02 August 2012

Obamacare's 1 August 2012 Reforms


Yesterday, 1 August 2012, a number of new requirements went into effect on all health insurance policies that are new/renewed from then on. A number of these cover women’s health and relate to preventative care.

It makes sense to cover preventative care. How many women can we vaccinate against HPV for the cost of treating one woman with cervical cancer? (Yes, I know not all cervical cancer cases are caused by HPV, but there are also a number of health consequences of HPV. This is just an example). Just on this point, one study concluded that, “Implementing a prevention plan for cervical cancer that includes annually vaccinating Medicaid-enrolled adolescent females of the Appalachian region of Kentucky against HPV infection is cost-efficient for the Medicaid system when considering the total expenditures associated with the illness” (Prasad & Hill 2008). This cost savings would not come for several decades, sure, but the cost savings would come (not to mention the savings in pain and suffering). The question some might ask is why, if there is a cost savings, insurance would not choose to cover this anyway without regulation. I’m not an insurance company, but I’m guessing that bills several decades later, when this individual might not even be on their insurance, has something to do with it. In a health care system where we are trying to reduce costs as a country, however, it makes an awful lot of sense to cover these kinds of vaccinations. Note - This vaccination requirement began to go into effect on 23 September 2010, and since I am a big vaccine proponent I feel the need to share it often (Information of vaccines covered by insurance due to the Affordable Care Actcan be found here).

A number of preventative care requirements began to go into effect yesterday, however, and I feel the need to address them. These requirements, like the vaccination coverage, will ultimately save money. They should be quite popular, and they should prevent a lot of pain and suffering. Also, nobody is required to use them, insurance is just required to cover them (the government, after all, has the right to regulate interstate commerce which includes the ability to require insurance to cover certain transactions, but does not have the right to force you to participate in a commerce).

Some of the now covered women’s health preventative care include (information is available at the Health Resources and Service Administration’s Website):
1)      Well-woman Visits – insurance must cover annual checkups for women to receive age-appropriate health assessments and care. Well-woman visits include such procedures as (according to the University of Washington):
a.       General physical exams
b.      Mammograms
c.       Pap smears
d.      Colonoscopies
2)      Gestational diabetes screening – pregnant women with a high risk for diabetes must be covered to have a gestational diabetes screening. Gestational diabetes is high blood sugar that coincides with pregnancy.
3)      HPV testing - women over thirty are covered for a DNA test checking for human papillomavirus once every three years.
4)      STI counseling – women’s counseling related to sexually transmitted infections is covered.
5)      HIV testing – annual HIV testing and counseling is covered by insurance.
6)      Contraception – contraception is covered as proscribed (this one has an exception for some cases where religion is involved)
7)      Breastfeeding – supplies, support, and counseling are covered for breastfeeding women.
8)      Domestic violence screening and counseling.

One talking point I hear frequently from those opposed to health care reform is that it does nothing to reduce health care costs. Covering preventive care, such those cost savings from covering HPV vaccination, does lower costs. It just makes sense to minimize the likelihood that health problems will crop up later in life, and to detect potential health problems earlier rather than later.

Contraception is probably the least clear on how it saves money in the long run, but it ultimately makes sense that preventing unwanted/unplanned pregnancies saves money. There are a number of studies performing cost-benefit analyses on birth control, examining the effects of unplanned pregnancies, etc. Just for somewhat of an idea, it is noted that, “family planning is documented to prevent mother-child transmission of human immunodeficiency virus [HIV], contribute to birth spacing, lower infant mortality risk, and reduce the number of abortions, especially unsafe ones. It is also shown to significantly lower maternal mortality and maternal morbidity associated with pregnancy” (Tsui et al. 2010). For example, one study looked into, “the estimated effects of mass media campaigns discouraging unprotected sex, teen pregnancy prevention programs, and expansions in publicly funded family planning services, and then present[ed] new research showing that expansions in these policies would likely lead to reductions in teen and unintended pregnancy, out-of-wedlock childbearing, and child poverty. The research also shows that each dollar spent on these policies would produce taxpayer savings of between two and six dollars” (CCF Report,2012). This study goes on to note that, “A third contributing factor to the high rate of unintended pregnancy is that the costs of the most effective forms of contraception are sometimes prohibitive and/or access to them is limited” (CCFReport, 2012).

I am of the opinion that people fear the health care reform law because they don’t know what is in it. As they learn what is in it, the law will become more popular. Yes, there are parts I don’t like. The individual mandate, in my mind, is a poor substitute for a single-payer system. I also understand that the individual mandate was a compromise, and the only politically viable (and constitutional) way at the time to lower the cost passed on to insurance purchasers and tax payers from people who are unable to pay their medical bills. It is one of those situations where it is the best option we have at this point in time with this political landscape.

The health care bill continues to enhance the kind of coverage many Americans have (and significantly expands those who will be covered). The 1 August 2012 regulations are just one example.

NOTE – As always, if I got something wrong, PLEASE make me aware.

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