Barriers to coverage for gay couples
The New York Times published an article Friday about barriers to coverage for domestic partners faced by gay couples. Although Iowa, Vermont, and Maine have recently made headlines legalizing same-sex marriage — with a few other state legislatures currently considering it — more comprehensive health care coverage for domestic partners, whether couples are legally married or not, is not necessarily included in these civil rights breakthroughs.
One-third of companies with over 500 employees provide domestic partner benefits (up from 12% in 2000), but the proportion is much lower among small companies. And while some state and local governments offer employees domestic partner coverage, there is no such provision for federal employees.
Even if the relationship is formalized with the state in a marriage or union, that does not always obligate the employer to cover a same-sex spouse. For one thing, self-insured employers are not regulated by the states.
And other benefit-providing employers that choose not to offer such coverage can sometimes use the Defense of Marriage Act — a law that forbids the federal government to recognize same-sex marriage — to trump state laws.
Read more here.
In economic hardships, mammogram rate declines; women forgo health care more than men
The Centers for Disease Control and Prevention has tracked a slight reduction in the proportion of women getting annual mammograms in almost every state. In some parts of the country, out-of-pocket costs for routine mammograms range from $135 to $270 and, although under most insurance coverage the co-pay tends to be only $10 to $35, Mark Rukavina, executive director of the Access Project, a health reform advocacy organization, says, “even that small fee could seem insurmountable stacked against other costs right now.”
One breast cancer specialist, Christine Pellegrino of Montefiore-Einstein Cancer Center in the Bronx, believes the lower rate of mammograms is a reflection of cost affordability right now, noting that there has been no signs of declining mammogram rates among her patients, who are largely insured through Medicaid which covers the full cost of routine and follow-up mammograms. Such patients, Pellegrino says, “are not really affected by the bigger financial issues that end up causing other women to have to choose between their health care and more routine things, such as paying for food, housing, utilities or even the health care of their kids and spouses.”
And the Commonwealth fund released a study titled Women at Risk: Why Many Women Are Forgoing Needed Health Care, revealing that 52% of working-age women, compared to just 39% of men, report problems such as not being able to fill a prescription, go to the doctor, or get a medical test. The study focuses on the unmanageable costs of health care as they affect underinsured women.
Women who are insured but have inadequate coverage are especially vulnerable: 69 percent of underinsured women have problems accessing care because of costs, compared with half (49%) of underinsured men. Women are more affected by high health care costs because they have lower average incomes and use the health care system more frequently, and therefore face higher out-of-pocket health costs than men.
What’s more is that the conclusions of this study are based on data collected in 2007, long before the economic recession and related loss of coverage hit the country. A more recent Gallup survey polled 1,031 women, ages 18 to 44, of which 15% reported they have recently stopped taking medications due to cost, and one in seven reported putting of routine gynecological exams for the same reason.
Single-Payer or Bust
Tuesday’s Senate Finance Committee roundtable was livelier than usual, and no wonder: the topic was healthcare.
Doctors and other single-payer advocates disrupted the hearing, demanding to know why single-payer wasn’t on the table. Polling has shown both public and physician majority support for a single-payer system yet Chairman Baucus (D-MT) has stated that it is “off the table” to be considered for health reform.
Doctors say that a publicly-funded privately delivered single-payer system is the only solution to the crisis of ballooning costs and up to 22,000 annual deaths due to lack of comprehensive coverage.
Doctors and activists in attendance represented Physicians for a National Health Program, Healthcare-NOW!, Single Payer Action, Private Health Insurance Must Go, the Campaign for Fresh Air and Clean Politics, Prosperity Agenda, and Health Care for the Homeless.
The US Medicare system currently provides comprehensive care to the elderly in a single-payer system, and legislation HR 676 and S 703 seek to do the same for all Americans at the same cost as our current system.
Single-payer advocates will continue to use non-violent civil disobedience to get their message across.
And, via Ezra Klein: Senator Chuck Schumer (D-NY) has forced the Senate Finance Committee’s Health Care Coverage Roundtable to address the public plan, saying, “Just as bad as a public plan with an unfair advantage, is no public plan at all. My colleague from Kansas said the American people don’t want the government involved. Well, let me tell you, the American people have some problems with the government. But they have a lot more problems with private insurers.”
Schumer claims that opposition to the public plan is based on an idea of a private industry that doesn’t exist, namely that private insurers don’t know what procedures cost and won’t release data on quality or prices.
Mind the Gap
According to a new Harvard study, health disparities between those of different socioeconomic groups persists throughout middle age. But at 65, with near-universal Medicare benefits, health gaps narrow between Americans of different races, ethnicities, and education levels.
Previous research has shown that those with health insurance tend to be healthier, and that most likely those without are black, Hispanic, or have less education.
The study tracked health measures in adults ages 4o to 85 who had high blood pressure, coronary heart disease, 
stroke, or diabetes. After 8 years, blood pressure, blood sugar, and cholesterol had all improved–but there remained a gap between socio-economic groups.
After age 65–at which point all in the study were eligible for Medicare–the racial and educational gaps dropped significantly.
Universal healthcare would be beneficial in covering those in the most vulnerable groups. And, as Dr. Ashwini R. Sehgal of Case Western Reserve University writes, “Simply improving quality of care will not eliminate disparities. Because minority, socioeconomic, and insurance status often overlap, providing universal health coverage has the potential to reduce several types of disparities.”
Public Insurance Option Temporarily Set Aside for Employer Plan
Senator Max Baucus of Montana, chair of the Senate Finance Committee, announced at last Friday’s meeting that he was looking into ways to maintain employer self-insurance plans, meaning that a public payer option would be set aside for the moment, though it was “still on the table”.
Baucus said he believed that there should be a national system that allows benefits from differing state plans to transfer across state lines, but stressed that it is not his plan to interfere with employer-based health plans. “The system I envision is where self-insured companies, ERISA companies, can keep their own plans and manage health insurance in the way that they have. We’re not going to change the ways self-insured companies handle health care for employees” said Baucus.
The Senate Finance Committee will meet this Wednesday to discuss Baucus’ proposals. The Senate has the option of using the budget reconciliation process which would allow for legislation to pass with 51 votes rather than 60. However, many Democrats, Baucus included, have noted that the reconciliation process would not be needed if they could find a way to all work together.
Read more about this from Kaiser’s Daily Health Policy Report
One-Fifth of U.S. Adults Underinsured in 2007
“Consumers facing increased medical expenses are likely to report decreasing their contributions to retirement savings plans (29 percent), taking on credit card debt (22 percent), and experiencing difficulty paying for basic necessities like food, heat and housing (27 percent) as a result of their medical costs” according to Community Catalyst’s report, When Coverage Fails: Causes and Remedies for Inadequate Health Insurance.
The report discusses the ramifications of being under-insured, such as poor health and financial difficulties. According to the report, 50% of bankruptcies in 2007 were the result of medical debt. That same year, 25 million were under-insured–a 60% increase from 2003–meaning their insurance was not comprehensive, forcing them to forgo or delay medical treatments, preventative tests and doctor visits. The report concluded that the federal government could help alleviate the situation by setting standards for coverage and limiting deductibles.
There are many ways in which the term under-insured is used. How does Community Catalyst define ‘underinsured’? By analyzing the income of those with insurance and the out-of-pocket costs of health care they pay, and determining when those costs become too great of a barrier to overcome. The Commonwealth Fund classifies individuals as under-insured when more than 10% of their income (which is 200% below the federal poverty level) on out-of-pocket health expenses, or whose deductible consumed 5% of their income. The report found that families paid the highest deductibles, and those purchasing their insurance on their own (not through their employer) are more likely to be under-insured.
Family Planning Only Option to Fight Poverty
Women around the world continue to illustrate the disparity between the poor and the wealthy when it comes to access to contraceptives as well as information and counseling.
Global efforts to reduce poverty won’t get anywhere as long as women who can’t afford it continue to have multiple children–especially when they themselves want only a few. There is no way to elevate the lifestyles of these women and their children unless we help them have fewer children.
The UN estimates that 200 million women around the world have an “unmet need” for acess to safe and effective contraception. These are women who don’t want to get pregnant, but do not use family planning. This results in 70 to 80 million unwanted pregnancies each year, and subsequently 19 million abortions and 150,000 maternal deaths, according to the UN.
Family Planning Programs have stalled in the last years, in part because of abortion politics, which resulted in the US cutting off funding for the United Nations Population Fund, even though this resulted in more unwanted pregnancies and more abortions.
Another problem is that services are more difficult and complex than activists and enthusiasts ever expected. In nations such as Haiti, for example, where there are clinics and women say they want fewer children, there is still little counseling at these clinics when women have questions or problems, and oftentimes women feel as if the clinics are scornful of them if they are poor.
Husbands often refuse to wear condoms, and in Haiti’s social structure, women feel they have no choice but to acquiesce.
It is said that the best contraception is not the pill or an IUD, but educating girls, giving them the ability to earn an income and therefore elevate the status of women. This includes access to better counseling and a greater choice of family planning methods–for free.
There is no other way to reduce poverty, and evidence has shown that when parents are confident that their children will live, they have fewer children and invest more in each of them.
For more, read the New York Times piece here
Even Doctors Have Trouble Accessing Mental Health Care for Patients
Beyond Parity: Primary Care Physicians’ Perspectives On Access to Mental Health Care, an article featured in health policy journal Health Affairs, explores accessing mental health care from a different point of view. According to Peter Cunningham, a senior fellow at the Center for Studying Health System Change, found that in 2004-2005, more than 60% of primary care physicians were unable to obtain out-patient services for their patients seeking mental health care, a rate that is twice as high as barriers to other health related services. The report concludes that since the 1990’s, a little over 30% of patients in need of mental health care actually receive it. Among those providers that reported difficulty in accessing mental health care for patients were pediatricians. Problems also stemmed from the fact that there are shortages of mental health providers in the community.
Patients with chronic illnesses forego treatment in recession
The recession has left virtually no one unaffected, and those with chronic ailments are definitely no exception. The New York Daily News reports that diabetics are cutting back on visits to the doctor, insulin and blood sugar testing, actions that could have lethal repercussions. Adding to the severity of the situation, more individuals are being diagnosed with diabetes each year, with 1.6 million new cases in 2007. Without insurance, the cost of care for diabetics can range from $350 to $900 each month. Furthermore, the medications and treatments for the condition have declined. 
The New York Times recently published an article detailing the case of a man whose insurance company paid for the removal of his brain tumor, but not complete cost of the cancer pills that his doctor prescribed for his treatment. The pills, Temodar, cost $5,500 for the first 42-day, then $1,700 each month thereafter. In cases of cancer, oral drugs are quickly replacing IV treatments as the most successful options, but insurance companies and prescription drug plans often do not cover the treatment. Only providing minimal coverage, these plan often leave patients to pay the majority of the bill. As result, some patients are not able to receive the medications that they desperately need. Medicare Part D’s “doughnut hole” is another factor contributing to the lack of access to health care and prescription drugs. Not only do oral cancer drugs require a 25% co-pay, the doughnut hole ceases to provide coverage when health care costs reach $2,700; coverage is reinstated after beneficiaries pay health costs totaling more than $3000 out-of-pocket.
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