Wrangling Over Proposed Insurance Exchanges and Standard Health Care Benefits Takes a Nasty Turn
Barely recovering from the last congressional gaffe about redefining the rape of a woman in a transparent attempt to get out from under the federal Hyde Amendment criteria for Medicaid payments, the “powers-that-be” have made another mind blowing error in public engagement. In a nutshell and yes, I do mean all of these puns, here is the latest blunder by the Republicans controlling the house.
In a public hearing for testimony on the federal health insurance exchanges and standardized benefits for primary health care, which includes birth control options as benign as birth control pills, no women were allowed to testify at the hearing. It certainly is curious that those who are actually capable of pregnancy are excluded from the hearing. This refusal was despite vigorous opposition by female congresswomen. I actually listened to the hearing in order to believe it. And the woman they refused to allow to testify about the insurance exchange’s proposed standardized women’s health care was a college student. Yah, that is just what we want to discourage in this country, a woman with an education using prudence in reproductive matters.
And if that isn’t enough to befuddle a rational thinker, the reason the committee chairman gave for denying any woman the right to speak was because the meeting was about voting and safe guarding conscience in decision making. Interesting, I wasn’t aware that women lacked conscience, especially when you look at the violent crime statistics. But then again I guess these boys have turned their eyes away from those statistics. One wonders if they also were party to the move to redefine rape of an unconscious woman as a noncriminal event. If this is a matter of conscience, one wonders about theirs.
We are constantly assailed with Republican blather about fighting against big government, yet they seek to prevent birth control services from being covered on private insurance plans. As I have previously reported, several states already have enacted laws which prevent even private insurance plans from covering birth control services. Here are the members of this hall of shame: Kentucky, Missouri, Oklahoma, Idaho, and North Dakota. According to a 2003 Kaiser Foundation survey on contraceptive care, 87% of private employers provided coverage for birth control services, including abortion. So despite the anti-big-government talks, this smacks of big brother to me, or is it daddy?
For more straight talk on health care attend the Northwest Women’s Show on March 2nd, as the healthpolicymaven™ will present findings from her book, Unraveling U.S. Healthcare with my conscience intact.
Showing posts with label reproductive rights. Show all posts
Showing posts with label reproductive rights. Show all posts
Friday, February 17, 2012
Monday, October 31, 2011
Rolling Back The Clock On Women's Health Care
Impact of the Vatican's Universal Translation of Faith, Catholic Owned Health Care Facilities and State Legislation on Health Care for Women
The triad of the new stricter Vatican rules for interpretation of Catholic protocols, the trend toward Catholic organizations purchasing non-Catholic hospitals, and the furor over the proposed women's health standards for the 2014 health insurance exchanges have made this a topic which must be revisited. In order of appearance here are the players:the Vatican, Swedish Health Services, and the State of Mississippi.
Vatican Rules on a Universal Translation for Catholics
Beginning November 27, 2011, the Vatican has issued another edict which attempts to tighten the interpretation of the Catholic faith, by mandating a single universal translation of the faith. The church hopes to reign in the more liberal interpretation which is prevalent in the United States and other western countries. Though one might think this only affects Catholics, not-so-fast, it affects all Catholic Church owned enterprises, including hospitals and schools, which serve an interfaith community and that brings us to our next player.
Swedish Health Services Acquiescence to the Catholic Entity Providence Health
Counter-intuitive to the trend of Catholic hospitals purchasing non-Catholic facilities throughout the United States, the secular hospital group, Swedish Health Services has acquired Providence Health Services hospital and clinics. However, what is most interesting about this transaction is the Pope still got his way, as the deal is subject to his approval, and he has mandated a line-item-veto on the secular facility’s ability to provide abortions. One could understand a Catholic hospital which did not wish to provide abortions, but Swedish is a secular institution and it is acquiring Providence. Though Swedish has indicated this wouldn’t have a huge impact on the service for women in the Puget Sound area of Washington State, they did not have any public hearings about this reduction in service. Clinically, there are cases where women may require a hospital facility for an abortion, but that doesn’t seem to matter here. At least in the Seattle area there are other secular facilities which will provide the service. It is important to note that the Vatican has specifically addressed the elective abortions, which can include victims of rape or incest. I am sure these women consider their legal health concerns to be paramount and hardly “elective.” Apparently there is no due process required if it concerns female reproductive rights, even in the highly secular community of Seattle, where Swedish is based. The fact that we have allowed our health care practice to be determined by a celibate male from another country offends not only me, but also the majority of residents.
According to a 2005 report by Catholics for a Free Choice , there are 60 Catholic health care systems located in all 50 states in the United States. One of the concerns about Catholic hospitals is do they restrict health services? This question applies not only for reproductive rights, but also for advanced medical directives for patients who wish to die without certain medical interventions. According to a 2006 survey by Pew Research Council, 70% of Americans felt that patients should sometimes be allowed to die, 70% also indicated they would rather die at home, than in a prolonged artificially extended manner in the hospital. Only 22% of those polled said that life should be prolonged using extraordinary measures. The majority of Americans shun the loss of dignity while being kept alive mechanically, but would a Catholic hospital respect their wishes? The nonprofit group Catholics for a Free Choice, states that Catholic hospitals do restrict health care services based on the edicts of the Vatican via the Ethical and Religious Directives for Catholic Health Care. It should be obvious that non Catholic patients as well as Catholics may disagree with these practices, so it behooves the patient to verify any service restrictions in policy and in practice in advance of treatment in a Catholic facility. Unfortunately, for many people in America this is not an option, as the only hospital in their area may be a Catholic institution, which has an impact on end-stage-of-life-care and other health services decisions.
Mississippi is Close to Defining Life as at the Point of Conception
Previously I have written about my 50-state analysis of the 2010 health care mandates for the regional insurance purchasing cooperatives, including the incendiary furor over women’s reproductive autonomy. Not to be outdone in its leap to the dark ages, the State of Mississippi is close to passing a law which defines human life as beginning at the moment of conception. Needless to say, this will be a sticky wicket when it comes to actually, catching-someone-in-the-act. The personhood law, if it passes will make it a crime for a woman to obtain an abortion at all, as the life of the fetus will supersede that of the woman who is already alive and kicking. Additionally, this “chastity belt” would also outlaw the use of certain birth control devices, including IUD’s which are intrauterine devices that allow fertilization but prevent embryo attachment to the uterine wall. Of course, the morning after pill would not be allowed either. Going a step further than just the birth canal, the destruction of any in vitro fertilized eggs would also be a crime.
The proposed law certainly cuts a wide swath across those who are fertile and those who may have fertility challenges. This state could potentially institutionalize pregnant women to enforce delivery and likewise for rape victims or incest victims. More to the point, for those fertile lasses who have already had several children while using various birth control measures, and decide they cannot afford more children, they would become criminals. It will be interesting to see how this one winds its way through the courts, if it passes the legislature.
Lest you want to write off Mississippi as an rogue state, Colorado attempted to pass similar legislation in 2008, which thankfully failed. In fact, Personhood USA is based in Colorado and is the backer for the Mississippi bill. Additional states who are considering personhood laws to circumvent the 1973 Roe versus Wade ruling that confirmed constitutionality for a woman to have an abortion prior to the fetus’s ability to live outside the womb include; Arkansas, Montana, Nevada, and Oklahoma.
From this vantage point there is no end-in-sight for the pitch back to the dark ages for women in the United States. I can almost see the black hole from here.
On a more personal note, I expect my book, Unraveling U.S. Health Care to be available within the first quarter of 2012 and yes, it is OK to say FINALLY. Anyway, thanks for reading and I hope you continue to review and comment on my musings.
The triad of the new stricter Vatican rules for interpretation of Catholic protocols, the trend toward Catholic organizations purchasing non-Catholic hospitals, and the furor over the proposed women's health standards for the 2014 health insurance exchanges have made this a topic which must be revisited. In order of appearance here are the players:the Vatican, Swedish Health Services, and the State of Mississippi.
Vatican Rules on a Universal Translation for Catholics
Beginning November 27, 2011, the Vatican has issued another edict which attempts to tighten the interpretation of the Catholic faith, by mandating a single universal translation of the faith. The church hopes to reign in the more liberal interpretation which is prevalent in the United States and other western countries. Though one might think this only affects Catholics, not-so-fast, it affects all Catholic Church owned enterprises, including hospitals and schools, which serve an interfaith community and that brings us to our next player.
Swedish Health Services Acquiescence to the Catholic Entity Providence Health
Counter-intuitive to the trend of Catholic hospitals purchasing non-Catholic facilities throughout the United States, the secular hospital group, Swedish Health Services has acquired Providence Health Services hospital and clinics. However, what is most interesting about this transaction is the Pope still got his way, as the deal is subject to his approval, and he has mandated a line-item-veto on the secular facility’s ability to provide abortions. One could understand a Catholic hospital which did not wish to provide abortions, but Swedish is a secular institution and it is acquiring Providence. Though Swedish has indicated this wouldn’t have a huge impact on the service for women in the Puget Sound area of Washington State, they did not have any public hearings about this reduction in service. Clinically, there are cases where women may require a hospital facility for an abortion, but that doesn’t seem to matter here. At least in the Seattle area there are other secular facilities which will provide the service. It is important to note that the Vatican has specifically addressed the elective abortions, which can include victims of rape or incest. I am sure these women consider their legal health concerns to be paramount and hardly “elective.” Apparently there is no due process required if it concerns female reproductive rights, even in the highly secular community of Seattle, where Swedish is based. The fact that we have allowed our health care practice to be determined by a celibate male from another country offends not only me, but also the majority of residents.
According to a 2005 report by Catholics for a Free Choice , there are 60 Catholic health care systems located in all 50 states in the United States. One of the concerns about Catholic hospitals is do they restrict health services? This question applies not only for reproductive rights, but also for advanced medical directives for patients who wish to die without certain medical interventions. According to a 2006 survey by Pew Research Council, 70% of Americans felt that patients should sometimes be allowed to die, 70% also indicated they would rather die at home, than in a prolonged artificially extended manner in the hospital. Only 22% of those polled said that life should be prolonged using extraordinary measures. The majority of Americans shun the loss of dignity while being kept alive mechanically, but would a Catholic hospital respect their wishes? The nonprofit group Catholics for a Free Choice, states that Catholic hospitals do restrict health care services based on the edicts of the Vatican via the Ethical and Religious Directives for Catholic Health Care. It should be obvious that non Catholic patients as well as Catholics may disagree with these practices, so it behooves the patient to verify any service restrictions in policy and in practice in advance of treatment in a Catholic facility. Unfortunately, for many people in America this is not an option, as the only hospital in their area may be a Catholic institution, which has an impact on end-stage-of-life-care and other health services decisions.
Mississippi is Close to Defining Life as at the Point of Conception
Previously I have written about my 50-state analysis of the 2010 health care mandates for the regional insurance purchasing cooperatives, including the incendiary furor over women’s reproductive autonomy. Not to be outdone in its leap to the dark ages, the State of Mississippi is close to passing a law which defines human life as beginning at the moment of conception. Needless to say, this will be a sticky wicket when it comes to actually, catching-someone-in-the-act. The personhood law, if it passes will make it a crime for a woman to obtain an abortion at all, as the life of the fetus will supersede that of the woman who is already alive and kicking. Additionally, this “chastity belt” would also outlaw the use of certain birth control devices, including IUD’s which are intrauterine devices that allow fertilization but prevent embryo attachment to the uterine wall. Of course, the morning after pill would not be allowed either. Going a step further than just the birth canal, the destruction of any in vitro fertilized eggs would also be a crime.
The proposed law certainly cuts a wide swath across those who are fertile and those who may have fertility challenges. This state could potentially institutionalize pregnant women to enforce delivery and likewise for rape victims or incest victims. More to the point, for those fertile lasses who have already had several children while using various birth control measures, and decide they cannot afford more children, they would become criminals. It will be interesting to see how this one winds its way through the courts, if it passes the legislature.
Lest you want to write off Mississippi as an rogue state, Colorado attempted to pass similar legislation in 2008, which thankfully failed. In fact, Personhood USA is based in Colorado and is the backer for the Mississippi bill. Additional states who are considering personhood laws to circumvent the 1973 Roe versus Wade ruling that confirmed constitutionality for a woman to have an abortion prior to the fetus’s ability to live outside the womb include; Arkansas, Montana, Nevada, and Oklahoma.
From this vantage point there is no end-in-sight for the pitch back to the dark ages for women in the United States. I can almost see the black hole from here.
On a more personal note, I expect my book, Unraveling U.S. Health Care to be available within the first quarter of 2012 and yes, it is OK to say FINALLY. Anyway, thanks for reading and I hope you continue to review and comment on my musings.
Sunday, January 30, 2011
Amending the 2010 Health Care Reforms Checklist
Suggestions for Amending the 2010 Health Care Reforms
Now that the teeth gnashing is on-going over proposed changes to the health care reforms of 2010, this article addresses some areas for potential modifications. If any of you are under the delusion that everything will be repealed, wake-up, because the Medicare changes are essential to management of that costly federal entitlement program. I am speaking of the pay-for-performance initiatives where Medicare (Center for Medicare Services) pays more money to organizations which have fewer medical errors and re-admissions for patient procedures. I am referring to the Accountable Care Act will have a major impact on how medical care is organized, models for disease interventions, and the reporting of performance metrics(I wrote about this last fall). So, that stays, but the rest of this article addresses some of the things that could go or at least be modified.
Federal Insurance Purchasing Subsidies for Mandated Health Insurance
A few months ago I did an analysis of the federal insurance purchasing subsidies for the middle-class under the Health Care Affordability Act and it was pretty eye opening. Based on World Bank data the mean income in the United States is $47,240, which is the average income per person using 2009 Gross Nation Income data . Using this average income as a starting point, what kind of a subsidy would someone receive in 2014, when the insurance exchanges are in place and medical insurance is mandated? Families with seven or more children and incomes equal to 133% of the federal poverty rate will receive a federal subsidy equal to 97% of the insurance premiums. This seems fair to me, as that is a modest income for a huge family. However, the federal subsidies also are slated to provide assistance to folks who fall within 400% of the federal poverty level, which can be a very decent income. For example, someone who is single and earns $54,120 is eligible to receive 90.5% of their insurance premium paid for by the federal government. First of all if you are single and have that much income you ought to be able to scrape by. Secondly, this income is higher than most of the world averages and higher than the USA’s average per capita. But it gets worse, based on the 400% of Federal Poverty Level criteria people who earn up to $185,160 are eligible to receive the same federal subsidy if they have at least eight children. Now, I think by anyone’s standards someone with that income, which falls into the top 10% of all incomes in the country, is not poor. I can see giving a subsidy to a family of four with the $54,120 income or even higher, but not over $100,000!
Budget Saving Suggestion
Here is my suggestion, only provide medical insurance subsidies to people who earn up to 150% of the mean national income, which equates to $71,131 and is roughly equivalent to $73,835 for a large family in the federal poverty criteria. For people who want tax subsidies for families earning over $100,000 I say start eating beans or tuna noodle casserole, which I ate a-lot-of as a child.
Possible Places for Federal Budget Cuts
For crying out loud, it would be nice if both parties could focus on the real apocalyptic events for the country, such as the fiscal meltdown from a strong country with reserves to the largest national debt in history in eight short years. The real concern should be reducing the national debt by cutting spending so the country will have to do less begging for financing from China and other creditors. According to the non-profit Kaiser Foundation, 40% of the entire 2010 federal budget was for defense spending. To decrease that by 50%, just cut the discretionary defense spending budget which equals nearly 20% of the entire federal budget, and we can get the country back in fiscal shape in no time. The country needs to find a way to pay for its existing programs, like Medicare, Medicaid, and Social Security and reducing spending on other ones is required.
Of course the Medicare expenses are of concern and the changes to the program in 2010 are a start towards reworking that care model. The USA will move to a Medicare model which provides services for the treatments that are most effective and hopefully pays the physicians a decent fee. There is still much to be done on aligning clinical reimbursement in both the Medicare and Medicaid programs. The latter is very onerous, because the federal government dictates Medicaid benefits but provides grossly uneven support to the states which are charged with administering the program.
Focus on the Real Issues which have significant Cost/Benefit Ratios
It would be nice if the Democrats would quit focusing on who-is-shagging-who or what someone’s sexual orientation is, because I really don’t want them to tell me about it. As long as it isn’t a crime (certain southern states excepted) I don’t need to hear about it and this goes for anyone’s sexual persuasion, I don’t care to hear about your predilections. I prefer to focus on issues we have in common, such as education, health care, and oh, not-going-into-the-poor-house as a nation. Don’t ask, don’t tell, don’t care is where I am at in this tired issue.
Republicans, I am tired of having abortion as such a divisive issue and I question whether the paltry amount of federal money that is actually spent on abortions for Medicaid women who have been raped (one of the criteria) is the real problem. What would it take to make you folks quit yapping about this issue, a total ban on federal money? The big stink made about offering birth control options, not just abortion in the federal insurance exchanges far exceeds the estimated $1 cost-per-head factor for this provision. Although I think it is immoral to prevent poor women from seeking birth control options which are legal, I believe the rational and generous people of this country will rise to their aid through contributions to Planned Parenthood and women's health organizations. Of course I know the right wingers will still flail away state-by-state (I reported on this in a July article for an east coast distribution and in my November blog about state appeals to the health care reform mandates) attempting to demonize women who seek medical procedures for which they do not agree. We can at least aspire to have a more effective and civilized national conversation about resource allocations.
Current focus on re-defining rape is actually part of the Republican Agenda in Congress
It would be nice if the vagina control police would spend less time defining what constitutes the a rape of a female, thereby qualifying her for federal funding for an abortion under the tan-your-Hyde Amendment, and focus on delivering cost effective primary care to everyone. The discussions on whether drug or alcohol induced sex with an incapacitated female constitute rape are too prurient for this voter. To say nothing of the “men's room chats” about redefining what is considered incest in the case of sexual intercourse. In other words if your uncle coerces his thirteen-year-old-niece to have sex with him and she gets pregnant that may not be considered rape unless other physical violence was involved (barring rape or incest the girl would not be eligible for a federally paid abortion). Also, since when are thirteen year-old girls women? The marginalizing of women in America is in full force, what is next, wearing burkas?
This article was written by Roberta E. Winter, MHA, MPA a health policy analyst and independent journalist and may be reprinted with her permission.
Now that the teeth gnashing is on-going over proposed changes to the health care reforms of 2010, this article addresses some areas for potential modifications. If any of you are under the delusion that everything will be repealed, wake-up, because the Medicare changes are essential to management of that costly federal entitlement program. I am speaking of the pay-for-performance initiatives where Medicare (Center for Medicare Services) pays more money to organizations which have fewer medical errors and re-admissions for patient procedures. I am referring to the Accountable Care Act will have a major impact on how medical care is organized, models for disease interventions, and the reporting of performance metrics(I wrote about this last fall). So, that stays, but the rest of this article addresses some of the things that could go or at least be modified.
Federal Insurance Purchasing Subsidies for Mandated Health Insurance
A few months ago I did an analysis of the federal insurance purchasing subsidies for the middle-class under the Health Care Affordability Act and it was pretty eye opening. Based on World Bank data the mean income in the United States is $47,240, which is the average income per person using 2009 Gross Nation Income data . Using this average income as a starting point, what kind of a subsidy would someone receive in 2014, when the insurance exchanges are in place and medical insurance is mandated? Families with seven or more children and incomes equal to 133% of the federal poverty rate will receive a federal subsidy equal to 97% of the insurance premiums. This seems fair to me, as that is a modest income for a huge family. However, the federal subsidies also are slated to provide assistance to folks who fall within 400% of the federal poverty level, which can be a very decent income. For example, someone who is single and earns $54,120 is eligible to receive 90.5% of their insurance premium paid for by the federal government. First of all if you are single and have that much income you ought to be able to scrape by. Secondly, this income is higher than most of the world averages and higher than the USA’s average per capita. But it gets worse, based on the 400% of Federal Poverty Level criteria people who earn up to $185,160 are eligible to receive the same federal subsidy if they have at least eight children. Now, I think by anyone’s standards someone with that income, which falls into the top 10% of all incomes in the country, is not poor. I can see giving a subsidy to a family of four with the $54,120 income or even higher, but not over $100,000!
Budget Saving Suggestion
Here is my suggestion, only provide medical insurance subsidies to people who earn up to 150% of the mean national income, which equates to $71,131 and is roughly equivalent to $73,835 for a large family in the federal poverty criteria. For people who want tax subsidies for families earning over $100,000 I say start eating beans or tuna noodle casserole, which I ate a-lot-of as a child.
Possible Places for Federal Budget Cuts
For crying out loud, it would be nice if both parties could focus on the real apocalyptic events for the country, such as the fiscal meltdown from a strong country with reserves to the largest national debt in history in eight short years. The real concern should be reducing the national debt by cutting spending so the country will have to do less begging for financing from China and other creditors. According to the non-profit Kaiser Foundation, 40% of the entire 2010 federal budget was for defense spending. To decrease that by 50%, just cut the discretionary defense spending budget which equals nearly 20% of the entire federal budget, and we can get the country back in fiscal shape in no time. The country needs to find a way to pay for its existing programs, like Medicare, Medicaid, and Social Security and reducing spending on other ones is required.
Of course the Medicare expenses are of concern and the changes to the program in 2010 are a start towards reworking that care model. The USA will move to a Medicare model which provides services for the treatments that are most effective and hopefully pays the physicians a decent fee. There is still much to be done on aligning clinical reimbursement in both the Medicare and Medicaid programs. The latter is very onerous, because the federal government dictates Medicaid benefits but provides grossly uneven support to the states which are charged with administering the program.
Focus on the Real Issues which have significant Cost/Benefit Ratios
It would be nice if the Democrats would quit focusing on who-is-shagging-who or what someone’s sexual orientation is, because I really don’t want them to tell me about it. As long as it isn’t a crime (certain southern states excepted) I don’t need to hear about it and this goes for anyone’s sexual persuasion, I don’t care to hear about your predilections. I prefer to focus on issues we have in common, such as education, health care, and oh, not-going-into-the-poor-house as a nation. Don’t ask, don’t tell, don’t care is where I am at in this tired issue.
Republicans, I am tired of having abortion as such a divisive issue and I question whether the paltry amount of federal money that is actually spent on abortions for Medicaid women who have been raped (one of the criteria) is the real problem. What would it take to make you folks quit yapping about this issue, a total ban on federal money? The big stink made about offering birth control options, not just abortion in the federal insurance exchanges far exceeds the estimated $1 cost-per-head factor for this provision. Although I think it is immoral to prevent poor women from seeking birth control options which are legal, I believe the rational and generous people of this country will rise to their aid through contributions to Planned Parenthood and women's health organizations. Of course I know the right wingers will still flail away state-by-state (I reported on this in a July article for an east coast distribution and in my November blog about state appeals to the health care reform mandates) attempting to demonize women who seek medical procedures for which they do not agree. We can at least aspire to have a more effective and civilized national conversation about resource allocations.
Current focus on re-defining rape is actually part of the Republican Agenda in Congress
It would be nice if the vagina control police would spend less time defining what constitutes the a rape of a female, thereby qualifying her for federal funding for an abortion under the tan-your-Hyde Amendment, and focus on delivering cost effective primary care to everyone. The discussions on whether drug or alcohol induced sex with an incapacitated female constitute rape are too prurient for this voter. To say nothing of the “men's room chats” about redefining what is considered incest in the case of sexual intercourse. In other words if your uncle coerces his thirteen-year-old-niece to have sex with him and she gets pregnant that may not be considered rape unless other physical violence was involved (barring rape or incest the girl would not be eligible for a federally paid abortion). Also, since when are thirteen year-old girls women? The marginalizing of women in America is in full force, what is next, wearing burkas?
This article was written by Roberta E. Winter, MHA, MPA a health policy analyst and independent journalist and may be reprinted with her permission.
Tuesday, November 2, 2010
State by State Analysis of Patient Rights under 2010 Reforms
State Reactions to 2010 Health Care Reforms
A virtual firestorm has ensued with state reactions to some of the federal government mandates under the health care reforms of 2010, from the Patient Protection and Affordable Care Act, the Public Health Services Act, and the Affordable Health Care Act for America. This article reviews two of these bones of contention, including the consumer protection aspects, which impact the Office of Insurance Commissioners and the reproductive rights provisions.
Consumer Protections under Federal Mandates
The federal government has awarded thirty million dollars in grants to the states to shore up their consumer protection services for health insurance policy holders. Since the insurance commissioners of each state are already charged with this duty, are staffed for it, and are funded by a tax on the insurance premiums for each insurer, I struggle with the necessity of this award. The insurance commissioner’s office for each state are very well funded and provide general revenue to each state well beyond their budget requirements. If those states aren’t able to staff appropriately for consumer protections, they should take this up with their state legislatures.
Upon reviewing the mandated consumer protections, they appear to reinforce existing protections in many states, but perhaps the standardization of the process is a good thing overall. Here are the new rules for an insured’s right to appeal a health insurer’s claim decision:
•Allows consumers to appeal when a health plan denies a claim for a covered service or rescinds coverage
•Gives consumers detailed information about the grounds for the denial of claims or coverage
•Requires plans to notify consumers about their right to appeal and instructs them on how to begin the appeals process
•Ensures a full and fair review of the denial
•Provides consumers with an expedited appeals process in urgent cases
These provisions are already spelled out in the Summary Plan Description which employers are required to distribute to medical plan participants as a federal reporting requirement under ERISA health and welfare plans. The new provisions codify what 44 states already have in operation for the outside appeal process. Still, the thirty million dollars to encourage compliance seems like overkill for the six states who are not already meeting these recommended standards, which were created by the National Association of Insurance Commissioners. Basically the new rules specify that the patient has a right to an independent review of a rejected claim. According to the Kaiser Foundation’s report on external reviews of insurance claims, the insured won 44% of the time on appeal. Certainly this is enough of an incentive for many patients to pursue a claim review, but one has to wonder, if it is a life saving treatment, the appeals process could still exhaust the patient’s treatment window for optimal efficacy.
Reproductive Rights under Federal Health Care Reforms
I reviewed legislation for all fifty states as of June 2010 and 86% of them had bills that were introduced to modify their compliance with the federal insurance exchanges and other mandates, to be rolled out in 2014. Basically here is what the fuss is about; the federal standards state that Medicaid and the insurance exchange plans will cover reproductive procedures. Of course this includes abortion and birth control. Since the Hyde Amendment restricts any federal money from paying for abortion, this means the insurance exchanges and Medicaid plans could include abortion coverage but the states or private employers would pay for it. This has raised the hackles of a lot of people, who do not want to be told what to do when they are going to pay the tab. According to a 2003 survey on contraceptive care provided by insurance programs, 87% of private employers offered coverage for abortion services, which covered approximately 46% of the U.S. population. Since the majority of private employer medical plans already cover abortion and birth control procedures for their female workers, this standard is not new. What is new is the government’s attempt to offer the same reproductive rights to low income women through Medicaid and the subsidies for eligible employers. Many of the states are objecting to the federal requirement that they must offer poor women the opportunity to receive birth control treatment. Why don’t you just keep them barefoot and pregnant? Here are my winners and losers on the reproductive rights bills:
Most female friendly regarding reproductive autonomy
Current Laws
Colorado Law 1021 requires insurers to cover contraceptives if they provide maternity coverage. Wisconsin SA458 improves sex education for youth.
Under Consideration
Illinois- Senate Bill 2482 requires insurance companies who provide prescription drug coverage to include coverage for contraceptives. House Bill 6205 codifies the right to abortion even if Roe-v-Wade is overturned. Bill 6205 also assures the right of Medicaid women to receive contraceptives and abortion as needed. House Bill 6842 blocks some access to reproductive health care under federal health reform stipulations.
Let’s give a shout out to South Dakota for proposing insurance companies cover contraceptives, but also for expanding Medicaid for pregnancy related services. Other states who seek to expand Medicaid for low income women are Alaska and Illinois.
The following states have bills stipulating improvements in sex education, emergency contraceptives upon request (morning after pill), and insurance reimbursement for contraceptives: Pennsylvania, New York, Missouri, Minnesota, California, and Hawaii.
Most paternalistic states regarding female reproductive autonomy
Current Law
Providers Can Decline to Provide Contraceptive Services
The following states have enacted laws which allow health care providers (pharmacists or clinicians) to decline to provide birth control services: Idaho S1353 enacted 3/29/2010 and Oklahoma S1891 signed 4/2/2010.
No Abortions under Private Insurance Plans Either
Under current law, the following states do not allow private insurance funding for abortion services; Kentucky, Missouri, Oklahoma, Idaho, and North Dakota. If you are unfortunate enough to live in North Dakota, now is a good time to consider moving over to the healthier and wealthier Minnesota neighbor, though I must confess I am a former Minnesotan.
No Abortions in Health Insurance Exchanges
States which have enacted laws that restrict abortion and other contraceptive services under state health insurance exchanges include Arizona and Mississippi.
Arizona- S1305 enacted 4/24/2010, prohibits insurance companies participating in the insurance exchanges from offering abortion and S1001 signed 4/1/2010, blocks portions of the federal health care reforms. If that isn’t charming enough, S1305 also prohibits insurance companies who cover state employees from offering abortion coverage.
States Seeking to Limit Birth Control specifically for Low Income Women
Virginia H30 passed 5/17/2010 limiting access to abortion for Medicaid eligible women and
Colorado L1311 prohibits the payment of abortion for Medicaid participants.
Pending Bills Restricting Reproductive Rights
North Carolina currently has a law that allows insurance companies to refuse contraceptive coverage, N.C. 1068 and also restricts access to contraceptives in school health services (let's keep those teen pregnancies coming). The coupe de tat’ Bill 890 makes an unborn child a crime victim separate and apart from the mother, legalizing the fetus status as an individual. North Carolina also introduced a bill on 3/31/2010 requiring all pregnant women to get an ultrasound, regardless of efficacy, to submit to a state lecture on fetal development, and to wait 24 hours before termination. Also a bill was introduced on 4/13/09 to prohibit state employees and teachers from having an abortion paid for by state medical plans. I wonder if the school boards can still fire teachers who become pregnant out of wedlock as well. Double winner here, ladies, cross your legs in NC. Bill 1157 would restrict funding for low income women on Medicaid, by not covering birth control services. A bill introduced on 6/17/2010 would block federal health care standards for women. Finally, Bill 431 would require parental consent in writing before getting an abortion. Let’s see, your parents may have a different religion, different sexual orientation, and you may not even be living with them, but you need their permission? How does this work for foster kids and run-a-ways?
Additional States that seek to limit access to sex education, contraceptives, fair access to birth control for low income women (Medicaid), and to criminalize abortion are:
Alabama, Louisiana, Virginia, Colorado, Nevada, New Mexico.
Does this really matter when the 1977 Hyde Amendment has continually been ratified and every federal budget limits payment for abortion procedures except in the case of rape, incest, or a life threatening situation? The tan-your-Hyde amendment has also been broadened to include no federal reimbursement for abortion for federal employees, women in the military, or for Indian Health Services. The latter is a real confounder since American Indian Tribes are considered sovereign nations, yet are conscripted to obtain health care from the occupying nation with opposing values. The 2010 reproductive rights provisions matter because the states can choose different provisions for abortion financing and service availability through the insurance exchanges and Medicaid programs. There is also specific language to protect clinicians who do not want to provide abortions, but no language protecting those who do. This is another example of unequal rights in the land of the not-so-free. The most onerous task is the mandate to attach a separate premium for abortion costs and to bill it as an addendum to the exchange plans. This seems like a lot of work for the estimated $1 additional cost per eligible woman, but that may be another way for the federal government to discourage abortions. What is next, wearing the letter A on our blouses? The shame attached to a common birth control method and often medically necessary procedure wastes a lot of resources that could be better spent on improving primary care across the board. For example, building a robust sex education program into the school system and providing contraceptive options to the sexually active population.
There will be other issues the states will argue about for health care reform implementations, but I thought we would start off with the most litigious and now the healthpolicymaven is signing off with condom in hand.
This article was written by Roberta E. Winter, MHA, MPA and may be reprinted with her permission.
A virtual firestorm has ensued with state reactions to some of the federal government mandates under the health care reforms of 2010, from the Patient Protection and Affordable Care Act, the Public Health Services Act, and the Affordable Health Care Act for America. This article reviews two of these bones of contention, including the consumer protection aspects, which impact the Office of Insurance Commissioners and the reproductive rights provisions.
Consumer Protections under Federal Mandates
The federal government has awarded thirty million dollars in grants to the states to shore up their consumer protection services for health insurance policy holders. Since the insurance commissioners of each state are already charged with this duty, are staffed for it, and are funded by a tax on the insurance premiums for each insurer, I struggle with the necessity of this award. The insurance commissioner’s office for each state are very well funded and provide general revenue to each state well beyond their budget requirements. If those states aren’t able to staff appropriately for consumer protections, they should take this up with their state legislatures.
Upon reviewing the mandated consumer protections, they appear to reinforce existing protections in many states, but perhaps the standardization of the process is a good thing overall. Here are the new rules for an insured’s right to appeal a health insurer’s claim decision:
•Allows consumers to appeal when a health plan denies a claim for a covered service or rescinds coverage
•Gives consumers detailed information about the grounds for the denial of claims or coverage
•Requires plans to notify consumers about their right to appeal and instructs them on how to begin the appeals process
•Ensures a full and fair review of the denial
•Provides consumers with an expedited appeals process in urgent cases
These provisions are already spelled out in the Summary Plan Description which employers are required to distribute to medical plan participants as a federal reporting requirement under ERISA health and welfare plans. The new provisions codify what 44 states already have in operation for the outside appeal process. Still, the thirty million dollars to encourage compliance seems like overkill for the six states who are not already meeting these recommended standards, which were created by the National Association of Insurance Commissioners. Basically the new rules specify that the patient has a right to an independent review of a rejected claim. According to the Kaiser Foundation’s report on external reviews of insurance claims, the insured won 44% of the time on appeal. Certainly this is enough of an incentive for many patients to pursue a claim review, but one has to wonder, if it is a life saving treatment, the appeals process could still exhaust the patient’s treatment window for optimal efficacy.
Reproductive Rights under Federal Health Care Reforms
I reviewed legislation for all fifty states as of June 2010 and 86% of them had bills that were introduced to modify their compliance with the federal insurance exchanges and other mandates, to be rolled out in 2014. Basically here is what the fuss is about; the federal standards state that Medicaid and the insurance exchange plans will cover reproductive procedures. Of course this includes abortion and birth control. Since the Hyde Amendment restricts any federal money from paying for abortion, this means the insurance exchanges and Medicaid plans could include abortion coverage but the states or private employers would pay for it. This has raised the hackles of a lot of people, who do not want to be told what to do when they are going to pay the tab. According to a 2003 survey on contraceptive care provided by insurance programs, 87% of private employers offered coverage for abortion services, which covered approximately 46% of the U.S. population. Since the majority of private employer medical plans already cover abortion and birth control procedures for their female workers, this standard is not new. What is new is the government’s attempt to offer the same reproductive rights to low income women through Medicaid and the subsidies for eligible employers. Many of the states are objecting to the federal requirement that they must offer poor women the opportunity to receive birth control treatment. Why don’t you just keep them barefoot and pregnant? Here are my winners and losers on the reproductive rights bills:
Most female friendly regarding reproductive autonomy
Current Laws
Colorado Law 1021 requires insurers to cover contraceptives if they provide maternity coverage. Wisconsin SA458 improves sex education for youth.
Under Consideration
Illinois- Senate Bill 2482 requires insurance companies who provide prescription drug coverage to include coverage for contraceptives. House Bill 6205 codifies the right to abortion even if Roe-v-Wade is overturned. Bill 6205 also assures the right of Medicaid women to receive contraceptives and abortion as needed. House Bill 6842 blocks some access to reproductive health care under federal health reform stipulations.
Let’s give a shout out to South Dakota for proposing insurance companies cover contraceptives, but also for expanding Medicaid for pregnancy related services. Other states who seek to expand Medicaid for low income women are Alaska and Illinois.
The following states have bills stipulating improvements in sex education, emergency contraceptives upon request (morning after pill), and insurance reimbursement for contraceptives: Pennsylvania, New York, Missouri, Minnesota, California, and Hawaii.
Most paternalistic states regarding female reproductive autonomy
Current Law
Providers Can Decline to Provide Contraceptive Services
The following states have enacted laws which allow health care providers (pharmacists or clinicians) to decline to provide birth control services: Idaho S1353 enacted 3/29/2010 and Oklahoma S1891 signed 4/2/2010.
No Abortions under Private Insurance Plans Either
Under current law, the following states do not allow private insurance funding for abortion services; Kentucky, Missouri, Oklahoma, Idaho, and North Dakota. If you are unfortunate enough to live in North Dakota, now is a good time to consider moving over to the healthier and wealthier Minnesota neighbor, though I must confess I am a former Minnesotan.
No Abortions in Health Insurance Exchanges
States which have enacted laws that restrict abortion and other contraceptive services under state health insurance exchanges include Arizona and Mississippi.
Arizona- S1305 enacted 4/24/2010, prohibits insurance companies participating in the insurance exchanges from offering abortion and S1001 signed 4/1/2010, blocks portions of the federal health care reforms. If that isn’t charming enough, S1305 also prohibits insurance companies who cover state employees from offering abortion coverage.
States Seeking to Limit Birth Control specifically for Low Income Women
Virginia H30 passed 5/17/2010 limiting access to abortion for Medicaid eligible women and
Colorado L1311 prohibits the payment of abortion for Medicaid participants.
Pending Bills Restricting Reproductive Rights
North Carolina currently has a law that allows insurance companies to refuse contraceptive coverage, N.C. 1068 and also restricts access to contraceptives in school health services (let's keep those teen pregnancies coming). The coupe de tat’ Bill 890 makes an unborn child a crime victim separate and apart from the mother, legalizing the fetus status as an individual. North Carolina also introduced a bill on 3/31/2010 requiring all pregnant women to get an ultrasound, regardless of efficacy, to submit to a state lecture on fetal development, and to wait 24 hours before termination. Also a bill was introduced on 4/13/09 to prohibit state employees and teachers from having an abortion paid for by state medical plans. I wonder if the school boards can still fire teachers who become pregnant out of wedlock as well. Double winner here, ladies, cross your legs in NC. Bill 1157 would restrict funding for low income women on Medicaid, by not covering birth control services. A bill introduced on 6/17/2010 would block federal health care standards for women. Finally, Bill 431 would require parental consent in writing before getting an abortion. Let’s see, your parents may have a different religion, different sexual orientation, and you may not even be living with them, but you need their permission? How does this work for foster kids and run-a-ways?
Additional States that seek to limit access to sex education, contraceptives, fair access to birth control for low income women (Medicaid), and to criminalize abortion are:
Alabama, Louisiana, Virginia, Colorado, Nevada, New Mexico.
Does this really matter when the 1977 Hyde Amendment has continually been ratified and every federal budget limits payment for abortion procedures except in the case of rape, incest, or a life threatening situation? The tan-your-Hyde amendment has also been broadened to include no federal reimbursement for abortion for federal employees, women in the military, or for Indian Health Services. The latter is a real confounder since American Indian Tribes are considered sovereign nations, yet are conscripted to obtain health care from the occupying nation with opposing values. The 2010 reproductive rights provisions matter because the states can choose different provisions for abortion financing and service availability through the insurance exchanges and Medicaid programs. There is also specific language to protect clinicians who do not want to provide abortions, but no language protecting those who do. This is another example of unequal rights in the land of the not-so-free. The most onerous task is the mandate to attach a separate premium for abortion costs and to bill it as an addendum to the exchange plans. This seems like a lot of work for the estimated $1 additional cost per eligible woman, but that may be another way for the federal government to discourage abortions. What is next, wearing the letter A on our blouses? The shame attached to a common birth control method and often medically necessary procedure wastes a lot of resources that could be better spent on improving primary care across the board. For example, building a robust sex education program into the school system and providing contraceptive options to the sexually active population.
There will be other issues the states will argue about for health care reform implementations, but I thought we would start off with the most litigious and now the healthpolicymaven is signing off with condom in hand.
This article was written by Roberta E. Winter, MHA, MPA and may be reprinted with her permission.
Subscribe to:
Posts (Atom)