Contraceptives Under the New Health Care Bill

Twenty-seven states have laws that require some level of prescription contraceptive coverage.  Access to additional free or subsidized contraceptives may (or may not) occur in the fall, when the health care reform changes will require new health plans to begin providing a range of preventive health services at no cost to members.  What that means for contraceptive coverage is not yet known.  Michelle Andrews has an article in the Washington Post that talks about the issues.

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The Rise of C-Sections & US Maternal Death

The National Center for Health Statistics has come out with a report that shows Caesarean births in the United States are at an all-time high. One third of all women now give birth via C-section, a rate that has been increasing over the past decade. The procedure raises risks for both mother and baby, and increases the hospitalization cost. Though C-Sections are necessary during birth complications, and to save the life of the mother or baby, experts say the procedure is being used far too often.

This report comes about a month after a series of articles were released detailing the rise of maternal mortality in the United States. According to an Amnesty International report, rates of maternal death in the US are higher than in 40 other countries. For instance, American women are 4 times more likely to die in childbirth than women in Germany and 5 times more likely than women in Greece.

The report includes striking racial differences in maternal care:

White women have a mortality rate of 9.5 per 100,000 pregnancies, the CDC said. For African-American women, that rate is 32.7 deaths per 100,000 pregnancies.

In many states, African-American women are 4 times more likely to die from pregnancy complications than white women. Much of this racial disparity has to do with poverty, poor standards of care, and lack of health insurance. About 13 million women of reproductive age (defined as ages 15 – 44) do not have health insurance, and about 52% of those women are women of color.

It’s shocking that in the United States, which spends more money than any other country on health care costs, and more on OBGYN care than other hospital care, the maternal mortality rate has doubled in 20 years. The absolute number may still be low, but this is a trend in the wrong direction.

Reflections on Health Care Reform

Late last night, the year-long health care debate (that lately has devolved into a circus), has, for all intents & purposes, come to a close. On Tuesday, Obama is expected to sign the bill into law. Of course, there are still potential roadblocks in the way: the Senate must approve reconciliations between its previously passed bill and the bill the House passed last night.

A list of the changed provisions can be found here.

Now, onto Stupak/Nelson. Once again, women’s issues are used as the main bargaining chip (and by men, of course). I want to get past the rhetoric about “baby killers” and this measure being the “end of choice” and think about what this really means. It’s true that those who want abortion coverage in the insurance plans may have a chance to opt for that. But here’s the problem: first of all, no one believes in advance that they’ll need an abortion. Facing that choice can be a daunting one in general, and now these measures seek to impose further financial difficulties on women. Secondly, because of the difficulties involved in obtaining abortion coverage, I believe this provision will have significant impacts in widening the gap between wealthy and poor women, since those who will have to rely on more subsidies will not be allowed to use that money to obtain an abortion. In my mind, this can only lead to more low SES women left without the choice that more affluent women can make.

Third, there’s been a lot of talk about private insurers dropping abortion coverage that they would have otherwise offered. This memo from the George Washington University’s Health Policy School outlines these concerns.  It’s a really good read, but here’s an excerpt:

Payments would have to be strictly segregated, subject to state insurance commissioner oversight and adherence to federal segregation requirements. For several reasons this provision could be expected to chill issuers’ willingness to sell products that cover a range of medically indicated abortions. They would have to comply with complex audit standards and more importantly, they would have to collect an additional fee from each member of their plan, a step that could be expected to encounter broad resistance. (It is also not clear what the consequences would be for plan members who do not make the payment or whether non-payment would place them in arrears). The more logical response would be not to sell products that cover abortion services.

And finally, this debate over abortion coverage further stigmatizes the medical procedure that statistics show 1/3 women will have in her lifetime.

Finally, I want to end with a more personal reflection from my own experiences with Medicaid. I spent over 2 years working with and representing individuals on Medicaid, helping them obtain their benefits in the face of improper termination, impossibly confusing forms and rules, surgeries and illnesses, apathy and discrimination. I knew many of them well. These people were not lazy or stupid, they were sick, and scared and poor.  They wanted a right to get the same HIV treatment as wealthier people, they wanted the same obstetric care, and they wanted an equal chance to fight their breast cancer– through all rounds of chemo, not just one. So to those who spout off inflammatory rhetoric about welfare queens and bums, I’m telling you that you’re using harmful and frequently racist synecdoches that you don’t even understand.

But I also know that though Medicaid’s existence is a necessary, crucial one– there are significant problems with its implementation and effectiveness for many Americans. Forms and rules are perplexing to the point where many individuals lose their coverage because of a gap in understanding. I spent time working with government staff who have little or no incentives in their jobs to provide quality care for Medicaid recipients. There are loop holes that no one cares to close, and there are tragic failures in the system that have real health consequences for real people, and there are countless people that fall through the cracks. So I can relate to the sentiment that increased government control over health care may not be positive.

Time will tell, and I’m hopeful but still skeptical. I can only hope that the government puts as much effort into effective and intelligent implementation of their grand plans as they do to dreaming them up in the first place.

Five Ways in Which the House Health Care Bill is Better Than the Senate’s

moveon.org sent an email comparing the Senate bill for health care reform to the better House plan.  This is what it said:

Five Critical Flaws in the Senate Health Care Bill
The Senate bill would:

#1—Deny Americans the choice of a public option. In contrast, the House bill contains a national public option, the key to real competition, greater choice, and lower costs.

#2—Leave insurance unaffordable for some lower income and working people. Both bills require virtually all Americans to buy insurance. But even with the subsidies provided, some families could have to pay up to 20% of their income on health care expenses.

#3—Impose dangerous restrictions on women’s reproductive health care. Unfortunately, both bills do this and the House provision is worse. Both versions would be a dangerous step and neither should be in the final bill.

#4—Tax American workers’ health coverage to pay for reform. The Senate would pay for part of reform by taxing the hard-won benefits packages of some working Americans. The House, on the other hand, pays for reform with a small surcharge on only the wealthiest Americans—a far better approach.

#5—Allow insurance companies to remain exempt from anti-trust laws. Under current law, insurance companies are actually exempt from laws designed to prevent monopolies and price-gouging. The House bill would fix this, but the Senate bill leaves it in place.

Of course, these aren’t the only problems with the bill. Most glaringly, both the Senate and House bill would leave millions uninsured, a far cry from the vision of universal coverage so many of us have fought for. That remains a long-term goal.

But these five things need to be fixed immediately—

Given the way the Senate Democratic leadership just caved in to the Republicans and its own dysfunctional Democrats, is it any wonder that I think that the Senate will get its way.

Buying Democratic Senator’s Votes for Health Care Reform

Soooo, how much money in the Senate health care reform bill is for earmarks for individual Democratic Senators?  Well, a lot!  And they think it is just the way it is always done.  Here’s what Harry Reid said about including the earmarks in return for obtaining the 60 necessary votes:

I don’t know if there is a senator that doesn’t have something in this bill that was important to them.  And if they don’t have something in it important to them, then it doesn’t speak well of them.

That’s really pathetic.  For an issue as vital as health care reform, the Senators find it necessary to push for every last dime for their provincial interests.  Here are what some of the Senators got in return for their assurance that they would vote for cloture.  A special place must be reserved for Ben Nelson, who obviously had more reasons than just his stated aversion to abortion to be the last of the 60.

First there was the “Louisiana Purchase,” $100 million in extra Medicaid money for the Bayou State, requested by Sen. Mary Landrieu (D-La.).

Then came the “Cornhusker Kickback,” another $100 million in extra Medicaid money, this time for Sen. Ben Nelson (D-Neb.).

This was followed by word that Sen. Christopher Dodd (D-Conn.) had written into the legislation $100 million meant for a medical center in his state. This one was quickly dubbed the “U Con.”

Earlier, when GOP staff member mistakenly thought the medical center was destined for Indiana rather than Connecticut, they named it the “Bayh Off” for Sen. Evan Bayh (D-Ind.).

For Democratic leaders, this created an appearance problem. Fortunately, they had removed from the bill the tax on cosmetic procedures (the “Botax”) and replaced it with a tax on tanning (which would primarily impact House Minority Leader John Boehner of Ohio).

. . . .

Indeed, the proliferation of deals has outpaced the ability of Capitol Hill cynics to name them.

Gator Aid: Sen. Bill Nelson (D-Fla.) inserted a grandfather clause that would allow Floridians to preserve their pricey Medicare Advantage program.

Handout Montana: Sen. Max Baucus (D-Mont.) secured Medicare coverage for anybody exposed to asbestos — as long as they worked in a mine in Libby, Mont.

Iowa Pork and Omaha Prime Cuts: Sen. Tom Harkin (D-Iowa) won more Medicare money for low-volume hospitals of the sort commonly found in Iowa, while Nebraska’s Nelson won a “carve out” provision that would reduce fees for Mutual of Omaha and other Nebraska insurers.

Meanwhile, Sens. Byron Dorgan and Kent Conrad, both North Dakota Democrats, would enjoy a provision bringing higher Medicare payments to hospitals and doctors in “frontier counties” of states such as — let’s see here — North Dakota!

Hawaii, with two Democratic senators, would get richer payments to hospitals that treat many uninsured people. Michigan, home of two other Democrats, would earn higher Medicare payments and some reduced fees for Blue Cross/Blue Shield. Vermont’s Sen. Bernie Sanders (I) held out for larger Medicaid payments for his state (neighboring Massachusetts would get some, too).

Isn’t It Nice That “Evangelical Leaders” Say Sen. Ben Nelson Should Agree to a Compromise on Abortion to Save the Health Care Bill?

What’s with Sen. Ben Nelson anyway?  He is willing to completely destroy any hope for a Senate bill on health care reform because of his abortion stance.  Never mind that the draft bill has been almost completely stripped of any meaningful reform.

And this is almost laughable.  According to the Associated Baptist Press, a coalition of 39 “pro-life Christian pastors and leaders released a statement Dec. 18 applauding alternative language aimed at preventing health-care reform from being derailed by debate over abortion.”  They say that they think “compromise” language proposed by Sen. Robert Casey (also a Democrat like Nelson) should be sufficiently acceptable to Nelson so that he can vote to allow the health care bill to go forward to a full vote.  And what do the “evangelical leaders” say they like about the compromise language?:

Sen. Casey’s alternative language, which we expect to be available in its final legislative form soon, could ensure that strong provider-conscience protections passed in the House bill are maintained; no federal funds pay for abortions in any way; and no [insurance] premium dollars from individuals who opt out of abortion coverage will be used to fund abortions.”

This is compromise language?  And Nelson will probably still not agree to it?  I have a hard time agreeing with Howard Dean and others that the current version of the Senate health care draft is so weak that we should just forget about the whole thing.  But the situation is so distressing that it makes you wonder.

Obama Abandons Campaign Pledge and Allows Big Pharm to Prosper and Individuals to Pay Higher Drug Prices

I think this is the saddest I’ve felt about the Obama administration.  During the campaign, President Obama promised to fight the drug industry so that Americans can get cheaper prescription medicine by importing it from countries like Canada.  He said: “We’ll tell the pharmaceutical companies ‘thanks, but no, thanks’ for the overpriced drugs — drugs that cost twice as much here as they do in Europe and Canada.”  Millions of Americans are forced to pay up to 10 times the prices Canadians and Europeans pay for identical medication, which is often produced in the same facilities by the same manufacturers.

Yesterday, the Senate rejected two proposals that would have provided exactly what Obama had promised.  The proposals would have saved the federal government $19 billion over 10 years, according to the Congressional Budget Office.  And consumers would have saved many times that.

The really sad part is that the Obama administration actively worked to prevent the proposals from passing.  In other words, Obama completely broke his promise and sided with the big-money lobbyists of the drug industry, which is among the top 10 contributors to federal election campaigns, having given more than $130 million to those campaigns over the past 10 years.

This was part of the broader health care legislation.  Earlier this year, the pharmaceutical industry had reached a “deal” with the administration that would allegedly cut their profits by $80 billion over 10 years and, in return, the Obama administration would not cut their profits any more.  (Also, Obama wanted the industry to spend advertising dollars in support of health care reform.)  In fact, to me, it didn’t seem like a “deal” at all, but a non-binding promise by the drug companies that they could break whenever they felt like it.  And the drug industry has already raised prescription prices nearly 10 percent this year.

Obama even issued a letter from the Food and Drug Administration that cited safety concerns by importing drugs.  That is bogus information since it doesn’t address the fact that there are safety issues when purchasing drugs from U.S. companies, who frequently have the drugs manufactures in places like China and India.

Consumer advocacy groups are obviously appalled by this.  For instance, AARP, the lobby group for older Americans, said: “Senators had a choice between meaningful savings for their constituents and higher profits for the drug industry. We’ll be letting our members know where they stood.”  Even John McCain is on the right side this time, saying that “[i]t’s really regrettable that the special interests again prevail.”

When will Obama learn to fight for the things he believes in.  Obviously, compromise is necessary to get his things through Congress.  But it seems as if he has abandoned too many things too early and too easily.