Tag Archives: health care

How the NFIB v. Sebelius Ruling Will Increase the Amount of Uninsured under the ACA

In a March 2012 report, the Congressional Budget Office (CBO) estimated that by 2022, the Patient Protection and Affordable Care Act (ACA) would reduce the number of nonelderly people without health insurance by 33 million, leaving another 27 million still uninsured.  A significant part of that 33 million included the 17 million more people the CBO estimated to qualify for Medicaid by 2022 under the ACA.  They had not previously qualified because the ACA increased the eligible income to those making up to 138% of the Federal Poverty Level.  This increase in eligibility would have been implemented by making all federal Medicaid dollars given to the states contingent on states increasing the pool of eligible individuals.

On June 28th, the Supreme Court ruled in National Federation of Independent Business v. Sebelius, however, that the federal government could not withhold current levels of Medicaid funding to force the Medicaid expansion.  Instead, it could only withhold the additional funds it planned to give out, making the Medicaid expansion optional state-by-state.

Based on the Sebelius ruling, the CBO reworked its estimates in a July 2012 report that concluded, because of the Supreme Court ruling, six million fewer people would qualify for Medicaid than previously estimated. Of those six million, however, an additional three million would qualify for the new exchanges.  Therefore, the net loss of insured people thanks to the Supreme Court ruling was three million.  In updating their numbers, the CBO did not attempt to guess which states would or would not expand their Medicaid program, but attempted to “reflect an assessment of the probabilities of different outcomes…and are, in their judgment, in the middle of the distribution of possible outcomes.”

These figures are being discussed again because of a June 2013 study by HealthAffairs, which did attempt to guess state-by-state who would be expanding their Medicaid programs and its affect on the uninsured.  They note that, after the Supreme Court decision, 14 states had announced their intent to opt-out of the expansion, six were undecided, three were leaning against the expansion, and two were leaning toward the expansion.  They found that if all currently undecided states opted in, 29.8 million people would remain uninsured by 2016 (compared to 26 million people uninsured according to the CBO by the same year).  That number would rise to 31 million if all of the undecided states opted out.  They also note that around 80% of those uninsured would be US citizens, and no matter which way the undecided states go, 4.3 million children and 1 million veterans would likely remain uninsured.

As of a September 17, 2013 a report by the Advisory Board Company found that the number of undecided and not participating states had increased. They found 15 (up from 14) states firm in opting out of expansion, seven (three) leaning against expansion, five (six) undecided or exploring an alternative model, four (two) leaning towards expansion, and overall 20 (25) firmly participating.  Therefore, the percentage of states that could be opting out has increased from 34-46% to 44-54% of states.  This will in turn increase the number of uninsured people.  As the merits of the ACA continue to be debated on Capitol Hill in light of the budget debate, and more states become firm in their plans to opt-in or opt-out of the Medicaid expansion, the number of those who are ultimately uninsured could rise and continue to undermine the goal of universal health care.

 

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Breast Pumps For All, But Not Necessarily The Best

The ACA requires insurance companies to provide new mothers with breast pumps and other equipment that is necessary to help them breast feed.

Unfortunately, the law doesn’t specify the type or quality of the breast pumps to be provided, so the companies (with doctors’ recommendations) get to decide. This issue leads to whether a company will provide a manual or an electric pump.

The benefits of an electric pump over a manual pump are several: they’re high-powered and can simulate a nursing child, while manual pumps can be weak, clumsy, and cumbersome for a working mother to use. They take more time to pump than an electrical pump.

The costs are also considerably different, when a high-end electric pump coming in at around $300, and a manual pump costing as little as $35.

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Surprise Benefit of Obamacare: Less Spending

On March 7th, Kathleen Sebelius of Health and Human Services announced that there has been a slowdown in medical spending since the implementation of the Affordable Care Act.

Obamacare, Sebelius said, is due the credit for increased efficiency and slowed medical spending growth.

“The health care law’s push for coordinated care and paying for quality rather than quantity is putting downward pressure on medical costs, the article reports,” Sebelius wrote in a blog post. “It’s improving the way health care providers do business, and that’s good news for patients.”

Sebelius cited a USA Today study that found the ACA’s cost-control measures are working.

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Anti-Trans Insurance Policies Banned in Oregon

It was announced on December 19, 2012 by the Oregon Insurance Division of the Department of Consumer and Business Services that private health insurance companies could no longer discriminate against trans policy holders.

Transgender advocates have been lauding the regulations, which prohibit denying coverage of hormone therapy, hysterectomies, mastectomies, and other medically-necessary treatments for gender dysphoria and sex-reassignment surgery. Even though many of these surgeries are already protected for non-trans policy holders, the law now specifically prohibits denying coverage for a surgery because the recipient is trans. The regulations also expand mental health services to include trans policy holders.

Being transgender is considered a mental health disorder known as Gender Identity Disorder in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) – a highly controversial decision. On December 2, 2012, the APA announced that it would be removing Gender Identity Disorder from DSM-V and replacing it with Gender Dysphoria. The difference is that GID focuses on whether a person feels their birth sex and gender are in alignment, and GD focuses on the anguish caused by being unable to make the alignment between sex and gender. For example, a person who might be diagnosed with GID doesn’t necessarily suffer from dysphoria if they have access to gender reassignment surgery, but a person who might be diagnosed with GID could suffer dysphoria if they’re prevented from getting medical treatments and surgeries to change their sex to suit their gender.

In the US, payment for health care treatment by insurance companies, Medicare, and Medicaid relies on the diagnosis of a specific disorder categorized in the DSM-IV. Some say the “disorder” should be struck because it inappropriately stigmatizes trans identities, much like homosexuality was until 1973, and some say it’s necessary in order for trans people to receive the health care they need, such as gender reassignment surgery. The American Psychological Association seems to agree that it is not being trans that causes the requisite distress or disability that qualifies a psychological state as a disorder, but rather the social stigma, discrimination, violence, and difficulty obtaining access to health care that trans people face.

For more information on what being trans means, you can visit the APA’s website on sexuality and gender identification.

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