Thursday, June 3, 2010

What's Going on with Health Reform Implementation?

From Raising Women's Voices:

First Things First: Immediate Help for People Who Need It Most

After just two months, a few key provisions of the new health reform law may already be making in difference in the health of your family and your community.  Last week, Health & Human Services Secretary Kathleen Sebelius talked about the first steps that she and her staff have taken to make sure that the new law gets help quickly to the people who need it most.  
Health Insurance for Young Adults.  Starting in September, the law will require insurance companies to allow parents to keep children on their health care plan until age 26.  According to an HHS analysis, this will make coverage possible for 1.2 million young adults and according to new guidelines from the Internal Revenue Service, the coverage for children on their parents' policies is tax-free. Even better, thanks to the advocacy of young people and Health & Human Services (HHS) Secretary Kathleen Sebelius, more than 65 insurance companies have agreed to provide coverage to young adults even before the deadline. Despite the fact that some insurance companies are stepping up, some employers are resisting the early policy change: see here for the full story.

Prescription Drug Rebates. People on Medicare who have reached the doughnut hole in prescription drug coverage are going to start getting $250 as soon as the second week of June. About four million seniors will get a rebate this year, making the drugs they need to stay healthy more affordable.

Secure Health Insurance When You're Sick.  One of the worst insurance industry abuses that will be ended is the practice of taking coverage away from people when they get sick.  Insurers will be prohibited from rescinding policies due to illness starting in September. Resigning themselves to the inevitable, the industry has agreed to follow the new rules immediately rather than waiting for the new law to make the old practice illegal.

More Affordable Insurance.  About 4 million small businesses and tax-exempt organizations are eligible immediately for tax credits that make it more affordable for them to buy health insurance for employees.  Over the next 10 years, small businesses and nonprofits are expected to get as much as $40 billion in tax relief – and the people who work for them will be able to get health insurance as a result.

How have women fared under the pioneering 
Massachusetts health reform law?

Women have achieved significant gains in insurance coverage, according to a new study presented this week at a conference in Boston. Moreover, "we have seen that increase in insurance coverage translating into improved access to health care," study co-author Sharon Long of the Urban Institute reported.

 "The Impacts of Health Reform on Health Insurance Coverage and Health Care Access, Use and Affordability for Women in Massachusetts," had a number of key findings, including:

  • 97.1 percent of women in Massachusetts had health insurance in the fall of 2009, compared to 91.4 percent in the fall of 2006, just before the law went into effect.
  • More than 90 percent of Massachusetts women had a general doctor visit in 2009 and nearly 80 percent had received dental care in 2009, significant increases over the rates from prior to health reform. The percentages of women reporting unmet health needs dropped correspondingly.

The women who have gained the most from the state's health reform law are the subgroups of women that have been a particular focus for Raising Women's Voices: low-income women, women of color and older women. Lower-income women went from 85.1 percent insured in 2006 up to 94.5 percent insured in 2009, while women from racial/ethnic minority groups went from 89.6 insured prior to health reform up to 95.5 percent by 2009. Both groups of women reported significant improvements in their ability to see a doctor, have a usual source of health care (other than hospital emergency rooms), obtain prescription drugs and dental care and obtain needed medical tests and treatment.

"I don't think you could name any other initiative that shows this kind of impact on health disparities," said JudyAnn Bigby, Secretary of Health and Human Services for the State of Massachusetts.

RWV will be reporting on the details of this study and additional presentations from the Boston conference on our website, The study was funded by the Blue Cross Blue Shield Foundation of Massachusetts. Read the study yourself here.

The Fight Goes On for Comprehensive Reproductive Health Care: Contraception IS Preventive Care
Under the health care reform law, all new private insurance plans written after mid-September will be required to cover various categories of preventive services without any cost sharing. ("Cost-sharing" includes things like co-payments, coinsurance and deductibles for all expenses that must be met before coverage kicks in). One of these categories is "preventive care and screenings" for women. This was music to our ears! Preventive care for women without co-pays! But will that preventive care include contraception?
There's a deadline coming up, and the U.S. Department of Health and Human Services (DHHS) has to act quickly and develop the list of specific things that with be included in this category. Reproductive justice advocates who know that contraception is a key component of preventive care for many women of reproductive age are making some noise to try and ensure that women get the health care they need!
According to a great new report from the Guttmacher Institute, the federal government has already made the case for for contraception as preventive care in their federal Healthy People series. This series of reports are updated every decade by DHHS to help set the official public health goals for the United States. The most recent version of these goals in Healthy People 2010, describes the importance of family planning services in terms of preventing the social, economic and medical costs of unintended pregnancy. The report finds that,
"Medically, unintended pregnancies are serious in terms of the lost opportunity to prepare for an optimal pregnancy, the increased likelihood of infant and maternal illness, and the likelihood of abortion.…The mother is less likely to seek prenatal care in the first trimester and more likely not to obtain prenatal care at all. She is less likely to breastfeed and more likely to expose the fetus to harmful substances, such as tobacco or alcohol. The child of such a pregnancy is at greater risk of low birth weight, dying in its first year, being abused, and not receiving sufficient resources for healthy development."
Universal coverage of contraception would offer tremendous benefits to women and families. Insurance practices that prevent women from getting the contraception that's best for them would be eliminated. Women wouldn't have to choose the cheapest form of contraception instead of the coverage that was best for their health. The other major benefit from including contraception under the new preventive care provision is the elimination of cost-sharing. Given the economic challenges we face, we must ensure that no one forgoes preventive care because of the cost. At the end of the day, federal programs, scientific clinical guidelines, and all the evidence we have tells us contraceptive coverage is preventive care. As we implement health reform, we would be doing a great injustice if family planning services were excluded or treated differently than other preventive care.  Stay tuned to the RWV blog for more updates and actions on this issue, as we raise our voices to ensure that women's reproductive health care is valued as health reform implementation goes forward.

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