Medical Monday: Breaking News from the World of Obstetrics and Gynecology

Affordable Care Act Sign.jpg

The big policy news is the ACA (Affordable Care Act). It is still in force. Furthermore, As of November 1st, it is enrollment time again, the fifth so far. Apparently 76% of Americans did not know that enrollment started last Wednesday. This is year is different, with uncertainty and confusion abounding. The public needs to be aware that the ACA is still in force, and that those eligible should enroll. A recent poll indicates that 18% of Americans do not think the ACA is still in force. They must be aware they may not see much about it in the media, since the Trump administration slashed funds for advertising by 90%. Moreover, they should be aware that the time for enrollment has been was cut in half, to 6 weeks, with no service for 12 hours on Sundays. The bottom line is that many consumers MISTAKENLY BELIEVE they will not get insurance the next year. 

Those that do sign up will find premiums have risen by 37 % on average. This is because of fears, loss of subsidies, and fewer insurers who are participating. All would do well to realize, though, that while there were 167 insurers in 2017 participating, there are still 132 this year. While the Trump administration has cited rising premiums as evidence that the ACA has failed, 80% of consumers can get a plan for less than $75 per month after tax credits. 

The States have generally recognized the long term and short term value of the ACA. Accordingly Governors, as a rule, have objected to its weakening. There are, however 12 States, who have taken matters in to their own hands, and run their own marketplaces. These plans will advertise normally, and have appropriate infrastructure to help consumers enroll. They realize that more enrollees makes a more stable market, and one that will run at the least possible cost. 

Preeclampsia has made the medical news this week. A new study has focused on the all too common disease process which pregnant women and their babies. An official at the CDC (Centers for Disease Control) has called it the most common severe problem for women in pregnancy. It leads to morbidity for both mother and baby. It has a price tag of over 2 billion dollars annually. And yet it’s exact cause remains unknown. We do know that it is more common in the very young and the very old who are pregnant, as well as the obese, the hypertensive, and those with certain autoimmune disorders. We do not that daily aspirin can help prevent recurrence, but that many patients are not receiving this simple, safe and inexpensive therapy. More research is needed. 

Contraception is again in the news. Columnist Bryce Covert has rightly summarized a large body of scientific literature in his opinion piece about the relationship between the availability of contraception and the strength of the economy. He points out that the Trump administration’s curtailment of access to contraception is likely to be associated with a gradual slowing of the economy. If women are able to easily chose the size of their family, they are more likely to chose a size they can afford. If they can put off childbearing until they are finished with education, their educational and professional attainments will be higher before bearing children, should they chose to do so. The pool of workers will be larger, and it will be more skilled. Families will be more solvent and have bigger savings. All these things contribute to the strength of the economy in very real terms. 

More good news for breastfeeding. Breastfeeding has numerous benefits to mother and baby. For mother, it helps slow post partum bleeding. It helps loss of pregnancy weight gain. It fosters bonding. It is convenient and hygienic. For babies, it enhances dental health, immunity, and growth of the newborn brain. It fosters bonding. New research also indicates that just two months of breastfeeding lowers the risk of SIDS, sudden infant death syndrome. The American Academy of Pediatrics recommends a minimum of one year of breastfeeding. 

Preterm birth rates are creeping up in the US, disproportionately affecting minority women. Complicating matters, is that the one proven preventive, 17- hydroxy progesterone, brand name Makena, is expensive, and is greatly underutilized nationwide, especially in underserved area. And here, I’d like to speak to insurance companies: Think Makena is expensive ? Try comparing that with a long stay in the Newborn ICU ! 


Stay tuned for more amazing news from the world of Obstetrics and Gynecology, next week, here on Medical Mondays !