This morning, President Obama spoke to the press about the Gulf Oil Spill. The BP Oil Spill in the Gulf Coast has given us little predictability as to what the future holds for this catastrophic event.  This is the worst oil spill in US history; therefore raising many questions that have never been answered before.  With tar balls now showing up on the beaches in Galveston County Texas (some 400 miles away from the source of the spill) the consequences of this spill are very much unknown.  The health of the people in the Gulf Coast area is obviously an immediate concern.

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.

Yesterday, the White House outlined new regulations which require health insurance carriers to provide coverage for many preventive care measures at no cost to policy subscribers. These preventive care measures include dozens of screenings and laboratory tests like blood pressure, diabetes, cholesterol, HIV, and cancer screenings, routine vaccinations, well-visits for infants and children, and prenatal care. Counseling to decrease obesity and stop smoking must also be offered free of charge. The complete list of tests and screenings was compiled by the United States Preventive Services Task Force, an independent panel of health experts.

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.

In 2006, Massachusetts established a broader health care system to provide universal health insurance coverage to its residents while also cutting down costs. The Massachusetts health care reform features several crucial components that expanded coverage to more than 100,000 uninsured.  The reform requires all Massachusetts adults to enroll in a health insurance plan or risk penalty, while all employers must also provide health insurance to employees or pay a penalty. Low-income adults have the opportunity to join one of the state-run Commonwealth Care plans.

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

Decided in 1973, the Roe v. Wade case forbade states from establishing laws that banned abortion.  It gave women the right to have an abortion in any US state up until their third trimester.  The ruling of this case has led to an ongoing abortion debate throughout the nation.  Anthony Kennedy, a Justice of the Supreme Court, is known for having a “swing vote” in many Supreme Court decisions.  However, people fear that a Republican President may choose to replace Kennedy.  Kennedy’s vote has always been important in the abortion cases.  If he were replaced, there is fear that Roe v. Wade may be overturned. This would allow states to enact laws against abortion at any point in the pregnancy if they so desire.

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.

Even as federal Medicaid funds through the stimulus package dwindle, experts and state officials are collaborating on ways to identify and enroll eligible children in CHIP and traditional Medicaid this year. They are also working on similar strategies to target the millions of adults who will become eligible for Medicaid in 2014. Kaiser Health Network recently interviewed three health policy analysts for their take on how states can bring the nearly 5 million eligible but unenrolled children into the Children’s Health Insurance Program. The experts from the National Academy for State Health Policy, the Center for Children and Families at Georgetown, the Kaiser Family Foundation, and the Center on Budget and Policy Priorities enumerated several strategies states could adopt.

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.

On Monday, Connecticut announced that it would be the first state to move low income residents to the Medicaid program.  This shift will allow the state to save over 53 million dollars over the next year.  Because the government made changes in the Medicaid program to allow low-income singles without kids to enroll in Medicaid for the first time Connecticut was able to move these people from the State Administered General Assistance (SAGA) program.

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.

Ladies, it’s a fact that our health needs are different than those of men.  Due to our genetic make-up, there are many other health concerns that we must consider when choosing our health insurance plan.  The future is unpredictable, so it is important that we get coverage for all our current and potential future conditions.

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.

Today is the deadline for states to submit details to the Department of Health and Human Services on how they intend to operate the high-risk health insurance pools mandated by healthcare reform. The high-risk pool program is intended to provide coverage to those who have been denied health insurance because of a pre-existing condition and who have been without coverage for more than six months. These pools are meant to bridge the gap for such individuals until subsidies and new health insurance exchanges are instituted in 2014. Other crucial reforms included in the package which brought on these pools are provisions that allow individuals to stay on their families’ insurance plans up to age twenty-six, prevent insurers from excluding children because of preexisting conditions, and eliminate lifetime limits on health costs imposed on policyholders. Twenty-nine state and the District of Columbia have elected to run their own pools and will be entitled to a portion of the $5 billion allocated by the federal government to fund them. Nineteen states said they would leave operation of pools in their states to the federal government. Some think tank analysts and state officials worry that federal funding may run out, leaving states liable to cover these high-risk patients out of their own budgets. Federal officials at the Department of Health and Human Services have assured these doubters that the funds will last for until 2014 in states where it will administer the pools. They further say the federal government will cover the costs of developing or modifying accounting or enrollment systems and any other start-up costs states may incur. The contracts due to Health and Human Services today must include strategies for operation of the pools, estimations of total cost, and other provisions. Enrollment in the pools begins July 1 and coverage for policyholders will begin August 1. For more information on the high-risk pools in your state, contact your state’s Department of Insurance.

Obama administration officials and some Senate Democrats are optimistic that the federal subsidy of COBRA benefits passed by the economic stimulus bill will be extended by inserting  a provision to this effect into the “extenders” package of jobless benefits working its way through the Senate this week. This bill is co-sponsored by Senators Bob Casey Jr. (D-PA) and Sherrod Brown (D-OH). As discussed in my last post here, it is estimated that over 2 million families who would have lost their employer-sponsored health insurance as the result of a lay-off took advantage of the COBRA subsidy. Instead of losing their coverage, COBRA has allowed them to keep their previous employer’s health insurance and the federal government’s subsidy has paid for 65% of the total cost of maintaining that coverage. This subsidy was a huge help for families who otherwise would have had to assume 100% of the total cost of premiums (including the portion their employer used to pay) to maintain their coverage under COBRA.

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.

According to Hartford Business online, the Connecticut State Government is debating on passing a bill which will mandate expanded coverage for more than six medical conditions. Such mandates would add approximately 3% to total premiums, according to insurance experts.

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.