Health and Political concerns for women have merged into one. Many of you have appreciated this for some time, but now the topic is mainstream.
Last Wednesday leaders representing over half a million medical students and doctors gathered to lobby Senators against the so-called BCRA (Better Care Reconciliation Act).Among the leaders were the Presidents of The American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists (ACOG). They validated and reiterated widespread concerns that without the ACA (Affordable Care Act) or similar, people will delay or forgo care. For example, under the new proposal, older patients will have cost sharing reductions curtailed in 2 year. The leaders also voiced concern about allowing individual States to determine what constitutes essential benefits. Dr. Munger of the American Academy of Family Physicians indicated this compromising essential benefits would constitute a special threat to people with chronic, rather than acute conditions, since their essential health needs are ongoing. The President of the American Academy of Pediatrics indicated that there will be a calculable “ body count” associated with this proposed law.
Dr. Haywood Brown, President of ACOG, stated the legislation represented an “ assault on women’s health”. He elaborated, saying BCRA could result in women and men paying differently for health care. It would end the guarantees on preventive care, i.e screening tests like paps and mammograms. Dr. Haywood also noted that fully 50% of pregnancies are unplanned. The BCRA bill would end guaranteed coverage of contraception and maternity services. These changes would worsen the already terrible trends in maternal mortality in the United states. He states he feared going back to the time when having a baby could lead to bankruptcy, and when treatments for cancer were not always within reach. Indeed, the Journal Cancer has published a study containing projections of the numbers of increased cases of late-stage breast cancer that will be diagnosed during to loss of access to screening mammograms. As if to drive home the point ,the Journal Cancer Epidemiology contains new research indicating that breast cancers appear to have been diagnosed earlier after the ACA was implemented.
California has its own contraceptive requirement, a goal that many States are now have accomplished or are working toward. The California policy, in place since the first of the year, requires that insurers cover contraception. It also requires that they cover 12 months of it at a time. It is estimated that in California, it will reduce the number of unintended pregnancies by 15,000, the number of miscarriages by 2000, and the number of abortions by 7000. Health care costs will be reduced by 43 million dollars annually.
Low income women are at particular risk if the BRCA goes through, since it would phase out the Medicaid expansion in a more permanent way than the ACA would. Of note, half of all births in the US are covered by Medicaid. One fifth of all American women use Medicaid.
Many observers have noted that BCRA healthcare bill disproportionately affects women, since it targets maternity, screening, and contraception. Bill Cassidy (R-LA) has come forward to say that the law should include provisions for all insurance plans to include prenatal care and for laws that require employers to grant maternity leave for both parents. Hooray for Republicans standing up for women’s health ! I did a little research and found that Senator Cassidy and his wife are physicians who feel this aligns with their Christian values. Why is this so rare ?
Another group is at risk of losing affordable insurance: Those who obtain their health insurance through their work. The Affordable Care Act currently mandates that businesses of a certain size offer their employees health insurance. That requirement is due to go, all or in part, by the wayside.
Modifications to the BCRA plan are under consideration. GOP senators had considered scrapping the “ wealth tax” on those families making more than $275,000, but now they are considering keeping it to help pay for extra funds to combat the opioid epidemic. Furthermore, GOP senators have conceded, at the urging of insurance officials, that the individual mandate be kept indirectly in that a penalty fee will be levied against all those who do not maintain health insurance at all times. Insurance industry representatives have asked for this to help stabilize the insurance market. Personally, I think it is an important part of any health care plan, since it requires people to prioritize their health, it enables people to comPlanned Parenthoode in for care especially screenings, and it protects patients, caregivers, hospitals and the rest of us paying insurance against direct or indirect financial loss due to health mishaps.
Two GOP Senators, both women, have criticized the BCRA over its defunding of Planned Parenthood.
Personally I think it would be just fine if the GOP scraps the ACA then puts it all back together piece by piece, gives it a different name, and takes full credit for it. I just hope that, being Republicans, they find a fiscally responsible and sustainable way to fund it. I favor heavy vice taxes. Why ? Because they discourage vices ( true and documented !) and they make lots of money for the public coffers. Cigarettes are heavily taxed, but they could get taxed even more. Alcohol could be further taxed. Soda taxes could be tried but have not been popular… too bad ! Finally, in my opinion, marijuana should be taxed in those States where it is legal, for all but those with legitimate cards. FaIling these, I favor increased gas taxes and increased sale taxes on luxury items.
On to the medical news.
Zika precautions for pregnant and potentially pregnant women are still in place. Travelers heading anywhere south of the Mason Dixon line should inquire on the CDC.gov website about regional risk.
Opioids. These are the pain pills or IV drugs, the morphine derived compounds that are so addictive. It turns out they are not really that much help with actual pain. It turns out they work less and less well over time, and that eventually, they need to be taken just to feel “ok”. Patients often begin them for legitimate reasons, but then end up taking them just to cope. They may not even realize they are addicted. Doctors give them for legitimate reasons, but also because they are lazy. It is hard to say no, especially when you think that saying no will cause your patient to leave your practice and medical care altogether. A new study has found that about half of opioids are given for mental health disorders rather than pain. Physicians and patients need to be educated. It is estimated that half a million people will die in the next decade due to opioid abuse, unwitting or otherwise.
Flu vaccine may be delivered by a painless patch in the future. A new study published in The Lancet reports on this research. I wonder if this will enhance vaccination rates.
Increased rates of air pollution are associated with shortened life spans. A new study published in the New England Journal of Medicine indicates that “ safe” levels may be lower than previously imagined. Indeed, there may be no “safe” level at all.
ACOG recently held its annual meeting. New research presented there focused on media representations of female genitalia. Dr. Cheryl Iglesia noted that images of female genitalia are “highly-curated, and extensively retouched” before being presented on the internet, “ leaving men and women little idea of the real range of normal efface genitalia”. She has suggested that this distortion is associated with a sharp rise in labioplasty surgery in the last year. Ten thousand such surgeries were done in the past year, a rise of 23% compared to the previous year. ACOG has issued a Committee Opinion document “...expressing concern about the lack of data and deceptive marketing practices surrounding a number of cosmetic vaginal surgeries”.
So much news ! Stay tuned here next week … for Medical Monday.
Meanwhile contact your elected officials at Congress.gov !! It's Independence Day ! Exercise your freedom !!