Stand Up for Health Care Blog

Not a week goes by without another report reminding us that the United States spends more on health care than any other country in the world, yet has worse health outcomes than most. How do we solve this problem and get more for our money? We need to focus on getting each person the right care at the right time.

In an effort to do this, nine leading doctors' groups, like the American Academy of Family Physicians and the American College of Cardiology, recently came together as a part of the Choosing Wisely campaign. This new campaign aims to raise awareness about the importance of relying on evidence when deciding what tests and procedures to do and to encourage doctors and patients to discuss the pros and cons of various courses of treatment. To achieve this, each of the nine specialty groups involved in the campaign created a list of five tests and procedures that are frequently overused or misused. Doctors and patients can use these new lists when deciding an appropriate course of treatment.

Sticking to evidence-based medicine limits a patient's exposure to possible harm. For example, the American Academy of Allergy, Asthma, and Immunology recommends that doctors treating patients with uncomplicated sinus infections avoid prescribing antibiotics, let alone ordering CT scans, as long as the illness is mild and the patient has access to follow-up care if he or she needs it. The vast majority of these infections are viral, so antibiotics will not help at all and, in some patients, they can cause significant side effects. Likewise, jumping to a CT scan will unnecessarily expose patients to radiation and will not help them get any better.

To ensure that patients are able to get the most of this valuable resource too, Consumer Reports will publish each of the lists in easy-to-understand language. This will help patients become active participants in their health care and encourage an informed dialogue with their health care providers. If more people start using information like this to make health care decisions, we will see quality improve and costs come down. This is a win-win situation for everyone.

This blog is cross-posted from Say Ahhh! A Children's Health Policy Blog.

By, Gene Lewit and Lian Wong, The David and Lucile Packard Foundation
Posted May 15, 2012

Those of you who are regular Say Ahhh! readers know that more children have health insurance coverage today than at any point in the nation's history. The steady growth in children's health coverage did not happen in a vacuum. State and federal leaders and program directors, policy and grassroots advocates, and concerned citizens - not to mention key pieces of federal legislation - all contributed to this success. In particular, state efforts, to grow and improve their children's coverage programs, supported and urged onward by policy and grassroots advocates, played a crucial role in the growth in children's coverage.

Today, the David and Lucile Packard Foundation and Mathematica Policy Research released new findings on the impact of children's health care coverage advocacy in the states. This brief, Applying Advocacy Skills in Tumultuous Times: Adaptive Capacity of Insuring America's Children Grantees, is the latest from the evaluation of the Packard Foundation's multi-year, multi-state, Insuring America's Children (IAC): States Leading the Way grantmaking strategy launched in 2007. One of IAC's goals was to broaden and strengthen the state-based children's health advocacy ecosystem to support the expansion of children's coverage at the state and federal levels en route to our goal of covering all of America's children. As the nation engages in the implementation of health care reform and attempts to address a number of other pressing problems, we believe the findings in the just released brief hold lessons not only for children's coverage advocates and funders but for broader advocacy efforts as well.

What ultimately transpired between 2007 and 2010 was a tumultuous period characterized by a severe economic downturn, an intense political battle around the reauthorization of the Children's Health Insurance Program, and widespread erosion of employer sponsored health insurance, capped by an intense debate on national health reform.

So, how did state-based advocacy groups navigate these rapidly shifting state and federal environments? By analyzing four years of comprehensive data, the evaluation team at Mathematica found that support of capacity and network building among state-based advocacy groups of different sizes strengthened their communications and policy capacity to make children's coverage a priority both within their own states, in other states, and at the national level. The groups' work strengthened popular support for the broad goal of insuring all children and supported many targeted policy goals, such as expansion of CHIP eligibility, program improvements, and simplified, more efficient enrollment and retention practices.

Findings from the study highlight the key strategies that advocacy groups pursued aggressively to prepare for and respond effectively in a dynamic environment, including:

• Building and adapting strategic partnerships as the economic and political contexts in their states were shifting. Advocacy groups assumed new and expanded leadership roles within state-based coalitions;
• Serving as critical sources of information and analysis to state policymakers and other key stakeholders. Advocacy groups strengthened their reach and influence;
• Employing consistent and positive messaging. Advocacy groups successfully broke through the mire of a gloomy economic forecast and sometimes combative political atmosphere;
• Leveraging technical assistance and external support by the Packard Foundation, such as peer-to-peer learning.

Advocacy groups were able to maximize their individual and collective efforts. As the goal of ensuring that all children have health care coverage becomes increasingly attainable, understanding how advocates have carried out this work in different and dynamic environments can provide lessons for future advocacy efforts on a variety of issues. The full details of these findings can be found on the Packard and Mathematica websites. To learn more about Insuring America's Children: States Leading the Way, visit our website.

The House is expected to vote today on a Republican proposal to slash health care spending for low-income and middle-class families. Unfortunately, cutting services for America's families is becoming a familiar refrain of House Republicans.

Following up on proposals made by the Energy and Commerce and Ways and Means committees, the House Budget Committee combined a set of proposals cutting help for families into a bill that the House will now vote on. The Sequester Replacement Reconciliation Act is intended to replace the automatic spending reductions in defense scheduled to occur early next year.

The list of proposed cuts makes clear the priorities of House Republicans. In order to avoid cuts to defense, the bill targets women, seniors, children, and families. Here are just some of the proposed cuts:

• Protections for families receiving tax credits used to buy health insurance under the Affordable Care Act? Done away with.
• Federal Medicaid payments covering citizens in the U.S. territories? Reduced.
• Encouragement for states to sign up eligible low-income children for Medicaid? Abolished.
• Rules ensuring that states don't cut people off of CHIP and Medicaid? Repealed.
• The Prevention Fund helping women get mammograms and helping children get screened for diabetes? Ended.
• Help to states to set up new, more consumer-friendly marketplaces for health insurance? Rescinded.
• Benefits from the Supplemental Nutrition Assistance Program (formerly food stamps) that ensure low-income families are able put food on the table? Reduced for all and cut off for many.
• The Child Tax Credit for the children of immigrants? Banned.
• The Social Services Block Grant, which funds child care, Meals on Wheels, and other important community services? Eliminated.

Furthermore, this legislation isn't even a long-term solution. Slashing these programs delays the automatic cuts to defense for only one year.

Although the Senate will not consider the bill, its passage in the House will send a signal to Americans: Republicans want to balance the budget on the backs of those who need help the most. None of these cuts address our long-term deficit problems. Instead of moving forward and giving us the real solutions we need, this legislation plays games with the lives of middle-class and low-income families.

As we await the Supreme Court's ruling on the Affordable Care Act coming in June, Families USA and other organizations are tallying up the benefits the law has provided so far-and the potential costs if the law is overturned. Last week, the Center for American Progress released Women and Obamacare, a report summarizing everything women stand to lose if the Supreme Court rules against the law-and it's not pretty.

In the pre-Affordable Care Act world, women faced high health care costs and routine discrimination in the health insurance market. Women's reproductive health needs mean that they require more examinations and prescription drugs, and women of reproductive age ended up spending 68 percent more on health care than men. The cost of critical preventive care kept millions of women from getting mammograms, pap smears, and prenatal care. When seeking to purchase health insurance, women could be denied for gender-related pre-existing conditions, including breast cancer, Caesarean sections, rape, and domestic violence. Those approved for coverage usually ended up paying significantly higher premiums than men, even though most individual health insurance plans didn't cover maternity care.

The Affordable Care Act is changing all that. Forty-five million women have already taken advantage of important preventive services that now cost them nothing, including screenings for breast and cervical cancer, and prenatal, well-baby, and well-child care. In August, women will also be able to get annual well-woman check-ups, screening for gestational diabetes, breastfeeding support and supplies, and screening for sexually transmitted infections at no cost. And in 2014, we can say goodbye to health insurance discrimination. Plans will have to cover maternity services and premiums will be gender neutral.

These changes are particularly critical for reducing health disparities. Women of color are less likely to be insured and have higher rates of chronic diseases, certain forms of cancer, maternal mortality, and adverse birth outcomes, including premature birth and low birth weight. The Affordable Care Act not only helps women of color obtain the care they need, but also improves data collection on race, ethnicity, sex, disability, and primary language in order to track disparities and support more targeted and effective interventions in the future. Lesbian, gay, bisexual, and transgender Americans, who experience many similar health disparities, will also benefit from improved coverage and efforts to end discrimination based on sexual orientation and gender identity in the new state-based health insurance exchanges.

But all of these key gains could be lost in June if the Supreme Court overturns the Affordable Care Act. A ruling that overturns the law could send us back to a time when half of all women delayed seeking medical care because of cost, when millions went without potentially life-saving cancer screenings, and when gender-based higher insurance premiums cost women an additional $1 billion a year.

The Kaiser Family Foundation estimates that, thanks to the Affordable Care Act, health insurance companies will send $1.3 billion dollars in rebates to consumers and small and large businesses this August. This is all because of the medical loss ratio provision that requires health insurance plans to spend most of your premium dollars on health care and quality improvements or to give your money back.

So that's $426 million that will go directly to consumers in the individual market and $918 million that will go to small and large businesses to repay their workers. However, these payments may not happen if the Supreme Court opinion or legislative action repeals the law.

The medical loss ratio in the Affordable Care Act requires that insurance companies spend at least 80 cents (or 85 cents if in the large-group market) of every dollar on paying health care claims or making quality improvements. If they don't spend enough money on health care, they have to give you money back in the form of a rebate. In essence, the Affordable Care Act ensures that everyone is in a health insurance plan that uses their money correctly.

And don't worry about the insurance companies-they will still have plenty of money to take care of marketing and administrative tasks. A study by the Government Accountability Office on whether plans will be able to meet this requirement shows that the ratio is reasonable.

The law also gives the Department of Health and Human Services the ability to review large hikes in insurance premiums to make sure that the higher premium means better care. These protections guarantee that insurance companies cannot waste your premium dollars and must give you real access to health care. They are just one of the many consumer protections at stake if the Supreme Court or Congress takes the Affordable Care Act away.

What do the national smoking cessation hotline, fresh vegetables for low-income urban neighborhoods, vaccinations for kids without insurance, and new residency positions for badly needed primary care physicians have in common?

If Republicans have their way, these efforts are all about to take a big hit.

You may have heard about recent attempts to keep interest rates on federal student loans from doubling this summer. President Obama went on late-night television to slow jam in favor of it, and even Romney supports it. But Republicans want to fund this effort by cutting $6 billion from the Prevention and Public Health Fund set up in the Affordable Care Act.

Like many important provisions of the law, the Prevention and Public Health Fund is already having a positive impact. It's providing training for new primary care doctors (we're currently 30,000 short) and doubling the number of smokers calling the national quit hotline. It's funding breast and cervical cancer screenings for hundreds of thousands of women, expanding opportunities for HIV/AIDS testing, and supporting suicide prevention. It's been used to fight obesity by creating a network of 600 healthy corner stores in Philadelphia and putting in sidewalks in Merced County, California, so kids can walk to school.

The fund works by providing grants to states and communities for these critical preventive efforts. One in six Americans already benefits from this work to promote better long-term health. Click here to see what the fund is doing in your state.

Preventing disease by fighting obesity and smoking, screening for cancer, making sure kids get vaccinations, and strengthening our primary care system saves money. Every dollar we put into proven community-based prevention programs yields $5.60 down the road.

There's a lot of talk right now in Washington about things we can't afford to do. With health care costs high and growing, we certainly can't afford to shortchange these critical preventive efforts.

Sadly, Republicans continue to use the federal deficit as an excuse to gut the nation's health care safety net. We've already looked at the extreme proposals in the House Budget and at last week's attack on the tax credits that help middle-class families buy health insurance. Now, the House Committee on Energy and Commerce is continuing this budget battle by targeting several key parts of the Affordable Care Act.

Under the health care law, states can't weaken their eligibility rules or otherwise cut back on the CHIP and Medicaid programs. These rules ensure that children, seniors, and struggling families continue to receive lifesaving medical care until the law is fully implemented. The Energy and Commerce Republicans voted to reverse this protection earlier this week. If their proposal becomes law, 400,000 people would lose their benefits in 2013 alone, two-thirds of whom are children.

The committee went further in targeting Medicaid by cutting the federal match to the U.S. territories, such as Puerto Rico and the U.S. Virgin Islands. The territories bear a disproportionate burden of Medicaid spending compared to the states, and the Affordable Care Act started to address this longstanding problem. By reinstating restrictions on Medicaid funding, Republicans are cutting off billions of dollars in critical health care for low-income residents in the territories.

In addition to slashing Medicaid, the committee voted to do away with the Prevention and Public Health Fund. This fund plays an important role in improving the country's health by promoting obesity prevention, tobacco cessation, and health screenings and immunizations. Repealing it now and ignoring preventable diseases will only lead to greater health care costs in the future.

Finally, the committee slashed grants to states to set up exchanges and loans for establishing non-profit health insurance organizations. But these ill-advised cuts are not the only notable part of the committee's proposal; there is a bit of positive news. The House Budget calls for turning Medicaid into a block grant, a drastic move that would cut the program's funding by more than one-third. However, instead of moving forward with a block grant, the Energy and Commerce Republicans chose to go after health care programs that they thought would garner less attention. Clearly, the pressure from advocates for health care is getting to them!

There's been no shortage of analysis about the Supreme Court arguments on the constitutionality of the Affordable Care Act. A lot of it has focused on the politics and tea-leaf reading: How will the Justices vote? What could the different outcomes mean for the November election? Will the law be upheld or will the conservatives on the court disregard legal precedent, strike down the law, and start a partisan legal revolution?

These are all important questions. But the truth is nobody outside the walls of the Supreme Court can predict with certainty how the Court will rule. The most important number for health care in this country between now and June, when the Court is expected to rule, isn't the billions of dollars politicians are arguing about. It isn't even the 270 electoral votes needed to win in November (though that will matter soon). It's "five"-the number of votes needed for a majority in the Supreme Court. The Court seems deeply divided: The four more liberal Justices (Breyer, Ginsburg, Kagan, and Sotomayor) are likely votes in support of the law. Three conservatives (Alito, Scalia, and presumably Thomas-as usual, he did not ask questions) are opposed. That leaves two (Kennedy and Chief Justice Roberts) in the middle. They asked tough questions of both sides, and how those two will rule on the various questions before the Court is anyone's guess.

But there is a vital perspective that's been missing from much of the coverage about the Affordable Care Act and the Supreme Court, particularly when we talk about what's at stake. It's the perspective of everyday people whose health, and whose lives, are now in the hands of the Supreme Court.

During the Congressional debate during 2009 and 2010, supporters of what became the Affordable Care Act spoke in hypothetical terms about what the public stood to gain from the law if it were enacted. Now, we need to talk in very concrete terms about how the highest court in the land could strip us of critical protections that we have or are about to gain. Every American with a stake in these protections should be speaking out. If you, a friend, or loved one has a health condition-for example, cancer, diabetes, high blood pressure, arthritis, or a back injury-that makes it hard or impossible to buy health insurance, your well-being is at risk. If you thought that, finally, you would not have to live in fear of bankruptcy because of high medical bills, think again-a bad decision from the Court would put us right back where we were. If you have been rolling the dice every time you walk out the door because you can't afford health insurance and are just hoping you don't get sick, and you thought that at last security was within your grasp, well, five justices of the Supreme Court could strip that security away from you.

There has been some terrific coverage in recent weeks about people who would suffer if the Court were to strike down the law. Stories about people in car accidents; about children born with cerebral palsy; about people with ulcerative colitis. There need to be more. In the coming weeks, Families USA will be launching new efforts to get these stories out and to make the voices of everyday people heard. But don't wait. Tell your story now. Explain how you, or someone you know, would be harmed if the Supreme Court struck down the health care law. Write a letter or submit a guest column to your local paper. Post your story on your local blogs. Share your story with the Families USA storybank. Now is the time to speak up and let people know that we do not live in a country where the highest court in the land would undermine the health security of millions-or at least, we sure hope we don't.

Families USA is proudly taking part in the Health Equity Can't Wait! blog carnival celebrating National Minority Health Month. Participating bloggers are health, consumer, civil rights, and provider advocates committed to promoting health equity. You can find all the posts for the carnival here.

Every year, as I wait in my doctor's office for my physical examination, I am reminded of all the possible health issues that I may face. I think about my mother having to take calcium supplements because of the increased risk of osteoporosis among Asian women. I look down at my stomach and remember that I am three times more likely to have stomach cancer than a white woman. My eyes meet the speculum on the table and I think of the possibility of cervical cancer. Each layer of my identity is associated with specific health risks.

Despite my concerns, I realize how blessed I am to have the opportunity to get screened for possible health issues, and if they are detected, to tackle them at an early stage. Plus, I do not have to worry about a large medical bill after my visit. However, this is not the case for millions of Americans, and many have faced life-threatening and even fatal consequences because of the lack of access to adequate health care. This leads to questions that I often ask myself, what causes these disparities, and how do we fix them?

There are many factors that contribute to the issue of health disparities, and these complex factors are like layers in an onion. On the outside layers we see physical characteristics, such as race and sex. Socio-economic status, geographic location, insurance status, age, gender, and sexual orientation exist on the inner layers. Each layer of the onion represents potential barriers to health care. These are many factors that lead to health disparities; therefore, in order to reach health equity, we need services that address all of the layers of the onion and peel away the obstacles between people and the high-quality, language-accessible, culturally competent care they need to maximize their health.

We cannot treat health care as if it were one size fits all. Because of my identity-a minority and a woman coming from a low-income background-not only am I more likely to face certain illnesses, but I am less likely to receive care. This is because minority women both have higher rates of chronic disease, including diabetes, heart disease, and stroke and are more likely to be uninsured. However, I am fortunate that I am living during a time that saw the passage of the Affordable Care Act because, for example, women can now receive preventive care with no co-pays, and come summer, the list of these services we can receive at no cost will grow.

This is why the health care law is crucial to the goal of health equity. The beauty of the law is that it fills in some of the gaps in access to care and coverage that feed into health disparities. The law addresses the layers of the onion to reach the core, helping Americans who have limited access to care get the care they need, including important preventive services. Health reform will increase access to critically important preventive care not only by requiring that all new insurance plans cover preventive services, but also that they provide them free of charge.

We need health equity now because people's lives are at risk. If we ignore health disparities, minorities will continue to face higher rates of disease, fewer treatment options, and reduced access to care.

To cap off the week, we're taking part in a Health Equity Can't Wait! Twitter chat on Friday, April 27, from 3-4 p.m. EDT. Follow the conversation and join along using the hashtag #HealthEquityNow.

Families USA is proudly taking part in the Health Equity Can't Wait! blog carnival celebrating National Minority Health Month. Participating bloggers are health, consumer, civil rights, and provider advocates committed to promoting health equity. You can find all the posts for the carnival here.

Recently, I had the privilege of participating in a dynamic community forum in Philadelphia organized with our partners, National Council of La Raza (NCLR) and Congreso de Latinos Unidos. It was an exciting morning. U.S. Surgeon General Regina Benjamin headlined the event, and it was standing room only. The mostly Puerto Rican crowd included seniors and students, local elected leaders and activists, health care providers and patients. They were there for one reason: They wanted to know how the health care law would make a difference in their lives. We were there because our mission is to spread the good news that the health care law is going to make an enormous difference, and we must work together to ensure the communities that need it the most take advantage of it and get the care they need.

When it was my turn I asked the crowd some questions: "How many of you know someone whose baby was premature?" About a quarter of the hands in the room went up. "How many of you know someone with diabetes?" Now about half the audience raised their hands. And when I asked how many knew someone with asthma, the hands that shot up vastly outnumbered the rest. Yep, there it was, evidence of what I call "the Puerto Rican curse," that yet to be explained phenomenon of Puerto Ricans having the highest asthma prevalence and mortality rates of any group in the nation.

Back in my office in Washington, D.C., I spent a lot of time studying disparity statistics-a stream of charts and graphs flickering across my computer screen. But there in that room, overflowing with human lives, those numbers had faces. I heard their voices, felt their need. Their thirst for information was palpable, with question after question, people struggled to make sense of what seemed an overly complicated, confusing law whose relevance to their lives seemed remote. Their hunger for health care justice was even more intense. We heard story after story about the obstacles they confronted: "my drug co-pays are too expensive;" "people's doctors' don't speak their language;" "it takes three months to get an appointment."

And because I, a Puerto Rican woman, and my little boy, are also victims of that curse, we talked about asthma-about how we know how to treat it, that it's really pretty simple, that no child has to die. Just make sure you have both a rescue inhaler and controller medication. That is how to stay out of the hospital, keep your kid in school and learning, keep her alive. But then one mom raised her hand, and asked, with a little embarrassment and a lot of anxiety, "What should you do if you can only afford one?"

I couldn't answer. Telling her she'd have cheaper options in 2014 seemed cruelly absurd.

This is why health equity can't wait-too many moms face this terrible choice, especially in communities of color. And if it's not asthma then it's diabetes or heart disease or one of the many cancers that are more deadly if your skin is dark. Sure, there are things that are helping right now. Millions of seniors can better afford their medications. More than 2.5 million young adults under 26 have been able to stay on their parent's insurance plans, including 1.3 million young people of color. Of course those are the ones lucky enough to have parents who have insurance. You can get preventive care with no copays, provided you have insurance. And that woman's child can no longer be denied coverage because of her asthma-but whether her parents can afford to pay for the coverage is another question entirely.

In this case, because of the health care law, that woman at the forum did have a better option. Congreso just opened a new federally qualified health center that provides free or very low cost care, right across the street, thanks to billions of dollars of new federal funding made available by the law. Because of this new money, she and her child had somewhere affordable to go.

Nevertheless, that night, as I diligently used both my inhalers and called home to make sure my son had as well, I gave thanks for being lucky enough to not be faced with those kinds of choices, and prayed that all those who do every day somehow stay healthy and safe for another 18 months.

Late in March, the House adopted a budget proposal that calls for the dismantling of Medicare and Medicaid as well as the repeal of the Affordable Care Act and its critical consumer protections. In a report released last week, Families USA took a closer look at the Republican proposal.

The budget was an opening salvo on a battle for the future of health care for millions of Americans. Today, the battle continued in the House Ways and Means Committee, which has jurisdiction over taxes and some health care programs. The Republicans on the committee approved legislation that would make some of the cuts recommended by the budget, including a proposal that directly targets middle-class families who need assistance paying their health insurance premiums.

Here's how it works: Starting in 2014, the Affordable Care Act will help uninsured middle-class families pay for health insurance premiums by giving them monthly tax credits, based on their predicted income. At the end of the year, the IRS makes sure that the right amount of credit was paid, based on a family's actual-rather than projected-income. The law protects the family from a huge bill by capping the tax penalty they will be obliged to pay if there is a difference between the projected income and actual income. So, families won't owe a lot of money to the IRS due to a simple, unexpected change in income, such as a mom getting a small year-end bonus.

Now, Republicans on the Ways and Means Committee have voted to eliminate these caps that protect middle-class taxpayers. While there are many other ways that the Committee could have found savings, its leadership decided to go after the middle class.

This has serious consequences. Families eligible for the tax credit should not be worrying about a heavy tax penalty when seeking help to afford health insurance. Fearing a potential tax penalty, thousands may choose to remain uninsured rather than risk paying a penalty if their family has unexpected income changes. This undermines the goal of the Affordable Care Act to reduce costs for families and to reduce the number of uninsured.

This attack on health care for families may be the latest, but it certainly will not be the last. With deficit reduction continuing to take up the spotlight, we can expect future efforts to follow the House-passed budget's proposals to cut critical health care programs. Look for Republicans to push these radical priorities that, like eliminating the penalty cap, will serve to raise the cost and reduce the availability of health care for all Americans.

It's a problem that we don't think about a lot-but it's very important. Many kids and families are not getting the routine dental care they need. There are many possible reasons for this, including the fact that many Americans lack dental insurance, many have trouble finding a dental provider, and dental care often comes with high out-of-pocket costs for both the insured and the uninsured.

The good news is that the Affordable Care Act will provide dental coverage to an estimated additional 5.3 million children. It will also extend certain financial protections to consumers, like offering premium tax credits to help purchase pediatric dental coverage through the exchange and banning annual and lifetime spending limits.

However, providing affordable dental insurance is only one piece of the puzzle. Ensuring that there are enough dental providers to treat vulnerable children is another issue. Dr. Louis Sullivan, a physician and the former secretary of the Department of Health and Human Services, raised this issue in a recent New York Times op-ed. He notes that the shortage of dentists is getting worse, and it may be time to expand the dental workforce in order to meet the growing dental need. He notes that 54 countries use mid-level dental providers known as "dental therapists" to provide preventive and routine dental care to kids who otherwise may not be able to get dental services. A comprehensive literature review on dental therapists shows that they provide effective and safe care to millions of kids throughout the world. Mid-level dental providers are working in rural and underserved communities in the United States in Alaska and Minnesota, providing preventive and routine care to kids who wouldn't normally have access to a dentist.

Expanding access to dental care will require many policy and practice changes. As we think of ways to help Americans get the dental care they need, one strategy that is essential to consider is an expanded dental workforce.

A recent report from the Commonwealth Fund predicts that, if the Medical Loss Ratio (MLR) provision of the Affordable Care Act had gone into effect in 2010, consumers would have gotten $2 billion back from insurance companies last year.

You read that right: Insurance companies would have given consumers a $2 billion refund. But what the heck is MLR? This wonky term simply means that insurers have to spend the majority of your premium dollars on health care and improving quality, instead of profits, advertising, or other administrative expenses.

Prior to the Affordable Care Act, in most states there was no system for making sure that the consumers' premiums actually went toward their health care expenses and not into the pockets of insurance company CEOs. Thanks to Obamacare, insurers must spend at least 80 percent of premium dollars on health care expenses. Any less than that, and they are required to send their customers a refund to make up the difference.

The Commonwealth Fund calculated that difference using data from 2010, one year before the MLR regulations took effect in January of 2011. Although consumers will not receive refunds from 2010, many will see checks in the mail this summer based on how insurance companies spent premium dollars in 2011.

But what happens if the Affordable Care Act is repealed, either by actions in Congress or the Supreme Court's decision? In most states , there will be nothing to stop insurance companies from keeping as much as they want of premium dollars as profit. Based on the report's prediction, repealing the Affordable Care Act could cost consumers as much as $2 billion a year.

That's a price that Americans can't afford to pay, and it's much, much higher when combined with the cost of losing other consumer protections in the Affordable Care Act. Without provisions like the MLR, guaranteed coverage for kids with pre-existing conditions, and the option for young adults to stay on their parents' health plan, real people are vulnerable. People are the heart of Obamacare, and we need to do everything we can to protect them.

This blog is cross-posted from the Department of Health and Human Services.

By Mayra Alvarez, HHS Director of Public Health Policy
Posted April 06, 2012

April is National Minority Health Month dedicated to advancing health equity on behalf of racial and ethnic minorities. This year's theme is "Health Equity Can't Wait. Act Now in Your CommUnity." It's also a time to celebrate the opportunities of the new health care law, the Affordable Care Act, groundbreaking policies to reduce health disparities.

To talk about Minority Health Month and what the health law means for Latinos, we'll be hosting a Spanish language twitter chat on Tuesday, April 10th at 2pm EST. You can follow along at our Spanish language twitter handle: @HHSLatino, and also by following the hashtag: #LaSaludLatina. Between now and then, think of the question you might have about Latinos and health, and then ask via twitter during the chat.

Historically, Latinos have faced significant barriers to accessing affordable health insurance and these barriers have contributed to significant health disparities.

• 32 percent of Latinos were uninsured in 2009 - higher than any other racial or ethnic group - and half of Latinos did not have a regular doctor, compared with only one-fifth of white Americans.
• Twenty percent of low-income Latino youth have gone a year without a health care visit - a rate three times higher than that for high-income whites.
• Latinos were diagnosed with AIDS at three times the rate of whites.
• In 2006, almost half of Latinos reported they did not always get care when they needed it, compared with 43 percent of blacks and 41 percent of white Americans.

Today, more than 1.2 million Latinos, Blacks, Asian Americans and American Indian/Alaska Natives have gained coverage because the Affordable Care Act allows young adults without employer-provided insurance to stay on their parents' plans until age 26. Under the new health care law, all Americans no longer have to worry about losing coverage if they're laid off or change jobs. And insurance companies now have to cover preventive care like mammograms and other cancer screenings. The new law also makes a significant investment in State and community-based efforts that promote public health, prevent disease and protect against public health emergencies.

We'll be discussing these topics and more. We hope you can join us next Tuesday at 2pm!

En Español

Abril es el Mes Nacional de la Salud de las Minorías, dedicado a mejorar la equidad en la salud de las minorías raciales y étnicas. El tema de este año es "La equidad en la salud no puede esperar. Actúe ahora en su comunidad". También es un momento para celebrar las oportunidades de la nueva ley de cuidados de salud, la Ley del Cuidado de Salud a Bajo Precio, políticas pioneras en cuanto a la reducción de las disparidades de salud.

Para hablar del Mes Nacional de la Salud de las Minorías y qué significa la ley de cuidados de salud para los latinos, llevaremos a cabo una conversación por Twitter, el martes 10 de abril a las 2 p.m., hora estándar del este. Puede seguirnos en @HHSLatino, y también mediante el hashtag #LaSaludLatina. Desde ahora y hasta ese momento, piense en las preguntas que pueda tener acerca de los latinos y la salud, y luego hágalas por Twitter durante la conversación.

Históricamente los latinos se han enfrentado a barreras importantes en cuanto al acceso a un seguro médico asequible, y esas barreras han contribuido a crear importantes disparidades de salud.

• El 32 por ciento de los latinos no tenían seguro en 2009 (el porcentaje más alto a cualquier otro grupo racial o étnico) y la mitad de los latinos no tenían un médico habitual, en comparación con un quinto de los estadounidenses blancos.
• El veinte por ciento de los jóvenes latinos de bajos ingresos ha pasado un año sin visitar al médico, un índice tres veces mayor que el de los blancos de ingresos más elevados.
• Al grupo de los latinos se les diagnosticó SIDA a una tasa que triplica la de los blancos.
• En 2006, casi la mitad de los latinos informaron que no siempre recibieron atención cuando la necesitaron, en comparación con el 43 por ciento de las personas de raza negra y el 41 por ciento de los estadounidenses blancos.

En la actualidad, más de 1.2 millones de latinos, personas de raza negra, asiáticoamericanos y nativos de Alaska/tribus indígenas de Estados Unidos han recibido cobertura gracias a que la Ley del Cuidado de Salud a Bajo Precio les permite a los adultos jóvenes sin seguro provisto por el empleador permanecer en los planes de sus padres hasta los 26 años de edad. Según la nueva ley de cuidados de salud, ningún estadounidense tendrá que volver a preocuparse por perder la cobertura en caso de ser despedido o cambiar de trabajo. Y ahora las compañías de seguros tienen que cubrir los cuidados preventivos, como los mamogramas y otros controles oncológicos. La nueva ley también realiza importantes inversiones en esfuerzos estatales y comunitarios que promueven la salud pública, previenen las enfermedades y protegen contra emergencias de salud pública.

Debatiremos estos y otros temas. ¡Esperamos que pueda participar el próximo martes a las 2 p.m.!

What could explain a health insurance company charging one 25-year-old nearly double what another pays for the same coverage?

No, it's not a pre-existing condition or chronic illness. It's gender.

In most states, health insurers still charge women more for coverage simply because they are women, a practice known as gender rating. According to a report released this week by the National Women's Law Center, gender rating costs women about $1 billion a year. While a few states have banned or limited gender rating, the majority still allow it.

Gender rating is primarily a problem for women who don't have job-based coverage and don't qualify for federal insurance programs and therefore must buy insurance in the individual market. In states where gender rating is allowed, 92 percent of best-selling individual plans charge women higher premiums. And while state and federal anti-discrimination laws protect women with job-based coverage, health insurers can charge employers with a predominately female workforce extra.

To make matters worse, maternity coverage is hard to come by in the individual market. Most states do not require individual insurance plans to provide maternity coverage, and only 6 percent of the thousands of individual plans studied by the National Women's Law Center cover maternity services. Plans that do have this coverage sometimes charge a separate maternity deductible of as much as $10,000 or have waiting periods of up to a year before maternity coverage applies.

Women who have individual plans that don't cover maternity care can sometimes purchase riders that cover these services. However, only 7 percent of individual plans provide this option, and maternity riders can cost far more per month than premiums.

Fortunately, this situation is set to change. The Affordable Care Act prohibits gender rating and requires all plans to provide maternity coverage by 2014. It's one more reason for women to look forward to the full implementation of the new health care law!

Last year, House Republicans proposed a budget that would end Medicare as we know it. Their proposal was met with strong opposition. In a series of town hall meetings across the country, Americans made their opinion known: Medicare should be left alone.

A year later, not much has changed. A February poll shows that 70 percent of people want to keep Medicare the way it is, but House Republicans persist in their efforts to privatize Medicare and cut giant holes in the social safety net. This year's budget, which was released on Tuesday by House Budget Committee Chairman Paul Ryan (R-WI), reveals once again that Republicans are more interested in cutting taxes for corporations than they are in protecting America's seniors (or, for that matter, middle-class Americans, low-income families, children, and people with disabilities).

Here's a closer look at what's inside the Republican budget proposal:

First, the budget proposes privatizing Medicare and converting it to a voucher system. In an effort to avoid the backlash they saw last time, Republicans gave seniors a choice between traditional Medicare and a voucher to purchase private insurance. And they made sure that the changes won't be implemented for another decade, so the current generation of seniors won't be affected. While this might protect the budget from some of the opposition that Republicans saw last year-the fact remains that the proposal will end Medicare as we know it and shift costs to seniors.

That's right, under this proposal, seniors will see higher costs. Although it might seem like a good idea to offer seniors a choice between traditional Medicare and the voucher system, the budget does nothing to prevent private insurance companies from cherry picking the healthiest seniors and leaving sicker beneficiaries in traditional Medicare. As a result, premiums in traditional Medicare will skyrocket. At the same time, seniors who elect to switch to the voucher system will also be subject to higher costs because private plans are less efficient than traditional Medicare. Plus, private plans have additional expenses, such as advertising, agents' fees, and profits, which seniors would pay for with their premium dollars. The Congressional Budget Office (CBO) estimates that, each year, new beneficiaries could pay up to $1,200 more by 2030 and more than $5,900 more by 2050.

Second, the House budget repeals the Affordable Care Act and all of its consumer protections. This would hurt all Americans, especially those already benefiting from important provisions. For example, the provision that prevents insurance companies from denying coverage to children with pre-existing conditions would be gone. So insurance companies could again deny coverage of costly treatment for pre-existing conditions like asthma, diabetes, or cancer, and families would be left on their own to pay the bills.

Third, the Republican proposal cuts federal support for the existing Medicaid program by $810 billion over the next 10 years. States will have no choice but to cut health care for seniors in nursing homes, low-income children, and people with disabilities. And, by repealing the Affordable Care Act, the budget halts the Medicaid expansion set to begin in 2014.

Finally, the House budget takes a swing at middle-class families in favor of corporations and wealthy Americans. By repealing the Affordable Care Act, the budget denies 28.6 million families help with insurance costs. In exchange for taking away these tax credits, the Republicans propose tax breaks that total $3 trillion for the richest Americans and corporations.

While you would think that last year's backlash would have taught the GOP a lesson, it clearly fell on deaf ears. Although this year's budget might be framed differently, the big picture remains the same: House Republicans want to privatize Medicare, cut Medicaid, and repeal the Affordable Care Act-all at the expense of Americans who need help the most.

Thanks to the Affordable Care Act, people across the country will never again have to worry about being denied health coverage because of a pre-existing condition, being dropped from coverage because they got sick, or paying extraordinary out-of-pocket medical expenses.

But these critical benefits are being ignored by state officials who are using taxpayer dollars to challenge the law in court for political gain.

On Monday, the Supreme Court will hear arguments on the law, with a ruling expected by the end of June. We're confident the Court will uphold the Affordable Care Act, but we can't take this challenge lightly.

That's why on Friday, March 23 - in honor of the two-year anniversary of the Affordable Care Act - we're partnering with Mom's Rising, the National Council of La Raza, and Young Invincibles on a Tweet storm to show the justices that Americans support the law and want to see it upheld.

Getting involved is easy to do, just share your thoughts on how the Affordable Care Act is making a difference for your family and include the hashtag #HCRatStake. Or, feel free to use our sample tweets below.

Thanks for your help and we look forward to tweet-storming with you this Friday!

Sample Tweets:

#HCRatStake: Today we celebrate 2 years of success w/ #ACA. Make sure we can celebrate year 3. RT to tell #SCOTUS to uphold #hcr

If #SCOTUS strikes down #ACA – insurers can say ‘no' to coverage if you have a pre-existing condition. #HCRatStake

If #SCOTUS strikes down #ACA – women will lose access to no-cost birth control. #HCRatStake #itworks

If you're on #Medicare and #SCOTUS strikes down #ACA – you could end up paying more for prescription drugs. #doughnuthole #HCRatStake

No #ACA means lifetime caps, dropped coverage if you're sick, & no protections for pre-ex conditions. #HCRatStake

#ACA is about making sure people can get the care they need when they need it. RT 2 tell #SCOTUS uphold #hcr #HCRatStake

If #SCOTUS strikes down #ACA – young adults won't be able to stay on their parent's plan until age 26. #HCRatStake #itworks

No #ACA means higher premiums, more uninsured, fewer protections, & HIGHER deficit. #HCRatStake #itworks

No #ACA: unjust health disparities will continue to grow. RT 2 tell #SCOTUS uphold #hcr #itworks #HCRatStake

We agree with Joe Biden! It's a #BigEffinDeal. Tell#SCOTUS to uphold #HCR #HCRatStake

This blog is cross-posted from the National Council of La Raza.
By: Jennifer Ng'andu, Deputy Director, Health Policy Project, National Council of La Raza

It's probably the hottest seat in Washington, DC-and you can't buy tickets to it. Next week, the U.S. Supreme Court will begin hearing oral arguments on the constitutionality of the Affordable Care Act (ACA), the almost two-year-old health care reform law. For or against it, hundreds of people will line up on the steps to try and secure one of the limited seats in the Court reserved for the public. And for good reason: the Supreme Court's decision will have major bearing on the health care experiences of Americans for generations to come.

The outcome of this case is especially important for Latinos because it will dictate future health care access for a population that is increasingly a driving force in the country, but whose health has been put at risk because they are pitifully underserved in our current system. As the data from the 2010 Census revealed, Latinos, often perceived as an emerging population, have unquestionably come of age. Already one in four children in the United States is Latino-and that number is expected to increase to one in three by 2030. Yet Latinos have long been disconnected from the health care system, carrying many unnecessary medical burdens and ills throughout life.

Even from birth, Latinos have less equitable access to health care in almost every part of the system. Latino children have uninsurance rates double that of the general population. Furthermore, experts from the National Center for Disease Control and Prevention note that one in two Latino children born in 2000 are at risk of developing diabetes within their lifetime. Roadblocks to quality, affordable health coverage and care had been virtually cemented in place prior to the enactment of health reform. The Affordable Care Act was the first step forward in changing the status quo that made Latinos the most uninsured community in the country.

While lawyers and experts may disagree about whether or not the Affordable Care Act should move forward, there's no disagreement about one simple fact: this law has already shifted health care as we know it in the United States. From a parent's or caretaker's perspective, there are obvious gains that have been made in a short amount of time. Consider this:

• Most Americans should have seen their out-of-pocket medical expenses for necessary tests and screening decrease between 2011 and 2012. Seventy-two preventive services were declared free of charge for patients, meaning that services such as well-child visits became free. This was an important addition to the pocketbooks of Latinos, who dish out more of their resources for medical expenses than any other group.
• Key provisions in the law already require that states maintain eligibility levels for Medicaid. The protections have been vital in securing program access for the most vulnerable Americans, including the one in four Latino adults and one in two Latino children who are on Medicaid or the Children's Health Insurance Program (CHIP).
• An astonishing 736,000 young adult Latinos under the age of 26 were able to secure insurance through their parents in the two years after the enactment of the ACA. That is the highest gain in insurance of any racial or ethnic group, and a promising trend for a population in which 50,000 individuals turn 18 each month. Similar to their peers just entering the workforce or college, they may not have another option for affordable insurance.
• Finally, consumer protections have been heavily bolstered. For instance, insurance companies can no longer deny dependent coverage to a family with a very sick child.

So as the Supreme Court proceedings inch closer, legal jargon and political statements may rule the day. But hundreds of people camped out for seats show what-and who-is really at stake. Should we take away coverage for more than a million young adult workers just getting on their feet, or children suffering from cancer or asthma or heart conditions? That is exactly what would happen without the Affordable Care Act. Whatever the Supreme Court rules, one thing is undeniable-the Affordable Care Act has already and could continue to open access to health coverage for millions of Americans who need it.

This blog is cross-posted from the National Council of La Raza.
By: Jennifer Ng'andu, Deputy Director, Health Policy Project, National Council of La Raza

The Affordable Care Act turns two this Friday. The law is still fairly new, but some of the most significant progress during its infancy was made on behalf of America's elders.

The Medicare program's latest additions-a direct result of the Affordable Care Act-are designed to bolster access to high-quality health care, create efficiency in how the program serves seniors, and reduce health care costs. Now, Medicare's seniors can access dozens of free preventive care services and obtain a free annual wellness exam.

The U.S. Department of Health and Human Services (HHS) has chosen to profile the senior community today. Throughout the law's anniversary week, HHS will continue to highlight the rules and benefits that have already been put into place for many different communities that stand to gain from health care. You can access those resources here. Check out the first profile below.

These critical prevention benefits were among a set of program changes that, for the first time in history, give seniors the ability to establish a health care plan that meets their needs, instead of just using Medicare for the treatment of an illness or health condition. The services may be especially meaningful for many in the Latino senior community who often join the program after a lifetime without health insurance, and who are more likely to rely on Social Security benefits as their sole source of income in retirement.

Want more information on Hispanic seniors and the Medicare program? Check out NCLR's most recent statistical brief on Medicare, which offers state-by-state details on Latino enrollment in the program.

• Did you know that about 3.5 million Latinos access the Medicare program?
• Did you know that about one in four Hispanics on Medicare is also enrolled in the Medicaid program?
• Did you know that nearly half of disabled Hispanics use Medicare?

Lately, it seems like women's health and freedom are being attacked daily. Today, that attack comes in the form of a new rule in Texas that eliminates state funding for Planned Parenthood and other clinics that are affiliated with abortion providers.

This rule is in direct violation of federal law, which says that only patients-not state officials-can decide which provider is best for themselves and their families. Because the new rule violates this law, the federal government announced on Thursday that Texas will no longer receive federal funding that last year provided about $39 million for the Women's Health Program.

The Women's Health Program, which is Texas's Medicaid family planning program, provides care to about 130,000 Texas women between the ages of 18 and 44 who earn less than $20,000 a year, or less than $41,000 for a family of four. The program covers family planning exams, related health screenings, and birth control. Before the rule, Texas was only responsible for footing 10 percent of the bill, and the federal government picked up the rest of the tab.

Rick Perry claims that the state will make up this immense loss by funding the program with money from other parts of the budget, and he refuses to raise revenue to cover the loss. Unfortunately, Perry has already slashed $73 million from the state's family planning budget. Combined with Thursday's cut in federal funding, that's a loss of more than $100 million for essential women's health services.

Currently, more than 40 percent of all services in the Women's Health Program are provided by Planned Parenthood-the rule's primary target. So, unfortunately for Texas women and families, even if there were enough state dollars to fund the program, without Planned Parenthood, there would not be enough providers to meet women's needs.

But here's the biggest problem with all of this: The Women's Health Program never funded abortions in Texas because federal law already prohibits Planned Parenthood from using government funds for abortions. And let's not forget the now-famous chart that revealed the truth about the services that Planned Parenthood delivers. Critical cancer prevention and screening services, STD testing, and contraception account for 86 percent of Planned Parenthood's work. In contrast, abortions account for a mere 3 percent of the services that they deliver. Clearly, this rule misses its mark if its real goal is to prevent abortions.

On top of everything, 59 percent of Texas voters oppose the new rule and believe the Women's Health Program should be left alone.

The war on women's health wages on across the country. With this new rule in Texas-and with Arizona on the verge of passing similar legislation to defund Planned Parenthood-lawmakers continue to attack women's health by limiting women's freedom to decide what is best for their families and themselves.