Category Archives: Health care

Alabama gets F on protecting the unborn from preterm birth

Few states can match Alabama in its zeal to protect the unborn. Our lawmakers happily flout U.S. Supreme Court decisions in their efforts to close abortion clinics. Every year, bills appear at the Statehouse that would prohibit abortions closer and closer to the date of conception.

Such efforts to limit abortions are, of course, easy for lawmakers. Regulating clinics out of existence has no effect on the state budget, and the effort to do so generally receives public approval.

The sincerity of the state’s concern for the unborn does not stand up to scrutiny.

The annual March of Dimes report card on premature births came out recently, and Alabama was one of three states to receive an F.

Compared to an 11.4 percent rate of premature births nationally, Alabama’s rate is 15.1 percent. Louisiana had the same rate as Alabama, and only Mississippi — at 16.6 percent — was worse. Failing to meet the national rate is an embarrassment, as 130 countries have a lower percentage of premature births than the United States.

And while the national rate has been creeping down, Alabama’s rate is rising.

To put Alabama’s 15.1-percent rate into global context: Only 11 countries have a rate over 15 percent. All but two are in sub-Saharan Africa.

Does the state’s high rate of preterm births matter? Absolutely. Premature births are the No. 1 killer of children under the age of 5. Alabama has 10,000 premature births a year, contributing to 520 annual deaths of children less than 1 year old.

Does the state have the ability to reduce preterm births? Again, absolutely.

Not surprisingly, there is a direct correlation between the percentage of uninsured women — 21.2 percent in Alabama — and the rate of premature births. States with relatively low rates of premature births invariably are states that have liberal Medicaid coverage. A healthy mother is far more likely to deliver a full-term and healthy baby, but women without insurance are less likely to be healthy.

So in a state like Alabama, where almost every politician vows publicly and often to protect the rights of the unborn, why do we not do more to reduce premature births?

Partly because of money, and partly because of politics.

Improving the health of prospective mothers — through Medicaid expansion, education and preventive care — costs money. In a cash-strapped state, that means raising taxes on the wealthy. And those who control Montgomery through political contributions are both wealthy and resistant to taxes.

Railing against abortion and passing laws that close abortion clinics costs nothing. Protecting unborn children from the health risks of premature birth, however, requires funding.

It’s also, however, simple politics. Most Alabamians oppose abortion, but they also oppose the most direct route to preserving the lives of the unborn: Medicaid expansion.

It is time for Alabamians and their elected representatives to either abandon their avowed enthusiasm for protecting unborn children, or to recognize that supporting the sanctity of life is not just about rebelling against the U.S. Supreme Court. We can save the lives of children by expanding access to health care.

(Published July 26, 2015)

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Filed under Abortion, Alabama politics, Health care

With court battles over, it’s time to improve Obamacare

The U.S. Supreme Court’s ruling Thursday — that the Affordable Care Act authorizes the payment of premium subsidies in states, including Alabama, that use the federal insurance exchange — was huge for Alabamians.

There are 132,000 Alabamians who rely on the subsidies to maintain health insurance. That number is likely to double next year.

This is not a program for people who choose not to work. The subsidies do not apply to people below the poverty line. People are eligible for subsidies even if their incomes are four times the poverty level, or well above Alabama’s median income. The subsidies benefit working Alabamians whose employers do not provide health insurance.

When what now is known as Obamacare passed in 2010, the typical GOP opposition was that it would damage America’s superb health care system, a system that was the envy of the world. It did not take long for the party to realize the health care system that was superb for those with excellent insurance and no pre-existing conditions was terribly deficient for millions of Americans.

To the credit of GOP lawmakers, the opposition has changed. U.S. Rep. Robert Aderholt, R-Haleyville, trotted out the party line shortly after the court ruled Thursday.

“I think that everyone agrees that our healthcare system needed changes and improvement,” Aderholt said. “However, this was a typical bureaucratic, overreaching approach to a situation that did not need to be nearly as complicated.”

To be sure, it is complicated.

The legislation is a patchwork of compromises designed to provide needed coverage to millions of uninsured Americans while dodging the main objections of insurance and health industry lobbyists. It is far more complicated — and less effective in its goal of making sure all Americans have access to quality health care — than the universal Medicare legislation shot down by Congress during the Clinton administration.

Like any major piece of legislation, it needs changes to work efficiently. Already imperfect, its deficiencies blossomed when the U.S. Supreme Court in 2012 struck down a provision effectively requiring states to expand their Medicaid programs. For states like Alabama that rejected a Medicaid expansion, the irrational and sometimes tragic result is that people who make too much money to be on Medicaid but not enough for subsidies are left hanging.

The immediate consequence of Thursday’s Supreme Court decision is that 8.7 million Americans will keep the subsidies that make their insurance affordable.

The long-term consequences could be just as important if Alabama and the GOP-controlled Congress will quit trying to destroy the law and instead try to improve it.

A first step — one that could be taken by the state — would be to expand Medicaid and thereby eliminate the coverage gap. It’s a move that would give 300,000 Alabamians access to health care, improve the state’s labor force and revitalize hospitals.

Economists estimate the expansion, more than 90 percent of which would be paid for with federal tax dollars, would have a $20 billion economic impact on the state and create more than 30,000 jobs.

There are dozens of changes that could be made by Congress that would streamline the law and increase competition in the insurance exchanges, thus reducing premiums and taxpayer costs.

Lawmakers of both parties now recognize how desperately the nation needed health care reform. With the significant legal challenges over, it is time for them to accept the Affordable Care Act as a starting point and to begin the process of improving it.

(Published June 26, 2015)

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Filed under Alabama politics, Health care, Medicaid, Obamacare

Alabama needs to embrace ACA

This was my response to a friend who opposes the Affordable Care Act. I first sent him this story of what is happening in Kentucky, a state seeing remarkable success with the ACA despite similar demographics. Kentucky, of course, embraced the reforms as a long-overdue way to help its citizens while stimulating its economy and saving its hospitals.

I continued as follows:

Alabama is not working well, which was the state government’s goal. We have not expanded Medicaid — and note that the KY story involved the working poor, who do not have Medicaid in Alabama. The state has done nothing to curb the BCBS monopoly and it refused to create its own anti-monopoly exchange or promote the federal exchange, so BCBS remains the only significant player and controls premiums.

In Decatur we don’t have it quite so bad yet because Huntsville/Decatur Morgan hospitals are trying to provide diagnostic tests and specialized care to the uninsured, usually after a referral from the Free Clinic. (In the Kentucky story, note that diagnostic tests and specialized care were the biggest pre-ACA problems.) In talking to hospital officials, though, it is clear that can’t continue. Decatur Morgan is not breaking even; HH barely is. They are not required to provide MRIs or cancer screens or most cardio tests. All the hospital is required to do is stabilize the patient and send her home. The specialists are not required to see the uninsured patients at all, and fewer and fewer are willing to see them.

When 17% of our population has essentially no access to health care, it is inevitable that the transition will be difficult for everyone — doctors, hospitals, insured patients. Many uninsured have been struggling with untreated illnesses for years, and they will strain the health infrastructure initially. Those who have been previously denied insurance due to preexisting conditions will put upward pressure on premiums for everyone.

The transition also is difficult because the ACA is a major overhaul of a huge and complex system. There are dozens of minor changes that would make it work better, but the U.S. House does not want it to work better.

I avoid saying this publicly, but you’re a friend: For me, it comes down to my acceptance of Christ’s teachings. We have the ability to heal the sick and give them an opportunity to become productive members of society. We have the ability to treat diabetes and prevent its horrific consequences. We have the ability to alleviate painful conditions that ruin the quality of life for thousands of Alabamians. Nobody gets healthcare for the fun of it, so we are not even creating the “dependency” issues that cause our governor such consternation.

ACA has plenty of problems. Its initial rollout, as you mentioned, was a disaster. The pre-ACA status quo, however, was an affront to everything I believe in. While the vote ended up being partisan, ACA was formulated by both parties and numerous experts. Short of a politically untenable single-payer system, it’s our best shot.

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Filed under Alabama politics, Health care, Medicaid, Obamacare

The gospel of simple mercy

How can our annual celebration of Christ’s humble birth not jolt us from our year-long exercise in complex self-justification?

Jesus, Christians agree, was the one perfect man. His perfection manifested itself not in the accumulation of riches, but in poverty. His generosity was complete and unconstrained by judgment.

He was the one man with a right to judge, yet his gifts of food and healing and salvation had no conditions attached. He gave to the undeserving based not on their merit, but based on their need.

This man whose perfection we proclaim felt the hunger of the poor, and he fed them. He felt the pain of the sick, and he healed them. He felt the hardness of our souls, and he saved us.

Two thousand years later, we chafe at this man’s simplistic gospel.

His response to hunger was to provide food. Ours is to weave intricate masterpieces of logic: The seeming generosity in paying $1.40 per meal to feed the hungry will really doom them to perpetual hunger. We harm the hungry by giving them sustenance, because our gifts will make them dependent.

When this perfect man confronted illness, his naive response was to offer healing. We come up with elaborate justifications for withholding health care: If all who are sick have access to a cure, our health-care facilities will be overburdened. The cost of healing the impoverished sick will harm the productive potential of the rich, which ultimately will hurt the poor. Universal health care will incentivize unhealthy lifestyles.

We have become enamored of our intellect. With ever-more-elaborate twists of logic, we can prove that food stamps cause hunger and health care causes illness.

And yet on Dec. 25, most of us bow to a man who rejected such logical games. If we were hungry, he gave us food. If we were sick, he healed us. His perfection was simple, but inconvenient. Our imperfection is complex, but convenient.

If we want to pick holes in the Affordable Care Act, we can do so. It is a creation of imperfect humans. If we want to find justifications for whittling away at food stamps and dropping benefits for those who cannot find a job, we can do so.

In the midst of our efforts to construct logical self-justifications for abandoning the poor, however, should we not be jolted each Christmas? Most of us worship a perfect man — the son of a forgiving God — who was both poor and selfless. For him, there was no complexity in goodness. Not one of us deserved his mercy, yet he fed us and healed us and died for us.

Feed the hungry. Heal the sick. As imperfect as we are, we have the power to do both. It’s not convenient, but it’s simple.

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Filed under Conservatism, Health care, Medicaid, Poverty, Religion, Uncategorized

Obama wrong: you can’t keep junk insurance

The horror stories are rampant. In Alabama alone, Blue Cross Blue Shield is canceling 87,000 health insurance policies. Around the nation, people who liked their inexpensive individual insurance plans say they must replace them with a more expensive one because of the Affordable Care Act.

The stories raise two distinct issues, one minor and one major.

One is whether President Barack Obama lied when he said, more than once, “If you like your plan, you can keep it.” This is the minor one.

Certainly Obama was wrong. Maybe he was making a paternalistic assumption that people do not “like” lousy individual insurance policies. Or maybe he was lying; it would hardly be the first time for a U.S. politician. This is a minor issue, because he’s serving his final term as president. His fluctuating poll numbers really don’t much matter.

Distinct from Obama’s motives in making the false statements is whether the fact not all people can keep the cheap individual insurance policies they “like” is a bad thing.

The policies being canceled under Obamacare do not meet even the minimum standards of the law. They fall far short of the excellent “platinum” insurance, fall short of the gold and silver policies, and can’t even meet the minimalist coverage requirements of a bronze policy.

The common gripe is that it’s unfair for one insured to have to pay premiums for a service he will never use; why should a man have to pay premiums for policies that cover maternity care or mammograms? But this is not unique to Obamacare. Men already pay premiums for policies that cover uterine cancer, just as women pay premiums for prostate cancer. It’s called sharing the risk, and it’s the point of insurance.

A recent Consumer Reports investigation looked at a horror story that went viral. A 56-year-old Blue Cross insured told CBS her monthly premium would jump from $91 to $591.

For starters, Consumer Reports concluded her actual premium would only increase to $165 after subsidies.

More importantly, her $91 policy was “junk insurance,” to use Consumer Reports’ term.
The plan she likes was of little benefit even for minor ailments. If she were to require treatment for something major — Consumer Reports used the example of breast cancer — the $91 policy would be all but worthless.

The investigation assumed a $120,000 treatment cost for breast cancer. The policy the woman said she likes because it costs her little in premiums would leave her with a $119,000 bill. The policy that complies with the ACA, while it has a higher premium, would limit her personal expense to $6,300.

Because the woman had an annual income of $30,000, a $119,000 medical bill probably would mean bankruptcy and a shifting of her providers’ unreimbursed costs to the rest of us.
The uproar over the fact that some people with individual insurance will pay more under Obamacare may suggest the president was dishonest.

More importantly, however, the uproar focuses attention on the number of people who have junk insurance that provides little protection for them and almost none to a nation reeling under the burden of unpaid medical bills.

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Filed under Health care, Obama, Obamacare

Appropriate GOP response on exchange: Mission accomplished

The pathetic rollout of the federal Affordable Care Act exchanges was an embarrassment that, if not remedied soon, could jeopardize long-awaited access to health care for millions. There are plenty of people in the Obama administration that deserve blame.
In the midst of the blame game, however, it is worth stepping back for some context.
The first question Alabamians should ask, of course, is why the federal government is running the state’s exchange. In deference to the same states’ rights movement loudly proclaimed by Gov. Robert Bentley during his candidacy and after, the ACA provided states with the authority and funding to set up their own exchanges. Bentley and Alabama legislators declined. They were open about their reason for leaving this critical task to Washington: They hoped that if enough states refused to create exchanges, the burden on the federal government would undermine the law.
It turns out the strategy was clever. The federal government must run the exchanges in 36 states, many of which rejected the responsibility in the hopes of derailing efforts at health-care reform.
Alabama also was one of several states — all Republican-controlled — that filed suit seeking to have the ACA ruled unconstitutional. The ACA became law in March 2010, but it wasn’t until June 2012 that the Supreme Court ruled it was constitutional. The law was in legal limbo for more than two years. In retrospect the federal government should have been pumping money into development of the exchanges during this period, but at the time the wisdom of doing so was not obvious.
Even after the Supreme Court ruling, the GOP managed to keep the fate of Obamacare an open question. Republican candidates in the 2012 presidential election were unanimous in their determination to do everything in their power to thwart health-care reform, so it wasn’t until the results of the November election — less than a year ago — that federal agencies, contractors and insurance companies began to have confidence that the 2010 law actually would take effect.
When the Department of Health and Human Services sought congressional approval to transfer some of its funds to improve implementation of the ACA, the GOP-controlled House of Representatives shot it down. Republicans also blocked the Obama administration’s efforts to make legislative tweaks to the complex law, the sort of changes that are necessary in any major piece of legislation.
The nation is at the beginning of what will no doubt be endless congressional hearings on what went wrong with the rollout of the federal exchanges. Those hearings will reveal that blame is appropriate. The consequences for those who are to blame should be harsh, because the mistakes have jeopardized the ability of millions of uninsured Americans to obtain access to health care.
In the midst of casting blame, however, Americans should remember that Republicans in Alabama and Washington have spent much of the last 3-1/2 years in an open and determined effort to sabotage Obamacare. They wanted the exchanges to fail. While millions of uninsured Americans have every right to complain, elected Republican officials should limit themselves to two smug words: Mission accomplished.

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Filed under Alabama politics, Health care, Obamacare

Obamacare would help IP workers

For many of the 1,100 workers employed at International Paper’s Courtland plant, the overwhelming issue is health care.

They understand they will lose their jobs. IP announced last week it will close the Courtland plant, opened in 1971. The employees are casualties of the transition to a paperless world, and they get that.

Many have skills they can utilize to sustain themselves after the plant closes. Maybe they can fix cars or build cabinets or paint siding. The work ethic that benefited IP shareholders can benefit them.

The problem for the IP workers is the same problem faced by millions of Americans. Individual health insurance is not affordable, especially in a state like Alabama monopolized by a single health insurance carrier. Accessing health care without insurance is not feasible. The only option for the uninsured is the emergency room, which does little to deal with the chronic conditions that come with age and which leads to bankruptcy for those forced to use it.

“Obamacare,” originally promoted by conservatives as a market-driven alternative to Medicare-for-all, has become a partisan hotspot. Republicans, historically champions of the laborer, feel compelled to condemn the Affordable Care Act.

Even in Alabama, one of the poorest states in the nation, elected representatives vow to do what they can to defeat a law that uses the market to provide health care to all.

In the next few months, 1,100 IP workers will be losing their jobs. Some will find new employment, complete with health insurance. Many — probably most — will piece together sustenance from a variety of odd jobs, none of which offer health insurance. But beginning in January, that’s OK. In January — if efforts by Alabama’s elected officials to defund “Obamacare” fail — they can buy individual health coverage at reasonable rates.

Gov. Robert Bentley swears he will do anything to help the IP workers. So do U.S. Rep. Mo Brooks and U.S. Senators Richard Shelby and Jeff Sessions. But all four are doing everything in their power to block health-care access to the IP workers who are soon to be unemployed.

It’s time for Congress — especially poverty-stricken Alabama’s representatives — to quit treating the Affordable Care Act as a partisan tug-of-war.

The law is imperfect, but a Congress with a desire to help those without access to adequate health care can fix it. Governors who are more interested in helping their people than undermining the president can help, too.

As 1,100 IP workers soon will discover, America’s health-care system is a mess. The Affordable Care Act is an initial step toward fixing the system, and it deserves bipartisan support.

If they care more about their constituents than about partisan bickering, the elected representatives from Alabama — including Bentley, Brooks, Shelby and Sessions — will do their best to make “Obamacare” work.

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Filed under Alabama politics, Health care, Obamacare