Medical Monday : Breaking News From the World of Obstetrics and Gynecology.

Republican efforts to repeal of the ACA (Affordable Care ACT) continues to worry many. In particular, the new administration is starting to hear from cancer patients and cancer survivors. These are people who will forever have a preexisting condition. They have been assured with promises to protect people with problems in any forthcoming health legislation. And, yet, no proposal has yet been put forth to sustain the viability of the insurance companies providing the health care. 

Tackling the ACA has, understandably proven to be more difficult than Republicans estimated. Leaders in the House and the Senate have been meeting with patients, hospitals and insurers. With all these legitimate concerns being brought to the table, divisions are developing among Republicans despite the fact that both the House and the Senate are dominated by Republicans. No one said it would be easy. 

Republican led States are petitioning to reduce Medicaid costs by increasing coverage restrictions. These could take the form new small premiums, work requirements for the non-disabled, and time limitations on coverage. This could lead to different Medicaid benefits in different States. Governance of States' Medicaid programs may come under increasing control of individual States, rather than the Federal government. 

Republicans seek to increase utilization of Health Saving’s Accounts (HSAs). HSA’s are basically registered accounts in which people may place money, tax-free, to spend on health care, usually their out of pocket portion of their insurance. The idea behind this is that when people are spending “ their own money rather than the insurance companies’  money” they will be more careful with it. If a person who has low income and therefore a low tax rate has a high deductible, as many do, for example $5000 to pay their deductible out of an HSA is still $5000. However, if a person in a high tax bracket socks away the amount of his deductible in an HSA and is not taxed on it, they make save as much as 35% of that money as saved taxes. As far as I can see, HSA’s will only help people in high tax brackets. 

Popular support of the ACA increased since the inauguration from 41 to 45%. 

The contraceptive mandate, part of the ACA, requires the birth control be covered with no copay. However, it is believed that the new Secretary of Health and Human Services, Tom Price, will try to repeal it since he did not support it to begin with. Again, it is my opinion, and the opinion of many, that the contraceptive mandate is a money saver, and a abortion preventive. There is solid evidence to both effects. Some was cited in last week's blog post. 

A Federal Judge in Austin Texas has blocked the withdrawal of funds from Planned Parenthood in Texas. He stayed that that State did not provide evidence of any violation warranting such termination. This will protect care for about 11,000 of the State's poor who currently get their Medicaid funded care through Planned Parenthood. 

President Trump has vowed to enforce a “global gag rule” whereby family planning funds from the US will be withdrawn from any international organization who so much as speaks about abortion, let alone performs it. By doing so, $600 million will be withdrawn from these organizations providing broad family planning and health services to women. As a response, the Netherlands has started a fund to replace the shortfall, and has been joined by Norway, Sweden, Denmark, Belgium, Luxembourg, Finland, Canada, and Cape Verde. 

Last week the Indiana House Public Policy Committee passed a law which will require abortion providers to discuss a procedure which does not exist, namely “abortion reversal”.  I have no idea what they can even say about such a thing since it simply does not exist. ACOG (American College of Obstetrics and Gynecology) spoke truth to power about this, but it did no good. 

This week other lawmakers in Arizona are considering a bill to require lifesaving treatment for babies miscarried or aborted at 20 weeks of age which show some signs of life. Babies at this gestational age can briefly have gasping, or a slow heart rate for a very short period of time, but it does not indicate any potential for surviving. This law would require that these babies receive advanced life support measures, similar to an adult with a cardiac arrest. Again, another impossibility. When will lawmakers acknowledge that scientific reality should have a role in laws ? 

Many lawmakers across both sides of the aisle have taken exception to the new president’s anti-vaccine philosophy. They are beginning to speak out in support of their State’s respective vaccine policies. 

Policy news seems to have overshadowed medical news this week. However, there is something from the “ we-already-knew-this” department. New research published in the American Geriatrics Society indicated that, in older women, central body fat is associated with shortened life, more so that being fat overall. They also discovered that being underweight shortens life as well. 

Finally, ACOG has recommended that all pregnant women be offered genetic screening and carrier screening. Formerly, we based carrier screening on ethnicity. However, now it is believed that a large number of Americans are of mixed or unknown ethnicity, and so carrier screening for specific disease causing genes is indicated for all. 


Stay tuned next week for more unbelievable and disturbing news from the world of Obstetrics and Gynecology, next week, on Medical Monday.