Innovative Chicago Hospitals Improve Care in Urban Areas

The program links each patient to a non-ER medical home where they can make appointments for non-emergency issues. The program was once led by Michelle Obama and has linked 5600 people to a medical home since it began. The idea behind finding patients a medical home is that redirecting non-emergency needs to a primary care physician or specialist at a clinic will result in higher-quality care for patients than they would receive at hospitals where costs are also much higher than at clinics. Decreasing the number of patients appearing unnecessarily for routine issues in emergency rooms will increase both cost-efficiency and quality of care.

Though these patients are not maintaining a consistent relationship with one doctor after they are referred by the University of Chicago to its directory of primary care providers, they are maintaining a closer relationship with a facility (their medical home) which helps target the national problem of those with chronic conditions not seeking preventive care. Increasing the rate at which these chronic conditions are addressed earlier and more consistently not only helps prevent premature deaths but also saves the healthcare system tens of billions of dollars. Though the problem of not seeking preventive care from a primary care doctor regularly is a national issue that transcends income groups, the problem is most severe in low-income neighborhoods such as those served by the Urban Health Initiative, where doctor’s appointments are low on the list of priorities.

The Urban Health Initiative has grown to include 24 community-based clinics and other providers and has a budget of over $6 million annually. The number of appointments made at clinics through program referrals have jumped nearly 40% to 3649 in the last year, compared to 2006. Critics point out however that in 2005 34% of patients (884 people) who were referred by the program kept their appointments at their medical home clinic. In 2010, that number has grown to 1386 patients – only 39% of all referrals.

Despite this criticism, the success of the program has been lauded nation-wide, to the point that the Urban Health Initiative is now poised to escalate research initiatives and teaching opportunities for physicians hopefully leading to its being a national model for medical care in urban areas.

While there are many guidelines for schools, there is no wide sweeping federal mandate regarding students dealing with food allergies. Many students avoid allergic reactions by sitting at special peanut-free lunch tables or classrooms for severely allergic students. However, many parents protest segregating students because of their food allergies.  Another group of parents want to completely ensure their children’s safety, and encourage peanut-free zones in the cafeteria. Other parents want a complete ban on peanut products: unfortunately, it is very difficult to completely ban peanut butter and other related products from schools. Peanut butter and jelly sandwiches are often the centerpiece of a child’s lunch, as they are easy to make, nutritious, and relatively inexpensive.

Still, allergies have grown into a critical issue at many schools throughout the country. More children and adults have food allergies than ever before.  According to a study at Children’s Hospital in Boston, Mass., the number of food related allergic reactions in children doubled from 164 cases in 2001 to 391 just five years later in 2006. The study also noted an increase in anaphylaxis, one of the most dangerous types of allergic reactions. When a person goes into anaphylactic shock, they may experience sudden rash, breathing issues, dizziness, vomiting, and a dramatic blood pressure drop. More than 30,000 individuals, children and adults alike, will go to the emergency room for allergic reactions to food every year.

Nut Allergies a Rising Concern in American Schools

While some children outgrow their allergies, some still suffer from food allergies well into adulthood. Those allergic to peanuts and tree nuts suffer from more severe reactions, and they are also less likely to outgrow their allergies as they grow older. As a result, managing care for food allergies in colleges and universities has grown more important in the 21^st century.

Colleges are working hard to give students with food allergies safe food alternatives. Although an estimated 4 percent of the population has a food allergy, only a small percentage of these college students ask staff for help finding alternatives. Still, many colleges offer frozen meals and gluten free bread for such students. At Franklin and Marshall College, dining halls are completely nut free and foods like granola are clearly marked so allergic students can avoid them.  Other schools like Tufts provide online menus with clickable ingredient lists, and food cards made for every meal on the menu to ensure safety.

At the College of the Holy Cross, students have access to a wide variety of allergy free meals. Students can pre-order such meals from the campus dining hall, where staff makes meals specifically for the student.  In the case that the student forgets to order meals in advance, the dining hall boasts an allergy free kitchen stocked with supplies necessary to make a meal. This approach allows students to eat with friends despite their allergies.

While many universities across the country are working hard to improve food quality for students, there is still much to be done for younger students.  It is imperative that we make school cafeterias and mealtimes safe for our children, no matter what their age or allergy.

Missouri Opposes Federal Individual Mandate

71% of Missouri voters approved the measure while only 29% voted against it. Though turnout for the vote was low, the vast majority of those who did vote were Republicans. Analysts know this because even though Missouri’s open primaries do not require voters to register their party affiliation, many more voters took Republican ballots than Democratic ones. Republican legislators originally wanted to put Proposition C on Missouri’s November election ballot as a vote on a constitutional amendment, but to avoid a Democratic state senate filibuster they settled for a proposed law on last week’s primary ballot.

The purpose of the federal law’s individual mandate is to widen the pool of healthy individuals covered by insurers to balance out the influx of unhealthy individuals expected to enter the pool as a result of separate provisions which prohibit insurers from denying people with pre-existing medical conditions. Were there not to be an individual mandate in conjunction with eliminating denials based on pre-existing conditions, premiums would rise out of control.

Though this is nothing more than a symbolic gesture of disapproval from voters, several other states have also passed similar statutes not based on referenda, including Arizona, Georgia, Idaho, Louisiana, and Virginia. Arizona and Oklahoma voters are set to vote on state constitutional amendments to the same effect in November. In the same vein, public officials in more than twelve states (including Missouri) have filed lawsuits claiming the individual mandate violates usual federal-state relations. Defenders of the law argue the mandate falls under Congress’s power to levy taxes and regulate interstate commerce. Federal courts are expected to weigh in on the constitutionality of this issue before the individual mandate goes into effect.

A number of high powered interest groups were involved in campaigning for Proposition C. The Missouri Hospital Association was particularly vocal – to the tune of $400,000 – in warning voters that passage of the measure could increase hospital costs for treating the uninsured. The group argues that were there not to be an individual mandate, there is the potential for a massive cost-shift onto the insured to cover those visiting emergency rooms because they lack insurance. There was little opposition from grass-roots organizations or unions and consumer groups who had forcefully supported reform earlier this year.

To encourage workers to use the program, companies waive deductibles, cover travel and hotel costs for patients and their families, and reduce co-insurance payments by as much as half. Even factoring in travel costs on the company tab and in some instances monetary incentives to workers, most large employers who’ve tried “domestic medical travel” say they can reduce their costs 20-40% by directing workers to facilities with higher-quality care and lower negotiated prices. Employers who’ve promoted domestic medical travel include Alpha Coal West, BridgeHealth Medical’s group of small and midsize companies, and the Health Services Coalition of employers and unions in Nevada. Alpha Coal West has reported its medical costs have remained flat even as such spending has risen nationwide in the nine years since it implemented the program.

Medical Tourism in the US

If domestic medical travel becomes popular amongst large employers, health industry experts argue the shift could improve quality of care overall and help drive down costs by “fostering a truly national competition.” Savings with domestic medical travel programs result not only from lower prices (negotiated between the company and the out-of-state hospital) but from fewer complications with procedures done at high-quality hospitals. Better hospitals perform procedures better, meaning fewer costs incurred after surgery to resolve complications. Any necessary follow-up care (like physical therapy) is usually performed at the local hospital and covered under the company’s normal insurance plan.

The concept of domestic medical travel is really nothing new; employers and insurers have always sent patients to very high-quality facilities for complex procedures like organ transplants. Domestic medical travel is taking this idea to another level, applying the same concept to more types of medical care like back, knee, and heart surgeries.

Some critics argue the movement toward domestic medical travel could backfire if employers and insurers forget about quality and focus only on cost-savings. Also, some workers (even with incentives and paid travel for patients and family members) are reluctant to travel for surgery. Though the programs are now voluntary, critics worry they may become mandatory and force patients to travel for their procedures even when they don’t want to. For these reasons, and because such programs can anger the local provider community, some insurers are reluctant to encourage domestic medical travel.

These considerations do not seem to be hindering the trend toward domestic medical travel, especially since major companies like Alpha Coal West have experienced such success (and savings) with their programs. It appears as rising medical costs continue to increase nationwide, domestic medical travel is the way of the future for major companies to flatten escalating costs while simultaneously providing their employees with the best quality of care.

In the past, a medical resident could expect to work more than 100 hours a week, with minimal rest in between. Things changed in 2003, when the Accreditation Council for Graduate Medical Education (also known as ACGME), cut down the hours to 80 weekly, although this ruling was not strictly enforced. Still, many shifts can last over a day, up to 30 hours with limited time to sleep.

A new proposal set by ACGME will cut down on mistakes and ensure that patients are safe.   Maximum shift lengths would be reduced hopefully reduce harmful medical from 24 hours to 16 hours for first year residents and to 24 hours for all other physicians. Additionally, attending physicians would be required to make patients aware that they are under the charge of a resident.  The new guidelines will require attending physicians to supervise residents more closely in an effort to improve patient safety. Still, these regulations would only affect first year residents. All other physicians would limited to 24-hour shifts.

Studies have shown that sleep-deprived residents are more prone to making medical mistakes.  A Mayo Clinic study revealed that fatigued, distressed medical residents were more likely to make preventable medical mistakes. Yet another study found that residents were three times as likely to say that they’d made an error during months when they worked one 24 hour long shift.  In 2004, a report discovered that medical residents who worked all night shifts were ultimately accountable for over half of medical errors.

Overworked Medical Residents May Be Catching a Break

Ultimately, some medical mistakes prove fatal. One famous medical malpractice case is that of Libby Zion, an 18 year old college student who died when her overworked, fatigued medical residents prescribed her medication that reacted dangerously with her antidepressants.

Grueling shifts can compromise the health of the doctors themselves. Dr. Shannon Gulliver recently wrote a piece for the New York Times in which she detailed her own weakened immune system, a result of the long hours and high stress of her position. She developed esophagitis, while her colleagues themselves developed shingles, fungal infections, C. difficile diarrhea, and more.

While education is undoubtedly a priority during residency, maintaining the health of both doctors and patients is equally important.  As long as these regulations can cut down life threatening mistakes, I feel that cutting back these hours can be a good thing. Medical residents will still be able to gain the experience they need to practice, and after they complete their first year of residency, young doctors will only be restricted to 24 hour shifts. Ultimately, these guidelines will improve quality of care for patients and better health for doctors and patients alike.

However, including one service in the preventative care has been a source of contention for many groups. Namely, that service is free contraception and family planning services for women.

Should Birth Control Be Included Under the Preventative Care Mandate?

According to Michelle Andrews from Kaiser Health News, American women spend an average of 30 years attempting to prevent pregnancy, and only five years of their lives actively trying to become pregnant. Birth control is one important approach to family planning, and many women’s and employer groups argue that it should be deemed a preventative service.

Still, many more conservative groups oppose including contraceptives in the preventative care mandate, honing in on the support of socially conservative voices. The U.S. Conference of Catholic Bishops argues that pregnancy is not the same as a disease, and therefore contraception should not be placed in the same category as preventative care.

Already, 27 states include birth control as preventative care measures. According to Ms. Andrews, there are over 3 million unplanned pregnancies nationwide every year—a product of the high cost of birth control. Women who use the birth control pill as a contraceptive can expect to spend nearly $75 every month to prevent pregnancy. Not surprisingly, many unexpected births can be attributed to the high cost of birth control options like the pill and IUDs (intrauterine devices).  Even when health insurance plans provide birth control, copayments could still be too high for women—ranging from $50 for the birth control pill and hundreds for IUDS. Young women in particular are hit hard by the prices.

And remember—even married women use birth control to prevent unwanted pregnancy. In fact, over 11 million American women use contraceptives.  Unplanned pregnancies actually cost the American health care system over 5 billion dollars every year—and 40% of these births are covered by Medicaid. Low-income women on Medicaid are less likely to have access to affordable birth control. Plus, many health plans for individuals do not include maternity coverage.

Some employer groups argue that offering contraceptives as a part of preventative care will decrease the cost of insurance, as prenatal and postnatal care is far more expensive than the cost of birth control.

Still, the issue is a touchy one—pregnancies are not as black and white as diseases.  To the millions of American on birth control, hoping to avoid pregnancy, birth control is a crucial part of preventative care. To other Americans, pregnancy is not a disease to be prevented, but the gift of a life. Thus, birth control—like the new morning after pill, Ella One— falls into the health care reform’s gray area of morality.

Despite the tremendous cost benefits that providing contraception would provides—as well as a high demand, the White House took the politically safe route and opted not to include contraception in the preventative care mandate.

HIV/AIDS Drug Assistance Programs Impacted By Recession

Now, HIV positive people depend on HAART to live. Drug therapy for HIV/AIDS is incredibly expensive: one Florida man’s medications cost him over $4,500 monthly, ringing up at around $54,000 every year.  Most HIV positive people simply can’t afford the skyrocketing costs of their prescriptions. Many of these people instead rely on the AIDS Drug Assistance Programs (ADAP), where they only have to pay $12,000 for their drugs.  Currently, AIDS Drug Assistance Programs serve around 170,000 who are unable to buy these mind-numbingly expensive drugs.

However, because of the recession, AIDS Drug Assistance Programs have been hit hard.  In order to balance strained budgets, many states have squeezed their ADAPs, forcing thousands of people nationwide onto waiting lists and off their prescriptions. Many states have either created more strict requirements for enrollments or trimmed their prescription drug formularies in order to keep the programs afloat. At the same time, more and more people are applying for assistance because of the high unemployment levels, squeezing the ADAP’s resources even more.

The effectiveness of HAART has also contributed to the ADAP crunch.  Because of drug therapy, HIV positive people are living longer because the drugs more successfully slow the progression from HIV to AIDS.  At the same time, the CDC’s HIV testing initiatives has resulted in more people knowing their status sooner, adding even more people to the ADAP pool.

Some people on the waiting list have been able to procure drugs from other resources: some pharmaceutical companies offer free or discounted drugs to qualifying patients on a temporary basis. Still, gaps in HAART can have deadly consequences for patients.  HAART most effectively suppresses HIV when used consistently: when patients are off drugs, the HIV viral load increases and can even reduce the effectiveness of those drugs.  When patients skip doses, the AIDS virus becomes resistant to that drug.

Ultimately, these programs need more funding. The government made a commitment to HIV/AIDS when it began promoting increased HIV testing and renewed the Ryan White Act, and it should thus help defray the costs of drug assistance. The states are not economically equipped to fund these programs.  The National Alliance of State and Territorial AIDS Directors have requested $126 million dollars worth of funding to keep their programs afloat and patients alive, a number which dwarfs President Obama’s proposed $20 million in additional funding. Meanwhile, several Republican senators want the whole amount to be paid for from Department of Health and Human Service stimulus.

For people relying on state AIDS Drug Assistance Programs, enrollment in an ADAP can mean the difference between life and death. It is imperative that the United States continue its commitment in the war against HIV by increasing funding for such crucial programming and in turn, save lives.

Will EllaOne Be Available in the US?

However, as expected, it raises the ongoing abortion debate.  This new pill, ellaOne, delays ovulation and therefore inhibits conception.  It does so by preventing the progesterone hormone, a hormone that causes females to ovulate, from being released in the female body.  Conversely, those who are on the pro-life side of the debate claim that it is an abortion pill.  They believe that the pill does not prevent this hormone from being released.  Rather, the fact that it works for five days leads them to believe that it stops the fertilized egg from being implanted in the female’s uterus; therefore killing the fertilized egg.  This being the case, then they consider it an abortion.  If the pill was used the morning after, fertilization may not have taken place.  But, by the fifth day fertilization has taken place.  Nevertheless, some assert that the pill does both: it delays ovulation and prevents the fertilized egg from implanting in the uterus.  So the question is: how does it really work?

This debate has not stopped the pill from being released.  Medical experts find that there are more benefits to it than drawbacks.  No major side effects of the pill on women’s health have been found.  If you take the EllaOne Pill within this five day window, there is only a 1.8% chance of you becoming pregnant.  Whereas, with Plan B you have a 2.6% chance of becoming pregnant.

EllaOne is not yet available in the US.  There was a recent assembly in the US where the Federal advisory panel of medical experts met to discuss the potential sale of ellaOne in the US.  These 11 experts unanimously voted in approval of the emergency contraceptive pill.  Now, the FDA will take this vote into consideration as they decide whether or not to allow the sale of ellaOne in the US.  If the FDA approves the pill, it will be available in the US by prescription only; not over the counter.  However, you will need to check with your health insurance provider to see if this contraceptive pill is covered by your insurance plan.  This final decision by the FDA could take up to several months.  EllaOne is currently sold in France (where it originated) and Great Britain.

Will Obama Fund Abortions in High Risk Insurance Pools?

Pro-choice advocates further allege that the administration does not have the legal authority to determine whether funding can be used to pay for abortions, as the use of funds for such procedures in high risk pools was not mentioned in the language of the Affordable Care Act or the subsequent executive order. Pro-lifers and Republicans say that even if the high risk pools were not included in the language of the executive order which affirmed the Hyde Amendment, the principle of the deal which solidified pro-life Democrats’ last-minute votes should still apply. Essentially, the President promised Democrats the reform would neither expand nor contract abortion availability, and his office should keep that promise.

Abortion-rights groups respond that many states’ existing high risk pools currently cover abortions for good reason. Many of the women enrolled in high risk pools have chronic health problems like diabetes which can make pregnancy dangerous. Abortions must be available to these women as a backup plan if their birth control fails as a pregnancy could seriously threaten their health, or even their lives.

My dog Lace has kept me healthy by being a great exercise buddy. When she was a puppy, Lace was the runt of her Golden Retriever litter. But by the time she was two, Lace had grown to a very portly 100 pounds – far exceeding the healthy weight for her breed. We took her to the veterinarian to make sure she was clear of all possible thyroid or other problems, and she was given a clean bill of health. The veterinarian told us that because we tended to feed Lace table scraps after dinner, she was gaining too much weight. We needed to keep her on a strict diet of diet dog food and exercise her much more regularly to ensure that her doggy obesity didn’t impact her health.

My Dog Before Our Workouts - Such a Porker!

Around this time, I had decided to sign up for a club volleyball team. To get both of us back in shape, Lace and I decided to become jogging partners. We ran around my neighborhood each day, starting out slow and eventually working up to hour-long jogs down the hilly streets of our town. Lace was even more enthusiastic about our plan than I was! Even when I saw a hill ahead and started to slow down, she just kept pushing, encouraging me to run farther. I’m happy to report that both Lace and I have managed to stay in shape by continuing our daily runs, and that she’s now a healthy 75 pounds.

Little research has been carried out on the long-term effects of oil spills on people’s health.  Those who are currently doing research on the potential health risks of oil presume that most of the health concerns will be short term.  However, they do fear potential long-term damage to the liver, lungs, and kidneys.  These short-term and long-term health concerns would be resultant of the oil fumes that workers are subject to while cleaning up the spill.  Other research has found that those working to clean up the oil may experience temporary DNA damage that the body will repair itself over time.

On a more positive note, physical contact with the oil does not pose many health threats.  The oil itself is potentially harmless. Although some people may experience a rash from skin contact with oil, this is only temporary skin irritation.  Health officials announce that you are not in notable danger if you touch or swallow small amounts of oil, but it is not advised to do so.

What consequences will the Gulf Oil Spill have for human health?

How we choose to manage the present circumstances of the BP Oil Spill can be controlled.  Hence, BP has organized clean-up crews in a particular manner.  Complaints have been recorded of an irrational amount of volunteers “standing around” at clean-up sights.  What they don’t realize is that this particular strategy has been arranged to prevent potential health risks to the volunteers.  The volunteers at the spill clean-up spill sites are working in near 100 degree temperatures.  Extended water breaks and shorter working periods reduces the potential of heat-related health risks, such as heatstroke and dehydration.  It also increases the clean-up efficiency of the volunteers

One health concern that has been deemed inevitable is the mental health of residents in the area of the BP Oil Spill.  Mental health issues are bound to arise because it has happened in every past oil spill.  Residents in the areas affected by the oil spill have higher rates of depression and other mental health issues as a result of the spill.  This ensues as a direct result of damages to the resident’s homes, beaches, and jobs.  People lose their jobs because tourism in the area decreases as a direct result of the damages to tourist attractions (especially beaches).  Also, those in the fishing industry lose their jobs because the oil contaminates many fish and people are more concerned with consuming fish.

While working to clean up the most disastrous Oil Spill in US history, all those involved with the Spill must take precaution.  With so much unknown about the potential health threat of oil, research could potentially find that it is toxic.  It is best to take safety measures.  The oil itself contains organic compounds, which can be carcinogenic.  Those working with oil or around oil fumes have a high risk of exposure to these carcinogens in the oil, such as benzene.

Preventive Services Now Free For the Insured

The new regulations will apply to new health plans beginning coverage after September 23, 2010 as well as to existing plans that make major changes after this date. Secretary of Health and Human Services Kathleen Sebelius estimates this change will affect 10 million Americans with individual and family health insurance and 31 million Americans in new employer-sponsored plans next year. In most instances, the task force has detailed how frequently a screening should be performed. Where the task force hasn’t specified a service’s recommended frequency, they ask health insurers to use “reasonable medical management techniques to determine the frequency.” Though these tests must now be offered to subscribers at no cost, insurance carriers will still be allowed to charge patients for treatments related to conditions detected after a screening.

The benefits of utilizing preventive services are real: Secretary Sebelius noted in a press conference for the release of these regulations that 100,000 deaths annually could be prevented if patients effectively used colorectal and breast cancer screenings, flu vaccines, counseling on smoking, and counseling on aspirin therapy to prevent heart disease. Unfortunately, it’s estimated that Americans use preventive services at only half the rate recommended by physicians and experts. Consumers need to take advantage of the preventive services that will be more widely available (and free!) as a result of these new regulations. Now there should be no excuse for those with individual and family or employer-sponsored coverage for whom these tests are free to take responsibility for their own health by getting screenings.

Secretary Sebelius also announced the task force is now compiling a list of preventive services that carriers must offer for free to women to supplement the services already required, including genetic counseling for women with family history of breast cancer, counseling to promote breast-feeding, and osteoporosis screenings. A controversy is on the horizon already with regard to this second list of women’s services. The Planned Parenthood Federation of America has argued publicly that insurance plans should be required to cover contraceptives without co-payments, a proposition pro-life groups will undoubtedly oppose.

Massachusetts Must Control It's Health Insurance Costs

While Massachusetts has succeeded in expanding health insurance coverage, it has not succeeded in slashing costs. As of June 2010, Massachusetts has the lowest uninsured rate in the United States at 4.8 percent, having slashed the uninsured rate by 60 percent. Compare that to the United States as a whole, where 15.4% of citizens are not covered.  Massachusetts’ efforts in expanding covered should be classified as successful.

However, the successes of broader coverage cannot hide the plan’s inability to cut costs.  The wide coverage, coupled with state subsidies and reduced rivalry between health providers, has caused costs to rise. The Massachusetts Department of Insurance has denied insurers’ demands for rate hikes in an attempt to keep expenses low for consumers. Meanwhile, insurers argue that reducing rates without slashing health provider costs places undue stress on them. Premiums have increased substantially for individuals and families, while the use of the emergency room for non-emergencies did not markedly decrease, perhaps indicating a deeper issue: the primary care physician shortage.

The similarities between the Massachusetts plan and the 2010 US Affordable Care Act make Massachusetts’ successes and failures ever more glaring on the national stage. According to a report from Fortune Magazine, both the Massachusetts and Obama plans increase health care demands without addressing health care shortages.  Prices have gone through the roof, and according to Fortune, will not decrease until the government stops targeting insurers.  Insurance pools also grow more expensive as younger, healthier members drop out while sicker members stay in.  Subsidizing middle-income plans may also prove expensive, while additional state-mandated benefits have also strained the system.  According to Fortune, Massachusetts residents have begun to manipulate the system to optimize their health insurance benefits and subsidies.

If Massachusetts can successfully manage the costs associated with its health care reform, perhaps this will bode well for the Affordable Health Care Act.  Four years into the Massachusetts plan, costs have continued to skyrocket as more residents are covered. In the current economy, controlling costs is ever more crucial to the health care industry and to the country’s economy as a whole.  Solving the primary care and health provider shortage may prove a good step in shaving down costs.

In the end, it will be the costs, not universal coverage, that determine success for both the Massachusetts and federal reform programs. I hope that both reforms can find a way to cut costs beyond placing limits on insurers, perhaps by streamlining health care overall and improving the pool of preventative

Supreme Court Nomination May Overturn on Roe v. Wade

If Roe v. Wade was overturned, the likelihood that we would see any variation in the amount of abortions in the US would be slim.  More problems may arise than would be solved in the event that Roe v. Wade was overturned.  If it was, there are about 20-25 states that would immediately enact laws against abortion.  This would make it more difficult for females to find a doctor offering abortion services.  However, it would not stop them from having abortions.  Females will either go to the states offering abortion services or find other means that are less safe and healthy than finding an available doctor.  Overturning Roe v. Wade would theoretically eliminate 170 doctors providing abortion services, which is less than 10% of all services available in the US.

Overturning Roe v. Wade will pose serious health and financial burdens.  As mentioned before, females will take more risky measures to have an abortion.  Those who decide to keep their baby are immediately faced with the high hospital costs and medical costs associated with having a baby.  Consequently, more women may consider taking contraceptives to prevent pregnancy in the first place.  However, this too can be expensive because many health insurance plans do not cover contraceptives.  If they do offer coverage, there is often a high out-of-pocket charge for the contraceptive prescription.  Also, there are very few health insurance companies that offer abortion coverage (most are private insurance companies).  It is likely that these health insurance companies will establish much higher costs in the states that would choose to allow abortion after overturning Roe v. Wade.

The replacement of Anthony Kennedy is not an immediate concern, but it is a possibility in the near future.  Kennedy’s retirement should not be in question because he is not likely to retire soon.  The only imminent threat to his position would be a Republican president, who may choose to replace Kennedy with a candidate who opposes abortion.  This decision, however, would have many repercussions and may not solve any abortion issues.

First, simplify Medicaid enrollment by giving states the option to enroll children automatically based on their records with other government agencies like those that administer food stamps or subsidized school lunch programs. In early 2010, Louisiana identified nearly 10,000 children via its food stamp program who were eligible for CHIP or Medicaid by not enrolled. Express lane eligibility could be expanded by developing a joint Medicaid/CHIP online application which eliminates the now-mandatory in-person interview. This expedited process is currently allowed for enrolling children under a 2009 federal law and 18 states already use it as an option. Federal law could further be changed to allow express lane enrollment for adults, especially those who will become Medicaid eligible in 2014. Creating an express lane process which applies to all Medicaid eligible individuals would encourage enrollment by lowering the barriers to entry. Eligibility terms could also be increased from 6 months to 1 year, and the process for renewing Medicaid coverage could be streamlined.

New Strategies Employed to Enroll More Children & Adults in Medicaid

States might also consider eliminating the asset test applied when determining adults’ Medicaid eligibility. This test has already been dropped for parents enrolling their children in most states. One big barrier to enrolling more of the Medicaid eligible population is the social stigma associated with being on Medicaid. Unfortunately, this stigma places Medicaid enrollees in the same category as welfare recipients. Though both these programs provide necessary services to families in need, “welfare” has taken on a negative connotation in popular culture, one which Medicaid has also acquired. In order to encourage a culture of coverage, states could rename Medicaid to something more appealing and which sounds less like a welfare entitlement. My home state of Connecticut already made such a change, renaming CHIP the “Husky” Program after our NCAA Champion UConn basketball teams.

Finally, experts suggested paying incentives to nonprofit social service agencies who help enroll children in Medicaid and CHIP. Some states including Oregon, California, Louisiana, New Hampshire, Illinois, and Indiana have had success enrolling thousands of kids via these groups using paid incentives. Any or all of these strategies could prove useful to Medicaid program administrators in the years to come as the pool of eligible individuals is set to swell tremendously.

Low-Income Single Adults Eligible for Medicaid in CT

Medicaid provides a wider range of health services than SAGA, and by enrolling low-income singles in Medicaid, Connecticut will save money and provide the approximately 45,000 qualifying individuals with more medical care.  Before the Affordable Care Act, adults without kids did not qualify unless the state allowed exceptions. On top of the savings, Connecticut will get some cash from the federal government for this endeavor. Kathleen Sebelius, Secretary of Health and Human Services Department, lauded Connecticut for early enrollment because it

The District of Columbia also followed Connecticut’s lead, and requested the government to expand its own Medicaid program, slashing over 56 million dollars from the city’s budget.  Both Connecticut and Washington, DC took advantage of the Affordable Care Act.  By 2014, every state will need to expand its Medicare coverage with federal funding, so successes in Connecticut and DC could indicate overall success for the Affordable Care Act.

Are states finally accepting the Affordable Health Care Act? Hopefully Connecticut and Washington, DC’s Medicaid expansion will truly prove successful in reducing expenses and providing citizens with quality health care.

Questions all women should ask about their health insurance coverage

1. Does my health insurance plan cover health screenings recommended annually for women?

It is recommended that women have annual mammograms, cervical cancer screenings, and osteoporosis screenings beginning at a certain age.  There are others important annual tests, but these tests are specific to women. The law requires that health insurance companies offer coverage for one annual mammogram for women 40 and older to prevent breast cancer.  Most states mandate that insurance companies cover an annual cervical cancer screening, such as pap smears.  Also, health insurance companies are required to offer coverage for annual osteoporosis screenings since they are necessary for health maintenance.  Osteoporosis tests begin around age 60.

2. Does my health insurance company cover specialty doctor visits?

Most health insurance companies cover for your OB/GYN services.  But it is important to check your health insurance plan to see what costs and treatments are covered because some are excluded from insurance.  For example, sterilization is rarely covered by health insurance companies.

3. Will my pregnancy be covered by health insurance?

Today, the average cost of having a baby is over $6000. Health insurance companies will most often cover doctors office and hospital visit expenses (with a small co-payment).  But there’s a catch: you must have health insurance before you get pregnant! Women who are already pregnant are considered “high-risk” candidates and it will be much more difficult to get coverage.  Other things you may want to check with the insurance company is if they offer coverage for services during your pregnancy (associated with the pregnancy but not the typical office visits) and prescriptions for possible depression. Even if you don’t needs these, better safe than sorry!

4. What if I need infertility treatments? Is that covered?

Infertility insurance is limited, but you’re not out of luck.  There are 14 states with mandates for health insurance coverage of infertility treatments.  If infertility treatments are not specifically excluded form your insurance plan, you can get coverage.  If needed, get a copy of your plan from your health insurance provider.  Otherwise, infertility treatment coverage is also offered by private insurance companies.

5.  Does my health insurance cover all of my prescription drugs?

There are many prescription pills specifically for women, such as contraceptive pills.  Generally, contraceptives have not been covered by health insurance companies in their plan. But, each insurer is different.  It is important to ask your provider because they may offer contraceptive coverage.

6. Is there coverage for treatment against diseases common to women?

Women are at a higher risk for osteoporosis, breast cancer, cervical cancer, and many others.  It is important for women to take preventative measures in their healthcare as well as have insurance for their expenses.  Vaccines are common preventative measures, such as Gardasil, a vaccine to prevent HPV and cervical cancer.  Many insurance companies cover this preventative vaccine because it reduces the chance of future medical conditions. However, check with the health insurance provider you are considering before making the final decision.

It is important to get coverage before you become ill.  Difficulty arises with health insurance coverage if you are already ill because the insurers many consider it a pre-existing condition.  Or some companies may offer coverage for office visits and pharmacy charges, but have you on a waiting list for any other treatment coverage you may need.

COBRA Subsidy Running Out for the Unemployed

As of June 1, 2010, the 15-month COBRA subsidy has expired for those who took advantage of it when it first became available in February 2009. The National Employment Law Project estimates that more than 144,000 households each month will be dropped from the subsidy as these families hit their 15-month mark. Many families whose COBRA subsidy has not yet expired hope the Senate will pass this extension of the COBRA subsidy beyond the 15 month mark so that they can continue paying just 35% of the total cost of their previous employer’s insurance premiums and keep their old coverage. Here are five reasons why I don’t think an extension of this subsidy will make it into the final jobless benefits package which should come to a vote this week:

1)      Centrist House Democrats rejected a similar proposal to extend COBRA subsidies in May 2010 because of concerns about continuing to run-up the national deficit.

2)      Last week, the non-partisan Congressional Budget Office evaluated the Senate’s trimmed down version of the proposal which is in currently in the works. Extending the COBRA subsidy again is estimated at $4.1 billion, which is much higher than supporters had anticipated.

3)      Congress already extended the subsidy once in November 2009, allowing COBRA beneficiaries to continue receiving the 65% subsidy of their total premium cost for a maximum of 15 months. The original subsidy as passed in the American Recovery and Reinvestment Act of 2009 was set to expire after 9 months.

4)      There are few other areas of the bill from which co-sponsors Sens. Bob Casey Jr. (D-PA) and Sherrod Brown (D-OH) can pull funds for the subsidy. The subsidy extension is only part of a package of provisions the Senators are trying to attach to the must-pass legislation. Their whole package has a total cost estimated at nearly $7 billion. Other parts of their provisions would extend unemployment benefits and make changes in dozens of federal programs, and these are not areas from which the senators could easily justify cutting funding in order to make room for another COBRA subsidy extension.

5)      A similar proposal to extend the COBRA subsidy was dropped from the House-passed bill. Additionally, Senate Democratic leaders omitted it from their version when the bill was originally drawn up.

Unfortunately, it seems that given the strained economy and need for budget-consciousness in Washington families who have relied on the federal subsidy to keep their coverage under COBRA will have to reevaluate their options.

The six medical condition mandates for the new proposal include: ostomy-related supplies, prosthetic devices, hearing aids for children and wigs for patients who experience hair loss due to medical conditions. These mandates would cover what is typically paid for out of pocket, therefore increasing premium costs.