All heat and no light: The contraception kerfuffle

Another high-profile dust-up played out in the Senate last week over women’s health, when Sen. Roy Blunt (R.-MO) teed up a vote to allow employers or insurers to deny coverage for any “moral or religious” reason. As Sen. Barbara Boxer (D.-Calif.) pointed out, although contraception coverage was the target, the amendment would have imperiled insurance coverage for cancer treatments, health screenings, obesity-related conditions, and virtually any other needed medical care.
As one in a long line of attacks on the Affordable Care Act, the Senate’s all-too-close defeat of the Blunt amendment has health advocates breathing a sigh of relief. But opponents of both contraception coverage and healthcare reform will doubtless resurrect this debate, like a dead horse they can’t stop beating, over the coming year.
And the fight isn’t limited to Congress. There are the lawsuits — six and counting — brought by a few far-right advocacy groups and one from seven state Attorneys General on legal and constitutional grounds against the rule. We recently published a comprehensive reply to opponents’ claims. Our overall conclusion? Despite the intensity on display, their arguments just don’t hold up.


So much for gender equality

Women’s History Month started under less than auspicious terms for women as another unjust fight against their rights has been picked by Republicans. As if the recent state-level initiatives targeted at curbing reproductive rights weren’t enough, the amendment to the Patient Protection and Affordable Care Act introduced by Senator Roy Blunt of Missouri pushed the right-wing crusade against reproductive rights back on to the national stage. The measure seeking to allow employers to opt out of the federal benefit mandate would have translated into decreased coverage for women seeking preventive services, including contraception, and was voted down in the Senate by a narrow margin.

This is yet another example of extreme legislative initiatives aimed at eroding women’s access to reproductive health care. While this might not sound as radical as forcing a woman to have a transvaginal ultrasound or as putting an equal sign between a “fertilized egg” and a “person”, having a debate on contraception in the 21st century in the United States seems to be outside the realm of reality. Perhaps more appropriate for the Middle Ages, this discussion certainly doesn’t fit our modern world and a democratic society, where a woman having control over her body should be a non-debatable, fundamental human right.


The IPAB is bad medicine for seniors

This week, the House Energy and Commerce Health Subcommittee marked up H.R. 452, the Medicare Decisions Accountability Act, legislation I introduced to repeal the dangerous rationing board created by the Affordable Care Act – the Independent Payment Advisory Board (IPAB).

Next week, the House Ways and Means Committee is holding a hearing to examine the impact IPAB will have on the Medicare program. There is bipartisan concern about this board and how it could harm Medicare. It is important for these committees to shine light on the dangers posed to seniors by the IPAB.

The IPAB will consist of a group of fifteen unelected bureaucrats who will decide what constitutes “necessary care,” and who will create a “one size fits all” solution when it comes to medical care. As a physician, I can tell you firsthand how troubling this mindset can be. In medicine, every case is unique and must be treated that way.


Here are the women

What if, two weeks ago, instead of letting five men discuss what insurance coverage of contraception means to them (photo here), House representatives let five women speak? What might they have said?
One would tell how embarrassed and powerless she felt when, standing at the pharmacy counter, she first learned that contraception was not covered by her insurance. She had to walk away, unable to afford it.
Another would say that she recently gave birth, and her doctor explained that she needed contraception because it would be physically detrimental to become pregnant again too soon. But her insurance coverage doesn’t cover contraception when used to prevent pregnancy, even when it’s medically necessary to do so.


IPAB repeal: good policy and good politics

What if I told you there was a country where medical decisions were made not by doctors in consultation with their patients, but by a panel of 15 unelected bureaucrats who determine the fate of millions of Americans? You would probably think that such a system would only exist thousands of miles off our shores, where access to even the most rudimentary healthcare is reserved for the privileged few. You would be incorrect.
When the Affordable Care Act (ACA) was passed, it created the Independent Payment Advisory Board (IPAB) with the intent of slowing future spending growth of Medicare, which already consumes $468 billion of our federal budget and is projected to rise ever higher. But Congress decided to give the Board unprecedented power to make cuts to Medicare where they see fit, and only a supermajority vote can overturn them. On Wednesday, the House Energy and Commerce Committee’s Subcommittee on Health will vote on HR 452, the Medicare Decisions Accountability Act, which would repeal IPAB and send a clear signal that the American people will only fully except the ACA when all of its fatal flaws, chief among them IPAB, are rectified.


Fundamental shift needed to tackle deficit, health care

American health care spending continues to rise, and by 2019, health care costs will approach $4.5 trillion – nearly 20 percent of our projected GDP. With this spending trajectory and our significant debt in mind, serious deficit reform must tackle rising health care costs, particularly in Medicare and Medicaid, and do so by sustainably removing costs from the system. 

Traditionally, cost-cutting efforts in health care have involved tweaking eligibility, increasing out-of-pocket costs, and squeezing reimbursement to providers of health care goods and services. Though these actions may achieve a small favorable score from the Congressional Budget Office, they fail to contain costs over the long term. They also often create other problems, primarily because they address symptoms of the problem in our system and shift them to someone else instead of addressing the source of the problems directly. 

It’s like rearranging the deck chairs on the Titanic to make it harder to reach the lifeboats while doing little to alleviate the need to abandon ship.


PDUFA critical for innovation and patients

Just a few decades ago, a company could submit a new drug application and commonly wait up to 30 months before the Food and Drug Administration (FDA) rendered a verdict. FDA Commissioner Margaret Hamburg says the Prescription Drug User Fee Act – better known as PDUFA – has become a “game-changer” in the agency’s efforts to more efficiently review and approve potential new treatments.


Care work in America: Expected but not respected

Last month the Bureau of Labor Statistics reported that home care is the fastest-growing occupation in the United States. More jobs will be created in home care than in any other occupation through 2020.

But this positive news is tempered by the negative realities facing many workers in the industry. Home care work is too often “expected but not respected,” in the words of worker Tracy Dudzinski, dismissed as neither skilled nor demanding enough to qualify as a real job. That may explain the surprising fact that home care workers are denied federal minimum wage, overtime, and other protections under the Fair Labor Standards Act (FLSA), a law that was passed over 70 years ago.

Reform is long overdue, but it may be finally taking root. On December 15, Tracy stood proudly behind President Obama as he announced a proposed rule that would provide most home care workers with FLSA coverage. Unfortunately, an opposition movement led by highly profitable national home care corporations is trying to keep the rule from being issued.


In setting health care reform’s path, we must protect equity in care

This year is shaping up to be another year of monumental changes for health care in this country. With the two -year anniversary of the Affordable Care Act (ACA) bill signing fast approaching, stakeholders across the country are working feverishly to build the infrastructure and get the necessary provisions in place so that the goals of the ACA can be attained. Even with the looming Supreme Court decision muddling the process, there are steps that the Centers for Medicare and Medicaid Services (CMS) can take now to solidify some of the key patient protections that have stood at the center of health reform over the last few years.

One of the most promising aspects of the ACA, from the kidney patient community’s perspective, is its creation of a baseline Essential Health Benefits (EHB) package that will create a floor of benefits and services offered by all insurance plans as of 2014. This key provision was created with the intent to ensure a consistent, minimum level of benefits across all plans, to allow easier comparisons of plans for consumers and to prevent insurers from manipulating health plans to “cherry pick” healthier enrollees.


Getting outdoors for healthier families, children and economies

The American West has loomed large in our Nation’s imagination ever since Lewis and Clark started sending stories back East about its geography, stunning landscapes, plants and wildlife. Today it is tourists, retirees, adventure lovers and entrepreneurs who are the explorers.

Outdoor recreation employed an estimated 6.5 million people and contributed $730 billion to the national economy, according to a 2006 report by the Outdoor Industry Foundation. In 12 of the Western states, outdoor industries employed 1.3 million people and contributed $143 billion to the region’s economy. The economics alone are a good reason to protect the West’s natural assets and enhance tourism, but there is another, perhaps less obvious reason, and that is our nation’s youth.