Tag Archives: treatment

6 surprising health items that could disappear with ACA repeal

The Affordable Care Act of course affected premiums and insurance purchasing. It guaranteed people with pre-existing conditions could buy health coverage and allowed children to stay on parents’ plans until age 26. But the roughly 2,000-page bill also included a host of other provisions that affect the health-related choices of nearly every American.

Some of these measures are evident every day. Some enjoy broad support, even though people often don’t always realize they spring from the statute.

In other words, the outcome of the repeal-and-replace debate could affect more than you might think, depending on exactly how the GOP congressional majority pursues its goal to do away with Obamacare.

No one knows how far the effort will reach, but here’s a sampling of sleeper provisions that could land on the cutting-room floor:

CALORIE COUNTS AT RESTAURANTS AND FAST FOOD CHAINS

Feeling hungry? The law tries to give you more information about what that burger or muffin will cost you in terms of calories, part of an effort to combat the ongoing obesity epidemic. Under the ACA, most restaurants and fast food chains with at least 20 stores must post calorie counts of their menu items. Several states, including New York, already had similar rules before the law. Although there was some pushback, the rule had industry support, possibly because posting calories was seen as less onerous than such things as taxes on sugary foods or beverages. The final rule went into effect in December after a one-year delay. One thing that is still unclear: Does simply seeing that a particular muffin has more than 400 calories cause consumers to choose carrot sticks instead?  Results are mixed. One large meta-analysis done before the law went into effect didn’t show a significant reduction in calorie consumption, although the authors concluded that menu labeling is “a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories.”

PRIVACY PLEASE: WORKPLACE REQUIREMENTS FOR BREAST-FEEDING ROOMS

Breast feeding, but going back to work? The law requires employers to provide women break time to express milk for up to a year after giving birth and provide someplace — other than a bathroom — to do so in private. In addition, most health plans must offer breastfeeding support and equipment, such as pumps, without a patient co-payment.

LIMITS ON SURPRISE MEDICAL COSTS FROM HOSPITAL EMERGENCY ROOM VISITS

If you find yourself in an emergency room, short on cash, uninsured or not sure if your insurance covers costs at that hospital, the law provides some limited assistance. If you are in a hospital that is not part of your insurer’s network, the Affordable Care Act requires all health plans to charge consumers the same co-payments or co-insurance for out-of-network emergency care as they do for hospitals within their networks. Still, the hospital could “balance bill” you for its costs — including ER care — that exceed what your insurer reimburses it.

If it’s a non-profit hospital — and about 78 percent of all hospitals are — the law requires it to post online a written financial assistance policy, spelling out whether it offers free or discounted care and the eligibility requirements for such programs. While not prescribing any particular set of eligibility requirements, the law requires hospitals to charge lower rates to patients who are eligible for their financial assistance programs. That’s compared with their gross charges, also known as chargemaster rates.

NONPROFIT HOSPITALS’ COMMUNITY HEALTH ASSESSMENTS

The health law also requires non-profit hospitals to justify the billions of dollars in tax exemptions they receive by demonstrating how they go about trying to improve the health of the community around them.

Every three years, these hospitals have to perform a community needs assessment for the area the hospital serves. They also have to develop — and update annually — strategies to meet these needs. The hospitals then must provide documentation as part of their annual reporting to the Internal Revenue Service. Failure to comply could leave them liable for a $50,000 penalty.

A WOMAN’S RIGHT TO CHOOSE … HER OB/GYN

Most insurance plans must allow women to seek care from an obstetrician/gynecologist without having to get a referral from a primary care physician. While the majority of states already had such protections in place, those laws did not apply to self-insured plans, which are often offered by large employers. The health law extended the rules to all new plans. Proponents say direct access makes it easier for women to seek not only reproductive health care, but also related screenings for such things as high blood pressure or cholesterol.

AND WHAT ABOUT THOSE THERAPY COVERAGE ASSURANCES FOR FAMILIES WHO HAVE KIDS WITH AUTISM?

Advocates for children with autism and people with degenerative diseases argued that many insurance plans did not provide care their families needed. That’s because insurers would cover rehabilitation to help people regain functions they had lost, such as walking again after a stroke, but not care needed to either gain functions patients never had, such speech therapy for a child who never learned how to talk, or to maintain a patient’s current level of function. The law requires plans to offer coverage for such treatments, dubbed habilitative care, as part of the essential health benefits in plans sold to individuals and small groups.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. This story from HKN is published under a Creative Commons license.

CDC considers lowering threshold for lead exposure

The CDC is considering lowering its threshold for elevated childhood blood lead levels by 30 percent, a shift that could help health practitioners identify more children afflicted by the heavy metal.

Since 2012, the U.S. Centers for Disease Control and Prevention, which sets public health standards for exposure to lead, has used a blood lead threshold of 5 micrograms per deciliter for children under age 6.

While no level of lead exposure is safe for children, those who test at or above that level warrant a public health response, the agency says.

Based on new data from a national health survey, the CDC may lower its reference level to 3.5 micrograms per deciliter in the coming months, according to six people briefed by the agency.

The measure will come up for discussion at a CDC meeting Jan. 17 in Atlanta.

But the step, which has been under consideration for months, could prove controversial. One concern: Lowering the threshold could drain sparse resources from the public health response to children who need the most help – those with far higher lead levels.

The CDC did not respond to a request for comment.

Exposure to lead — typically in peeling old paint, tainted water or contaminated soil — can cause cognitive impairment and other irreversible health impacts.

The CDC adjusts its threshold periodically as nationwide average levels drop. The threshold value is meant to identify children whose blood lead levels put them among the 2.5 percent of those with the heaviest exposure.

“Lead has no biological function in the body, and so the less there is of it in the body the better,” Bernard M Y Cheung, a University of Hong Kong professor who studies lead data, told Reuters. “The revision in the blood lead reference level is to push local governments to tighten the regulations on lead in the environment.”

The federal agency is talking with state health officials, laboratory operators, medical device makers and public housing authorities about how and when to implement a new threshold.

Since lead was banned in paint and phased out of gasoline nearly 40 years ago, average childhood blood lead levels have fallen more than 90 percent. The average is now around 1 microgram per deciliter.

Yet progress has been uneven, and lead poisoning remains an urgent problem in many U.S. communities.

A Reuters investigation published this month found nearly 3,000 areas with recently recorded lead poisoning rates of at least 10 percent, or double those in Flint, Michigan, during that city’s water crisis.

More than 1,100 of these communities had a rate of elevated blood tests at least four times higher than in Flint.

In the worst-affected urban areas, up to 50 percent of children tested in recent years had elevated lead levels.

The CDC has estimated that as many as 500,000 U.S. children have lead levels at or above the current threshold. The agency encourages “case management” for these children, which is often carried out by state or local health departments and can involve educating families about lead safety, ordering more blood tests, home inspections or remediation.

Any change in the threshold level carries financial implications. The CDC budget for assisting states with lead safety programs this year was just $17 million, and many state or local health departments are understaffed to treat children who test high.

Another concern: Many lead testing devices or labs currently have trouble identifying blood lead levels in the 3 micrograms per deciliter range. Test results can have margins of error.

“You could get false positives and false negatives,” said Rad Cunningham, an epidemiologist with the Washington State Department of Health. “It’s just not very sensitive in that range.”

The CDC doesn’t hold regulatory power, leaving states to make their own decisions on how to proceed. Many have yet to adapt their lead poisoning prevention programs to the last reference change, implemented four years ago, when the level dropped from 10 to 5 micrograms per deciliter. Other states, including Virginia and Maine, made changes this year.

The U.S. Department of Housing and Urban Development is close to adopting a rule requiring an environmental inspection — and lead cleanup if hazards are found — in any public housing units where a young child tests at or above the CDC threshold.

If the CDC urges public health action under a new threshold, HUD said it will follow through. “The only thing that will affect our policy is the CDC recommendation for environmental intervention,” said Dr. Warren Friedman, with HUD’s Office of Lead Hazard Control and Healthy Homes.

To set the reference value, the CDC relies upon data from the National Health and Nutrition Survey. The latest data suggests that a small child with a blood lead level of 3.5 micrograms per deciliter has higher exposure than 97.5 percent of others in the age group, 1 to 5 years.

But in lead-poisoning hotspots, a far greater portion of children have higher lead levels. Wisconsin data, for instance, shows that around 10 percent of children tested in Milwaukee’s most poisoned census tracts had levels double the current CDC standard.

Some worry a lower threshold could produce the opposite effect sought, by diverting money and attention away from children with the worst exposure.

“A lower reference level may actually do harm by masking reality – that significant levels of lead exposure are still a problem throughout the country,” said Amy Winslow, chief executive of Magellan Diagnostics, whose blood lead testing machines are used in thousands of U.S. clinics.

Shots urged as flu cases rise in Wisconsin

Wisconsin health officials say flu cases are on the rise and they are urging people to take precautions like getting a flu shot.

The Wisconsin Department of Health Services said on Dec. 28 there had been 161 influenza cases so far this season, and 95 hospitalizations, including eight children and 78 adults age 50 and older. Of those hospitalized with influenza, 63 percent were 65 or older.

State Health officer Karen McKeown says getting a flu shot is still one of the best ways to protect yourself and your family and friends from complications of the flu.

McKeown says other steps include practicing good hand-washing hygiene, covering your cough and not sharing drinking cups and straws.

 

If Republicans repeal health law, how will they pay for replacement?

Leading Republicans have vowed that even if they repeal most of the Affordable Care Act early in 2017, a replacement will not hurt those currently receiving benefits.

Republicans will seek to ensure that “no one is worse off,” said House Speaker Paul Ryan, R-Wis., in an interview with a Wisconsin newspaper earlier this month. “The purpose here is to bring relief to people who are suffering from Obamacare so that they can get something better.”

But that may be difficult for one big reason — Republicans have also pledged to repeal the taxes that Democrats used to pay for their health law. Without that funding, Republicans will have far less money to spend on whatever they opt for as a replacement.

“It will be hard to have comparable coverage if they start with less money,” Gail Wilensky, a health economist who ran the Medicare and Medicaid programs under President George H.W. Bush, said in an interview.

“Repealing all the ACA’s taxes as part of repeal and delay only makes a true replacement harder,” wrote Loren Adler and Paul Ginsburg of the Brookings Institution in a white paper out this week. It “would make it much more difficult to achieve a sustainable replacement plan that provides meaningful coverage without increasing deficits.”

The health law’s subsidies to individuals buying insurance and the Medicaid expansion are funded by two big pots of money.

The first is a series of taxes, including levies on individuals with incomes greater than $200,000, health insurers, makers of medical devices, brand-name drugmakers, people who use tanning salons, and employer plans that are so generous they trigger the much-maligned “Cadillac Tax.” Some of those measures have not yet taken effect.

However, the Congressional Budget Office estimated in early 2016 that repealing those provisions would reduce taxes by an estimated $1 trillion over the decade from 2016-2025.

The other big pot of money that funds the benefits in the health law comes from reductions in federal spending for Medicare (and to a lesser extent, Medicaid). Those include trims in the scheduled payments to hospitals, insurance companies and other health care providers, as well as increased premiums for higher-income Medicare beneficiaries.

CBO estimated in 2015 that cancelling the cuts would boost federal spending by $879 billion from 2016 to 2025.

The GOP, in the partial repeal bill that passed in January and was vetoed by President Barack Obama, proposed to cancel the tax increases in the health law, as well as the health premium subsidies and Medicaid expansion. But it would have kept the Medicare and Medicaid payment reductions. Because the benefits that would be repealed cost more than the revenue being lost through the repeal of the taxes, the result would have been net savings to the federal government — to the tune of about $317.5 billion over 10 years, said CBO.

But those savings — even if Republicans could find a way to apply them to a new bill — would not be enough to fund the broad expansion of coverage offered under the ACA.

If Republicans follow that playbook again, their plans for replacement could be hampered because they will still lose access to tax revenues. That means they cannot fund equivalent benefits unless they find some other source of revenue.

Some analysts fear those dollars may come from still more cuts to Medicare and Medicaid.

“Medicare and Medicaid face fundamental threats, perhaps the most since they were established in the 1960s,” said Edwin Park of the liberal Center on Budget and Policy Priorities, in a webinar last week.

Republicans in the House, however, have identified one other potential source of funding. “Our plan caps the open-ended tax break on employer-based premiums,” said their proposal, called “A Better Way.”

House Republicans say that would be preferable to the Cadillac Tax in the ACA, which is scheduled to go into effect in 2020 and taxes only the most generous plans.

But health policy analysts say ending the employer tax break could be even more controversial.

Capping the amount of health benefits that workers can accept tax-free “would reduce incentives for employers to continue to offer coverage,” said Georgetown University’s Sabrina Corlette.

James Klein, president of the American Benefits Council, which represents large employers, said they would look on such a proposal as potentially more damaging to the future of employer-provided insurance than the Cadillac Tax, which his group has lobbied hard against.

“This is not a time one wants to disrupt the employer marketplace,” said Klein in an interview. “It seems perplexing to think that if the ACA is going to be repealed, either in large part or altogether, it would be succeeded by a proposal imposing a tax on people who get health coverage from their employer.”

Wilensky said that as an economist, getting rid of the tax exclusion for employer-provided health insurance would put her “and all the other economists in seventh heaven.” Economists have argued for years that having the tax code favor benefits over cash wages encourages overly generous insurance and overuse of health services.

But at the same time, she added, “I am painfully aware of how unpopular my most favored change would be.”

Republicans will have one other option if and when they try to replace the ACA’s benefits — not paying for them at all, thus adding to the federal deficit.

While that sounds unlikely for a party dedicated to fiscal responsibility, it wouldn’t be unprecedented. In 2003 the huge Medicare prescription drug law was passed by a Republican Congress — with no specified funding to pay for the benefits.

Republished under a creative commons license via Kaiser Health News.

Trump action on health care could cost Planned Parenthood

One of President-elect Donald Trump’s first, and defining, acts next year could come on Republican legislation to cut off taxpayer money from Planned Parenthood.

Trump sent mixed signals during the campaign about the 100-year-old organization, which provides birth control, abortions and various women’s health services. Trump said “millions of women are helped by Planned Parenthood,” but he also endorsed efforts to defund it. Trump once described himself as “very pro-choice.” Now he’s in the anti-abortion camp.

The Republican also has been steadfast in calling for repeal of President Barack Obama’s health care law and the GOP-led Congress is eager to comply.

One of the first pieces of legislation will be a repeal measure that’s paired with cutting off money for Planned Parenthood.

While the GOP may delay the impact of scuttling the law for almost four years, denying Planned Parenthood roughly $400 million in Medicaid funds would take effect immediately.

“We’ve already shown what we believe with respect to funding of Planned Parenthood,” House Speaker Paul Ryan, R-Wis., told reporters last month. “Our position has not changed.”

Legislation to both repeal the law and cut Planned Parenthood funds for services to low-income women moved through Congress along party lines last year. Obama vetoed it; Trump’s win removes any obstacle.

Cutting off Planned Parenthood from taxpayer money is a long-sought dream of social conservatives, but it’s a loser in the minds of some GOP strategists.

Planned Parenthood is loathed by anti-abortion activists who are the backbone of the GOP coalition. Polls, however, show that the group is favorably viewed by a sizable majority of Americans — 59 percent in a Gallup survey last year, including more than one-third of Republicans.

“Defunding Planned Parenthood as one of their first acts in the New Year would be devastating for millions of families and a huge mistake by Republicans,” said incoming Senate Minority Leader Charles Schumer, D-N.Y.

Democrats pledge to defend the group and they point to the issue of birth control and women’s health as helping them win Senate races in New Hampshire and Nevada this year. They argue that Trump would be leading off with a political loser.

But if he were to have second thoughts and if the Planned Parenthood provision were to be dropped from the health law repeal, then social conservatives probably would erupt.

“They may well be able to succeed, but the women of America are going to know what that means,” said Rep. Diana DeGette, D-Colo., citing reduced access to services Planned Parenthood clinics provide. “And we’re going to call Republicans on the carpet for that.”

At least one Republican senator, Susan Collins of Maine, may oppose the effort.

Collins has defended Planned Parenthood, saying it “provides important family planning, cancer screening, and basic preventive health care services to millions of women across the country.” She voted against the health overhaul repeal last year as a result.

Continued opposition from Collins, which appears likely, would put the repeal measure on a knife’s edge in the Senate, where Republicans will have a 52-48 majority next year.

Senate GOP leaders could afford to lose just one other Republican.

Anti-abortion conservatives have long tried to cut Planned Parenthood funds, arguing that reimbursements for nonabortion services such as gynecological exams help subsidize abortions. Though Planned Parenthood says it performed 324,000 abortions in 2014, the most recent year tallied, the vast majority of women seek out contraception, testing and treatment of sexually transmitted diseases, and other services including cancer screenings.

The defunding measure would take away roughly $400 million in Medicaid money from the group in the year after enactment, according to the nonpartisan Congressional Budget Office, and would result in roughly 400,000 women losing access to care.

One factor is that being enrolled in Medicaid doesn’t guarantee access to a doctor, so women denied Medicaid services from Planned Parenthood may not be able to find replacement care.

Planned Parenthood says private contributions are way up since the election, but that they are not a permanent replacement for federal reimbursements. “We’re going to fight like hell to make sure our doors stay open,” said Planned Parenthood spokeswoman Erica Sackin.

Doctors, hospitals say ‘show me the money’ before treating patients

Tai Boxley needs a hysterectomy. The 34-year-old single mother has uterine prolapse, a condition that occurs when the muscles and ligaments supporting the uterus weaken, causing severe pain, bleeding and urine leakage.

Boxley and her 13-year-old son have health insurance through her job as an administrative assistant in Tulsa, Oklahoma. But the plan has a deductible of $5,000 apiece, and Boxley’s doctor said he won’t do the surgery until she prepays her share of the cost. His office estimates that will be as much as $2,500. Boxley is worried that the hospital may demand its cut as well before the surgery can be performed.

“I’m so angry,” Boxley said. “If I need medical care I should be able to get it without having to afford it up front.”

At many doctors’ offices and hospitals, a routine part of doing business these days is estimating patients’ out-of-pocket payments and trying to collect it up front.

Eyeing retailers’ practice of keeping credit card information on file, “there’s certainly been a movement by health care providers to store some of this information and be able to access it with patients’ permission,” said Mark Rukavina, a principal at Community Health Advisors in Chestnut Hill, Massachusetts, who works with hospitals on addressing financial barriers to care.

But there’s a big difference between handing over a credit card to cover a $20 copayment versus suddenly being confronted with a $2,000 charge to cover a deductible, an amount that might take months to pay off or exceed a patient’s credit limit. Doctors may refuse to dispense needed care before the payment is made, even as patient health hangs in the balance.

The strategy leaves patients financially vulnerable. Once a charge is on a patient’s credit card, they may have trouble contesting a medical bill. Likewise, a service placed on a credit card represents a consumer’s commitment that the charge was justified, so nonpayment is more likely to harm a credit score.

Approximately three-quarters of health care and hospital systems ask for payment at the time services are provided, a practice known as “point-of-service collections,” estimated Richard Gundling, a senior vice president at the Healthcare Financial Management Association, an industry group. He could not say how many were doing so for higher priced services or for patients with high-deductible plans, situations that would likely result in out-of-pocket outlays of hundreds or thousands of dollars.

“For providers, there’s more risk with these higher deductibles, because the chance of being able to collect it later diminishes,” Gundling said.

But the practice leaves many patients resentful.

After arriving by ambulance at the emergency department, Susan Bradshaw lay on a gurney in her hospital gown with a surgical bonnet on her head, waiting to be wheeled into surgery to remove her appendix at a hospital near her home in Maitland, Fla. A woman in street clothes approached her. Identifying herself as the surgeon’s office manager she demanded that Bradshaw make her $1,400 insurance payment before the surgery could proceed.

“I said, ‘You have got to be kidding. I don’t even have a comb,’” Bradshaw, a 68-year-old exhibit designer, told the woman on that night eight years ago. “I don’t have a credit card on me.”

The woman crossed her arms and Bradshaw remembers her saying, “You have to figure it out.”

As providers aim to maximize their collections, many contract with companies that help doctors and hospitals secure payments up front, often providing scripts that prompt staff to talk with patients about their payment obligations and discuss payment scenarios as well as software that can estimate what a patient will owe.

But as hospitals and doctors push for point-of-service payments to reduce bad debt from patients with increasingly high deductibles, the risk is that patients will delay care and end up in the emergency room, Rukavina said. “Patients are essentially paying for their procedures up front,” he said. “It may not be a significant amount compared to their salary, but they don’t necessarily have it available at the time of service.”

The higher their deductible, the less likely patients are to pay what they owe, according to an analysis of 400,000 claims by the Advisory Board, a health care research and consulting firm. While more than two-thirds of patients with a deductible of less than $1,000 were likely to pay at least some portion of what they owe, just 36 percent of those with deductibles of more than $5,000 did so, the analysis found.

Fifty-one percent of workers with insurance through their employer had a deductible of at least $1,000 for single coverage this year, according to the Kaiser Family Foundation’s annual survey of employer health insurance. (KHN is an editorially independent program of the foundation.)

Boxley pays $110 a month for her family plan. She could not afford the premiums on plans with lower deductibles that her employer offered. She plans to talk with the doctor and hospital about setting up a payment plan so she can get the surgery in January.

“I’ll make payments,” Boxley said, although she acknowledged what she could pay monthly would be small. If that doesn’t pan out, she figures she’ll have to use student loan money she got for graduate school to cover what she owes.

Still, experts say that trying to pin patients down for payment in more acute settings, such as the emergency department, may cross a line.

Under the federal Emergency Medical Treatment and Labor Act (EMTALA), a patient who has a health emergency has to be stabilized and treated before any hospital personnel can discuss payment with them. If it’s not an emergency, however, those discussions can occur before treatment, said Dr. Vidor Friedman, an emergency physician who is the secretary-treasurer of American College of Emergency Physicians’ board of directors.

Bradshaw finally got her appendix removed by calling a friend, who read his MasterCard number over the phone. The surgery was uneventful and Bradshaw was home within 24 hours.

“It’s a very murky, unclear situation,” Friedman said of Bradshaw’s experience, noting that a case might be made that her condition wasn’t life threatening. “At the very least it’s poor form, and goes against the intent if not the actual wording of EMTALA.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Published courtesy of Kaiser Health News.

Civil rights groups urge clemency for Chelsea Manning

The American Civil Liberties Union and more than a dozen LGBT groups on Dec. 5 urged President Barack Obama to commute Chelsea Manning’s sentence for disclosing classified information to raise public awareness regarding the impact of war on civilians.

Manning is serving the seventh year of a 35-year sentence.

Ian Thompson, ACLU legislative representative, said, “Ms. Manning is the longest serving whistleblower in the history of the United States. Granting her clemency petition will give Ms. Manning a first chance to live a real, meaningful life as the person she was born to be.”

The letter to the president states, “Manning, a transgender woman who is being forced to serve out her sentence in an all-male prison, has been subjected to long stretches of solitary confinement — including for attempting suicide — and denied necessary medical treatment related to her gender dysphoria. The Army even opposed her request to use her legal name and to be referred to by female pronouns. While the armed forces have finally opened the door to transgender men and women who wish to serve, the government has continually fought Ms. Manning’s efforts to be treated with basic dignity.”

The following groups signed the letter:

American Civil Liberties Union
BiNet USA
COLAGE
Family Equality Council
FORGE, Inc.
GLBTQ Legal Advocates & Defenders
Immigration Equality
KhushDC
Lambda Legal
League of United Latin American Citizens
Los Angeles LGBT Center
National Black Justice Coalition
National Center for Lesbian Rights
National LGBTQ Task Force
National Organization for Women
Pride at Work
Transgender Law Center

On the Web

Free Chelsea Manning.

Groups challenge abortion restrictions in 3 states

Abortion rights groups filed three lawsuits challenging medically unnecessary abortion restrictions in Alaska, Missouri and North Carolina.

This follows the U.S. Supreme Court’s decision in Whole Woman’s Health v. Hellerstedt, which struck down two Texas laws that devastated access to abortion in the state. Since the ruling, abortion restrictions in Alabama, Alaska, Arizona, Oklahoma and Wisconsin were blocked.

The lawsuits involve the Center for Reproductive Rights, Planned Parenthood and the ACLU and challenge the following:

  • Medically unnecessary Alaska restrictions, passed more than 40 years ago, that ban abortion in outpatient health centers after the first trimester of pregnancy, forcing many women to travel out of state for procedures.
  • A ban on abortion after the 20th week of pregnancy in North Carolina which was recently amended to further restrict the already narrow health exception to extremely limited health emergencies.
  • Medically unnecessary restrictions in Missouri that have closed all but one health center that provides abortion in the state.

“Today’s filing is a major step in the fight to ensure all women can get safe and legal abortions in their own communities, when they need them,” stated Nancy Northup, president and CEO of the Center for Reproductive Rights.  “We are a nation of laws, and the center is prepared to use the full force of the law to ensure women’s fundamental rights are protected and respected.  We are proud to stand with our partners in challenging these unconstitutional measures and vow to continue the fight for women’s health, equality, and dignity.”

At Planned Parenthood Federation of America, chief medical officer Raegan McDonald-Mosley said, “These restrictions have a disproportionate impact on those who already face far too many barriers to health care as people of color, people who live in rural areas, or people with low incomes. These laws are dangerous, unjust, and unconstitutional — and they will come down.”

Added Jennifer Dalven of the ACLU’s Reproductive Freedom Project: “With the cases we are filing today, we are sending a clear message that we won’t stop working until every woman can get the care she needs no matter who she is, where she lives, or how much money she makes.”

In the Alaska case,  Planned Parenthood of the Great Northwest and Hawaiian Islands is represented by Janet Crepps of the Center for Reproductive Rights, Brigitte Amiri of the ACLU, Carrie Flaxman of Planned Parenthood Federation of America, Tara Rich and Eric Glatt of the ACLU of Alaska, and Susan Orlansky of Reeves, Amodio, LLC.

In the North Carolina case, Planned Parenthood South Atlantic is represented by Maithreyi Ratakonda and Carrie Flaxman of Planned Parenthood Federation of America; Beverly Gray, M.D. and Elizabeth Deans, M.D. are represented by Andrew Beck of the ACLU; Amy Bryant M.D., M.S.C.R., is represented by Genevieve Scott and Julie Rikelman of the Center for Reproductive Rights; Irena Como and Christopher Brook of the ACLU of North Carolina is representing all plaintiffs.

In the Missouri case, Comprehensive Health of Planned Parenthood Great Plains and Reproductive Health Services of Planned Parenthood of the St. Louis Region are represented by Melissa Cohen and Jennifer Sandman of Planned Parenthood Federation of America and Arthur Benson of Arthur Benson & Associates.

The U.S. Supreme Court has consistently held that women have a constitutional right to decide whether to end or continue a pregnancy and states cannot ban abortion prior to viability.

Earlier this year, the Supreme Court refused to review North Dakota’s ban on abortion as early as six weeks of pregnancy and Arkansas’ ban on abortion at 12 weeks of pregnancy that had been struck down by lower courts.

The Supreme Court’s Whole Woman’s Health decision also affirmed that states cannot pass sham restrictions on abortion.

Trump to nominate women’s health opponent for health secretary

Planned Parenthood Federation of America today expressed concerns about President-elect Donald Trump’s plan to nominate U.S. Rep. Tom Price, R-Ga., to be secretary of health and human services.

Tom Price poses a grave threat to women’s health in this country. If Price had his way, millions of women could be cut off from Planned Parenthood’s preventive health services like birth control, cancer screenings and STD tests. From his plan to take no-copay birth control away from 55 million women and allow insurance companies to charge women more for the same health coverage, to his opposition to safe and legal abortion, Price could take women back decades.

Tom Price has consistently demonstrated that he’s out of touch with women’s lives. Despite the fact that 20.2 million women need publicly funded contraception, he has falsely stated that every single woman in America already has access to affordable birth control.

Our nation’s HHS Secretary should aim to break down barriers to health care. Instead, Tom Price wants to build more. These barriers to care have a disproportionate impact on those who already face inequities and barriers in the health care system – including people of color, people who live in rural areas, people with low incomes, and immigrant communities.

Fear of a Health and Human Services Secretary like Tom Price is why Planned Parenthood has seen a significant increase in in online appointments for birth control, with a more than ten-fold increase in people seeking IUDs the first week following the election. People are worried they will lose their health care.

The Senate should give Representative Price’s record the full examination it deserves.  Each Senator must decide whether a man who wants take away no co-pay birth control coverage from 55 million women is the right choice to serve as the Secretary of Health and Human Services. Meanwhile, we at Planned Parenthood will continue to work to ensure that everyone — including the 2.5 million patients we serve each year — has access to the basic health care they depend on, no matter what.

Despite clear evidence to the contrary, Price believes “there’s not one woman” who doesn’t have access to birth control.

  • A Hart Research poll found that one in three women voters have struggled to afford prescription birth control, including 55 percent of young women aged 18 to 34.
  • According to the Guttmacher Institute, 20.2 million women in the U.S. were in need of publicly funded family planning services like birth control in 2014, an increase of 1 million since 2010.

Price wants to repeal the Affordable Care Act, and has supported 65 attempts to repeal it, which means:

  • 55 million women would lose access to no-copay preventive services, including birth control, STI screenings, and life-saving preventive services such as breast cancer screenings and pap tests.
  • Being a woman could once again be considered a pre-existing condition, allowing health insurers to deny health coverage to tens of millions of women.
  • Women would pay an estimated $1 billion more than men for the same health care plans if “gender rating” was allowed again.
  • Millions of low-income women would lose their health insurance, which they have gained through the ACA’s Medicaid expansion. In 2015, Medicaid covered 17% of women ages 19-64 (16.66  million), up from 10% in 2008 (pre-ACA).

Price wants to cut off women’s access to basic health services at Planned Parenthood, which has already been proven to have devastating consequences:

  • A recent study in the New England Journal of Medicine showed that blocking patients from going to Planned Parenthood in Texas was associated with a 35% decline in women in publicly funded programs using the most effective methods of birth control and a dramatic 27% increase in births among women who had previously accessed injectable contraception through those programs.
  • Blocking patients from care at health centers  has a disproportionate impact on communities of color, who already face systemic barriers in accessing quality health care. For example, in Texas, researchers found that more than half of women reported at least one barrier to reproductive health care. Spanish-speaking women from Mexico were more likely to report three or more barriers.
  • In Wisconsin and Texas, researchers found that fewer women could access lifesaving cancer screenings following the closure of Planned Parenthood health centers.  An increase in 100 miles from the nearest health center resulted in a 6 percent decrease in the rate women obtained breast exams, and 9 percent decrease in Pap tests.
  • The CBO projects that the net cost to taxpayers if Planned Parenthood is defunded would be $130 million over 10 years because of an increase in unintended pregnancies without the high-quality contraceptive care we provide.

Despite Price’s repeated statements that “patients, families and doctors should be making health decisions, not Washington DC,” he would interfere with women’s access to safe and legal abortion. In Congress, he has routinely voted in favor of dangerous bills that would:

  • Restrict abortion access;
  • Block access to basic preventive care at Planned Parenthood;
  • Interfere in the doctor-patient relationship;
  • Prevent medical students from being trained on how to provide abortion;
  • Block insurance coverage of abortion;
  • Allow bosses to take away birth control.

Planned Parenthood Federation of America is many things to many people. We are a trusted health care provider, an informed educator, a passionate advocate, and a global partner helping similar organizations around the world. Planned Parenthood delivers vital health care services, sex education, and sexual health information to millions of women, men, and young people.

For Trump and GOP, ‘Obamacare’ repeal is complex and risky

Here’s the idea: Swiftly pass a repeal of President Barack Obama’s health care law, perhaps soon enough for Donald Trump to sign it the day he takes the presidential oath.

Then approve legislation restructuring the nation’s huge and convoluted health care system — despite Republican divisions, Democratic opposition and millions of jittery constituents.

What could go wrong?

With Republicans controlling the White House and Congress in January, they’re faced with delivering on their long-time promise to repeal and replace “Obamacare.”

Here are hurdles they’ll face:

SPEED VS DELIBERATION

Trump and congressional Republicans will be under intense pressure from their core conservative supporters to repeal Obama’s 2010 health care law — and fast. After all, Congress already sent Obama a repeal bill last January, which he vetoed, and many GOP voters will see no reason for delays this time.

But there probably won’t be anything fast about Congress’ effort to replace Obama’s law, which is likely to take many months.

While the replacement effort is underway, Republicans will risk aggravating up to 30 million people who are covered by the law or buy policies with prices affected by its insurance marketplace. Democrats will be sure to accuse the GOP of threatening the health care of millions.

A SOLUTION

Nothing’s been decided, but here’s one likely scenario:

The new Congress, which convenes Jan. 3, tries to quickly approve legislation repealing Obama’s health care law, maybe completing it by Trump’s Jan. 20 inauguration or soon after. But the repeal would not take effect until the future, perhaps a year later, to give lawmakers time to fashion a replacement. The version Obama vetoed had a two-year delay.

Seemingly acknowledging that two-step process, Vice President-elect Mike Pence said Sunday on “Fox News Sunday” that Trump “wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare.”

Because Republicans will control the Senate by just 52-48, Congress will first have to approve special budget procedures to prevent Democrats from stopping repeal legislation by filibuster. Bill-killing filibusters require 60 votes to end.

But those special rules would apply only to items that affect the federal budget. Republicans, for example, would need a simple Senate majority to end IRS penalties against people who don’t buy insurance but would still need 60 votes — requiring Democratic support — for other changes such as raising limits on older people’s premiums.

House Budget Committee Chairman Tom Price, R-Ga., says that will restrain Republicans’ ability to ram a “lock, stock and barrel” repeal through Congress.

GOP RISKS

One GOP danger: Congress and Trump might repeal Obama’s law, but while they’re laboring on a replacement, nervous insurance companies begin pulling out of markets and raising premiums. Insurers have been doing that under Obama, but now it would occur under a Republican government.

Another hazard: Congress’ work could spill into the 2018 campaign season, when the entire House and a third of the Senate face re-election. Republicans will grow increasingly timid about anything that might anger voters.

“We want to be the rescue party instead of the party that pushes millions of Americans who are hanging by the edge of their fingernails over the cliff,” says Sen. Lamar Alexander, R-Tenn., who chairs the Senate Health committee.

GOP PATHWAYS

Virtually all Republicans want to get rid of the health law’s mandates that individuals buy coverage or risk IRS fines, and that large employers insure workers.

They also want to erase taxes on higher-earning people and the health care sector. And they’d like to retain parts of the law guaranteeing coverage for people with pre-existing medical problems and keeping children under age 26 on family plans.

Unifying Republicans much beyond that is a work in progress.

Trump’s health care views have varied and lack detail. His campaign website touts tax deductions for health insurance premiums and permitting policies to be sold across state lines. He’d also revamp Medicaid, which subsidizes health coverage for low-income people, directing fixed amounts of money to states and letting them structure benefits.

House Speaker Paul Ryan, R-Wis., last summer unveiled an outline of the House GOP’s solution, though it lacked cost estimates and details. It would provide tax credits, impose taxes on the most generous employer-provided health care plans, revamp Medicaid and let Medicare beneficiaries pick private plans instead of today’s fee-for-service coverage.

Senate Finance Committee Chairman Orrin Hatch, R-Utah, has also advanced a framework relying heavily on tax credits.

REMAINING QUESTIONS

Thirty-one states — including Pence’s Indiana, where he is governor — plus the District of Columbia have expanded Medicaid coverage to 9 million additional people under Obama’s law. Curtailing that program will divide Republicans.

Taxing the value of some employer-provided health plans, aimed at curbing the growth of costs, is “a political land mine,” says GOP economist Douglas Holtz-Eakin. Republicans have long resisted tax increases.

Obama’s law mandates coverage for individuals because without that requirement many healthy people would forgo policies, driving up costs for everyone else and destabilizing insurance markets. Ryan has proposed shielding people from higher premiums if they’ve had “continuous coverage,” allowing higher rates for people who have not had policies, but Republicans have yet to decide how to keep insurance markets viable.