The GOP has confirmed that they still do not have the votes to pass a rewrite of the Affordable Care Act. More particularly, Congress could not compromise their efforts to prevent a government shutdown by complicating matters with healthcare. Thus, the government has stayed open at least for another week.
The lack of ability to bring a proposal to the floor demonstrates yet again the deep divisions within the GOP on the issue of health care. It is interesting to note that the only subgroup within the GOP to endorse the current proposal is the far right House freedom Caucus.
Physician leader organizations have again jointly written to Congress this last week criticizing the latest iteration of the American Health Care Act. The primary concerns addressed in this letter were two. First they criticize allowing states to scale back “Essential Health Benefits". Secondly, they voiced concerns about the possibility that those with pre-existing conditions will again be discriminated against.
Meanwhile Democrats continue to characterize the Trump administration's efforts in healthcare as those which sabotage women's healthcare across the board: not only reproductive rights including contraception, but also access to general health care including cancer screening like mammograms and Pap smears. It has also been noted across both sides of the aisle that the Trump administration seems to be disproportionately withdrawing health care support for the the poor. There is also concern that the GOP healthcare plan will weaken Medicare. Is this for these reasons that centrist Republican Governors and Representatives balk at supporting his proposals since they know they will shift a bigger financial burden onto their states. This would be true since states would pick up the tab for the care of these populations. This would even be true if they do not pick up the tab, since without regular care, the uninsured will simply come in on an emergent basis, which is especially costly. Then these unpaid medical bills are indirectly covered by the rest of us, those who self pay or have private insurance. Thank you, federal government.
We pay for the underserved populations via our taxes through federal programs like the Affordable Care Act. Or, we pay if the States do not or cannot pitch in for their medical care. I would rather pay for a program which allows people to get preventive care, early diagnosis and treatment, simply because it is right, and also because it prevents human suffering, and because it is far cheaper in the final analysis.
Case in point is the recent situation in Florida. The Florida House passed legislation last Wednesday requiring able bodied low income Medicaid recipients to meet new work requirements to keep their healthcare. This excludes people with disabilities, the elderly and children as well as those who have documented medical reasons to be off work. This sounds like a great idea, right? The purpose of the bill was to save the state of Florida money, and perhaps to engender responsibility. However, opponents of the bill expect that these requirements will actually result in a partial exodus from the rolls of Medicaid since not all current Medicaid recipients will comply with the new requirements. Opponents of the bill believe that as people come off the Medicaid rolls, the actual healthcare costs for this population will increase since they will once again utilize hospital emergency rooms for their emergent and non-emergent needs.
As a reminder, in our country, uninsured people are never turned away from the emergency room for the inability to pay or for the absence of any form of insurance. The care the uninsured receive is in every way standard and is in effect paid for by those with medical insurance and those who pay their own bills.
In a good policy news department, a forward thinking Republican senator from Omaha Nebraska, Joni Craighead, has sponsored a Nebraska bill which would require doctors to notify women if their mammogram reveals dense breast tissue. This is because dense tissue signifies higher risk of developing breast cancer. It is also the because dense breast tissue requires more and sometimes different imaging to diagnosis abnormalities.
In how-can-you-not-realize-this department, the Journal Birth has published new research on the risks of home birth. Researchers reviewed data for more than 47,000 home births overseen by midwives. Expectant mothers whose babies were breech or those who were attempting vaginal birth after cesarean section “may fare worse trying to deliver outside a hospital". In particular the study revealed that “risk of fetal death is 8 to 10 times higher for a home delivery with these risk factors”. This is death we're talking about here.
A new survey by the College Health Association has revealed that college women tend to choose less effective forms of birth control such as condoms or pills, rather than IUDS. Cost and access to these better methods are thought to be the explanation.
In the incredibly creepy department, a new form of reproductive violence against women has come to light. A new study in the Columbia Journal of Gender and Law has discussed “stealthing”. Stealthing involves a man removing his condom during sex without the knowledge or consent of his partner. Women are then at risk for pregnancy and sexually transmitted infections. What do men possibly get out of this ? A survey of online forums show that it relates to a a belief about a male’s “natural” right to dominance and authority, to “spread his seed”. Although victims are commonly confused by how to describe what has happened to them, it is a form of sexual assault, i.e. rape. Switzerland has already established a legal precedent for convicting this as rape.
In the “ finally” department, the FDA ( Food and Drug Administration) has finally spoken out against unproven cancer treatments being hawked on the internet. They have called out 65 bogus products that not only have no proof, but also that may cause harm. They also mention that patients often believe these are substitutes for traditional therapies.
Studies of general medical conditions are now known to greatly underrepresent women and minorities. This has important implications, since the results of those studies on topics as important as heart disease, cancer and diabetes may not be as relevant to women and minorities.
One more tool has been added to the global toolbox used to fight post partum hemorrhage. It is called Tranexamic Acid. It reduces death from bleeding about 20 percent and is less than a dollar a dose. It is meant to be added to the other usual methods of preventing and treating hemorrhage, such as massage, draining the bladder, pitocin, cytotec, and methergine. The clinical trial to producing this information involved 20,000 women in 21 countries. It was funded by Wellcome Trust, Pfizer, Britain’s health department, and the Gates foundation. Tranexamic acid’s brand name is Lysteda, and interestingly, it is produced by a separate drug company, Ferring Pharmaceuticals. If you have a little time for extra reading, take a detour and read about the American British Pharmacist Sir Henry Wellcome HERE.
Stay tuned for more drama from the world of Obstetrics and Gynecology next week, on Medical Mondays.