Thursday, March 28, 2013

Health/PAC Bulletins Now Available Online

Searchable and free at www.healthpacbulletin.org.

From HealthPACBulletin.org –

Before there was an internet, with blogs, listservs and web pages to turn to, there was the Health/PAC Bulletin, the hard-hitting and muckraking journal of health activism and health care system analyses and critiques. A new web site, www.healthpacbulletin.org, is a complete and searchable digital collection of Health/PAC�s influential publication, which was published from 1968 through 1993. Health/PAC staffers and authors in New York City and briefly, a West Coast office in San Francisco, wrote and spoke to health activists across the country on every issue from free clinics to women�s health struggles to health worker organizing to environmental justice. Health/PAC both reported on what was going on and reflected back on a wide variety of strategies and tactics to build a more just health care system � a conversation that continues today.

Health/PAC coined the terms �medical empire� and �medical industrial complex� to capture the ways the profit motive distorted priorities in the American health care system. It critiqued big Pharma and rising health care costs, explored the differing forms of health activism, and made it clear that a seemingly disorganized health care system was in fact quite organized to serve ends other than health care. Its first book, The American Health Empire (1970), published by Random House, brought its analysis to national attention. Other edited collections of the Bulletins followed: Prognosis Negative (1976) and Beyond Crisis (1994). Many of today�s leading health activists, reformers and policy scholars got their start at Health/ PAC.

The website adds immeasurably to the resources documenting the history of mid- to late- 20th century American health policy and politics. Activists, scholars, journalists, practitioners, professors, and students will all find these Bulletins a sources of useful analysis and information.. This is not only a way to learn about the late 20th century history, but to consider why certain issues continue to plague our health system.

The site is a work in progress and we welcome your feedback and suggestions. It was a real labor to get these collected and available and we hope you find the site a useful resource.

Thursday, March 21, 2013

Affordable Care Act at 3: Paying for Quality Saves Health Care Dollars

This blog originally appeared on the Health Affairs Blog.

For decades before the passage of the Affordable Care Act, health care costs outstripped inflation, without corresponding improvements in health care quality.� Our system didn�t incentivize quality or efficiency.� We paid providers for the quantity of care, not the quality of care.� And we were not using technology to deliver smarter care.

The Affordable Care Act includes steps to improve the quality of health care and lower costs for you and for our nation as a whole.� This means avoiding costly mistakes and readmissions, keeping patients healthy, rewarding quality instead of quantity, and creating the health information technology infrastructure that enables new payment and delivery models to work.

Here are just a few ways that the health care law builds a smarter health care system and incentivizes quality of care � not quantity of care - to drive down costs and save you money.

We�re Shifting the Focus to Quality, Not Quantity

The health care law creates new Accountable Care Organizations (ACO) that incentivize doctors and other providers to work together to provide more coordinated care to their patients. �ACOs agree to take responsibility for the cost and quality of their patients� care, to improve care coordination and safety, and to promote appropriate use of preventive health services.� And when this new care model saves the Medicare program money, that savings is shared with the ACO. Over 250 organizations are participating in Medicare ACOs, giving more than 4 million Medicare beneficiaries access to high-quality coordinated care throughout the nation.� ACOs are estimated to save the Medicare program up to $940 million in the first four years.

The Affordable Care Act also ties Medicare Advantage bonus payments to the quality of coverage these private plans offer.� This gives seniors a broader range of higher-quality Medicare Advantage plans from which to choose.� As a result, in 2013, the 14 million Medicare beneficiaries currently enrolled in Medicare Advantage have access to 127 four- and five-star plans, which is 21 more high-quality plans than were available in the previous year.

Keeping You Out of The Hospital

Every year, about 2.6 million seniors � or nearly one in five hospitalized Medicare enrollees � are readmitted within 30 days of discharge, at a cost of more than $26 billion to the Medicare program.� Many of these readmissions stem from preventable problems. These rates can be drastically reduced if we do a better job coordinating care and support.� The health care law�s Hospital Readmissions Reduction Program reduces Medicare payments to hospitals with relatively high rates of potentially preventable readmissions to encourage them to focus on this key indicator of patient safety and care quality.

We�re starting to see results.� Medicare readmissions rates have remained stuck near 19 percent over the five years that the data has been collected (and likely for decades prior to that), but in 2012 the nationwide rate of hospital readmissions of Medicare patients declined to about 17.8 percent.� This translates to over 70,000 fewer preventable hospital readmissions.

Lowering Costs

Taken together, these improvements are providing more value for your health care dollar and helping to fuel historically low cost growth rates in Medicare and Medicaid.� Last year, per-beneficiary Medicare costs increased by only 0.4 percent, continuing the historically low Medicare growth we saw in 2011 and 2010. Per-beneficiary spending in Medicaid actually decreased 1.9 percent from 2011 to 2012.�

And a recent report found that health care price inflation in January dropped to 1.5 percent, one of the smallest increases on record.

As the nation�s largest insurer, Medicare can lead the way in effective practices like this that deliver better care and drive down costs.� Our goal is that these reforms and investments build a health care system that will ensure quality care for generations to come.

Learn more about the key features of the Affordable Care Act.

Follow Secretary Sebelius on Twitter at @Sebelius.

Wednesday, March 20, 2013

Affordable Care Act at 3: Abby’s Story

I remember the day the health care law passed three years ago. The law made history as one of the most significant pieces of health related legislation since the passage of Medicare and Medicaid. On a personal level, it fundamentally changed the course of my life. At the time, I was 20 years old, a college student, and facing the reality that I would be kicked off my parents� high-quality private insurance, on my twenty-first birthday. I would have limited, if any, options for health insurance and it put me face to face with my own mortality.

I was born with a serious, rare disease. Without high-quality health care, or health insurance, I would suffer potentially fatal consequences. Most children who are born with my disease, toxoplasmosis, have profound side-effects that can include organ failure, blindness, and intellectual disabilities. Throughout my childhood, I was fairly healthy. But during high school I began to face the realities of what it meant to have this disease. I had neurosurgery to replace the 16-year-old shunt that was installed to drain spinal fluid collecting on my brain, and I lost vision in my left eye when the parasite attacked my eyes. Since then, I have struggled to remain healthy and have had several shunt replacements and eye surgeries.

Knowing how stressful, painful, and scary these experiences were with health insurance, as I got older, my family and I went into a panic. We knew I would no longer be eligible for their insurance, and we knew beyond a shadow of a doubt that I would be denied coverage due to my multiple pre-existing conditions. This was where we were in March 2010.

But everything changed three years ago, when President Obama signed the Affordable Care Act.

Over the last three years, my fear has disappeared and has been replaced with a profound sense of hope and empowerment.� Now, I can stay on my parents� plan until I turn 26. As a 22-year-old college graduate with multiple pre-existing conditions, I could not be more grateful. Moreover, now there are no more lifetime limits on how much my insurance company will pay for my essential health benefits � and annual limits are ending, too. And in 2014, the health care law helps to ensure that I cannot be denied coverage due to my chronic illness.

However, there is greater hope beyond what I am experiencing personally. The governors of many states are getting behind expansion of Medicaid coverage for Americans who may find it difficult to afford private insurance. �The states and the federal government also are creating a Health Insurance Marketplace for each state, where people can compare health plans based on price and benefits and purchase the one that best fits their needs. Open enrollment starts Oct. 1, 2013, with coverage beginning as soon as January 2014.

I am eager to see what the coming years will bring. The Affordable Care Act is still a new law, and there is certainly more work to be done. It will not happen overnight, nor will it be easy. However, in just three years, we are already well on our way to building a more equitable, effective, and high-quality system of care. This is not the end; it is merely the beginning.

The U.S. Department of Health and Human Services supports the statements by the guest author of this article.

Friday, March 15, 2013

Medicare Open Enrollment: Last Week to Review and Compare Medicare Plans

This blog was originally posted on The Medicare Blog.

With housework, doctor appointments, time with family, and job responsibilities, there are always tasks that get left until the last minute. But whether I�m choosing an insurance plan or planning a vacation, I still want to make sure my �I�s are dotted and my �T�s crossed. I want to know that everything�s taken care of � without worry and confusion.

Speaking of insurance, time is running out! If you�ve been thinking about changing your Medicare coverage, the time to act is now. The dates for Medicare Open Enrollment are early this year to allow for a smoother transition to a new plan.� Not only did Open Enrollment start earlier, but it also ends earlier � the last day for you to change your Medicare plan is now December 7.� This gives Medicare enough time to process any change you may make and have you linked correctly to the plan you choose as soon as your coverage starts. That way you can go to the doctor or your pharmacy on January 1 without having to worry about your coverage.���

This year, thanks to the Affordable Care Act, you have better �choices, more benefits and lower costs, and it�s worth it to review them. Our counselors worked with a man in Oregon who has saved more than $600 a month on his prescription drugs between benefits from the health care law and lowering his doses.� $600 a month makes a huge difference in helping him pay other bills, and still put some money into savings.

I know that sorting through your health and drug coverage choices during Open Enrollment can be confusing but you don�t have to do it alone.�

Look around for all the Medicare information out there. We have plenty of resources to help you think about cost, coverage, extra benefits, and convenience when evaluating your plan choices. And visit our Open Enrollment center, where we�ve gathered everything you need online, including a video on how the Medicare Plan Finder works, to walk through your options.�

Medicare�s here to help you, stronger than ever. Take the time this week to review and compare plans. It�s worth it � you can relax later.

A Health Care Marketplace to Help You Find Insurance

Today, we are taking steps to relieve one of the biggest headaches middle-class families face - finding affordable health insurance. By 2014, state-based Affordable Insurance Exchanges will be in place to give consumers the kind of choices their Members of Congress have. They include unprecedented tax relief for families that will bring the cost of insurance down.

When you shop for groceries, you typically go to a supermarket where you can compare prices and brands, and find the best products that meet your personal needs. Soon you�ll be able to purchase your health insurance in a similar way � through a marketplace called an Exchange.

What is an Exchange? And how does it help you? An Exchange is a one-stop marketplace where you can choose a private health insurance plan that best fits the needs of you and your family. Just like you can purchase your eggs, milk, vegetables, and cleaning supplies from your local supermarket, an Exchange will be your one stop for all of your health insurance needs. You will be able to:

Look for and compare private health plansGet answers to questions about your health coverage optionsFind out if you�re eligible for health programs like Medicaid and the Children�s Health Insurance Program, or tax credits that make coverage more affordableEnroll in a health plan that meets your needs

You might remember that on July 11th the Department of Health and Human Services announced a proposed framework to help states build Affordable Insurance Exchanges. Today, we�re partnering with the Department of Treasury to take the next steps to establish these Exchanges.

The three proposed rules issued today seek to create a path to a simple, seamless and affordable system of coverage for you and your family. They include:

Exchange Eligibility and Employer Standards: The first HHS-proposed rule details the standards and process for enrolling in qualified health plans and insurance affordability programs. It also outlines basic standards for employer participation in the Small Business Health Options Program (SHOP).Medicaid Eligibility: The second HHS proposed rule expands and simplifies Medicaid eligibility and promotes a simple, seamless system of affordable coverage by coordinating Medicaid and CHIP with the new Exchanges.Health Insurance Premium Tax Credit: The third proposed rule, which is issued by Treasury, lays out how individuals and families can receive premium tax credits to make health insurance coverage more affordable.

To make sure we structure the Exchanges in a way that meets your needs, we want to hear from you. In the weeks ahead, both Departments will conduct a robust outreach campaign to receive your comments on these rules. We�ll then make modifications based on the feedback we receive. You can submit comments here: Exchange Eligibility and Employer Standards, Medicaid Eligibility, Health Insurance Premium Tax Credit.

I am also eager to continue collaborating with states to set up their Exchanges without wasting resources. Today, I sent a letter to Governors soliciting comments from states on how their partnership with HHS will allow them freedom to innovate and help design an Exchange that works best for the citizens in their state.

We are on our way to 2014 when millions of individuals, families, and small businesses will have access to the same kind of affordable insurance choices as Members of Congress.

For more about the announcement today, you can read the news release here.

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Thursday, March 14, 2013

Celebrating Healthier Patients and Stronger Communities

Today we are celebrating the work of the National Health Service Corps in communities across the country.� This year�s theme is �Healthier Patients, Stronger Communities,� and that theme is reflected in the work that our NHSC providers do every day.

The National Health Service Corps helps improve access to health care in communities that need it most. �It provides financial support for doctors, nurses and other health care providers as well as students training for a career in primary care.� This financial support in the form of loan repayment and scholarships allows clinicians who are passionate about serving in our communities the ability to pursue jobs in primary care disciplines without the burden of overwhelming debt.�

Now, thanks to investments made by the Obama Administration there are close to 10,000 National Health Service Corps �doctors, dentists, nurse practitioners, physician assistants, mental and behavioral health specialists, and other health providers treating more than 10.4 million people throughout the country.� In fact, the number of providers serving in the NHSC has nearly tripled from 3,600 since the start of the Obama Administration. �And, while Corps members commit to working for at least two years in high need areas, more than 82 percent decide to stay beyond their initial commitment, helping ensure more Americans get the care they need.

I am also excited to announce that this year, the health care law has invested almost $230 million in the NHSC through 4,600 loan repayment and scholarship awards to clinicians and students who are committed to working where they are needed most.

Today, we celebrate Corps Community Day to honor the important work of National Health Service Corps members who are bringing their talents to communities that need health care providers.� To those of you who are serving in the Corps or will serve, I want to say thank you. Thank you for the work you do each and every day to ensure that Americans get the primary care they need and deserve to lead healthy lives.

For stories from National Health Service Corps clinicians, please visit: http://nhsc.hrsa.gov/corpsexperience/memberstories/index.html� or http://nhsc.hrsa.gov/corpsexperience/40clinicians/index.html

Romney: Obama's Health Care Mandate Is A Tax

fromNHPR

July 5, 2012

Listen to the Story 4 min 20 sec Playlist Download Transcript   Enlarge image i

Republican presidential candidate Mitt Romney walks with his wife, Ann, and other family members, along with Republican Sen. Kelly Ayotte, in the Wolfeboro, N.H., Independence Day parade Wednesday. Ayotte has been mentioned as a possible vice presidential contender.

Kayana Szymczak/Getty Images

Republican presidential candidate Mitt Romney walks with his wife, Ann, and other family members, along with Republican Sen. Kelly Ayotte, in the Wolfeboro, N.H., Independence Day parade Wednesday. Ayotte has been mentioned as a possible vice presidential contender.

Kayana Szymczak/Getty Images

Republican presidential challenger Mitt Romney spent his July Fourth holiday marching in a New Hampshire parade, and backtracking statements a top adviser made about the individual mandate in the Obama health care law.

There was something for almost everybody in Wolfeboro's Independence Day parade: a local brass band, bonnet-wearing Daughters of the American Revolution, a Zumba instructor shimmying across the bed of a pickup truck, and even a Jimmy Durante impersonator, complete with prosthetic nose.

Romney, who has a house on Lake Winnipesaukee, was decidedly at ease as he marched down Wolfeboro's main street. He was joined by his wife, Ann, a pack of supporters wearing blue T-shirts and also about 20 family members, most of whom traveled the parade route in antique trolley cars. By and large, they and their family's patriarch got a warm welcome in this very Republican small town.

"We love Mitt. He's going to be great for America," says Jeff Bichard, who lives in Wolfeboro and manages a fleet of trucks for a lighting company.

Bichard is convinced Romney will invigorate the economy, and he plans to work hard to help Romney carry the state, where recent polls show the former Massachusetts governor and President Obama in a near dead heat.

"I am picking up a sign for my house," Bichard adds. "I am going to put it on my front lawn, and I'm going to get a T-shirt and I've got it on my hat. We love Mitt."

But love was by no means the only emotion at this parade. Pat Jones, a 70-year-old former postmaster, shaded her eyes and shook her head as she watched one Romney after another wave and smile from their wooden trolleys.

"Would you ask Mitt how much a loaf of bread costs, how much a gallon of gas is and how much heating oil is?" Jones asks. "He is so removed from all of this. His world is so different from the common man."

Her husband, John Paul Jones, was quick to utter the epithet that has dogged Romney for years: "He's a flip-flopper."

That's a message Democrats will be selling, and Romney gave them some fresh ammunition.

"The majority of the [Supreme] Court said it's a tax, and therefore it is a tax. They have spoken. There is no way around that. You can try and say you wished they had decided another way, but they didn't," Romney told CBS News regarding the requirement that all Americans have insurance.

The individual mandate is at the core of Obama's health insurance overhaul. It's also the linchpin of the health law Romney passed as Massachusetts governor.

Earlier this week, a top Romney adviser said Romney viewed the mandate in the federal health law the same way he saw it in the Massachusetts law, as a fee or a fine, and not a tax. Romney's remarks to CBS directly contradicted that. Romney's new stance made him sound more like the GOP leaders in Congress.

"The American people know that President Obama has broken the pledge he made; he said he wouldn't raise taxes on middle-income Americans," Romney said.

That's an accusation Romney may soon hear turned against him. But on this day, the fighting words were mostly left unsaid.

When Romney spoke at a brief rally in Wolfeboro, he never mentioned the president. He even took pains to compliment the behavior of Obama supporters he met during the parade.

"They were courteous and respectful and said, 'Good luck to you' and 'Happy Fourth of July.' This is a time for us to come together as a people," Romney said.

Romney also said he hopes to make America more like America. And while it's hard to know precisely what that means, it's a hard point to argue with on Independence Day.

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Wednesday, March 13, 2013

Research ties economic inequality to gap in life expectancy

ST. JOHNS COUNTY, Fla. � This prosperous community is the picture of the good and ever longer life � just what policymakers have in mind when they say that raising the eligibility age for Social Security and Medicare is a fair way to rein in the nation�s troublesome debt.

The county�s plentiful and well-tended golf courses teem with youthful-looking retirees. The same is true on the county�s 41 miles of Atlantic Ocean beaches, abundant tennis courts and extensive network of biking and hiking trails.

The healthy lifestyles pay off. Women here can expect to live to be nearly 83, four years longer than they did just two decades earlier, according to research at the University of Washington. Male life expectancy is more than 78 years, six years longer than two decades ago.

But in neighboring Putnam County, life is neither as idyllic nor as long.

Incomes and housing values are about half what they are in St. Johns. And life expectancy in Putnam has barely budged since 1989, rising less than a year for women to just over 78. Meanwhile, it has crept up by a year and a half for men, who can expect to live to be just over 71, seven years less than the men living a few miles away in St. Johns.

The widening gap in life expectancy between these two adjacent Florida counties reflects perhaps the starkest outcome of the nation�s growing economic inequality: Even as the nation�s life expectancy has marched steadily upward, reaching 78.5 years in 2009, a growing body of research shows that those gains are going mostly to those at the upper end of the income ladder.

The tightening economic connection to longevity has profound implications for the simmering debate about trimming the nation�s entitlement programs. Citing rising life expectancy, influential voices including the Simpson-Bowles deficit reduction commission, the Business Roundtable and lawmakers on both sides of the aisle have argued that it makes sense to raise the eligibility age for Social Security and Medicare.

But raising the eligibility ages � currently 65 for Medicare and moving toward 67 for full Social Security benefits � would mean fewer benefits for lower-income workers, who typically die younger than those who make more.

�People who are shorter-lived tend to make less, which means that if you raise the retirement age, low-income populations would be subsidizing the lives of higher-income people,� said Maya Rockeymoore, president and chief executive of Global Policy Solutions, a public policy consultancy. �Whenever I hear a policymaker say people are living longer as a justification for raising the retirement age, I immediately think they don�t understand the research or, worse, they are willfully ignoring what the data say.�

A Social Security Administration study several years ago found that the life expectancy of male workers retiring at 65 had risen six years in the top half of the income distribution but only 1.3 years in the bottom half over the previous three decades.

In 1980, life expectancy at birth was 2.8 years longer for the highest socioeconomic group defined in a research study than the lowest, according to a report by the Congressional Budget Office. By 2000, the gap had grown to 4.5 years.

Continue reading…

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Tuesday, March 12, 2013

Healthcare petition urges: Everybody In, Nobody Out

For more than five years, medical students from the University of Kansas Medical Center have put in long hours serving uninsured patients at their Jay Doc Free Clinic.

Last year, a number of students and physicians involved in such efforts started a new group, Heartland Healthcare for All. Their aim is to push universal health care beyond the walls of their free clinics and into federal legislation that would leave no patient behind.

With a new president preparing to take office, they’re not wasting any time sending their ideas to Washington, D.C.

Elizabeth Stephens, a medical student at KU Med and a member of Heartland Healthcare for All, says the organization started with a viewing of Michael Moore’s 2007 documentary, Sicko, which criticizes the current model of private health care as ineffective and unjust.

“They left the movie outraged by what they had seen,” Stephens says of a group of students and professionals at the screening. “They started talking in the lobby and decided to form a group of concerned citizens.”

Since then, the HHFA has organized vigils and protests to advance a more equitable system. They’ve thrown their weight behind a publicly financed, single-payer system, like the one proposed by Michigan Congressman John Conyers and co-sponsored by Missouri U.S. Rep. Emanuel Cleaver. “We really believe the most equitable and most cost-effective way to truly have a system where everybody’s in and nobody’s left out is a single-payer system,” Stephens says.

Now the group is trying to get more citizens on board.

After Barack Obama became the Democratic nominee for president, his campaign called for citizens to hold meetings in their homes and to discuss the changes they’d like to see in Washington, D.C. About 40 people showed up to an HHFA-sponsored gathering to talk about health care, Stephens says. The group came up with a unanimous vision. They put that wording down on paper. Now they’ve turned that session into an online petition that demands: “Everybody In, Nobody Out.”

In the two weeks since it went live, the effort has gained more than 100 signatures. Stephens says the hope is to get as many names as possible and then send the message to the new president once he takes office.

“He’s asked for input from the people who elected him,” Stephens says of Obama. “We thought this would be a great time to show the president-elect and local representatives and senators there is strong support for this and people want it. Politicians aren’t ever going to go out on their own and do something radical. They have to know the people who voted for them want that change first. We want to demonstrate wide support for this so they can get behind it, as well.”

This weekend, the Obama camp is once again calling on citizens to throw house parties to jump-start political discussions. Before then, though, the members of HHFA will gather at the same free clinic that hosts the Jay Docs tonight to keep pushing for a system that’s open to everyone.

This article is from pitch.com.

Monday, March 11, 2013

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White House Tries Again To Find Compromise On Contraception

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Feds And Health Insurers Partner To Fight Fraud

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Cancer Patient Gets Help From 'Bake Sale' And Aetna CEO

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Saturday, March 9, 2013

Need A Price For A Hip Operation? Good Luck With That

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Panel Proposes A New Tax To Pay For Public Health

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Does the Health Insurance Industry Have Congress In Its Pocket?

No one ever talks about dismantling the Fire Department, Police Department, or Postal Service because they’re models of a scary socialist project. Why should healthcare be any different? Quite simply, the health insurance industry stands in the way. And as the Real News Network reports, they’ve been lobbying hard to make sure that a for profit system of care remains the law of the land. But labor, single payer advocates, and Americans who want basic healthcare are pushing back.

“We believe the health insurance industry is trying to buy their way onto the table with health care reform,” says Carmen Balber of Consumer Watchdog at a protest against the American Health Insurance Plans’ 2009 Policy Forum. “We see this in two big points,” she goes on to explain, “one which is a mandate that would require individuals to purchase private health insurance… and secondly we know the insurance industry is trying to block any sort of public option for the American people. They don’t want the competition, so we’re here to call out the insurance industry for trying to buy Congress’ position.”

You can see more videos at The Real News Network.

This article is from GRITtv.

Friday, March 8, 2013

Humiliation and Shame: Part of Being Insured in America

Oh, the things we did not fix in the healthcare bill are shocking. Just as seniors falling into the Medicare drug benefit donut hole begin to get the $250 checks meant to calm their fears about our new healthcare legislation, the rest of us would do well to remember the abuses of the for-profit healthcare system that will continue and even accelerate in the coming years.

Health insurance is not health care. Health insurance is a financial product marketed and sold to protect health and wealth which may do neither thing very well. I view it as a defective product. Yet, very soon we will be buying more of it and helping more of our fellow Americans buy more of it with the subsidies that support the great health insurance bailout that is being called �patient protection.�

Yesterday, I went to the doctor for an appointment I waited weeks to secure. I am insured. I have what some would say is fairly good insurance from one of the for-profit insurance giants. I waited patiently in the waiting room, and then was escorted to the exam room. There was a flurry of activity around me. A thorough history was taken. X-rays were taken. The nurse said, �Oh, honey, are you in pain? Those X-rays show some pretty awful deformity.� I said I have been hurting for years but that I have waited until I could stand no more to seek treatment. Most of the time I take large amounts of OTC anti-inflammatory medication and muddle through. It�s the American way. It�s the insured American�s way. It�s the working, insured American�s way.

The doctor buzzed in rather quickly and began discussing a treatment plan with me. Some immediate care to relieve some of the pain, and some longer term non-invasive care to see if we could avoid surgery. I was hopeful and thrilled though a bit worried about how it would feel to get shots in the joints of my feet to help the heel spurs and the bone pain. I�ve had shots in my knees, and it isn�t fun.

Suddenly, as quickly as I had felt the anticipation of some relief, the flurry of activity ground to a halt. The doctor left the room. Another office person came in. She said, �I�m sorry Ms. Smith. Your insurance will not cover what the doctor wants to try.� Matter of fact. She�s said these words before � many times. I ask how much it would cost to pay for it myself. She answers. I cannot pay that much. The visit is ending. The hope is shriveling.

I could feel the muscles in my face tense as the humiliation spread through my body. This body, just moments ago worthy of plans to relieve pain and head for some better health, now was deemed unworthy of care. Shame. All that old shame I used to feel before our medical bankruptcy was rising in my gut. It hurt so badly. But I was determined not to show my anger or my sadness.

The doctor wandered by the room and saw me. He stepped in and gave me some soft inserts for my shoes. He said they won�t help much or for long, but that maybe it would be a little relief. He must have seen the look on my face and felt at least a little compassion. A little. I thanked him. But I could say little else, and I could not look him in the eye. I felt so ashamed, and I don�t even really understand why I�ve been so conditioned as a patient to feel it is my failure when these things happen.

On the way home, I alternated between sadness and anger. Clearly someone wasn�t being honest with me. Either the treatments this doctor was suggesting really aren�t a good idea (as the insurance company�s denial to pay would lead one to believe) and therefore are not approved for coverage or the insurance company just wants to push those costs onto patients who cannot usually afford them. Either way, I didn�t get the care I needed. Either way, I left hurting. Either way, I lose. The doctor made some money on the office visit and my co-pay at least. The insurance company avoided paying for anything beyond that.

My husband sat beside me in the car, sad and angry for me. As a person covered under one of our nation�s single-payer programs and a supplemental private policy, he has never heard the words I heard � he has never been denied care. He felt helpless for me. As I cried tears of rage, he sat silently.

And, so, how will any of this change under the new healthcare bill? It won�t. In fact, the pressure for insurance companies to deny more care will grow as they are compelled by law to take more people who have pre-existing conditions like having feet. Cherry picking the healthiest folks will require a bit more skillful contortions for the for-profit insurance companies, and doctors will leave more patients sitting on the edge of exam tables like naughty little children who do not deserve to be treated.

Healthcare is a basic human right in most of the rest of the modern world. Only in this nation do we believe that only the richest people deserve the best of care. It�s a wild twist on the old Bible lesson about it being tougher for a rich man to get to heaven than for a camel to get through the eye of a needle. We�ve made it harder for a working person or a poor person to get healthcare in America than for a rich man to get to heaven. We are a sick society indeed. No Golden Rule values herein.

Only when we finally decide that we believe in a compassionate and just healthcare system for all will we ever have the courage to change it. Right now we just don�t believe in that sort of system at all. As a patient, I am fodder. At least this morning I was able to turn my outrage back on the system that left me in that exam room alone and sucking back tears of anger. No one should go to a doctor to seek care and leave less well. That�s cruel and unusual.

I was raised to have more compassion than this for my fellow human beings, and I think most Americans were raised with similar values. How in the world did we get to a place where we participate in doing this to one another? Is this the system we want to leave to our children? Do you want to leave your child lacking care when he or she needs it? Your grandchild? Then, for heaven�s sake — for heaven�s sake — stand up and let�s get back to work to fix this mess. There is much to be done.

Health Insurers Set To Pay $1.3 Billion In Rebates

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Oregon Activists Look to Grassroots Approach to Win Universal Health Care

With health care premiums rising three times faster than workers� income, more and more unions have come to see the existing health care system as unsustainable, despite their best efforts at the bargaining table.

In Oregon, activists are responding by rejuvenating a dormant campaign to win a health care system that covers everyone�and pays for it by cutting out the insurance companies. The concept is called �single payer.�

This isn’t the first time that Oregon activists have tried to win single payer. Ten years ago, they put an initiative on the ballot, but despite initially promising polls, the measure was trounced�victim of a flood of insurance company money and the sharp opposition of the Oregon AFL-CIO, which called it a threat to union health plans.

Times have changed.

When Portland Jobs with Justice began making the rounds of local union halls in 2008, urging support for national single-payer legislation sponsored by Representative John Conyers, the response was generally sympathetic. The national AFL-CIO has endorsed single payer on principle, and current state President Tom Chamberlain has been a consistent supporter.

The current focus isn�t just gaining endorsements, however.

Three activists from the Vermont Workers Center toured Oregon in December at the invitation of local Jobs with Justice chapters to spread the word on how they won landmark legislation laying the groundwork for a single-payer health care system in their state.

Their essential message: take it to the grassroots. Don�t split hairs over policy analysis. Don�t try to win over legislators who have heard all the arguments but haven�t felt the heat from their constituents. Don�t even use technical terms like �single payer,� unless you�re talking to people who already know what it means.

Instead, talk about health care as a human right�something everybody should have, regardless of the state of their bank account or their immigration papers, their medical condition, their job, their age, race, or gender, or whether some insurance underwriter thinks they�re a �good risk.� Seek out the people in all walks of life who have been burned by the health care system, get their stories, and turn them into effective activists and advocates.

For three years Vermonters built support in every corner of the state through one-on-one surveys, photo petitions, and public meetings where politicians were invited to hear testimony, comparable to the Workers� Rights Board hearings that are a standard part of the Jobs with Justice toolkit.

The Vermonters� tour made a tremendous impact, from metropolitan Portland to rural communities in eastern Oregon. Not everyone agreed with every aspect of the VWC approach, but everyone was talking about it. By the end of January, a new statewide coalition had convened to �create a comprehensive, affordable, publicly funded, universal health care system serving everyone in Oregon and the United States.�

By April, the coalition had a name�Health Care for All-Oregon�and close to 50 affiliates, including several statewide unions, immigrant rights groups, and community organizations ranging from the Rural Organizing Project to Elders in Action to Sisters of the Road (which advocates for the homeless).
Some, like Physicians for a National Health Program (PNHP) and the Mad as Hell Doctors (whose cross-country tour in 2009 brought the message to a host of new audiences), make single payer their main focus. The majority of affiliates have other priorities, but have come to understand that the collapse of our health care system threatens everything else on their agenda.

The Oregon Latino Health Coalition, which has labored tirelessly under the radar to secure medical services for the state�s 150,000 undocumented, recognized immediately that the Health Care for All human rights framework provides an opportunity for open advocacy without being isolated or marginalized. In voting to affiliate, the Representative Assembly of the Oregon Education Association noted that the skyrocketing cost of teachers� health benefits is draining money out of the classroom and has left the union increasingly vulnerable to attack.

State vs. National

For unions, perhaps the biggest sticking point has been the question of state vs. national legislation. When Congress passed the Affordable Care Act in spring 2010 and ended, for the time being, the prospect of any genuine national health care reform at the federal level, Portland Jobs with Justice made a strategic decision to pursue state legislation as a way to keep single payer before the public.

Working with state Representative Michael Dembrow (who is also a Teachers union officer and Jobs with Justice member), with activists from the 2002 initiative campaign, and with PNHP and the Mad as Hell Doctors, we drafted a bill that attracted a dozen legislative co-sponsors. In March 2011, supporters of the Dembrow bill staged a mass rally on the Capitol steps followed by a dramatic two-hour hearing before the House Health Care Committee. The legislation didn�t make it to the House floor, but it has more than proved its value as an organizing tool, energizing new activists across the state.

Some single-payer supporters question how far it can be implemented at the state level. They point to a host of federal laws and regulations that would need to be waived, and the difficulty of achieving the cost savings of a truly universal risk pool when the program stops at the state line.

This has in fact been a problem in Vermont, whose new law, while a giant step in the right direction, falls short of single payer. (Many Vermonters remain outside the risk pool, and funding, while administered by the state, still comes from multiple sources.) Unions with multi-employer Taft-Hartley health plans, which often cross state lines, worry that a statewide risk pool will not be viable enough to maintain the level of coverage they currently enjoy.

For this reason, Portland Jobs with Justice has made national legislation the ultimate objective, and has taken the position that the best union health plans set the standard by which any public plan should be assessed. Significantly, the �insurance exchange� provisions of the Affordable Care Act directly undermine Taft-Hartley trusts, by giving small employers a way to bypass unions and buy inferior, cut-rate insurance coverage for their workers. For unions, the Affordable Care Act is no solution: even if it survives the current Supreme Court challenge, its lack of cost controls and other internal contradictions will render it unworkable.

The challenge for us is to be ready with an alternative that has popular support, and the more states join Vermont in projecting such alternatives, the better.

Health Care for All-Oregon wants to bring everyone together to hammer out a strategy that works for all. The immediate task in Oregon, though, is not legislation but building the kind of mass base that changes the political climate in the state and makes legislation possible.

Efforts to pass single-payer bills in Vermont go back 20 years, but it was only after the Vermont Workers Center did three years of organizing around the principle of health care as a human right that they got results. Now that the Oregon coalition is up and running, we�ll see how much of Vermont�s game plan can be successfully exported.

Peter Shapiro is an organizer with Portland Jobs with Justice.

Thursday, March 7, 2013

Good News on Health Care Spending

For years, health care costs have been rising faster than inflation, driving up the cost of health care and making it less affordable for families and businesses.

But now, the good news about the slowing growth of health care spending nationwide is being increasingly recognized by independent analysts. Just this week, USA Today reported that according to the newspaper�s own analysis that �health care spending last year rose at one of the lowest rates in a half-century.�� According to the paper, health care providers and analysts found that �cost-saving measures under the health care law appear to be keeping medical prices flat.�

As USA Today put it, �Spending for medical care has increased modestly for five consecutive years, the longest period of slow growth since Medicare began in 1966.� And, according to the newspaper�s own number-crunching of Bureau of Economic Analysis data, health care spending shrank slightly as a share of the overall economy.

A report that we released earlier this year also showed that Medicare spending per beneficiary has continued at a historically slow pace � by only 0.4% in fiscal year 2012, following slow growth in 2010 and 2011 and significantly below the 3.4% growth per person in the economy overall.� And a report released last week shows that Medicaid spending per beneficiary also grew at historically slow rates in 2012.

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. It�s improving the way health care providers do business, and that�s good news for patients.

USA Today reports that incentives in the law that encourage more coordinated and higher quality care are working.� The newspaper quoted Dan Mendelson, the CEO of Avalere health saying �Institutions are taking both cost control and quality improvement more seriously."

Essentia Health, a hospital system based in Duluth, Minn., now does more extensive home monitoring of its 300 sickest congestive heart failure patients, which the newspaper says �has cut 30-day admissions to less than one-tenth of the national average and saved millions of dollars.�

�Until now, the government has paid on volume. Now it�s trying to pay more on quality,� said Peter Person, CEO of Essentia and a doctor of internal medicine, as quoted by the article.

This good news from USA Today is just more evidence that the health care law is working.� The Affordable Care Act is driving down costs and improving quality, which will have long-term benefits for our economy and our health.

For more information on the Affordable Care Act and patients� new protections and rights, see www.healthcare.gov/law/features/rights.

Good News on Health Care Spending

For years, health care costs have been rising faster than inflation, driving up the cost of health care and making it less affordable for families and businesses.

But now, the good news about the slowing growth of health care spending nationwide is being increasingly recognized by independent analysts. Just this week, USA Today reported that according to the newspaper�s own analysis that �health care spending last year rose at one of the lowest rates in a half-century.�� According to the paper, health care providers and analysts found that �cost-saving measures under the health care law appear to be keeping medical prices flat.�

As USA Today put it, �Spending for medical care has increased modestly for five consecutive years, the longest period of slow growth since Medicare began in 1966.� And, according to the newspaper�s own number-crunching of Bureau of Economic Analysis data, health care spending shrank slightly as a share of the overall economy.

A report that we released earlier this year also showed that Medicare spending per beneficiary has continued at a historically slow pace � by only 0.4% in fiscal year 2012, following slow growth in 2010 and 2011 and significantly below the 3.4% growth per person in the economy overall.� And a report released last week shows that Medicaid spending per beneficiary also grew at historically slow rates in 2012.

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. It�s improving the way health care providers do business, and that�s good news for patients.

USA Today reports that incentives in the law that encourage more coordinated and higher quality care are working.� The newspaper quoted Dan Mendelson, the CEO of Avalere health saying �Institutions are taking both cost control and quality improvement more seriously."

Essentia Health, a hospital system based in Duluth, Minn., now does more extensive home monitoring of its 300 sickest congestive heart failure patients, which the newspaper says �has cut 30-day admissions to less than one-tenth of the national average and saved millions of dollars.�

�Until now, the government has paid on volume. Now it�s trying to pay more on quality,� said Peter Person, CEO of Essentia and a doctor of internal medicine, as quoted by the article.

This good news from USA Today is just more evidence that the health care law is working.� The Affordable Care Act is driving down costs and improving quality, which will have long-term benefits for our economy and our health.

For more information on the Affordable Care Act and patients� new protections and rights, see www.healthcare.gov/law/features/rights.

Medicare Open Enrollment: Last Week to Review and Compare Medicare Plans

This blog was originally posted on The Medicare Blog.

With housework, doctor appointments, time with family, and job responsibilities, there are always tasks that get left until the last minute. But whether I�m choosing an insurance plan or planning a vacation, I still want to make sure my �I�s are dotted and my �T�s crossed. I want to know that everything�s taken care of � without worry and confusion.

Speaking of insurance, time is running out! If you�ve been thinking about changing your Medicare coverage, the time to act is now. The dates for Medicare Open Enrollment are early this year to allow for a smoother transition to a new plan.� Not only did Open Enrollment start earlier, but it also ends earlier � the last day for you to change your Medicare plan is now December 7.� This gives Medicare enough time to process any change you may make and have you linked correctly to the plan you choose as soon as your coverage starts. That way you can go to the doctor or your pharmacy on January 1 without having to worry about your coverage.���

This year, thanks to the Affordable Care Act, you have better �choices, more benefits and lower costs, and it�s worth it to review them. Our counselors worked with a man in Oregon who has saved more than $600 a month on his prescription drugs between benefits from the health care law and lowering his doses.� $600 a month makes a huge difference in helping him pay other bills, and still put some money into savings.

I know that sorting through your health and drug coverage choices during Open Enrollment can be confusing but you don�t have to do it alone.�

Look around for all the Medicare information out there. We have plenty of resources to help you think about cost, coverage, extra benefits, and convenience when evaluating your plan choices. And visit our Open Enrollment center, where we�ve gathered everything you need online, including a video on how the Medicare Plan Finder works, to walk through your options.�

Medicare�s here to help you, stronger than ever. Take the time this week to review and compare plans. It�s worth it � you can relax later.

Community Health Centers: Increasing Access to Affordable, High Quality Care

For some of our most vulnerable members of society, finding quality care at an affordable price can be difficult if not impossible. Whether uninsured, in a low paying job, or in a rural community, many people wind up forgoing care at the expense of their own health.�

Yet thanks to community health centers, more and more Americans are getting the care they need. For more than 45 years, community health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay.

This week, we�re celebrating National Health Center Week, where we pay tribute to the vital work of community health centers. Currently, there are over 1,100 health centers operating more than 8,100 sites around the country that provide care to nearly 20 million patients.�

Health centers can be found in schools, hospitals and universities and in houses of worship, shopping centers and mobile vans.� They are in urban neighborhoods and rural towns where care is scarce.

They offer preventive care to patients, young and old, to help stop health problems before they start. Nearly three-quarters of children who are treated at health centers receive all recommended immunizations by their 2nd birthday, and health centers provide prenatal care to almost half a million expectant mothers. Health centers help patients manage chronic conditions, such as diabetes or heart disease, so they can stay out of the hospital, and they provide much-needed dental and mental health care.

Community health centers do all of this at an affordable price, regardless of whether a patient can pay or not.

Furthermore, community health centers are an important source of local jobs and economic growth in many underserved and low-income communities. Total health center employment is more than 131,000 individuals nationwide, and health centers added more than 18,000 jobs over the last two years.

We have made expanding our nation�s network of community health centers a top priority. Over the last two years, we�ve provided resources to help community health centers treat and care for an additional two and a half million patients. And the Affordable Care Act established the Community Health Center Fund that provides $11 billion over 5 a year period for the operation, expansion, and construction of health centers throughout the nation � including $28.8 million to 67 community health center programs across the country.

In the months to come, we�ll continue to work to support America�s community health centers and to achieve our ultimate goal of making sure every American, no matter where they live, has access to the primary and preventive care they need to stay healthy.

To find your local health center simply go to HRSA.gov and click �Find-A-Health Center,� or download the free �Find-A-Health-Center� app for your iPhone.

Tuesday, March 5, 2013

Infections With 'Nightmare Bacteria' Are On The Rise In U.S. Hospitals

More From Shots - Health News HealthInfections With 'Nightmare Bacteria' Are On The Rise In U.S. HospitalsHealthA Costly Catch-22 In States Forgoing Medicaid ExpansionHealthOften A Health Care Laggard, U.S. Shines In Cancer TreatmentHealthGot A Health Care Puzzle? There Should Be An App!

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If The Health Care Overhaul Goes Down, Could Medicare Follow?

More From Shots - Health News HealthInfections With 'Nightmare Bacteria' Are On The Rise In U.S. HospitalsHealthA Costly Catch-22 In States Forgoing Medicaid ExpansionHealthOften A Health Care Laggard, U.S. Shines In Cancer TreatmentHealthGot A Health Care Puzzle? There Should Be An App!

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Monday, March 4, 2013

Health care activists lament single-payer snub

Frustrated by the exclusion of government-financed medical care from the debate to revamp the nation’s troubled health system, advocates of a “single-payer” plan are increasingly turning to demonstrations and civil disobedience as a way to get their message across.

During Senate Finance Committee hearings May 5 and 12 on health reform, 13 doctors, nurses, lawyers and activists stood up to complain that no single-payer proponent had been invited to take part and were arrested for disrupting the proceedings.

On Friday in San Francisco, about 200 single-payer proponents held a rally in front of the Federal Building and headed in small groups to Rep. Nancy Pelosi’s office to urge the speaker of the House, who was in China, to back single-payer legislation and give its supporters a seat at the table of the health reform debate. The public appeals were part of a series of demonstrations being held in more than 50 U.S. cities over the next few days to encourage lawmakers to enact a single-payer plan.

Some advocates of a nationalized health plan are calling for activists to become even more militant.

“It’s the only way – direct confrontation with the people who are blocking what the majority of the American people want,” said Russell Mokhiber, the founder of the newly formed Single Payer Action.

“It’s about getting in people’s faces and being serious about the fact that 60 Americans are dying every day because of lack of health insurance,” said Mokhiber, who was arrested at the May 5 hearing and arraigned earlier this week in Washington.

Single payer unlikely

Reforming health care has become a focus of the Obama administration, with the president urging Congress to get legislation to his desk by the end of the year that would cover most of the nation’s 47 million uninsured. Whether that will happen remains to be seen, but whatever Congress passes is not likely to come in the form of a single-payer plan.

In a single-payer system, as envisioned by most advocates, the federal government would pay for basic medical care delivered by public and private health professionals. The money would come from taxes, and medical bills would go directly to a government insurance plan, similar to Medicare.

President Obama and lawmakers have proposed a form of “single-payer lite” – a government-administered plan people could buy into as an alternative to purchasing an individual policy offered by insurers. But single-payer supporters say this option doesn’t go far enough. They want private insurers completely out of the business of covering basic care, which they say could save nearly 30 percent in administrative costs.

That’s clearly not something the health insurance industry supports. Many of the nation’s largest insurers prefer a form of “universal” health care that would cover all Americans, while keeping them in business. They tend to avoid discussing the single-payer option largely because it hasn’t been included in the national debate.

Some statistics show the single-payer concept has grown in popularity as problems in the nation’s health care system have worsened. A CBS News/New York Times poll conducted in January found 59 percent of the 1,112 people surveyed said they supported government-provided national health insurance.

Physician support

Several groups, including the California Nurses Association and Physicians for a National Health Program, call for a single-payer option. While not supported by the American Medical Association, a nationalized health system got the backing of 59 percent of physicians in a poll published last year in the Annals of Internal Medicine.

The California Legislature has twice passed a state-level single-payer bill – in 2006 and 2008 – making it the first state to do so, but both times the effort was vetoed by Gov. Arnold Schwarzenegger. The legislation, authored by former state Sen. Sheila Kuehl, D-Santa Monica, has been reintroduced as by Sen. Mark Leno, D-San Francisco. Leno’s version is expected to meet the same fate as its predecessors.

Still, single payer has been largely dismissed from serious discussion on the national level as politically infeasible.

“It’s off the table in Washington because of the politics,” said Laurence Baker, associate professor of health research and policy at Stanford University.

Health insurers and drugmakers have contributed millions of dollars to members of Congress. One of the top recipients of that money, said Consumer Watchdog, an advocacy group based in Santa Monica, was Sen. Max Baucus, D-Montana, chairman of the Senate Finance Committee, who was running the hearings when the arrests took place this month. He accepted $413,000 in drug and health insurance campaign contributions during that time.

Many single-payer supporters interpret the resistance to the single-payer idea to be simply the result of a formidable lobbying effort by the health insurance and pharmaceutical industries, but Stanford’s Baker said the hurdles are more nuanced.

Distrust for government

Americans are clearly frustrated by the health care system. While some polls indicate that a majority of Americans favor single payer, some polls show a distrust of government’s ability to take over health care, he said. In a Kaiser Family Foundation poll released in April, just 35 percent of those surveyed expressed support for a government-run health system like Medicare.

As the debate continues, single-payer supporters have clearly ramped up their activity and tactics. The 50 demonstrations have been organized by a variety of groups including Healthcare-NOW!, Progressive Democrats of America and the Green Party.

But not all single-payer groups promote civil disobedience as a way to draw attention to the cause. Don Bechler, chairman and founder of Single Payer Now, a statewide advocacy group in San Francisco that helped organize the demonstrations, said he is more interested in drawing in more supporters than seeing people get arrested.

California nurse DeAnn McEwen didn’t set out to become one of the “Baucus 13,” the 13 arrested at the Senate Finance Committee hearings. She happened to be in Washington for a nurses’ union organizing committee meeting when she learned about the hearings.

McEwen, of Long Beach, a nurse for 35 years, said she felt compelled to speak out about the lack of a single-payer voice at the table.

“At that point, I felt I couldn’t be silent anymore because it was like I was seeing a gag, a hand covering the mouth of a victim,” McEwen said. “There’s therapy for the broken health care system, and any other reform that includes the insurance companies is not going to get us where we need to go in terms of providing equitable and fair coverage.”

Health care proposals

A number of health policy proposals are under consideration as lawmakers work to overhaul the nation’s health care system, but a proposal to have the government pay exclusively for basic health care has largely been left out of the discussions. Here are some of the ideas on the table:

Public plan: Create a government-financed purchasing pool or “exchange” – one that people could buy as an alternative to individual health policies offered by private insurers.

Individual mandate: Require individuals to get health insurance through an employer, the government or on their own. In exchange, insurers would have to stop discriminating against people with medical problems.

New taxes: Tax job-based health insurance benefits, a controversial option that proponents say could help pay for the overhaul estimated to cost some $1.2 trillion to $1.5 trillion over 10 years. Other taxes would come from hikes on alcohol, tobacco and soda.

Reduce health costs: Improve efficiency in the delivery system by upgrading technologies, increasing the availability of generic medications, realigning provider payments to reward quality of care rather than just quantity, and funding efforts to figure out which medical treatments work best.

PBS Ombud Sides with Frontline Critics

By FAIR–

PBS ombud Michael Getler is siding with critics of a Frontline documentary that failed to examine single-payer national health insurance as a possible alternative to the U.S. healthcare system.

Citing FAIR’s study “Media Blackout on Single-Payer Healthcare,” which documented that single-payer advocates were all but shut out of the media discussion about healthcare reform, Getler stated:

I find myself in agreement with those who wrote initially and who felt it was a missed opportunity by Frontline to shed some light on where this specific idea – clearly telegraphed in the previous program about how other countries do it, enjoying some level of popular and professional support and formalized in a bill before Congress – stood in today’s political environment.

The only alternative to the current U.S. healthcare system that was examined in any depth in Sick Around America was Massachusetts’ system of mandating that people buy insurance from for-profit health insurance companies. FAIR had criticized the film for misrepresenting the findings of Frontline’s earlier documentary, Sick Around the World (4/15/08), which had emphasized that all other countries ban insurance companies from making a profit on basic care, and had discussed single payer alternatives including Taiwan’s healthcare system.

Today, FAIR’s radio program CounterSpin airs an interview with T. R. Reid–a Frontline reporter for Sick Around the World who quit the production of Sick Around America because it contradicted the earlier Frontline documentary. (Audio file available here).

A Health Care Marketplace to Help You Find Insurance

Today, we are taking steps to relieve one of the biggest headaches middle-class families face - finding affordable health insurance. By 2014, state-based Affordable Insurance Exchanges will be in place to give consumers the kind of choices their Members of Congress have. They include unprecedented tax relief for families that will bring the cost of insurance down.

When you shop for groceries, you typically go to a supermarket where you can compare prices and brands, and find the best products that meet your personal needs. Soon you�ll be able to purchase your health insurance in a similar way � through a marketplace called an Exchange.

What is an Exchange? And how does it help you? An Exchange is a one-stop marketplace where you can choose a private health insurance plan that best fits the needs of you and your family. Just like you can purchase your eggs, milk, vegetables, and cleaning supplies from your local supermarket, an Exchange will be your one stop for all of your health insurance needs. You will be able to:

Look for and compare private health plansGet answers to questions about your health coverage optionsFind out if you�re eligible for health programs like Medicaid and the Children�s Health Insurance Program, or tax credits that make coverage more affordableEnroll in a health plan that meets your needs

You might remember that on July 11th the Department of Health and Human Services announced a proposed framework to help states build Affordable Insurance Exchanges. Today, we�re partnering with the Department of Treasury to take the next steps to establish these Exchanges.

The three proposed rules issued today seek to create a path to a simple, seamless and affordable system of coverage for you and your family. They include:

Exchange Eligibility and Employer Standards: The first HHS-proposed rule details the standards and process for enrolling in qualified health plans and insurance affordability programs. It also outlines basic standards for employer participation in the Small Business Health Options Program (SHOP).Medicaid Eligibility: The second HHS proposed rule expands and simplifies Medicaid eligibility and promotes a simple, seamless system of affordable coverage by coordinating Medicaid and CHIP with the new Exchanges.Health Insurance Premium Tax Credit: The third proposed rule, which is issued by Treasury, lays out how individuals and families can receive premium tax credits to make health insurance coverage more affordable.

To make sure we structure the Exchanges in a way that meets your needs, we want to hear from you. In the weeks ahead, both Departments will conduct a robust outreach campaign to receive your comments on these rules. We�ll then make modifications based on the feedback we receive. You can submit comments here: Exchange Eligibility and Employer Standards, Medicaid Eligibility, Health Insurance Premium Tax Credit.

I am also eager to continue collaborating with states to set up their Exchanges without wasting resources. Today, I sent a letter to Governors soliciting comments from states on how their partnership with HHS will allow them freedom to innovate and help design an Exchange that works best for the citizens in their state.

We are on our way to 2014 when millions of individuals, families, and small businesses will have access to the same kind of affordable insurance choices as Members of Congress.

For more about the announcement today, you can read the news release here.

Sunday, March 3, 2013

Virginia-Care: Keeping Health Insurance Costs Down for a Small Business

Virginia Donohue and her husband started Pet Camp in 1997 with a love of their dogs and little else. Located in San Francisco, California, they provided group play, open spaces, and a pool. Cats had disco lights to play with, aquariums to watch and wide window sills for perches. When the business became sustainable in 2000, Virginia says, it was time to provide health insurance to their employees.

�To me it�s a moral issue. People need to have health care and how we get it is through work,� she says. �I have been one of the employers out there saying, �Look, offering health care is important.��

Virginia says that when she heard about the health care tax credit for small businesses available under the Affordable Care Act, �I was really excited.�

The health care law�s tax credit for small businesses is making it more affordable for Virginia�s company offer health coverage to its employees. She uses the funds from the tax credit to offset the company�s insurance costs. The health care tax credit, she says, amounted to about $7,000 in 2010 and about $8,000 for 2011.

The tax credit is also helping her company stay competitive in the marketplace for good employees.

�We offer health insurance because we want to attract and retain the best employees that are out there, and I think to do that you have to offer quality benefits. � [F]or us, that includes health insurance � that includes bring[ing] your dog to work,� Virginia says.

Virginia-Care in Action: Tax Credits for Small BusinessesFact Sheet: Small Businesses and the Affordable Care ActLearn how the law makes care more affordable for employers, employees, and early retireesSee all MyCare stories ?

Justice Department Looks For Ways To Recruit Forensic Pathologists

More From Shots - Health News HealthHealth Insurers Brace For Consumer Ratings In Some StatesHealthA Mother's Death Tested Reporter's Thinking About End-Of-Life CareHealthSacrificing Sleep Makes For Run-Down Teens � And ParentsHealthChange In Law May Spur Campus Action On Sexual Assaults

More From Shots - Health News

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Helping Parents Quit Smoking

As a pediatrician, I�ve seen too many children whose health problems could have been avoided if they hadn�t been exposed to cigarette smoke. And when parents smoke, it�s especially dangerous to their children.

Exposed to smoke, children are at greater risk of serious lower respiratory infections such as bronchitis and pneumonia.� They are more prone to ear infections.�� If they have asthma, they have more frequent and severe attacks.��

In pregnant women, smoking can cause serious complications.� Babies born to mothers who smoke are more likely to be lower birth weight, have lung problems, and other health problems.� They�re more likely to die from sudden infant death syndrome.�

But it�s not easy for a person with a tobacco addiction to quit.� That�s why it�s so important to reach pregnant smokers, with services like face-to-face counseling, telephone quit-lines staffed by specially-trained coaches, and�in very limited cases�medication, if a woman and her doctor determine that it�s necessary.�

It�s why the Centers for Medicare & Medicaid Services (CMS) sent a letter to all state Medicaid directors today, reminding them that state Medicaid programs now must fully cover tobacco cessation services for pregnant women, as a result of the Affordable Care Act.� In addition, CMS is making it easier for states to fund tobacco use treatment for all Medicaid beneficiaries by making funding available for quit-lines.

And smoking adults model unhealthy behavior for children. Every day, an estimated 4,000 children try their first cigarette; 1,000 of those kids become daily smokers. Helping the adults in their lives to quit is a powerful message to them not to start.

The State Medicaid Director letter was issued in conjunction with National Prevention and Wellness Month, to bring attention to the power of prevention to improve health and quality of life for millions of Americans.� It�s just one way we�re making access to preventive services easier.�

The Affordable Care Act also eliminated the Medicare Part B deductible and copayments for a host of preventive tests and screenings for seniors.� We�re working on closing the Medicare Part D donut hole, since we know that making prescription drugs more affordable increases the chance they�ll be taken as needed to stay well.
If we�re successful at preventing disease and promoting health we might also bring down the high cost of health care.� According to the Congressional Budget Office, the reduction in preventable health problems resulting from an investment in tobacco cessation services would create savings for states and the federal government.� According to the American Legacy Foundation, we could save $9.7 billion over five years if every Medicaid beneficiary stopped smoking.

If you add in the intangible costs of pain and suffering, the costs of chronic illness are simply unacceptable.�� Everyone in the community�including parents and children�benefits when essential services that people need to stay healthy are within their reach.

'We Have No Choice': A Story Of The Texas Sonogram Law

January 22, 2013

Listen to the Story 29 min 0 sec Playlist Download Transcript   Enlarge image i iStockPhoto iStockPhoto

Tuesday marks the 40th anniversary of Roe v. Wade, the Supreme Court decision legalizing abortion. But in some states, access to facilities that perform abortions remains limited.

In part, that stems from another Supreme Court ruling from 20 years ago that let states impose regulations that don't cause an "undue burden" on a woman's abortion rights.

Texas, for instance, requires that a woman seeking an abortion receive a sonogram from the doctor who will be performing the procedure at least 24 hours before the abortion. During the sonogram, the doctor is required to display sonogram images and make the heartbeat audible to the patient.

The law went into effect on Feb. 6, 2012; Carolyn Jones had an abortion two weeks later. It thrust her into the complicated world of abortion politics and led her to write an article in the Texas Observer titled "We Have No Choice: One Woman's Ordeal with Texas' New Sonogram Law."

Read Carolyn Jones' Articles We Have No Choice: One Woman's Ordeal With Texas' New Sonogram Law Pregnant? Scared? Can They Help? Texas Women's Health Advocates To Bypass State In Bid For Federal Funds

Following that article's publication, Jones wrote a series for the Observer examining the impact of cuts to family planning services in Texas. Jones reported that since the state Legislature voted in 2011 to cut Texas' family planning program by two-thirds, 146 clinics lost state funds, and more than 60 of those clinics closed.

Jones talks about these cuts with Fresh Air's Terry Gross, and tells the story of her own encounter with the sonogram law.

Pregnant with her second child, Jones went for a routine sonogram and was told by her doctor that he was worried about the shape of her baby's head. A second sonogram that day at a specialist's office revealed a problem that was preventing her son's brain, spine and legs from developing correctly. The specialist warned that if the child made it to term, he would suffer greatly and need a lifetime of care. Jones and her husband decided she would have an abortion.

More On Roe V. Wade Shots - Health News 'Roe V. Wade' Turns 40, But Abortion Debate Is Even Older Around the Nation Involved For Life: Pregnancy Centers In Texas

Although she'd had two sonograms that day, the new Texas law required that she get another, administered by her abortion doctor, and listen to a state-mandated description of the fetus she was about to abort. (Four days after that sonogram, the state issued technical guidelines for its new mandatory sonogram law, indicating that if a fetus has an irreversible medical condition, as Jones' did, the pregnant woman does not have to hear a description of the sonogram.)

In her article, Jones asks: "What good is a law that adds only pain and difficulty to perhaps the most painful and difficult decision a woman can make?"

Jones tells Gross: "The politicians wanted women to have the sonograms so that they can see the life of the child that they are about to end, so it's an entirely ideological justification for why a woman would have to have a sonogram."

A full transcript of this interview is posted below.

Copyright © 2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. Today is the 40th anniversary of Roe v. Wade, the Supreme Court decision that legalized abortion. But since then, many states have passed laws that restrict women's access to abortion. According to the Guttmacher Institute, more state-level abortion restrictions were enacted in 2011 than in any prior year. And last year brought the second-highest number of restrictions ever.

We're going to look at what's happening in Texas, with a journalist who wrote about her abortion under the new Texas sonogram law. Later, we'll hear from the executive director of two Christian-run pregnancy centers, in Dallas, that encourage teens and women with unplanned pregnancies to keep the baby or put it up for adoption.

My first guest, Carolyn Jones, learned halfway through her pregnancy with her second child that the baby she was carrying had a severe developmental problem. She and her husband wanted a baby very much. But they decided to get an abortion, a decision she describes as heartbreaking.

She had her abortion in Austin, last February; just two weeks after Texas implemented its mandatory sonogram law. For reasons she'll explain, this law made the abortion even more heartbreaking. Her personal experience led her to write a series of articles for the Texas Observer, about how the state legislature has restricted access to abortion and has cut off state funding to Planned Parenthood clinics.

Carolyn Jones, welcome to FRESH AIR. Let's talk about some of the things you learned about changes in the Texas abortion law, from your own abortion experience. You wanted this child very much. You were hoping to have a brother for your little girl. And you had the abortion in January of last year. You had had a sonogram halfway through the pregnancy. What did the sonogram reveal?

CAROLYN JONES: What we'd expected the sonogram to reveal was the gender of the baby, the sex of the baby, which it did; but it also revealed that our baby had a major neurological flaw. And his brain, spine and legs had not developed correctly. And the doctor wasn't even sure whether he would make it to term - that the flaw was so serious - but that if he did make it to term, he would lead a life of great suffering. He would be in and out of hospitals, and it would be a life of pain and suffering for him.

GROSS: This was a hard choice for you to make. Can you talk a little bit about how you and your husband chose to proceed with an abortion instead of having the baby?

JONES: Mm-hmm. For me and my husband, we already have one child - a daughter; she's almost 3. And we love her so intensely. And I know that anyone else who, as a parent - will understand that intense parental impulse to protect your child from anything; absolutely any pain, you want to protect them from it. And when we heard that our second, very much-wanted child, if we brought him into the world, his life would be one of constant pain and suffering - to us, it was an instinctive response to think for this very brief moment, we have a choice about whether to introduce him to a life of pain or not.

And so to us, it was actually - it was a terrible choice; it was a heart-wrenching one. But it was also a simple one because as his parents, we chose what we believed was best for him, to prevent him from knowing a life of pain. And that was, in fact, quite a quick choice we were able to make as well, within minutes of my doctor giving us the terrible news. It was also almost an instinctive response about the choice that we would make. And this month, it's almost a year to the day that we made that decision. It was still the right decision for us because it was an instinctive one about protecting our child from pain.

GROSS: Once you made that choice, there were several steps you had to go through before the state permitted you to have the abortion that you chose to have. One of those steps had to do with a mandatory sonogram. You had already had a sonogram, the one that revealed the defect in the baby's nervous system. Why did you have to have another?

JONES: I actually, I'd had two sonograms that day. The first one was the one that revealed the anomaly. The second one was, we went straight to a specialist to confirm it. Those were both medically necessary sonograms, to understand exactly what the problem was. The third sonogram was one that was mandated by the state of Texas. It was a new law that had come into effect just two weeks prior to that day. And the law was intended to - let's see, the way the politicians described it, was to promote informed consent. The politicians want women who are having abortions to have the sonograms so that they can see the life of the child that they're about to end. So it's an entirely ideological justification for why a woman would have to have a sonogram. It's got nothing to do with - there are no medical reasons that the state required me to have it.

GROSS: Now, as it turns out - before we go any further, I want to mention that, you know, the law had just gone into effect, and a lot of health care providers weren't sure what they were mandated to do. As it turns out, under the law, you wouldn't have had to undergo this mandatory sonogram because the baby you were carrying had irreversible developmental problems.

JONES: That's right.

GROSS: But your doctor didn't know that yet because it was so unclear, and I don't think...

JONES: That's right, yeah.

GROSS: Yeah. So you had the mandatory sonogram that women - with few exceptions - have to get in Texas now. So what are the requirements surrounding the mandatory sonogram? And as we just explained, you ended up having this sonogram because your doctors didn't realize yet that you were exempted.

JONES: The requirements are that a woman must have the sonogram 24 hours before the abortion procedure can go ahead. The doctor who performs the abortion must also perform the sonogram - which, as you can imagine, creates all sorts of logistical nightmares for clinicians who are traveling from clinic to clinic. They're now having to add in this extra day, to provide the sonograms as well.

On top of providing the sonogram that every woman - with a few exceptions - must undergo before having an abortion, every woman must then wait for 24 hours. And, I mean, even though I was technically exempt from having had the sonogram, I wasn't exempt from the 24-hour waiting period.

Sorry, just to go back to the sonogram itself, the doctor would then have to describe the physical characteristics of the fetus. And the doctor - he or she - would also play the fetal heartbeat as well, for you to hear. The doctor would then have to read through a formal script, written by the state, about the abortion procedure as well as the risks of abortions. And two of the risks that are mentioned in this list are an increased chance of getting breast cancer, as a result of having an abortion; and an increased chance of having negative psychological outcomes - both of which, I should point out, have been discredited by mainstream medical science. Nonetheless, these two discredited facts, as well as - sort of unnecessarily graphic description of the abortion procedure itself, are part of the government script that a clinician must read to a patient before the abortion can go ahead.

Other parts of the requirements, as well, is that before the woman can go ahead with the abortion, she must also listen to a government script that tells her that the father of the child is liable to pay child support, whether he wants the abortion or not; and that the state may or may not pay for your maternity care. So these are all things that have to be included in the script that the woman hears, regardless of whether she wants to have this abortion or not.

GROSS: Let me just back up a bit. So the doctor performing the abortion, that has to be the same doctor who's doing the sonogram ...

JONES: Yes.

GROSS: ...and describing what he or she sees, to the woman who's having an abortion. So does that mean - like, in your case, the sonogram reveals terrible developmental problems in the fetus. Would the doctor be required to tell you that? Or is the doctor just supposed to say, I see arms; I see beginnings of legs; I see a little head - do you know what I'm saying?

JONES: I do, and I do think there is - you know, there are sort of formal characteristics that the doctor is required to describe. I have to admit that I imagine that the doctor, if he or she saw, you know, anomalies, they would describe them. But I have to admit, with the doctor, when he began to read this description to me - describe it to me, I found it so traumatizing that I heard the beginning; where he said that he could see four healthy chambers of the heart. And it's true - is that my very unwell child did have a healthy heart; not much else that was healthy, but the heart was. And to hear that was so traumatizing, that I did try and turn away, and try not to listen. So I really can't say what is part of the formal (technical difficulties), but I do imagine that they would have described what they saw, and perhaps my doctor did. I can't say.

GROSS: It sounds like the nurse wanted to help you not listen...

JONES: Mm-hmm. That's right.

GROSS: ...because she saw how traumatized you were, and she turned up the volume of the radio as the doctor was describing the fetus while reading the sonogram. Did that make you feel any better - like, at least somebody was trying to protect you from this mandatory sonogram?

JONES: In a very strange way, it did because in the room, at the time, was me, my husband, the doctor and the nurse. And there was not one of us in that room who wanted to go through that process of having to go through the sonogram. And, you know - and the doctor said to me, before it all started - and I was, you know, I was in a very emotionally fragile state. He did say to me, I'm so sorry I have to do this but if I don't, I will lose my license.

And that actually really helped; to imagine that all four of us were in it together, in a way. They showed such compassion for me in that no one agreed with it. And that did, in a strange way, help. And also, with the nurse turning the radio on - you know, I think it was, you know, maybe a D.J. or perhaps a commercial for used cars or something, clattering in the background. It was, you know, a slightly surreal experience. But again, the whole experience was so unpleasant that I appreciated any efforts they could make to stay within the law but still, you know, behave compassionately towards me and my husband.

GROSS: And one more sonogram question. You know, we've heard so much about transvaginal ultrasounds being mandated; you know, attempts to mandate that in some states. In Texas, it's not transvaginal; it's just an on-the-belly sonogram, right?

JONES: Actually, it is transvaginal. For anyone in the early stages of pregnancy, the only way that you can actually get a good look at the fetus is to use a transvaginal probe. For me, because I was at 20 weeks of pregnancy, I had the old - what would be called the jelly on the belly; which is, you know, the wand that you pass over your stomach. But for any woman in early stages of pregnancy - and in fact, you know, thousands of women in the last year have had to have a government-mandated transvaginal probe, for no medical reason.

GROSS: The goal of the mandated sonogram is to get the woman who is planning on having an abortion, to reconsider. What impact did the sonogram, and the recitation of the information that the government mandates the doctor to tell you - which is intended to discourage the woman from having an abortion - what impact did that actually have on you, and on your frame of mind, when you proceeded with the abortion?

JONES: It had no impact on my decision to go ahead with the abortion; none whatsoever. It was a private choice I'd made, and I was going to stick with that private choice no matter the people who tried to interfere with me. In terms of my broader frame of mind, it did make me feel very angry, and I still do. I still feel very angry that someone who has absolutely no say in, you know, my personal decisions, could still be there at that moment. The darkest day of my life was the day that we - I found out that information and had to make that decision. That someone could invade upon that - a politician, who has absolutely no jurisdiction over my private life - that they could invade upon that and so reduce my dignity, I do feel that that's an incredible injustice; and I still do, which is why I felt the need to write about it.

GROSS: We've talked a little about the abortion that you had because you were carrying a baby that had severe neurological impairments; and the doctor told you if the baby survived to the point of childbirth, that it would be basically condemned to a life of suffering. Let's broaden that discussion into what the Texas state legislature has been doing in the area of women's reproductive health care. In the 2011 session, the legislature cut the state's family planning program by two-thirds. What was the program, and who was most affected? What services were most affected?

JONES: The program - this would have been the state family planning budget; and before the 2011 legislature, it accounted for about $112 million. And that pot of money funded family planning and well-women services for about 220,000 of the poorest men and women in Texas. And not only did that provide birth control but also well-women exams and STD screenings, and breast cancer and cervical cancer screens. So it was really quite a comprehensive program.

During the 2011 legislature, that budget was slashed by two-thirds. It brought it down to about $40 million. Now, the reason that this money was slashed was because the conservative legislature wanted to starve Planned Parenthood of any state funding. And in a very unfortunate development, the legislature had somehow conflated abortion with family planning.

And these are not big chains, family planning chains across Texas. Many of them are actually small, mom-and-pop providers out in the rural areas, working with very small communities. You know, what we discovered at the Texas Observer was that within about six to eight months of these cuts happening, more than 60 family planning clinics across Texas were forced to close.

GROSS: Now, you write that many clinics that didn't close rely on funding from another endangered source in Texas, the Women's Health Program. What is that program?

JONES: That's right. The Women's Health Program, before the 1st of January of this year, was a federally funded program aimed at - again - the poorest men and women in Texas. I think it covered about 115,000 men and women. And it provided them with contraception and well-women care, and breast and cancer screening. As I said, it was federally funded; which means that for every $1 that Texas spent on this service, the federal government spent another 9. So as you can imagine, this was a good program for us to have in Texas.

Now, Planned Parenthood was the dominant provider of women's health program services in Texas. Forty-five percent of the clients in this program were seen by Planned Parenthood providers. And because this is Texas - and the conservative legislature have a vendetta against Planned Parenthood - in the 2011 legislature, they decided they needed to do whatever they could, to get Planned Parenthood out of Texas. So another way that they chose to do that was to exercise another law that meant that - it was called the affiliate rule - which claimed that Planned Parenthood would not be able to access federal funds because they were affiliated with abortion providers.

So Texas tried to exercise this affiliate rule. The federal government said it was not legal to remove one of the providers from the program. And it was then litigated in court; back and forth, between Planned Parenthood and the state of Texas, about whether they can or cannot be within this program. On the 31st of December, the federal government said that they would not be able to provide federal funding towards a fund that had evicted one of the providers.

And so the state of Texas said they would happily walk away from that 9-to-1 federal match because they really did not want to have to have Planned Parenthood in the program itself. So on the 31st of December, we lost the federal funding for that program. On the 1st of January this year, it became an entirely Texas-funded program. So it's now called the Texas Women's Health Program.

GROSS: Is there an estimate of how much money Texas is walking away from?

JONES: Yes, I think in - over a two-year period, it will probably cost Texas $70 million that they wouldn't have had to have spent if they'd stayed within the Medicaid program.

GROSS: We've talked about cuts to women's reproductive health care. We've talked about counseling against having abortion. What effect do you think all of this is having on the quality of women's health care and access to women's health care in Texas?

JONES: Well, we already know that at least 60 clinics across Texas have closed. We also know that even those clinics that still receive state funding, it was much less than what they were receiving before. So where they were providing family planning services for free, now they must share the costs with the patients. And that's very tough for these women, these low-income women who are in dire economic straits as it is. The other impact that we're seeing is that the family planning clinics that are still able to stay open, they aren't able to offer some of the more expensive yet more effective contraceptive options. So that's reducing women's choices as well.

Something else we're seeing, too, is that the Texas Health and Human Services Commission - the state agency that's responsible for all of this - they've already started their projected budget for 2014 and 2015. And they have projected 24,000 extra births as a result of these cuts to the family planning budget. And they have said that their budget will need, probably, about $273 million in order to cover the costs of all of these extra births. Now, this has more than doubled the size of the family planning budget that was slashed so dramatically in 2011.

We won't yet see exactly how many births there are, for a while. We won't see the impact of women whose cancer screenings - who weren't picked up in time. Those will come later. But, I mean, if the state agency itself is already projecting for so many extra births and so many greater costs, I think we can be sure that the collateral damage from those decisions made in 2011, will be far-reaching - and very damaging for women and men in low-income state, across Texas.

GROSS: I don't know if you can answer this, but are the extra births because women are deciding against abortion, or because they don't have access to contraception?

JONES: I would guess that there are both. I mean, we won't know this until we've got the figures. But I would imagine that there will be extra births from lack of access to contraception, and more women being funneled towards crisis pregnancy centers whilst those family planning clinics they might have gone to before have closed.

GROSS: The state of Texas is funding a program called Alternatives to Abortion, and this is a state program that funds crisis pregnancy centers.

JONES: Mm-hmm.

GROSS: What are these centers?

JONES: Crisis pregnancy centers are - their sole raison d'etre is to convince women with unplanned pregnancies to keep the child rather than have an abortion. And they're often Christian organizations, and they promote either parenting or adoption. And they really do their very best to persuade women that abortions are not the right decision for them.

GROSS: So what do you know about the information that is provided, and if there is information that is withheld for women at these centers?

JONES: Yes. The information that they will provide is, in fact, the same information that was provided to me when I went to the abortion clinic. It comes from a pamphlet written by the state, called "A Woman's Right to Know," which describes exactly - which describes the abortion procedure in very graphic detail. They speak about suctioned body parts and crushed skulls. It's really a very graphic, and very upsetting description.

And they also - the pamphlet will also speak about the link between having an abortion and getting breast cancer; the link between abortion and thoughts of suicide or depression; all of which, as I said before, have been discounted by the medical community. So this is the information that crisis pregnancy centers - or certainly, the ones that are receiving funding from the state - will give to women who come in there; women that they call - in their terms, abortion-minded women.

The information that they will give to them about parenting or adoption is overwhelmingly positive information. And, for example, the one crisis pregnancy center I was looking at in Abilene, Texas, the information they'll say is: Now that you are pregnant, you are already a mommy. And if you choose adoption, it's the most unselfish choice you can make for your child. So they lay out the choices that these women have. But as you can see, you know, they weight them all very differently.

GROSS: Since Texas has cut funding to family planning centers and to clinics that provide abortions, where is the money for the Texas Alternatives to Abortion program coming from?

JONES: The money came, interestingly, from the family planning budget. So during the - the one that was slashed so heavily in the last legislative session. Each session that goes by - the Alternatives to Abortion program has been running since 2005; it gets more and more money siphoned towards it. So that money is coming out of a program that is designed to prevent unwanted pregnancies, and is now going towards a program that's designed to promote childbirth and prevent abortion. It's sort of missing out the middle bit - which is, you know, the trying to help women prevent the pregnancies that would lead them to have an abortion, or lead them to end up in a crisis pregnancy center.

GROSS: In discussing alternatives to abortion, does the state allow the crisis pregnancy centers to discuss birth control with women who, after they deliver the baby, they can - if they so choose - not get pregnant again in the near future, until they're ready?

JONES: The terms of the contract are pretty sparse. So no, the state does not require the crisis pregnancy centers to discuss family planning with their clients. And in fact, that many of the crisis pregnancy centers - but they choose to discuss it anyway, and many of the crisis pregnancy centers promote abstinence as the only form of birth control. And this has much to do with the sort of religious affiliation of many of these crisis pregnancy centers; where they believe that chastity is actually the only effective form of birth control. And in fact, there are a few crisis pregnancy centers who believe that abstinence is also the only form of birth control for women who are married.

So that's quite an extreme position to take. And anyone who is at a crisis pregnancy center is, by definition, sexually active. So for these centers to promote abstinence as the only way to prevent future pregnancies is very irresponsible, from a public health perspective; and very troubling that the state does not require these centers - that are receiving state funding - to actually give them scientifically valid information about preventing future pregnancies. And not only is this concerning for women in that they're not receiving the information they need about preventing future unwanted pregnancies, but it's also, they're not giving them information about preventing things like sexually transmitted infections.

Again, these centers, crisis pregnancy centers will talk about the dangers of sexually transmitted disease; but again, they'll say that the only way that they can prevent getting a sexually transmitted infection is to abstain from having sex. But in fact, for teens and women in their 20s and 30s, that's not a realistic choice for many people. And again, it's - you know, very worrying, from a public health perspective, that these centers are promoting this information and in fact, they are receiving state funding to do so whilst at the same time, the evidence-based centers that were providing women with medically accurate information about their health, are being de-funded.

GROSS: But Texas doesn't mandate that these crisis pregnancy centers have an abstinence-only approach.

JONES: No, not according to the contract that these centers have with the state. It's not mandated. But it's also - there's nothing included in there, that says that they should give them accurate advice, either.

GROSS: You grew up in Zimbabwe, and I have no idea what Zimbabwe's abortion policies are. But is there anything that's particularly surprised you about the abortion debate in America, compared to who - what you were exposed to in Zimbabwe?

JONES: Mm-hmm. You know, I can't really speak to the abortion policies in Zimbabwe. But I can certainly just say, it surprised me just how restricted women's access is, in the U.S. I - honestly, before my personal experience, I was extremely naive about what kind of rights we have in the U.S. I mean, my understanding - and it was, as I said, very naive understanding - was since Roe versus Wade 40 years ago, women in the U.S. had the right to have an abortion. And to me, it was as simple as that, really.

And it wasn't until I had my own, personal experience that I started looking into this and thinking actually, though women have a legal right to an abortion, that those rights are being chipped away at - all of these different states. And in fact, what surprised me the most is that the legal right to abortion was enshrined, in 1973, for all women in the U.S. But then the Hyde Amendment - then actually removed that right for low-income women. The Hyde Amendment prohibited federal funds from paying for women's abortions unless - in the cases of, I think, rape or incest, or perhaps fetal anomaly as well; there were fewer - exceptions but essentially, it took away women's economic access to having an abortion. And that that has had a huge impact on women in the U.S.

So we may have a legal choice to have an abortion in the U.S. but actually, our choices are very much constrained by the kind of social and economic access that we have in society. And I'm horrified by how hollowed out that legal choice actually is.

GROSS: Well, Carolyn Jones, I want to thank you very much for talking with us.

JONES: Thank you for having me, Terry.

GROSS: Carolyn Jones has written about her abortion, the Texas mandatory sonogram law, and state cutbacks to family planning centers, for the Texas Observer. You'll find links to some of her articles on our website, freshair.npr.org.

Coming up: Carolyn Cline, the CEO of a Christian group that runs centers that discourage women with unplanned pregnancies from having abortions; and offers counseling and assistance to help with their pregnancies.

This is FRESH AIR.

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