In the most important news of the week, the ACA replacement plan was unveiled this last Monday, March 6th. It’s official name is “The American Health Care Act”.

The bullet points:

Federal insurance subsidies are replaced by individual tax credits and state grants.
The individual mandate to have insurance will be scrapped, and replaced by a 30% surcharge the next time you try to purchase insurance.
The Medicaid expansion would end.
Protection of those with preexisting conditions will stay.
The ban on lifetime coverage caps will stay.
The ability to insure children until age 26 will stay.

Initial reactions were negative to tepid, even among Republicans. Analysts have noted that the tax credits will range between $2000 and $4000 based on age, rather than income. Tax credits will, of course only materialize for those who pay taxes, and the full credit will be utilized only if the patient pays enough tax to use it. Assuming even that the whole credit is received, it is still not as much as current subsidies. In many cases it will not cover deductibles. In short, the ACA replacement plan lowers prices for the more well off and increases prices for the poor.

The bill was strongly criticized by very conservative lawmakers based on budgetary concerns. Conservatives and moderates also voiced concerns regarding widespread loss of coverage that will occur. Assuming there are no Democrats who approve the bill, there can be no more than 22 Republicans who disapprove of it for it to fail.

By the end of the week, two key House Committees, Ways and Means, and Energy and Commerce did approve the bill. Nonetheless, many Republicans are against it as is every doctor group, every health care group, and every consumer rights group.

Trump is reaching across the aisle on the issue of prescription drugs. He, together with most Democrats, favor allowing Medicaid to negotiate with drug companies on prices. Republicans have long opposed this. Hopefully it will save costs but not detract from research.

Many continue to worry about the loss of contraceptive benefits by one means or another. One nonprofit called “Child Trends” has come out with an estimate that keeping contraceptive access for all women would SAVE $12 billion yearly. They also estimate this strategy would be accompanied by drops in unintended pregnancies, unintended births and abortions by 63-67%.

In #alternativemedicalfacts news, many authorities are decrying the Indiana law requiring that the “abortion reversal procedure “ be discussed with patients. Medical authorities including ACOG (American College of Obstetricians and Gynecologists) have been very vocal about the fact that the procedure simply does not work, does not exist, and is not real. Utah has passed a similar bill.

In Pennsylvania, one bill is seeking to ban the abortion pill. This pill is used to effect very early abortions without surgery. However, it is also used to stop hemorrhages after deliveries or miscarriages. Difficulty getting this medication would be an unmitigated disaster. We use it every day on our Labor and Delivery unit and it literally saves lives there and the world over.

Kentucky has passed a bill defunding Planned Parenthood even though Kentucky Planned Parenthood does not provide abortion.

Maryland has devised a bill to fund Planned Parenthood on their own, should it otherwise be defunded.

Nevada democrats are testing the judicial waters by introducing a bill which would require insurers in the state to cover contraception regardless of religious objections. Of course this would be in opposition to the Supreme Court decision prompted by Hobby Lobby which states that businesses “with religious objections”. supplying insurance do not have to cover contraception. Go to Michaels or Joannes instead but stop by Michaels to tell them what you think. #canabusinesshaveareligion ?

New Mexico has installed state law requiring that all insurers cover contraception at no out of pocket costs. They have gone a step further and added Vasectomy to the list of covered services.

The US Preventive Services Task Force (USPSTF) has again questioned the utility of the annual pelvic exam. This has happened before. As before, ACOG has maintained its validity as a screening tool. I personally find all kinds on things on routine screening pelvic exams on asympmotmatic patients. Perhaps the devil is in the details. Perhaps the utility or sensitivity of the exam depends on the examiner. A general surgeon friend of mine one told me with a wry look, “the pelvic exam is not sensitive in my hands”, meaning he really does not know what he is feeling, even though he is an excellent general surgeon. Perhaps if the USPSTF compared the utility of the pelvic exam for ob/gyns to the pelvic exam for other caregivers, they would see a difference.

Beyond that, I want to know why the routine pelvic exam is being so rigorously studied. Is it costing the taxpayer a disproportionate amount of money ? Is it harmful ? Is it generating false positive results ? Is there a problem ? Aren’t there more pressing problems in health care that deserve our attention ? Why are women’s health care procedures always first on the chopping block ? #waronwomenshealth

We have a new department in Medical Mondays. You’ll love it. It is called “Outrage of the Week”. Let’s hope we do not have one every week, but something tells me we will. You will not believe this, and I mean you all on both sides of the aisle will not believe this. Republican Representative John Shimkus of Illinois has questioned why men should have to pay for insurance covering prenatal care. The Washington Post has reported that, among critics of the ACA, this is not the first time this question has been posed. #waronwomenandchildrenshealth

In the human nature department we report the following: The percent of overweight and obese patients has increased from 53 to 66 % in the last 3 years. However, the percent trying to lose weight has decreased from 59 to 49 %. These patients are invariably very expensive, medically speaking. Should insurance prices account for weight or other health habits ? Should insurance give breaks for those who do not have issues or those who show documented effort to resolve their issues ?

In medical good news department, we report on easy cancer prevention. In a two decade study of 60,000 women, published in the International Journal of Cancer, the Mediterranean diet has been found to be of benefit. In particular, it is estimated that about a THIRD of estrogen receptor negative cases of breast cancer would never happen if women were to adhere to this particular diet.

On that tasty note, we will conclude, and hope that you will have the stomach for next week’s Medical Monday.