Closing Racial and Ethnic Disparity Gaps for Women
Posted by on July 19, 2013 - 11:57am

For all intents and purposes, the Affordable Care Act (ACA), the President’s signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and new means of accessing and paying for care will benefit them disproportionately. Nevertheless, with more than 20 percent of the nation’s Black population uninsured, more than 30 percent of Hispanics uninsured and a country still grappling with understanding and properly addressing disparities, just how far does the ACA take uninsured women in the US?

By mandating individual health insurance coverage and expanding the list of covered preventative services, ACA legislation should, theoretically, improve the quality of health care for women at a disproportionate risk of being uninsured and having low incomes. However, research has shown that having health insurance itself does not necessarily have a substantial impact if women cannot find a doctor to see them, do not have proper information about accessing resources, or are not treated in a culturally and environmentally competent manner.

Moreover, when the number of uninsured could be decreased by more than half, but being uninsured is not equitable across racial and ethnic groups in the US, what happens to our countries most vulnerable women and children?

It has been well documented that low-income women and those without employee-sponsored insurance (ESI) are more likely to be women of color. Kaiser and US Census estimates indicate that there are significant differences in insurance rates by race and ethnicity, with national averages approximating there are almost three times as many uninsured Hispanics as Whites. In Louisiana, for example, it is believed that more than 50% of the state’s Hispanics are uninsured, while only 18% of Whites are. In the same state, it is estimated that 30% of Blacks are uninsured, reiterating just how unbalanced our country remains and how terribly far we have to go to eliminate inequalities.

Even in Massachusetts, where health reform has been a success, the number of Blacks and Hispanics that remain uninsured is two and three times that of Whites, respectively.

Although the ACA takes us a step forward in giving many of the countries uninsured woman an insurance card, the US must address what to do about probable provider shortages that will result from a lack of primary care physicians and different utilization in care between races, ethnicities and gender. We must be prepared to understand both to cultural differences in demand and pent-up demand of the previously uninsured, as well as start to really face how to deal with persistent racial and ethnic inequality in this nation that shows itself in our health care system every day.

Employer-Sponsored Insurance Beginning to Dump Spouses and Children
Posted by on April 6, 2013 - 11:51am

Two weeks ago for Forbes I wrote about some of the unintended, but positive, consequences that could result from employers dropping employer-sponsored health insurance (ESI). Following that post, many weighed in about various other consequences of such behavior from employers and what that means for health care coverage for millions of families in the US. One issue in particular caught my attention; not only because of the touching stories associated with the discussion, but because of the unique and inspiring methods some providers are utilizing to compensate for the lack of insurance coverage.

As Jodi Carroll of VoteFacts.org underscored, millions of women in the United States are reliant on their significant other,s employer to provide their family’s health insurance. Women, in particular, are disproportionately reliant on husband’s employers for coverage, with children who are also dependents.

Although positives will most likely develop in the individual market due to ESI transitions, the current and near future are exceptionally frightening for many women as employers have started down that slippery slope by excluding many dependents from future insurance coverage.

Given the recent discussion in the media, spouses and children being dropped from employer coverage is a growing concern. In the context of a bloated and dysfunctional health care system, this significant and immediate alteration in health insurance coverage could be very difficult for many households to absorb financially, particularly if their income falls just above the threshold for federal subsidies to purchase policies in the upcoming health insurance exchanges.

But, what if these mothers and children had an option that could provide them with most of the services they need, and was easily accessible and affordable.

Throughout the nation, in response to shifts in health care, many small direct health care providers are opening shop. These direct providers are able to combat many concerns through price transparency, easy access and lower costs as they establish what is basically a menu of cash only services. Further, these one-on-one scenarios improve decision-making between patient and physician and take out the need for insurance and proof of citizenship.

While many services are not available through these direct providers, a bulk of what the majority of people need are. Chronic disease management, acute care services and preventative care are all available at a face value, affordable price.

Residents in North Carolina, for example, have embraced a shining example of this new system. Access HealthCare is a direct care provider in NC with results to be impressed by. One of their diabetic female patients, and her teenage son, had lost their health insurance when her husband them, taking his ESI with him. According to her KevinMD website interview, she was working two retail jobs to fund her diabetes treatment and medical, at a cost of $5,000 a year.

However, once she found Access Healthcare, her annual costs were reduced to $450 annually and her health care results improved.

Similarly, according to Dr. Brian Forrest, founder of Access Healthcare, “a patient who normally has an 80/20 plan (like Medicare Part B) might end up having to pay 20% of their fee to see a specialist for a stress echo. If the cardiologist I use gives them an 85% discount to just pay cash up front, then the patient actually spends less out of pocket by not using their insurance.”

Although not all medical care can be preventative or primary, Dr. Forrest contends that “only about 1% of the population gets hospitalized annually. Only about 5-10% of patients that seek care at a physician office cannot get the services they need in the outpatient setting.”

For now, most of what women and children need can be found in offices like those mentioned above. However, I would still encourage citizens to purchase, at minimum, catastrophic coverage for hospitalization.

Illinois to Create "Partnership" Health Insurance Exchange
Posted by on April 2, 2013 - 11:48am

Beginning in 2013, states will begin rolling out health care insurance exchanges as required by the Affordable Care Act (ACA). To this point most legislators, policymakers and health care experts have discussed the state-based and federal insurance exchange options at length. However, there is another form of insurance exchange that states are beginning to explore, and will soon be implemented in Illinois: the “partnership”.

In the state-federal partnership, states will divide obligations with the federal government. For this partnership model there is no requirement for a 50-50 split of labor, and the states are actually more of a facade whereby the consumers (individuals and employers) merely interact with the state. The federal government, on the other hand, will essentially perform all functions of exchange management except customer service and/or plan management. Moreover, states have the choice to run either one or both of those functions. According to former head of insurance exchange planning at HHS Joel Ario, “States that choose this option are ceding the more technical aspects of exchange activity to the federal government but can retain control
 of insurer oversight and consumer assistance.”

In the state-federal partnership model, the federal government will operate everything from consumer eligibility and enrollment to financial management and risk corridors. This essentially means that the federal government will take on most responsibility for the exchange, while granting states many of the perks they would receive if they had created a state-based exchange.

To date, only a few states have revealed that they intend to participate in a state-federal exchange. Here in Illinois, Governor Pat Quinn announced intention to run a partnership exchange in July of 2012. Since that announcement, the state has already received $39 million for the state, and this sum does not include monies issued for Medicaid expansion.

Currently, the Department of Health and Human Services (HHS) has written very little about this vague “partnership,” leaving many in Illinois wondering exactly what the collaboration will look like and how consumers will respond. The only known is that beginning in 2013, Illinois will embark down a new path for getting health care insurance to its citizens, and that will be facilitated through an exchange.

Health Care Reform Update: In Maps and Charts!
Posted by on November 28, 2012 - 11:45am

The re-election of President Obama ensured that the Affordable Care Act  will move forward in 2013. In the coming months and years American’s will see a series of sweeping changes that begin with state-level action for health care reform, impacting millions of American women.

However, with each passing day it seems that more and more states and policymakers are changing their minds about what the respective plans are for the future.

Within the first few weeks of 2013 states must make decisions about whether they will set up a health insurance exchange, what essential health benefits must be covered by insurance plans in their region, and whether the states will expand their Medicaid programs.

Due to the number of health reform changes coming, the complexity of these issues and regulations and the huge impact on women’s health, it is easy for anyone to fall behind. Even health policy experts see changes every day that alter our analysis and projected outcomes. To help sort through the chaos, a few experts have created tables, maps and blogs to help the rest of us out.

* A broad range of policy changes (in an easy to understand chart!) can be found on the new State Reform website. This website is a state-based online network that frequently updates the avowed intentions of each state.

* For visual people, the best new source for information is the ProPublica website which has created “The Outlook of ObamaCare in Two Maps” being widely circulated and the Wright on Health blog where writers (including myself) keep readers updated on changes weekly.

* The Kaiser Family Foundation has also created an entire tab on their website devoted to diagrams and updates on health reform. The search function within this tab further makes it easy to find exactly which issue of change one wants to see in visual form.

* More information on federal government extensions being granted to states and insurance plans can be located on the Department of Health and Human Services website.