Conservatives strike again! Don’t let them exclude essential services!!

If conservatives get their way on health reform, we will soon have quality, affordable health care for all — except for women, terminally ill patients, gays and lesbians, people with HIV and anybody else conservatives don’t like!

A slew of proposed amendments submitted to the Senate Health, Education, Labor and Pensions (HELP) committee Tuesday night would hobble that committee’s health reform proposal. Republican Senators Michael Enzi, Orin Hatch and Tom Coburn have proposed that:

* Coverage for abortion would be banned;

* Health providers and insurers would be protected against “discrimination” for refusing to provide health care requested by their patients including abortions, removal of feeding tubes from terminally ill patients, aid-in-dying (such as in Oregon, Washington and Montana, where this is legal) or really just about any health service they find objectionable;

* Federally-qualified health centers could not provide abortions and still get government grants;

* Any independent medical advisory board empaneled to offer advice to HHS on the benefits to be included in national health reform coverage would have to include “professional ethicists…with specialty in rights of the life of the unborn.”

These amendments would be damaging to women’s health and they don’t have public support. Public opinion research shows that large majorities of U.S. voters understand that reproductive health services are part of basic health care for women. Make sure the Senate HELP committee members know that the public supports health care reform that includes these reproductive health services and opposes exclusions like the ones being proposed. We want medical experts and citizens to make these decisions, NOT politicians.

If your Senator is one of these, let him or her know that you and the majority of US voters want them to stand strong for health reform that doesn’t include political exclusions: Edward Kennedy (MA); Christopher Dodd (CT); Barbara A. Mikulski (MD); Jeff Bingaman (NM); Patty Murray (WA); Jack Reed (RI); Bernard Sanders (VT); Sherrod Brown (OH); Robert P. Casey, Jr. (PA); Kay Hagan (NC); Jeff Merkley (OR). You can contact them at help_comments@help.senate.gov. As always, please cc info@raisingwomensvoices.net so we can track and feature your excellent letters!

Democrats talking and compromising and maybe a bill?

Yesterday the New York Times’ Robert Pear wrote an article describing recent updates in the health reform debate. It seems that Democrats are talking more and compromising more on things like the public option and taxed benefits. Check out the full article.

Health insurance and young people

Pennsylvania fighting to insure young adults

Those 18 to 35 are among those with least coverage in Pennsylvania, and elected officials are fighting right now to pass a law that would require insurance companies to offer parents the option of keeping their children on their health insurance until age 29. Especially in the current economy, students are graduating college without secure jobs and therefore no certain health coverage. However, the Kaiser Family Foundation finds faults with the proposed law and with similar mandates in other states. Read the full article from Pittsburgh Tribune here.

Option for college graduates in Illinois

The Chicago Tribune outlines all the options for young people just out of school. As with most other states and most other populations, young adults covered by their parents insurance are set, but those with pre-existing conditions face a whole bunch of challenges.

Health Affairs publishes an article about uninsurance and affordability

“Based on simulated bill paying, this paper examines trends in comprehensiveness of coverage, out-of-pocket spending for medical services, underinsurance, and the affordability of employer-based insurance from 2004 to 2007.”

Want to know more? Check out RWV’s fact sheet on this issue – it includes a checklist of things to consider if you’re young and uninsured.

Health care and taxes

Stuart Butler from the Washington Times made a parallel to the famous 1985 screen adaptation of the novel by George Barr McCutcheon, “Brewster’s Millions” in his most recent article. The story revolves around a man given the challenge of spending (without having resulting wealth from that spending) an absurd amount of money to receive at the end of the challenge an even more absurd amount of money. But this parallel is not about extravagant lifestyles or personal wealth – Butler calls on the film to represent the current health care crisis in the United States.

“Brewster’s tax code, you see, directs most of the coverage subsidy to people with good incomes who already have generous coverage. Little or no help goes to those who are just scraping by and can’t afford even a basic plan. It also limits the subsidy only to plans arranged by employers. Families without employer-sponsored coverage get zip. It’s a great way to use up the dough and leave millions without coverage.”

In this opinion piece, Butler proposes his solution: cap the amount of employer-based health insurance that is tax free and use the revenue to assist those unable to pay. For Butler’s full proposal, click here.

Demanding transparency in the health insurance market

On the heels of an earlier post about unexpected and hidden costs of child birth care, comes a discussion about transparency and standardization of coverage facts.  The Center for American Progress released a report detailing how little consumers understand about what their insurance will pay for and how difficult it is to take advantage of the much touted choice in plans when insurance companies play so many games to hide the large gaps in coverage that they build into policies.

In marketing their plans, insurance companies leave a lot of information undisclosed and the nature of the product — in part, a protection against unforseeable future events — makes it difficult for consumers to compare prices and quality as they would other products.  Consumers need to know that the insurance options are not always equal and greater transparency in coverage policies is essential if we are to believe that individual choice among plan options is beneficial to the American people.  The report suggests a new method for developing benchmarks to more clearly communicate types and cost of care in a variety of medical scenarios.

We recommend developing standardized health plan comparison tools—patterned on the U.S. Food and Drug Administration nutrition label, but for health insurance—that could help consumers appreciate the kinds of medical events for which health insurance may be needed and relative levels of protection provided under different policies.

As Amy Allina of National Women’s Health Network said, “they focus particularly on how terribly expensive it can be if you become seriously sick — but it would be interesting to see a similar analysis of the degree to which prevention services are covered or not.”

The health care costs of bringing home baby

While not the most exciting part of getting pregnant and having a baby, welcoming another member into any family is a major financial undertaking.  But even before expecting mothers and families start paying for food, clothes, childcare, and schooling, bringing a new baby into the world can place a huge financial burden on families in the first moments and days of their babies’ lives. 

Anna Wilde Mathews had a piece in the Wall Street Journal on May 7 about the hospital bills for the uncomplicated traditional delivery of her baby son last December.  As someone who is fortunate enough to have good health insurance, she did not have to pay much of the $36,625 bill that was sent to her home for three days of care, which charged her and her son separately.  Mathews stresses how important it is for expecting mothers, and patients in general, to have an idea in advance of how much they are going to owe for a hospital visit.  But in order to be informed “consumers” of health care, information needs to be made more accessible to patients.  In the weeks leading up to and following her son’s birth, Mathews had a difficult time getting her hands on specific, understandable information about the services she was charged for and the ultimate price she would have to cover out-of-pocket after her insurance company negotiated costs with the hospital.

In a call to her insurance company prior to her due date, Mathews asked how much the bill would be, assuming an uncomplicated delivery.  She never received a direct answer, and searching through the company’s website only got her an average expected cost for Los Angeles-area hospitals — no information was available for the specific hospital she had in mind.  When she did eventually receive five separate bills for her and her son’s stays in the hospital, the charges for each indivdual component of care seemed to her “stunningly high,” but she had little way of knowing whether such pricetags were generally accepted as appropriate for these services, or if something was wrong.

Furthermore, while Mathews’ plan places a $2,000 cap on her annual out-of-pocket charges on in-network care, she was unaware that when her son was born, he, too, came with a $2,000 cap, doubling the maximum amount she could be charged out-of-pocket for their care.

To decipher other items, I decided to check out consumer services that advise people about medical bills… Although my bills were hard to decipher, I couldn’t point to any mistakes in them, so I paid up. The experience left me befuddled, though. To be smart medical consumers, we need to be able to easily learn and compare prices for medical services. And we should have a way to effectively check our bills.

Mathews says that hospitals and insurers are aware of these problems in transparency and some are trying to work together to keep patients more informed.  Some hospitals have experts on-call 24 hours a day to answer patients’ questions about projected costs; others have websites capable of generating estimated out-of-pocket costs for a particular patient.  Her insurance company and the hospital where she delivered her son later informed Mathews that she could have called the hospital for an advanced estimate of out-of-pocket costs (although she was never informed of this option) and that they were working to add hospital-specific cost information to the insurer’s website.

A spokesperson for the insurance company later told Mathews they “view [it] as an error” that their customer-service representative failed to tell Mathews about her baby’s deductible in advance.

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.

Compromise on Public Plan Within Reach

Nancy-Ann DeParle, director of the White House Health Reform office, said on Wednesday that a compromise on a government-sponsored public health option is within reach.

The announcement of the possibility of a public plan has alienated and angered many Republicans, but DeParle insists there are ways of bridging gaps. The public plan could pay hospitals and doctors rates similar to those that private insurers pay, rather than paying lower prices for medical services and forcing private insurers out of business by offering consumers lower premiums. This would still cut costs, as the government would not need to turn a profit, and it would cut down on administrative expenses.

The ideological fears are harder to assuage. But, though many Americans may not realize it, the government already pays for almost half the nation’s healthcare anyway, covering seniors, poor families, and many children. Obama has proposed a plan to expand this to middle class workers and their families, via a purchasing pool through which they could enroll in a public plan if they choose.

Obama has remained vague on the details, which make all the difference, leaving himself open to compromise. If open to all individuals and employees, and offering hospitals and doctors Medicare rates, the public plan could phase out private insurers. But if open to individuals and small businesses only, and offering similar rates as private insurers, the public plan’s impact would be limited and ultimately help those who currently have difficulty getting coverage.

For the full article click here

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.