Global Gag Rule

Belated Medical Monday

I have just heard the best news about the Republican plans to replace the ACA (Affordable Care Act). Senate Republicans would like to postpone a repeal until……drum roll please …. the year 2020, when, you guessed it… another presidential election will take place ! I think this may be the GOP’s way of saying, “Sorry, never mind. We agree with President Trump who said, “Health care is hard.”." 

Especially now that the piper has started talking about getting paid… i.e. the Congressional Budget Office (CBO) has had it’s say, lawmakers on both sides of the aisle have come to realize that the costs of dropping the ACA provisions may exceed the costs of keeping them. 

There is however a need for action, and Senate Republicans will likely try to take action to stabilize premium costs. They will also to endeavor to continue federal insurance subsidies which help low income American with co-pays and deductibles. 

In other policy news, the Mexico City policy is back in place. This is the policy of withdrawing US aid funds from international organizations which provide reproductive services which include abortion. This is policy is meant to show the current administration's condemnation of abortion, and to curtail the incidence of abortion. However, Kenyan health care researchers have cited clear evidence from the past about what happens when the Mexico City Policy is in place. In fact, if these US funds are withdrawn from these types of health clinics, then many women go without health care and contraception and many more unintended pregnancies occur. Not surprisingly, under these circumstances, MORE abortions are actually performed. It seems impossible that the administration cannot be unaware of this. If this is true then it would seem they are really more interested in political posturing than abortion prevention or the health care of women. I'm going to speculate this this exact sort of thing will happen in that other part of the third world called Texas, where women's health care services have been severely restricted.

The Mexico City rule is also called the “ global gag rule” since all US funds can be withheld even if the clinic staff even speak of abortion.

Did you know that the current administration proposes not only to cut coverage of health care but also to health care research ? In his 2018 budget request titled “ A New Foundation for American Greatness”, cuts are proposed for the FDA ( Food and Drug Administration), the CDC (Centers for Disease Control), and the National Institute of Health (NIH) including the National Cancer Institute. How do you feel about this ? Tell your elected officials. 

Many on the red (Republican) side of the aisle continue to favor covering those with pre-existing conditions. Many of you may know of Jimmy Kimmel, the late night host and comedian. He has entered the health care debate in a most poignant way. His wife recently gave birth to a son with a congenital health defect. This defect required immediate very expensive and live saving surgery, which with insurance under the current Affordable Care Act, will be covered entirely. This baby's care coverage will not be subject to penalties for preexisting conditions, and there are currently no caps on insurance payouts under the ACA. Cases like this do become very costly, and in an environment where there are caps on what an insurance will pay, the Kimmel child might not get all the care he needs to live. So, legislators have spoken of health care plans which “pass the Jimmy Kimmel test". To pass the test, an insurance plan must cover all the care that such a baby would require. Many Republicans are coming out to favor plans which pass the Jimmy Kimmel test. See Jimmy’s moving monologue HERE:

http://ux.azcentral.com/story/life/tv/2017/05/02/emotional-jimmy-kimmel-discusses-baby-sons-heart-surgery/101189324/

In medical news, ACOG is trying to get the word out on normal anatomy. There is a disturbing rise in cosmetic surgery for the female genitalia, even in young women.  ACOG (American College of Gynecologists) is trying to educate patients and clinicians about the considerable variation in normal anatomy. They are also cautioning against so-called vaginal rejuvenation surgeries and other procedures which can have serious complications. One has only to look at the high costs of such surgery and the lack of insurance coverage of it to know that it is simply a moneymaking ploy used by unscrupulous gynecologists. 

In the “ we already knew this” department, a new study has come out reiterating that domestic violence is more common in pregnancy. Everyone needs to be aware of this. 

In the "you have some control” department, new research indicates that even one 10 ounce alcoholic drink may increase your risk of breast cancer- by nearly 10 % in post menopausal women ! The same study also shows that vigorous exercise reduces the risk of breast cancer. Worried ? Stop drinking and start exercising. 

It has now been well established that the HPV vaccine works to prevent genital warts and reduce the incidence of cervical cancer. The new revelation is that for kids under 15, only two rather than three doses are needed. 

Do you snore ? If you do, go get evaluated, regardless of your age. It is clear that sleep apnea increases risk of cardiovascular disease. New research also indicates that it complicates pregnancy, increasing risks of gestational diabetes and preeclampsia. 

Bed sharing with newborns increases risk of SIDS ( Sudden Infant Death Syndrome). A new program which includes face to face education and distribution of baby box kits has been shown to be effective in reducing the incidence of bed sharing. Baby boxes provide a separate space for baby with a flat mattress and a firmly fitted sheet. These boxes, as opposed to a bed or crib with lots of blankets, toys and fluff, are much safer places for baby to sleep. 

 

Stay tuned for next week’s Medical Monday and thank you for your patience ! 

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

Forty prominent groups concerned with women’s health have written a letter of complaint to the new administration. The recipients include President Trump, the Secretary of the Department of Health and Human Services Tom Price, White House aide Ivanka Trump. The letter has criticized each of the major changes that the present administration has either enacted or proposed, for example replacing Obamacare, cutting funds to Medicaid, reducing access to women's healthcare by shutting down Planned Parenthood as well as the "global gag rule”, also known as the “ Mexico City policy”  which prevents international organizations who offer abortion as part of their services from receiving any US funds. The letter further alleges that women's healthcare needs have been traded for political benefit. The letter went out during Women's Health Week to call attention to the issues. In order to begin addressing these concerns, Ivanka Trump has begun meeting with various groups concerned with women’s health, including female Democratic leaders. 

Imposition of the global gag rule may cut off millions in funding to combat other conditions like HIV/AIDS and malaria, leading to a global health crisis. 

In a move long opposed by Republicans, the Trump administration’s budget proposal will include 6 weeks of paid family leave for both mothers and fathers. 

Texas is still trying deal with having shot itself in the foot. Texas took a stand against abortion and removed Planned Parenthood from their Federal Funding recipients. By doing so under the Obama administration, they lost their Federal funding for the Texas Medicaid Women’s Health Program. Texas has the highest maternal mortality rate of all the States, and a very high percentage of uninsured people. They want their Federal funds back. 

Health insurance is not just about a single subscriber, or even a single family. It is a funding pool that we agree to make together, that lets us all have predictable manageable health expenses, even if something really bad and expensive should happen. It also is a way for everyone in society to help safeguard the future, by contributing to the care of the next generation. This is done by contributing to a pool that pays for the care of women and children. This elementary and beneficial concept behind health insurance seems to have escaped Republican Rod Blum from Iowa who believes men do not need to contribute to an insurance pool which covers pregnancy. He was jeered off the stage in a town hall meeting. 

And now for a piece of news that cinches the connection between policy and health care. Research presented at the annual meeting of ACOG (The American College of Obstetricians and Gynecologists) has shown that the Affordable Care Act (ACA) under Obama led many pregnant women to get prenatal care earlier and that led to better perinatal outcomes. Of course this is in jeopardy now. 

Researchers with the American Cancer Society have presenting new findings indicating that increased access to care under the ACA led to early detection of some cancers. These included breast, colon and lung cancers. Early diagnosis leads to more cures and longer survival. The biggest changes occurred in states with significant Medicaid expansions. These gains too are in jeopardy. 

A recent study has shown that women under fifty doubled their survival time in recent years. I suspect mammograms played a role in this. There is controversy on when mammograms should start: 40 versus 50. ACOG recommends 40. So do breast cancer survivors under 50. Cancer patients over 50 also saw increased survivals, but not quite so dramatic. 

The World Heath Organization has presented the shocking news that pregnancy complications are the leading cause of death for teenage girls worldwide. The biggest causes were hemorrhage, complications  from abortion, and obstructed labor. 

Lancet, one of the world’s premier medical journals produced research on “ Amenable Mortality”. “Amenable Mortality means deaths that could’ve been avoided through timely or effective medical care. American scores 80 on the heal care quality index (HAQ) and that is at the bottom on the second decile, on a par with Estonia and Montenegro. 

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

Policy news continues to dominate. The new administration's efforts to repeal the ACA (Affordable care Act) continue. However, Republican leaders are scrambling to resolve the internal GOP divisions which have developed over healthcare policy particulars.

The American College of Obstetricians and Gynecologists has again gone on record opposing any  changes that will limit women's reproductive coverage in this country. However OB/GYNs in this country also concerned about the so-called"Global Gag Rule”. The global gag rule is a policy that states that advising about or providing abortion disqualifies an international health care agency from receiving funds from the United States. It has been in and out of effect depending on the administration in office over the last 20 years. Dr. Daniel Grossman at the University of California San Francisco has recently published an editorial which sites research indicating that the “Global Gag Rule” actually increases the number of abortions in sub-Saharan African countries, due to reduced access to contraception. This is not a surprise since these international healthcare organizations use their funds for the spectrum of healthcare needs, including contraception. When they lose funds, they lose it for everything across-the-board. 

Dr. Grossman has also published about research on this country indicating that restricting access to abortion though administrative hoops or clinic closures does not reduce the number of abortions. It merely causes the  percentage of later second trimester abortions to increase. In case this is not clear, later procedures have higher risks of complications of all kinds. This is what we call an unintended consequence. 

Again it has come to light that if tax credits replace subsidies to pay for healthcare, the wealthy will benefit the most. That is because they have the most taxes against which to apply deductions. Younger people will also benefit disproportionately, since their premiums are low and the GOP proposal includes  giving the same dollar amount of credit to each person regardless of the amount of their premium. In contrast to these benefits for the young and wealthy, such GOP replacement plans as currently drawn will in increased costs for the majority of middle income and middle aged Americans.

The new administration has made it clear that it does not favor retaining the penalty for those who do not buy health insurance, the so-called “ individual mandate”.  Generally people with chronic health conditions make arrangements to have some form of health insurance coverage, since they know they will need it. It is the young andthe healthy who tend to skip purchasing health insurance since they think they can get away with it. I have two thoughts about this. Number one, They may not realize that if they have anything as simple as a car accident with a broken leg, they may end up with a bill that is tens of thousands of dollars. When they cannot pay this bill, it damages their credit, and the costs are absorbed by the rest of us who have taken the trouble to obtain insurance. Systemwide, their failure to get insurance also has effects. In particular, if the young and healthy tend to go without insurance, they are not contributing to the pool, and this drives up the insurance prices for the elderly and the unwell.

Utah has joined the league of States who now legally require abortion providers to counsel women about a procedure that does not exist, the “abortion reversal” procedure. Members of that House have dissented, saying the procedure is not backed science, and is medically inaccurate.  

A controversial proposal to require Medicaid recipients to work is on the table. A number of Republican Governors are promoting, this, ostensibly hoping people will work themselves right out of their Medicaid eligibility. Medicaid currently ensures one in five Americans. 

The CDC(Centers for Disease Control) has confirmed that American women who were pregnant with Zika  have a 20 fold increase in certain birth defects. The CDC continues to recommend restriction of travel to Zika affected areas for pregnant women. 

In the good news department, policymakers of various kids are working to secure women’s health care despite the repeal of the ACA. State based bills to preserve services of contraception, prenatal care, STI ( sexually transmitted infection) screening, sterilization and counseling are being introduced around the nation. 

The Virginia General assembly has recently outlawed FMG-female genital mutiliation. FMG is removal of the external female genitalia, including the labia and clitoris. It is carried out between infancy and the age of 15. It has no health benefits and commonly causes chronic pain, and urinary tract issues. At this time, 200 million women in 30 countries around the world have been “cut”. It is widely practiced in Africa, the Middle East and Asia and is considered an extreme form of discrimination against women. It is intended to render women less sexual, less “unclean", less likely to stray, and more marriageable. No religious scripts prescribe it, though practitioners believe the practice has religious support. The World Health Organization (WHO) considers it a violation of human rights. International human rights groups have applauded the Virginia decision. 

In more good news, Colorado has passed laws allowing pharmacists to prescribe oral contraceptives. Medical screening by the pharmacist will be required. ACOG has applauded the measure, citing the safety of the medications, and the improved access to contraception. 

Stay tuned next week for more interesting news from the world of Obstetrics and Gynecology.