Finally, this last Thursday, a group of Republican Senators met with representatives from the American College of Obstetrics and Gynecology. This is key since women’s health care is at the center of the debate on health care. As I mentioned last week, at issue is the concept of pooling risk, and pooling money. There are the well who do not want to help subsidize the sick, the non-pregnant who do not want to help subsidize the pregnant, adults who do not want to subsidize children and the young who do not want to help subsidize the old. My religious education reminds me of many scriptural mentions of our obligations toward widows, orphans, and the sick. Do you think that all they meant was to give them the gleanings from the fields ? No. It means paying into a pool of money that will provide for the care of such people.
Here is a summary of the plans in play : the ACA (The Affordable Care Act which is currently law), the House Bill, and the Senate Plan. This is taken from a particularly clear article from the Washington Post
The ACA requires Americans to have health insurance. The House bill would impose a 30% surcharge on new plans for those with lapsed plans. The Senate plan would impose 6 months wait time before new coverage could be obtained. ( Wait, don’t we want people to be covered ? )
Both the House and Senate plans would eliminate the employer mandate to provide insurance imposed by the ACA.
Under ACA, subsidies from the Fed help reduce insurance premiums for consumers across the board. All plans would sunset this coverage by 2020. However under the ACA it would be no sooner than this and it would provide for their continuance. Under the two proposed GOP plans, subsidies could be cut off much earlier than 2020. ( Does Trump really think he will still be President in 2020 ? )
Tax credits under the ACA and Senate bills are based on income age and geography, favoring low and moderate income people. In the House Bill, tax credits would be based only on age, and would not increase when premiums increase.
Under the ACA, one cannot be denied coverage or have premiums increase based on preexisting conditions. Under the House bill, premiums could increase based on preexisting conditions only if a lapse occurred. Under the Senate Bill, insurance companies may not deny coverage or increase premiums. However, they would be permitted to deny coverage for certain preexisting conditions altogether.
Under the ACA, rates for the old can be as much as three times that for the young. Under both other plans, this factor would increase to 5.
An HSA is a health savings account that you create in which to save money for health care expenses. You are not taxed on this money. However, there is only so much money that the Fed will let go untaxed. Pretax HSAs maximum amounts under the ACA are $3400 and $6750 for individuals and families respectively. Under both other plans this number would increase.(Remember though, HSA money is YOUR money, just not taxed. If your tax rate is low, this won’t save you much. HSAs are you providing your own health care subsidies rather than the Fed, as is currently the case. This is one of the many ways the GOP plans are trying to get consumers to shoulder more of the burden of healthcare expenses themselves.
High risk patients are well cared for under the ACA. However both the House and Senate Plans create “ high risk pools” . The House proposes $130 billion and the Senate $182 billion, earmarked for insurers who take big losses.
Under the ACA, the States are permitted to expand Medicaid to 138% of the poverty level. The Fed is expected to match funds. Under the House and Senate Bills, States would receive fixed amounts , i.e. “ block grants “ based on how much they are currently spending. In the House Bill, States would not be able to expand Medicaid. IN the Senate Bill, States could expand Medicaid, but the Fed would simply match less of it.
Under the ACA, "essential health benefits" are covered, such as hospital visits and mental health care. Under the other two bills, the definition of “essential health benefits" could change.
At the present time, under the ACA, Planned Parenthood may receive Medicaid funds. However, Federal Funds may not be used for abortions. Under the House and Senate plans, there would be a one year freeze in Medicaid funding to Planned Parenthood.
Finally, regarding lifetime caps on insurance benefits, the ACA has none. This would not change for the House and Senate proposals. However, the Senate Proposal provides for States to lift the ban on lifetime caps on insurance benefits.
Now that you know what all is being proposed, I will share with you the exact text of ACOG’s (American College of Obstetricians and Gynecologists) response to lawmakers :
ACOG: The BCRA Cannot Be Fixed
July 13, 2017
Washington, DC – Haywood Brown, M.D., President of The American Congress of Obstetricians and Gynecologists (ACOG) released the following statement regarding today’s revisions proposed by Senate Majority Leader Mitch McConnell (R-KY) to the U.S. Senate’s Better Care Reconciliation Act:
“This most recent version of the Better Care Reconciliation Act is not “better” for patients. The BCRA is deeply flawed, cannot be fixed and keeps getting worse. Its original version deliberately stripped landmark women’s health gains made by the Affordable Care Act, turning back the clock on women’s health. This new version threatens to leave patients with preexisting conditions without care. Senators drafting these proposals still aren’t listening to America’s doctors. Yesterday, ACOG joined leaders representing 560,000 frontline physicians on Capitol Hill with one unified message to Senators: the BCRA is dangerous for patients and must be rejected.
“ACOG’s bottom line is simple: No legislation should take away coverage that patients have today. There’s only one solution. The Senate should put the BCRA where it belongs, in the circular file, not on the floor for a vote. Republican and Democratic senators should work with ob-gyns and other physicians on a new approach that will preserve women’s access to contraception and maternity care and improve the health care system for everyone. We stand ready to partner with the U.S. House and Senate and the White House on practical solutions to improve our nation’s health and reduce health care costs.”
The day the newest proposal was release, several members of Congress stepped forward denouncing it, saying they were unwilling to vote even for putting it up for a vote.
That’s a comprehensive view of health policy news.
On to the Medicine.
In distressing news, the Journal Cortex has published new research showing that, in mice, alcohol consumed in pregnancy produces adverse brain changes that can be inherited for several generations. Human studies are unlikely to be done due to the nature of the questions. ACOG has already issued a statement indicating that no amount of alcohol is safe in pregnancy.
In unsurprising news, research out of Texas has recently shown that despite closure of abortion facilities in Texas, abortions in the State actually increased by 3 %. A wealth of data elsewhere has shown that access to basic health care including contraceptives curbs unintended and teen pregnancy, and abortion. In 2011 Texas reduced its family planning budget by 67%. As a direct result, there was a large scale closing of clinics which provided this kind of basic care, all with the goal of decreasing abortion.
For your consideration: Katy Talento is a White House Domestic Policy Aide to President Trump. She is an avowed anti-abortion advocate. But what defies reason is her campaign against contraception, which has the power to do so many good things including curb abortion. She has, on record stated that birth control is “ breaking your uterus” and causing miscarriages and abortions. She is probably referring to progesterone only methods which thin the lining of the uterus so that implantation is not possible. However, she is a very well educated woman, and to call this an abortion or miscarriage is disingenuous at best and deceptive at worst. She has alleged that doctors and drug companies conspire to provide birth control which causes cancer. #Alternativefacts have never been so harmful. In fact, combination oral contraceptive pills, while not for everyone, provide a set of strong health benefits from protecting bone density, preventing anemia, preventing endometrial (uterine cancer) and most dramatically, preventing ovary cancer. #stopalternativefacts.
Recent data support longer time intervals between paps in low risk patients. This is misinterpreted in the press, by patients, and even by certain doctors as meaning that all patients should have paps or even routine checkups less frequently. This is not the case. Add to this the fact the screening for chlamydia and gonorrhea usually occur at the same time as a pap. You have now a recipe for an unintended consequence: increased rates of undetected chlamydia. Findings documenting these increased rates of chlamydia carriage are published in the Annals of Family Medicine.
Preeclampsia is a disorder of pregnancy involving high blood pressure. In its milder forms, it is one of the commonest complications of pregnancy. However, in its more severe forms, it is one of the most dangerous. New data published in the American Journal of Obstetrics an Gynecology indicate that preeclampsia continue to be on the rise in America. Obesity, excess weight gain in pregnancy, high blood pressure and sedentary lifestyle are all risk factors for preeclampsia. Is it any wonder the rates are increasing ? It gets worse. Many patients and even some caregivers do not realize or emphasize that having preeclampsia in pregnancy increases the chances of lifelong hypertension and its consequences in perpetuity.
In the wish-this-were-better-understood department, prolonged breastfeeding appears to confer a protective risk against MS (multiple sclerosis) to the mother. These findings were published recently in the Journal Neurology.
In the tantalizing department, new research indicates that plain old hydroxychloroquine (plaquinel- a common drug used for both malaria prevention and lupus) prevents the Zika virus from crossing the placenta in mice, there by protecting the fetuses from the virus. This could of course hold promise for humans.
Also in the very good new and Zika related department, scientists prevented the vertical (mother to baby) transmission of Zika virus with the use of a vaccine in mice. This groundbreaking research was reported this week in the Journal Cell.
That’s it for this very big week. Again, it is critical that each and every one of you contact your elected officials and tell them what you think. Find yours here:
See you next week, right here, on Medical Monday.