Women, Obamacare...ooouuuch!!

     When it comes to healthcare and politics, there have generally been two areas that are off limits: women and children.  Do what you want to the fifty percent of the population that has an obsession with the TV channel changer, but you will lose votes if you corrupt care for the kids and their mammas.  So does The Affordable Care Act (Obamacare) stick to this maxim?  In particular, how does the not so new law of the land affect women?

    A substantial area of impact is preventative services.  Ideally, these are exams, tests, and studies that prevent disease instead of waiting to treat problems after they arise.  Since 2012, the following services are available to women with no co-pay involved:

  Well-woman visits.

  Gestational diabetes screening 

• Domestic and interpersonal violence screening and counseling.


• FDA-approved contraceptive methods and contraceptive education and counseling.


• Breastfeeding support, supplies, and counseling.


• HPV DNA testing, for women 30 or older.


• Sexually transmitted infections counseling for sexually-active women.


• HIV screening and counseling for sexually-active women.
  Mammograms and Colonoscopies (with certain restrictions for age)

    Remember, these services are not “free”; you are still paying for them with your premiums and deductibles.  It is vital to understand with all these changes there is no proverbial free lunch.  Someone is paying, and it is both the employer and employee who is supplementing both their own care as well as the care for those who don’t pay or are subsidized by the government.
    A somewhat controversial aspect of Obamacare is the mandate for contraception coverage.  The initial law stated that the following services would be mandated for coverage by insurance providers:

Barrier methods, like diaphragms and sponges
Hormonal methods, like birth control pills and vaginal rings
Implanted devices, like intrauterine devices (IUDs)
Emergency contraception, like Plan B® and ella®
Sterilization procedures
Patient education and counseling

    This coverage proved controversial among Christian hospitals, Christian charities, Catholic hospitals, and other businesses owned or controlled by religious organizations that oppose contraception on doctrinal grounds.  A compromise was reached that allowed religious organizations to opt out of the requirement to include birth control coverage in their employee insurance plans. In those instances, the insurers themselves will offer contraception coverage to enrollees directly, at no additional cost.  The controversy rages still with at least 63 lawsuits nationwide challenging the mandate.
    In addition to preventative services, women will have access to maternity care through their current insurer or through an expansion of Medicaid.  Policies issued by the ubiquitous health exchanges are also required to offer a level of maternity care.
    Proponents of Obamacare also state that women will benefit, although not uniquely, from the expansion of coverage, elimination of pre existing conditions, and government subsidies.
    Detractors of the Affordable Health Care Act quote generalized objections when asked specifically how Obamacare will impact women.  They raise issues of increased cost of premiums, restriction of access to doctors, being forced into Medicare or various health exchange plans, and cumbersome regulations.  All of these potentially will negatively effect health care delivered to women.
    A much less known but incredibly powerful regulatory agency may have a marked effect on women’s health care under the new law.  The US Preventive Services Task Force is a 16 member panel of appointed medical personnel charged with the daunting task of determining what constitutes prevention under the new law.  In other words, they decide if services, tests, and procedures are to be paid for.  More importantly, however; they also decide what won’t be covered, which can potentially restrict access either economically or pragmatically.  The word we all run from is rationing, yet on the surface it seems as if this is what may happen. According to their website the following services are not considered “justified” and will not be covered as preventative:

Chlamydia screening in most women over 25
Cervical-cancer screening in those over 65
Breast-cancer screening using digital mammography or MRI instead of the traditional x-ray.
Screening for ovarian cancer and the genes that raise a women’s risk of breast cancer   Clinical breast exams in women older than 40.
Even having a doctor teach women how to do a breast self-exam is unlikely to be covered, since the task force says women are rarely the ones to find their breast cancers.

    This is the same panel that said women should not get screening mammograms before the age of 40 and then sparingly between 40-50.  They also nixed the idea of routine HPV screening in young, sexually active women. 
    For women, The Affordable Care Act is a mixed bag.  While it creates a positive atmosphere where prevention is stressed , it also may limit certain choices and individualized care.  Now more than ever taking control of your own health by making solid healthy lifestyle choices becomes paramount. 

Youngsters Get The Shaft!

     A little known provision of ObamaCare could potentially financially wreck the system.  According to insurance insiders, if enough young adults avoid the new insurance marketplace, it could throw off the entire equilibrium of the Affordable Care act.  Young folks, not on their parents insurance or making too much to qualify for medicaid, are required to buy health insurance or be fined under ObamaCare.  The idea is that by forcing young healthy people into the “risk pool” you balance out the higher utilization by old fogies like me.  Can you say, redistribution? The irony of this is it is taking bucks from those just starting out to supplement us aging, decrepit, sick folks, who often times can afford it. 

     Wow, the young liberals who fled to the Obama camp in 2008 and 2012 may have to rethink all this. I mean, it was okay to redistribute the wealth when it flowed from the older successful people but they may sing a different tune when they have to shell out their paychecks even though they may have not been to a doctor for years.  It’s really a matter of economics (isn’t everything).  The average 26 year old can expect to pay $3000 a year in health insurance premiums under ObamaCare, whereas the “fine” for not purchasing insurance is a whopping $100.  Granted this increases over the years, but it never comes close to premium amounts.  So given that most 20-30 year olds feel they are invincible, what is the likelihood they will run out and spend beer and chips money on health insurance.  I think I can make an educated guess, a lot fewer than the delusional health wonks in Washington think.  This is simply another example of how many “what ifs” make up the ObamaCare fantasy. 
   
        

Speaking of penalties, we heard the other day that the administration has rolled back the date for instituting the “tax” on businesses with more than 50 workers who don’t provide insurance for their employees.  As Gomer Pyle used to say, Surprise, Surprise, Surprise! Maybe they figured out that businesses on the bubble, either right at 50 employes or close to it have either stopped hiring or shifted formerly full time employees to part time to avoid the penalties.  Did they really not see this coming?  Are they so captive in their ivory tower confusion to think that companies wouldn’t react this way?  The moment the IRS comes out with new taxes, there is a swarm of consultants, lawyers, and associated evil doers figuring their way around them.  The same thing is happening here.  Consultants are making a good living coaching businesses on how to “adapt” (i.e. avoid) many of the oppressive new regulations.  The authors of ObamaCare either were so deluded about the real world or the laws were so nebulous and uninterpretable that they never anticipated the work arounds.
    
     The bottom line is once again the law of unintended consequences rules supreme and ObamaCare will set new records for unintended consequences.  

Let the Lawyering begin!!

     A milestone in the implementation of ObamaCare was reached recently, at least that is what the newspaper headlines trumpted.  While I know it is hard to believe that anyone reads the newspaper anymore, I found the proclamation a bit perplexing and premature.  It referred to the compromise that the HHS wonks and religious organizations agreed upon to resolve the controversy surrounding contraception.  You remember that the original law mandated that, for example, Catholic hospitals had to pay for their employee’s birth control through their insurance plan.  Well, as you can imagine, this played at the Vatican about as well as Kim Kardashian at a Mensa meeting, so more than 60 groups filed lawsuits to stop the implementation of this mandate saying it violated very basic precepts of their religious teachings.  The government and these groups apparently had a Kumbaya moment and settled most of the legal wranglings and reached a compromise recently that allows the employees of said religious groups to have their birth control and eat it too.  In other words, very little on principle was really achieved. 

         
     This issue is much deeper than birth control, there are multitudes of rulings in the law that can be seen as moral rather than legal issues, and this compromise goes nowhere to settle the real question as to whether we want government dictating morals and ethics.  You might argue that is precisely what a government is for, to legislate and implement law that is moral, ethical, and in the interest of the general welfare.  If that is the case, I hope you are satisfied when legislators who have a different moral and ethical belief system pass laws that totally oppose your point of view.  A republic is based on a representative government, not a democracy, so the premise for such action is the Constitution, not the Bible, Koran, of Bhagavad Gita.  I have yet to see anywhere in the Constitution that the national government has the power to compel me to buy insurance and, as a business owner, pay for services I might object to.  I see this ruling solving very little and opening the floodgates of lawsuits of businesses objecting to everything from contraception to hospice care.  Let the lawyering begin!!     

An Apple a Day

Okay, okay, I realize that I have been less than generous in praising ObamaCare over the past several months, but it’s kind of like finding something good to say about a herpes outbreak.  This week I am actually going to mention a few of the things that may, and I emphasize the may, be

Anemia screening on a routine basis for pregnant women

Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer

Breast Cancer Mammography screenings every 1 to 2 years for women over 40

Breast Cancer Chemoprevention counseling for women at higher risk

Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women

Cervical Cancer screening for sexually active women

Chlamydia Infection screening for younger women and other women at higher risk

Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”

Domestic and interpersonal violence screening and counseling for all women

Folic Acid supplements for women who may become pregnant

Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes

Gonorrhea screening for all women at higher risk

Hepatitis B screening for pregnant women at their first prenatal visit

HIV screening and counseling for sexually active women

Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older


Osteoporosis screening for women over age 60 depending on risk factors

Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk

Sexually Transmitted Infections counseling for sexually active women

Syphilis screening for all pregnant women or other women at increased risk

Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users

Urinary tract or other infection screening for pregnant women

Well-woman visits to get recommended services for women under 65



    Whew! If you waded through all that I give you kudos.  Think about this for a moment, the government is mandating that your insurance cover these tests (and there are even more for kids and men) so what would you think your insurance may do if that is not already a part of your policy.  Do ya think they might jack up the premiums to compensate for the lost revenue due to mandated coverage...do ya??  I think we all know those answers, especially if you have seen your premiums recently.  This reveals another flaw in the system.  While I am not advocating a single payer system, the current structure allows insurance companies free reign to increase rates. Pundants claim competition in the exchanges will keep rates low, but how well has that worked in reality...not!
    So while I am a big fan of prevention and I am glad to see this kind of emphasis, remember...everything comes at a cost.

construed as good in this program.  Let’s start with preventative services.  According to the Affordable Care Act various screenings and preventative tests and check ups are encouraged and a person’s insurance has to cover them with no copay and no charge against the deductible. Below is a list of those tests for women (yes, this is a sexist blog) Oh and one other caveat, if your current plan was in force in 2010, this may not apply to you (clear as mud, I know):

The IRS Man Cometh

     In light of recent revelations, I feel it is both timely and appropriate to outline exactly the role of the IRS in administering ObamaCare.  What?  The IRS is involved in healthcare?? You bet your sweet premium it is.  The IRS, with the compassion of a pit bull in heat and the efficiency of the post
   

office, is mandated to play a key role in ObamaCare.  This is the same IRS that handles non profit requests as unbiasedly as Al Gore protecting an endangered polar bear. 
     The big stick, or big enema, that ObamaCare wields is a fine for anyone who doesn’t “buy” health insurance. (Remember buy is relative, if you are a middle class tax payer you are buying other’s health insurance for them with subsidies). So if you decide that rising premiums and falling coverage is not logical (imagine that) then who better to seek out and destroy your life, liberty, and pursuit of happiness than the IRS.  The Affordable Care Act (I giggle every time I say that) empowers the IRS to confiscate your tax refund to pay this new tax.  That means proving to the IRS you have insurance.  That means providing an inefficient, politically motivated, bloated bureaucracy with not only your financial wherewithal but also whether you had a prostate exam this year. So you are getting probed by both your urologist and a clerk at the Cincinnati IRS office who thinks conservatism is tantamount to leprosy.  Some one in the know was recently quoted as saying,
   
     “We the people have been told there is no choice. You must buy health insurance or pay the new Gestapo – the I.R.S.” 
   
     This wasn’t Rush Limbaugh or Glenn Beck...it was the Governor of Maine, Paul LePage. 
   
     In addition, Obamacare appropriates funds to hire new IRS employes to handle this influx of information.  Already the IRS has requested $473 million to begin the process (they didn’t specify how much was for line dancing instruction and Gilligan Island videos). 
   
     So to summarize, if you don’t have health insurance the IRS will be on you like Clinton on an intern. Now that’s an image that should make you sleep sounder at night.

Racism?? Are you kidding me!!

     A Louisiana state legislator, Karen Carter Peterson, recently made national headlines talking about opposition to ObamaCare by stating, “It’s about race. No, nobody wants to talk about that. It’s about the race of this African-American president.”
   
   
   

      Honestly I was wondering when it was going to come down to this.  This ignorant, manipulative rhetoric has been a staple of Obama supporters ever since he burst onto the national scene.  It is the fallacious argument that if you object to any policy or program it has nothing to do with the absurdity of the legislation, it is only because it is being pushed by a black man.  This is not only evil but insulting as it assumes that race is the only factor people consider when judging the benefits or downsides of an action.  Really?? Does this petty bureaucrat think so little of her president’s agenda that she has to ignore the substance and resort to a logical fallacy in defending the plan?  If I was to recommend to a patient that she have a hysterectomy, would her first inclination be to wonder about the validity of my advice due to my terminal Caucasian persuasion.  That’s absurd of course.  She would judge my advice based on the merits of the argument itself, pros and cons, benefits and risks.  So the American people are judging Obamacare based on the structure of the arguments not the fact that Barak Obama happens to posses an excess of melanin pigment. 
    
     When a policy is bad or failing, when logical arguments to defend it are proving illogical, when even supporters are horrified at how bad things are going, what is left is sycophants grasping for anything to bolster a crumbling building.  If the president was a woman, I’m sure there would be cries of sexism.  If the president was a Republican, there would be cries of wealthy elitism.  Let’s be honest, both sides can play this despicable game; however, we all acknowledge our revulsion at being labeled a “racist” and these Obamatons understand and exploit this political correctness with the fervor of a dog in heat. 
   
     I for one will not tolerate being accused of opposing this piece of legislation because of racism.  I oppose it because it is bad...pure and simple.  It will forevermore damage health care delivery in this country, bankrupt the national government, and hurt patients.  The president could be a troglodyte from Venus and I would feel the same way.     

On Memorial Day

    
   

So it is Memorial Day weekend.  A time marking the beginning of Summer, but much more importantly a celebration of those past and present who have sacrificed so much for us all.  The American military, in all its branches, seems to be more respected today than any other moment in my lifetime.  There is an unmistakable pride in the uniform, and those who wear it.  Family members proudly regale stories of loved ones currently or formerly defending our great country.  We relish the chance to say “thanks” to the stranger in uniform we encounter on the street.  It seems everyone loves the armed forces...then why do we seem to be giving them the old sucker punch in the gut when it comes to their health care? 
     Tricare, the current military health system, is under tremendous pressure to morph into ObamaCare.  The liberal ideologues that infest the Obama Administration are holding military families as economic hostages by jacking up Tricare premiums in some cases 70% in an attempt to corral military families into the quagmire of the Obama health exchanges.  Obama is telling America’s finest to pay up or ship out!  And this is not just the rantings of a middle aged baby hatching doctor, listen to the experts:  

   “The Affordable Care Act -- generally known as “Obamacare” -- could lead to increased health complications, emergency room visits and even shorter life spans for some veterans, according to a former under secretary of Health for the Department of Veterans Affairs.
     Dr. Kenneth Kizer, director of the new Institute for Population Health Improvement at the University of California, Davis, Health System, said the ACA’s creation of more healthcare options could cause increased “fragmentation” of care among vets who now rely solely on the Department of Veterans Affairs.
“Some data suggest that veterans receiving care from both VA and non-VA sources are more likely to be re-hospitalized and to die within a year compared with VA-only users,” Kizer wrote last year in a commentary for the Journal of the American Medical Association.”1

     So let’s hear it for the Commander in Cheat once again for giving the troops another great big Memorial Day “we don’t like you” enema to rid their system of one poorly run system and replacing it with an even worse alternative...ObummerCare.