insurance companies from charging women more for the same policies as men and require companies to provide maternity coverage in their basic plans.

See our previous coverage on this subject, featuring the best line of the 2009 HCR debates: The response by Sen. Debbie Stabenow (D-Mich.) to Sen. John Kyl (R-Ariz.) when he questioned why maternity coverage should be mandatory when he doesn’t need it — “I think your mom probably did.”

* Health-Reform Anxiety: One Doctor’s Perspective: Anne Brewster, an internist and instructor in medicine at Harvard Medical School, left primary care medicine because she says she “felt unable to care for patients the way I wanted to within the constraints of the current system.”

Now an an urgent-care provider in Boston, Brewster, who is also an Our Bodies Ourselves board member, has written an essay for WBUR public radio on whether health reform will empower doctors.

“Reform should make my job more, not less, satisfying,” writes Brewster. “Of course, doctors should be expected to offer the highest quality care in the most cost-effective manner, but policies must be built on a foundation of trust in physician motivation and competency. Most physicians have a sound knowledge base, and are driven by a genuine desire to take care of people and ‘do no harm.’ Professional autonomy must be protected. Instead of imposing mandates and restrictions from above like an authoritarian parent, policy makers should work to provide physicians with the tools to meet these expectations.” Continue reading


October 7, 2009

New Briefs on Health Reform Discuss Comparative Effectiveness Research, Women’s Access to Care

We have written in recent months about the inclusion of money for comparative effectiveness research (CER) in the stimulus bill, the call for comments as to priorities for that research, and the subsequent list of priorities for funding of that research.

Comparative effectiveness research and the associated process isn’t always easy to explain, though, and was the focus of some drama when the stimulus bill was debated, with some arguing that the research would lead to rationing of care.

To help understand the topic, the Kaiser Family Foundation has released a brief on the topic, Explaining Health Reform:  What is Comparative Effectiveness Research?. The document reviews the purpose of CER, recent federal actions, and where/how it is included in proposed health reform legislation. It also provides discussion of key questions such as whether this type of research should include cost (in addition to clinical efficacy), how the results will be disseminated, and how those results might affect coverage decisions and health care costs.

The National Partnership for Women and Families is also addressing this topic with their Myths & Facts about Comparative Effectiveness Research [PDF]. It responds to some ideas about CER such as whether the research might lead to rationing of health care, “one size fits all” medicine, or exclusion of special or minority populations, and whether drug and device makers might lose the incentive to create new treatments.

The Kaiser Family Foundation has also released a second brief on health care reform, Health Reform: Implications for Women’s Access to Coverage and Care. It discusses women’s access to insurance through various avenues and benefits of importance to women including preventive, reproductive health, and long-term care, providing relevant information about the current state of women’s access to care and where improvements might be made via health reform.

Full disclosure: one project I contribute to in my work is funded through the AHRQ, an agency which receives some of the comparative effectiveness dollars included in the stimulus package.


October 1, 2009

Health Care Reform Update: Effort to Restrict Abortion Coverage Fails, Mixed Results on Abstinence Only Funding

The health care reform debate hasn’t been encouraging for reproductive health advocates, but on Wednesday the Senate Finance Committee pushed back against a Republican amendment designed to “doubly triply restrict abortion coverage in the bill,” as Rachel Maddow described it last night.

Republican Olympia Snowe of Maine joined almost all of the Democrats to defeat the amendment 13-10. Sen. Kent Conrad of North Dakota, a Democrat, voted for the restrictions along with the rest of the Republicans. Robert Pear of The New York Times explains the framework of the amendment:

The bill, written by the chairman of the Finance Committee, Senator Max Baucus, Democrat of Montana, says that no tax credits could be used to pay for abortions except as allowed in the latest appropriations for the Department of Health and Human Services — in case of rape or incest or if the life of a pregnant woman was in danger.

Under the bill, some health plans would cover abortion, and some would not. Private insurers that chose to cover abortion would be required to segregate money, taken from private premiums, to cover the procedure.

The amendment, offered Wednesday by Senator Orrin G. Hatch, Republican of Utah, would have gone much further. It said that no money provided under the legislation could be used to pay “any part of the costs of any health plan that includes coverage of abortion,” with a few limited exceptions. Under the proposal, insurers could have offered “a separate supplemental policy” to cover abortions. Such policies would have been financed “solely by supplemental premiums paid by individuals choosing to purchase the policy.”

Once again, Sen. Debbie Stabenow (D-Mich.), who demonstrated last week during a debate about pregnancy coverage that she is a no-nonsense force to be reckoned with, fired back against treating women as second-class citizens. She argued that the amendment goes far beyond existing law, which already prohibits spending federal dollars to pay for abortions for women on Medicaid, and it would restrict access to abortion for all women. Here’s my transcript of the video above:

In fact, with all respect to my friend, as a woman, I find it offensive that in [this amendment], any woman, any family purchasing through the exchange — if they did not receive any tax credit — would be prohibited from having the full range of health care options that they may need covered. This doesn’t just refer to the tax credits. As I read this: “prohibit private insurers operating through the exchange from offering coverage” — this is an unprecedented restriction on people who paid for their own health care insurance.

Then, when we look at the fact that this offers, that people could have a supplemental single-service rider, the assumption that somehow a woman or family would say, “You know, some day we may have an unintended pregnancy, so we’re going to get a separate rider. Or maybe my pregnancy is going to have a crisis — many, many crises — and so we’re going to try to find some other rider.”

In my judgment, I don’t even know how that would work. In the few states that have tried to do that, there’s no evidence that even those kinds of riders are available.

It’s remarkable that discussions about abortion conveniently leave out that it is a legal, medical procedure. Or that one in three women will have had an abortion by age 45. Or that three-fourths of women who obtain an abortion say they cannot afford to have a child. Or — as we saw in the weeks after the murder of Dr. George Tiller, when women stepped forward to reveal their stories — the decision is sometimes heartbreakingly, medically necessary.

We’re not the only ones frustrated by the way abortion has turned into a wedge issue for health care reform.

“In a rational system of medical care, there would be virtually no restrictions on financing abortions,” reads an editorial published in today’s New York Times. ”But abortion is not a rational issue, and opponents have succeeded in broadly denying the use of federal dollars to pay for them, except in the case of pregnancies that result from rape or incest or that endanger a woman’s life.”

“There should be no restrictions on abortion coverage in the exchanges,” the editorial concludes. “Health care reformers should not retreat on this issue, but we recognize that principle is often sacrificed in Congressional bargaining. Democrats who support the compromise must find a way to prevent it from being used later to go after other tax subsidies and thus further deny Americans’ rights to make their own health-care decisions.”

Hatch put forth a second amendment to strengthen existing “conscience clause” laws protecting healthcare workers from performing abortions or other services to which they have moral or ethical objections. It also failed on the same on the same 10-13 margin; Snowe voted with the Democrats, and Conrad with the Republicans.

Funding for Abstinence Only Education

On Tuesday night, the committee approved a comprehensive sex education funding stream, the Personal Responsibility Education for Adulthood Training. That amendment, proposed by Baucus, provides $75 million for states, according to the Sexuality Information and Education Council of the United States (SIECUS), “$50 million of which would be geared to evidence-based, medically accurate, age-appropriate programs to educate adolescents about both abstinence and contraception in order to prevent unintended teen pregnancy and sexually transmitted infections, including HIV/AIDS. The remaining funds would be for innovative programs as well as research and evaluation.”

Snowe joined all Democrats in passing the amendment; the vote was 14–9.

Yet on the same night, the committee voted for an amendment introduced by Hatch to restore federal funding for abstinence-only education — “better known,” said Maddow, “as the best teen pregnancy and STD delivery system politicians have ever devised.”

Democrats Conrad and Blanche Lincoln of Arkansas joined all 10 Republicans on the Finance Committee to vote in favor of adding $50 million-a-year funding for the Title V abstinence-only program to the health care bill, despite the fact that President Obama’s 2010 budget eliminated funding for abstinence-only education programs — because they simply don’t work.

Even Texas got the message. The state that ranks first in spending on sexual abstinence has the third-highest teen birth rate in the country and the highest percentage of teen mothers giving birth more than once. As the Austin American-Statesman reported on Sunday, some school districts are giving up the abstinence-only model and adopting a more comprehensive sex education curriculum, also called “abstinence-plus.”

Both amendments still have to pass the full House and Senate, so it’s anyone guess where the dollars will fall, but SEICUS is optimistic that legislators will wake up and reject the abstinence-only funding.

“This amendment takes a giant step backward by restoring funding for the failed and discredited abstinence-only-until-marriage program for the states,” said William Smith, vice president for public policy at SEICUS. “However, because this program so clearly doesn’t work and half the states don’t even participate, we are confident it will be stripped from the final bill and ask Congressional leaders and the White House to ensure this happens.”


September 29, 2009

Health Care Reform Update: Senate Finance Committee Rejects Public Option

The Senate Finance Committee today rejected two proposals to add a public option — a government-sponsored insurance policy that would compete with private plans — to the health care reform bill put forth by Senator Max Baucus (D-Mont.).

David M. Herszenhorn of The New York Times writes:

The committee on Tuesday afternoon voted, 15 to 8, to reject an amendment proposed by Senator John D. Rockefeller IV, Democrat of West Virginia, to add a public option called the Community Choice Health Plan, an outcome that underscored the lack of support for a government plan among many Democrats.

Mr. Baucus voted no, as did Senators Thomas R. Carper of Delaware, Kent Conrad of North Dakota, Blanche Lincoln of Arkansas, and Bill Nelson of Florida, joining all 10 Republicans in opposition.

A second amendment by Senator Charles E. Schumer, Democrat of New York, to create a different version of a public plan was also defeated, though by a closer margin, 13 to 10, with the added support of Mr. Carper and Mr. Nelson.

Mr. Schumer who voted in favor of both proposals, said supporters of the public option would keep on fighting.

“We are going to keep at this and at this and at this until we succeed, because we believe in it so strongly,” he said.

Continue reading for more analysis.

This story in The Hill on the public option was published before today’s vote, but it’s worth reading for a look at the compromise Senate Majority Leader Harry Reid (D-Nev.) will try to forge between what emerges from the Finance Committee and the Senate’s Health, Education, Labor and Pensions Committee bill, which includes a strong public option. Polls show solid public support for a public option.

Plus: Have you seen this video of Robert Reich explaining the public option? He’s quite clear and concise.


September 29, 2009

Women & Health Care Reform – The Debate Continues

Women received a serious wake-up call Friday when Sen. John Kyl (R-Ariz.) questioned why his insurance should include maternity care. A comment left on my post asks, “Why require this in EVERY plan? Won’t that just raise costs? Men don’t need it, working feminist women who don’t have children certainly don’t either.”

Hmmm. Without taking that bait, I will say that the commenter, as well as the senator, apparently is unaware that insurance works on pooling of risks. While it might be interesting to see what Kyl’s personal a la carte health insurance plan might look like, such individual choice would not be practical or affordable so long as insurance companies seek to maintain the same level of profit. Not to mention that what one person thinks he or she needs today can change overnight. Can you imagine all the “pre-existing condition” denials?

There’s also the issue of wanting to improve health outcomes for all mothers and children, but clearly that’s not Kyl’s priority.

Already, insurance carriers are free in most states to charge women and men different premiums for individually purchased insurance under a practice known as gender rating, as this report (pdf) from the National Women’s Law Center explains.

Nancy Folbre, an economics professor at the University of Massachusetts, Amherst, notes that women are often discriminated against when they try to buy individual health insurance, in part because pregnancy and family planning require more health care. “The typical American woman who wants to have two children will spend about five years being pregnant, recovering from pregnancy or trying to get pregnant, and about 30 years trying to avoid unintended pregnancies,” Folbre writes in a post at the The New York Times Economix blog.

Maternity isn’t the only way in which women are penalized. Looking at health care coverage over a lifetime, Folbre makes a clear case for why reform is essential for women, starting with the point that for many women, their insurance is tied to their husband’s work. A job loss or divorce leaves them vulnerable to having no insurance. (This is one of the reasons Our Bodies Ourselves is in favor of a single-payer system, because coverage would be independent from marriage or employment.)

Folbre continues:

Although fewer adult women than men lack health insurance, they seem to be more affected by insurance-related problems, including inadequate coverage. A Commonwealth Fund study released last May found that about 52 percent of working-age women, compared to 39 percent of working-age men, reported in 2007 that they had to forgo filling a prescription, seeing a specialist, obtaining a recommended medical test or seeing a doctor at all as a result of medical costs.

In striking testimony to financial vulnerability, more than one-half of all bankruptcies related to medical costs in the United States in 2007 were filed by female-headed households.

Women in their 50s and early 60s who are married to older men face a distinctive risk — loss of access to their husband’s employer-related coverage when he makes the transition to Medicare but they are not yet old enough to be eligible. The resulting disruption in coverage often has adverse effects on their health.

Women are important health care providers as well as consumers. Over 59 percent of informal, unpaid caregivers are women, and women devote significantly more time to the care of sick, disabled and elderly family members than men do. Indeed, such commitments help explain why women are more likely than men to work part time and to exit the paid labor force for longer periods of time.

Cheers to Cindy Pearson, executive director of National Women’s Health Network, for adding this comment to Folbre’s post:

You’re so right! Thanks for this well-written commentary. Women’s health activists have known all this for a long-time & many of us are organizing in support of health reform. Remember Our Bodies, Ourselves? They’re just one of many women’s health groups working on this issue. Check out Raising Women’s Voices for the Health Care We Need, SisterSong, National Women’s Health Network and others.

Plus: In other health care news today –

* Katherine Seelye is live blogging the Senate Finance Committee debate on the public option. Democratic senators Charles Schumer of New York and David Rockefeller of West Virginia have proposed separate public option amendments (view Rockefeller’s and Schumer’s, both pdf’s). The debate was postponed from Friday. You can watch live here.

* David Kirkpatrick writes about how the health care reform debate has become a fight over abortion.

* A handy health care reform glossary.


September 28, 2009

Could a Smart Retort on Maternity Care Help Build Support for Comprehensive Health Care Reform?

That’s what reform advocates are hoping, as a video from Friday’s Senate Finance Committee spread over the weekend. The short clip, embedded below, shows a great practical and philosophical divide over women’s health care.

During discussion on the health care bill proposed by Sen. Max Baucus (D-Mont.), the committee debated one of Sen. Jon Kyl’s (R-Ariz.) amendments, which would prohibit the government from defining specific health benefits that insurers must offer.

Sen. Debbie Stabenow (D-Mich.) argued that under a new system, insurance companies should be required to cover basic maternity care. According to Kaiser Family Foundation, only 18 states mandate maternity coverage, and that number falls to 14 when applied to individual insurance markets.

Women who seek insurance on these open markets face other barriers, too; they can be disqualified for having had a previous c-section — or even for having been pregnant. Yes, pregnancy is a pre-existing condition. You can read more frustrating facts about the open insurance market — like how it’s still legal in nine states and the District of Columbia to deny a woman coverage because she’s been the victim of domestic violence — in this report by the National Women’s Law Center (covered here in October 2008).

But Kyl doesn’t plan on getting pregnant, so really, what’s the big whoop?

“Well, first of all, I don’t need maternity care,” Kyl said. “So requiring that to be in my insurance policy is something that I don’t need and will make the policy more expensive.”

Stabenow, smiling, interrupted: “I think your mom probably did.”

Kyl brushed off the remark, noting that was more than 60 years ago. Follow-up on insurers covering Viagra and prostate cancer did not ensue.

The Kyl-Stabenow exchange made the rounds in news stories and blog postings over the weekend. Almost 3,000 comments have been left on just this one Huffington Post brief. This version of the video has been viewed more than 122,000 times as of Monday morning.

Kyl should be thanked — it’s not every day a senator appears so stunningly tone-deaf on an issue that affects the entire population.

There are 4.3 million births per year in the United States, according to Childbirth Connection, which recently released a report (pdf) outlining how health care reform should address maternity care. Kyl’s staff should have held up flashcards noting that 85 percent of all women give birth, and 23 percent of hospital discharges are childbearing women or newborns. A woman’s health before and between pregnancies can have a major impact on pregnancy outcomes — and costs.

But again: Why should Kyl care?

For the record, Kyl’s amendment was defeated 14-9.

All this went down exactly one week after First Lady Michelle Obama made a personal appeal for health care, emphasizing the benefits to women and families. Speaking at an event sponsored by the White House Council on Women and Girls, Obama said “it’s still shocking” that women face discrimination when it comes to insurance premiums and coverage.

“I think it’s clear that health insurance reform and what it means for our families is very much a women’s issue,” said Obama (read her full remarks here).

Perhaps after watching Kyl, more Americans will be outraged that women can be denied coverage because of pregnancy. And maybe — just maybe — Stabenow’s six words, likely the first “your mother” joke  ever told during a debate on health care reform, will persuade voters that maternity coverage is worth it for everyone.

*For more compelling reasons why women need comprehensive health reform, see this fact sheet (pdf) from the National Women’s Law Center, and these statistics on health insurance coverage compiled by the U.S. Department of Health & Human Services.

Update: As noted in the comments below, the NWLC is asking people to send in baby photos to show Kyl why maternity coverage is basic health care for all.


September 22, 2009

Political Diagnosis: Senate Finance Committee Considers Health Care Reform Bill

The Senate Finance Committee today began its mark up on the health care overhaul bill put forth by Sen. Max Baucus (D-Mont.). C-SPAN is covering it live; you can watch streaming video here.

Baucus, chair of the committee, seemed to anger all Republicans and Democrats when he released a bill last week that was more conservative than what most Democrats in Congress wanted, yet not conservative enough for any Republican to sign on.

Other committee members have since contributed 534 amendments (here they are, in a 348-page document [pdf]), including three different amendments calling for a public health insurance option to compete with private insurers.

*A recent survey of more than 5,000 doctors by the Robert Woods Johnson Foundation found that the overwhelming majority support expanding health care coverage to include both public and private insurance options. Baucus’s bill shuns the public option in favor of co-ops, which are not considered much of a threat to the insurance industry.

Baucus also faces criticism on funding.

Richard J. Kirsch, national campaign manager of Health Care for America Now, told The New York Times: “The tax credits in the original Baucus plan were so low they would make premiums unaffordable for many moderate- and middle-income people, who could also face high out-of-pocket costs. And if they don’t pay the premiums, they might have to pay a fine.”

Baucus (above left, greeting the committee’s ranking Republican, Sen. Charles Grassley of Iowa) has said he will make some modifications to the bill to provide more assistance to moderate-income Americans who need help buying insurance.

The Amendments

Igor Volsky at Wonk Room breaks down some of the most important amendments into categories for coverage, financing and delivery reforms. View the complete list here.

Volsky’s charts also include some of the more outrageous Republican amendments, such as this gem from Sen. John Kyl (R-Ariz.): “Prohibit the federal government’s takeover of health care.”

Ezra Klein, who previously described the Baucus bill as “a very good platform with some very severe failings,” offers five recommendations to improve it, including phasing in Sen. Ron Weyden’s Free Choice amendment and creating real competition for insurance companies. Klein also prepared a good summary of the amendments Sen. Olympia Snowe (R-Maine) has offered, including a public plan trigger.

About Abortion

Sen. Jay Rockefeller (D-W.V.) has proposed a number of useful amendments, including establishing a public insurance option and limiting out-of-pocket costs. But it’s his amendment #C6 (see page 12) that really intrigues me. A hero last week to progressives for his strong stance against a Senate bill that lacks a public option, Rockefeller disappointed many of those same advocates for denying women enrolled in the public plan access to abortion services:

This amendment would add a strong public health insurance option, the Consumer Choice Health Plan (CCHP), to the exchange to compete directly with private plans. Like private health plans, CCHP would be offered to all individuals and businesses purchasing health insurance through the national health insurance exchange. […] At a minimum, the Consumer Choice Health Plan would be required to follow the same insurance regulations as private plans operating in the exchange. CCHP would also be required to offer the same type of plans as private plans participating in the exchange.

Well, not exactly. The CCHP, according to Rockefeller, “shall not include abortion, except in cases of rape, incest, or the life of the mother. It also prohibits the expenditure of Federal funding for abortion and it requires the segregation of funds to ensure that no Federal dollars pay for abortions.”

Did you get the underlined points? His emphasis, not mine.

The Hyde Amendment, enacted in 1976, already prohibits spending federal dollars to pay for abortions for women on Medicaid. Rockefeller’s amendment would expand the restriction to all women who choose the public option.

The Center for Reproductive Rights is urging supporters to call members of the Senate Finance Committee and ask them to vote against anti-choice amendments. You can also contact your senators and ask them to stop anti-choice amendments from being included in the health care bill.

More good reading on health care reform and the abortion debate:
- Frances Kissling, “Exploiting the Healthcare Debate to Restrict Abortion
- Molly M. Ginty, “Obama Fuels Battle Over Funds for Abortion
- Politifact, a project of the St. Petersburg Times, is running a Truth-O-Meter on federal subsidies and abortion
- Rep. Lois Capps, “The Truth About the Capps Amendment
- David Crary (AP), “Abortion-Rights Forces Vexed by Health Care Debate

Baucus Bill is “Bunk for Women”

In a post at Raising Women’s Voices outlining five reasons why the Baucus bill is no good for women, Amy Allina writes that the bill “imposes politics and ideology on what should be a purely medical decision — the question about what services an insurance plan will cover. It singles out abortion for special exclusions, rather than treating it like other medical care, by adopting language that was developed by the House Energy and Commerce Committee as a compromise to prevent anti-choice legislators from using the health reform bill as a vehicle to impose sweeping new restrictions on abortion.”

Another reason: Under the Baucus bill, older Americas could pay up to five times as much as younger customers. The bills to come out of the House allowed only a 2:1 ratio.

“Women, who live longer on average than men, are more likely to bear the costs of this age rating,” notes Allina.

Doing away with any niceties, James Ridgeway, in a post titled “How the Baucus Plan Screws Older People,” writes that “the people who stand to get screwed most by the plan are those who aren’t old enough to qualify for Medicare, but are still old enough to be discriminated against by insurance companies.”

Ridgeway quotes Uwe Reinhardt, an economics professor at Princeton University, who estimates that the age rating will enable insurers to cover roughly 70 percent of the added risk they’ll take on by extending insurance coverage to everyone.

“You’re just using age as a proxy for health status,” said Reinhardt.

Maggie Mahar, author of “Money-Driven Medicine: The Real Reason Health Care Costs So Much,” breaks down even further who benefits when health insurance premiums are allowed to vary based only on tobacco use, age, family composition and where you live (allowing for differences in local cost of care).

She writes at HealthBeatBlog.com:

If you smoke, they can charge you 50 percent more; if you have children they can charge you 50% more than they would charge a childless couple, and if you are a single parent, they can charge you 80% more than they would charge a single adult. (Since children’s health care costs are, by and large, significantly lower than adults’ costs, that seems a pretty steep surcharge for the sin of single parenthood.)

I can imagine that some readers would say that it is only fair to charge smokers more. But consider this: the vast majority of adult smokers in the U.S. are poor. Many will qualify for full subsidies; others will be eligible for partial subsidies. So who will pay 50% more for their health care—you, the taxpayer. If he receives a subsidy, the 50% surcharge isn’t likely to induce a smoker to stop smoking. This is simply another way to funnel more taxpayer money to private sector insurers.

Single parents also tend to cling to the lower rungs of the income ladder. Many will qualify for at least a partial, if not a full subsidy. Who pays the extra 80%? That’s right—you and I.

Finally, if insurers can charge 50-somethings five times as much as they charge 20-somethings (who the Baucus plan refers to as “young invincibles”), a great many of them are going to need subsidies. More tax-dollars winging their way to Aetna.

There is, however, an exemption from the mandate for people over 50 if coverage is deemed unaffordable — which makes no sense, really, since this the time they’re likely to need health care more, not less.

As Mahar concludes, “Somehow, this isn’t what I thought they meant by ‘universal coverage.’”


September 16, 2009

Breaking: Senator Max Baucus Releases Health Care Proposal

After much wrangling and delays, Senate Finance Committee Chairman Max Baucus (D-Mont.) today released his draft of a health care bill. Baucus will hold a press briefing at 12 p.m. ET.

The text of the 223-page America’s Healthy Future Act is available here (pdf). It does not include a government public option as many Democratic leaders had hoped but instead promotes membership-run co-ops to compete with for-profit insurance companies.

The bill is already drawing fire from both sides of the political spectrum. Sen. Charles Grassley of Iowa, the top Republican on the Senate Finance Committee, said he would not support the bill.

Neither would Sen. John D. Rockefeller (D-West Virginia), an advocate of a government insurance plan. “The way it is now, there’s no way I can vote for the Senate package,” Rockefeller said.

The plan would require individuals to purchase coverage and would prohibit insurance companies from denying coverage because of pre-exiting conditions.

The $856 billion package aims to extend coverage to more than 30 million uninsured American citizens via an expansion of Medicaid, government subsidies to modest-income individuals and families to help them afford coverage, and new state insurance marketplaces described in the bill as “state-based web portals, or ‘exchanges’ that would direct consumers purchasing plans on the individual market to every health coverage option available in their zip code.”

The bill is scheduled for markup by the Senate Finance Committee on Sept. 22.


September 10, 2009

Obama Explains the Financial and Moral Imperative for Health Care Reform

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President Obama last night did what should have been done a month ago: He presented a clear, passionate case for health care reform that re-charged supporters, and he reached out to groups wary of reform efforts.

“I am not the first President to take up this cause, but I am determined to be the last,” said Obama. “Our collective failure to meet this challenge – year after year, decade after decade – has led us to a breaking point.”

Now the question is whether the momentum will last.

Dan Balz of the Washington Post writes:

Seeking to appease independents worried that his agenda threatens a fiscal disaster for the country, he promised not to sign a bill that would increase the deficit. Addressing seniors, he looked directly into the cameras and vowed, “I will protect Medicare.”

Obama almost certainly will get a boost in the polls from Wednesday’s speech, as President Bill Clinton did when he gave a similar address to Congress in the fall of 1993. Obama’s key to success is to use the space created by this moment to drive Congress, particularly his Democratic allies, toward consensus and action. The longer the debate continues, the more his gains from the speech will dissipate.

The Nation’s Katrina Vanden Heuvel writes, “The speech still had a bipartisan flavor, but with a progressive spine.”

She continues:

Obama did not fully satisfy. The insurance exchange idea confused more than it clarified in explaining the role of the public option. Why will it take four years? Essentially, it’s a compromise because Congress doesn’t have the guts to raise money to do it more quickly. There may be some benefits up front, but there are still more questions than answers. What is clear is that the fight must still be waged to push through a public option — already a part of four of the five bills in Congress — if we’re to get an essential component of genuine and effective healthcare reform. After all, the public option is already a pragmatic all-American compromise (choice and competition). Medicare for All — or single-payer-was never on the table.

Here’s the full text of the president’s speech to Congress, and here’s the text of the late Sen. Ted Kennedy’s letter of support, which the president said he received after Kennedy’s death.

“[Y]ou have also reminded all of us that it concerns more than material things; that what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country,” wrote Kennedy. “And while I will not see the victory, I was able to look forward and know that we will — yes, we will — fulfill the promise of health care in America as a right and not a privilege.”

[Side note: Sen. Tom Harkin has been selected to take Kennedy's seat as chair of the Senate Health, Education, Labor, and Pensions Committee. Harkin is a supporter of the public option.]

The White House website has published the details of Obama’s plan, breaking down what will happen if you already have health care coverage and what will happen if you don’t.

Following the speech, MSNBC’s Keith Olbermann asked Jonathan Cohn, the author of “Sick: The Untold Story of America’s Health Care Crisis,” what he thought of the plans on the table.

“Do I wish the plans were better? Do I wish they looked more like a single-payer plan? Absolutely,” said Cohn. “Do  I think that what we’re talking about now will make a dramatic difference in people’ s live? Absolutely.”

The NYT posted some early reactions from healthcare policy experts.

Bonus: When Obama said undocumented immigrants would not be covered, South Carolina Rep. Joe Wilson shouted “You lie!,” prompting the head-turning shown at the top of this post. It was a moment that brought back all the heckling of the summer. But this time Democrats saw the opportunity and seized it.

Wilson is up for re-election this November, and ActBlue wasted no time in setting up a fundraising page for his opponent, Democrat Rob Miller, to defeat “the man who yelled ‘liar’ at Obama.” More than $45,000 has come in so far.