“Terrifying Implications”: Texas Says “No Thanks” To Women’s Health Care
If you haven’t been worn down reading about Todd Akin’s bizarre and ignorant views about the female reproductive system, now turn to Texas, where women’s uteruses may soon have to move out of state to find health care. Late Tuesday night, a federal court of appeals ruled that Texas can exclude Planned Parenthood from the Women’s Health Program, which provides basic preventative care—like birth control and cancer screenings—for low-income women. The decision has terrifying implications in a state where women’s access to health care is already poor.
One in four women in Texas is uninsured, and the state also has the third-highest rate of cervical cancer in the country. In Texas, women’s health-care clinics serving low-income populations rely on two sources of funding: the Women’s Health Program and general state family-planning dollars. Lawmakers have attacked both streams.
In 2011, the state legislature slashed state funding for family planning—you know, the thing that prevents abortions—by two-thirds. A recent report from the Texas Observer revealed that 60 family planning facilities have already closed as a result of the cuts. While a full picture of the effect is still emerging, the Legislative Budget Board, a bipartisan committee, had estimated that when all was said and done, the cuts would lead to 20,000 additional births (which Medicaid would have to pay for). Projections show that around 180,000 women would lose health services.
Then there’s the damage to the state Women’s Health Program (WHP), a separate program that serves 130,000 low-income women. Created in 2005, the WHP is a crucial state service that provides preventative health care and family-planning services. It’s run through Medicaid, so the feds paid for 90 percent of the $40 million program. While it only serves women who are not pregnant, it saved around $75.2 million in 2009 by preventing a projected 6,700 births. The program seemed like a win-win; it decreased unplanned pregnancies and abortions, while increasing access to health care.
But the WHP may soon not exist, or at least not in a recognizable way. Lawmakers added new rules in 2011 that excluded Planned Parenthood from receiving funding. The trouble is, Planned Parenthood provided services to nearly half the women covered under the program and received about 25 percent of the program’s total funding last year. Barring the organization leaves many wondering whether those clinics left would meet demand.
Furthermore, the state violated federal policy by slashing Planned Parenthood funding, which means Medicaid can no longer foot the bill for the Women’s Health Program. Texas supposedly has a plan to transition to a state-run program by November 1; that plan will continue to exclude Planned Parenthood. The influential organization is fighting the state’s decision, and in October, the two parties begin court proceedings on whether Texas can permanently exclude the main provider of women’s health from its Women’s Health Program.
Yesterday’s decision means that between now and the court case, Texas can halt funding to Planned Parenthood clinics. It’s only a few months, but the clinics are already reeling from the family-planning cuts. The loss of WHP funding is a double whammy. Twelve Planned Parenthood clinics have already shut down, alongside the many clinics with no relation to the organization. Meanwhile, if the courts ultimately decide Texas cannot exclude Planned Parenthood from the WHP, the state may opt to shut down the program entirely.
Many, including the attorney general and Governor Rick Perry, celebrated the decision, and the state Health and Human Services Commission announced it would immediately halt funding to the group. Meanwhile, for the hundreds of thousands of low-income women in the state, there are fewer and fewer health-care options.
By: Abby Rapoport, The American Prospect, August 22, 2012
“We Will Not Be Denied”: Giving Women Maternity Care Is Illegal. Really?
We all know that the health care law signed by President Obama in 2010 has its detractors. It’s a shame. The law goes a long way to expanding access to health care for women. It’s not perfect, but the law does some really important things, like ending gender discrimination in health care and making sure insurance coverage includes services women need like maternity care. But, a majority of Missouri State Representatives do not agree with me. In fact, they loathe this law so much that the House of Representatives recently passed a bill that would make it illegal to implement the health care law. The bill states, “Any official, agent, or employee of the United States government who undertakes any act within the borders of this state that enforces or attempts to enforce any aspect of the federal Patient Protection and Affordable Care Act is guilty of a class A misdemeanor.”
Wow, a class A Misdemeanor for implementing the health care law? This is serious stuff. And it’s pretty unfortunate because Missouri could stand to improve health care access for women.
Here is what’s not working in Missouri: 100% of health plans in the individual market in Missouri charge women more for the same health coverage than if they were men and no health plans in the individual market provide maternity services for women.
These policies should be illegal, and under the health care law, they will be.
The health care law is already helping women and families in Missouri. Health plans must now cover preventive services such as mammograms, flu shots, and colon cancer screenings at no additional out of pocket costs such as co-payments. Over 408,000 women in Missouri are receiving preventive services without a co-payment. The law also allows young adults to remain on their parents’ health insurance until age 26. Nearly 40,000 young people in Missouri have gained coverage thanks to the law. And this is just the beginning. Women will experience even more benefits as the law is fully implemented in 2014.
Despite these advances, legislators in Missouri want to make it illegal to implement the law. It’s illegal to make sure women have maternity coverage? It’s illegal to insist women should not have to pay more for the same health coverage as men?
Don’t let the opponents have their way. We will not be denied.
By: Anna Benyo, Senior Health Policy Analyst for Health and Reproductive Services, National Womens Law Center, NWLC Blog, April 23, 2012
“Good Job Mitt”: Romneycare Is Making Massachusetts Healthier
In newly released research, Charles Courtemanche and Daniela Zapata ask perhaps the most important question about the Massachusetts health-care reforms: Did they improve health outcomes in Massachusetts?
The answer, which relies on self-reported health data, suggests they did. The authors document improvements in “physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity.” The gains were greatest for “women, minorities, near-elderly adults, and those with incomes low enough to qualify for the law’s subsidies.”
Some of those results are a bit odd. Although it’s possible to tell yourself a story about how the Massachusetts health reforms affected the body mass indexes of the newly insured, you have to stretch a bit.
But most of them make perfect sense. The reforms led to more people having insurance, which is to say more people having more opportunities to see a doctor and get early and/or regular treatment for ailments. That led to improvements in health. If that hadn’t led to improvements in health, it would be the worth of going to the doctor and getting timely medical care that would be called into question. And if going to the doctor and getting timely medical care isn’t worth doing, the Massachusetts reforms are pretty far down the list of practices and policies we need to rethink.
The researchers end by asking whether the Massachusetts reforms provide a good guide to what will happen under the Affordable Care Act. “The general strategies for obtaining nearly universal coverage in both the Massachusetts and federal laws involved the same three-pronged approach of non-group insurance market reforms, subsidies, and mandates, suggesting that the health effects should be broadly similar,” they write. “However, the federal legislation included additional costcutting measures such as Medicare cuts that could potentially mitigate the gains in health from the coverage expansions. On the other hand, baseline uninsured rates were unusually low in Massachusetts, so the coverage expansions — and corresponding health improvements — from the Affordable Care Act could potentially be greater.”
I’d add one point to their discussion: The national reforms, unlike the Massachusetts reforms, included major investments in comparative-effectiveness research, electronic health records, accountable care organizations and pay-for-quality pilots. If any or all of those initiatives pay off, they could dramatically improve our understanding of which treatments work and force the health-care system to integrate that new knowledge into everyday treatment decisions very quickly.
If that happens, medical care could become substantially more effective than it is now, which should also improve health outcomes. Quality improvements like that could, for the already insured, be the largest payoff from the Affordable Care Act.
By: Ezra Klein, The Washington Post, March 12, 2012
Ineffective and Unfair: Conservatives Target Preventive Health Care for the Ax
It seems we’ve entered the season of shortsighted thinking. With 50.7 million uninsured Americans, Republicans are on a rampage to repeal the Affordable Care Act. Adding insult to injury, the most recent House Republican plan to cut the federal budget deficit this fiscal year took a scalpel to $10 billion in federal grants that provide health care to indigent women and children, slashing $2 billion in federal funding that is bound to have very expensive consequences.
Funding for community health centers will be cut in half by the Republican cuts. Sen. Orrin Hatch (R-UT), who was a co-sponsor of the legislation responding to President George W. Bush’s call to expand funding for these centers in 2008, says that “since 2001, additional funding has allowed health centers in more than 750 communities nationwide to provide care to about four million new patients. These centers provide affordable and quality care to at-risk Americans who otherwise might have to do without.”
He’s right on the mark. No health care costs will be avoided by cutting this $1 billion out of the budget because the absence of care doesn’t stop you from getting sick. It simply means you get sicker and you turn up at the emergency room or a hospital when your illness has progressed to the point that your care needs are exorbitantly expensive.
On top of this cut to care, which more often than not is the safety-net care for women and children, the proposals would also cut the maternal and child health block grant by 30 percent. This block grant pays for child immunizations and prenatal care for tens of thousands of women and children. It’s obvious that without access to immunizations more will have to be spent to care for kids sick with easily preventable illnesses.
And reducing access to prenatal care is both life-threatening and costly. A preemie baby’s health care costs are 10 times higher than a full-term, healthy-weight child, according to the March of Dimes. The organization estimates that the full lifetime health care costs for these fragile children hit the $17 billion mark. It’s simply penny wise and pound foolish to cut $199 million out of a program that has a proven track record of delivering health to babies and driving down America’s health care costs.
Among the programs slashed is one of the most efficient programs to improve child nutrition: the Women, Infants and Children program run by the Department of Agriculture. This program gives expectant mothers with very small children important tips on how to feed their children healthy meals. And it provides them with coupons to incentivize them to purchase the best foods for their children. Research shows that without this intervention the nutritional intake of these children would be higher in fats, salts, and sugars, according to a recent U.S. Food and Nutrition Services study.
Instead of spending $1,400 a month in extra medical care for an obese child, for just $41 per month this program shifts these young mothers and children into healthy eating patterns, says the Centers for Disease Control and Prevention. Clearly, the WIC approach is a useful and relatively cheap way to stem the rising tide of childhood obesity.
An unsurprising but equally shortsighted cut is the complete elimination of family-planning services. If you just listened to their sound bites, you would think these funds could be used for abortions. But we all know that’s not permitted. These federal funds make it possible for uninsured women and men to get access to critical contraceptive services, pregnancy counseling, and tests for sexually transmitted infections, cervical cancer screening, and other critical health screens. Without access to these health care services, the health care needs of these adults will not disappear.
Instead, these adults will end up with unintended pregnancies and preventable health conditions that could have been avoided had they had ready access to commonplace family-planning services and screenings. Indeed, every dollar spent on family-planning services saves taxpayers $4 in Medicaid-funded prenatal, delivery, and postpartum services alone, according to a recent study by the Guttmacher Institute.
The absurdity of these cuts to the block grant, community health care centers, and family-planning services is that none of this funding would be necessary if we had a fully functioning national health care system where every American had access to high-quality care.
Benjamin Franklin famously said, “An ounce of prevention is worth a pound of cure.” Millions more Americans will lose access to health care as a result of these cuts and as a result more will have to be spent to address the real health care consequences of these cuts. Franklin also invented bifocals so his aging colleagues could see the important documents they gathered to draft. Perhaps the Republican leadership needs to adjust their glasses so they more clearly see that $2 billion in cuts they propose to the health care services for poor women and children will cost the taxpayers billions more in unnecessary health care expenses.
By: Donna Cooper, Senior Fellow, Center for American Progress, February 10, 2011
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