Women’s Health Care and Your Taxes

When it comes to government decisions about women’s health, women in the United States have not had a good year. Funding has been cut at the Federal level and in most states. Planned Parenthood, with its low cost health services, has been under sustained attack since the new congressional freshmen took over. New abortion restrictions have passed in a couple of dozen states. Any way you look at it, women’s rights, particularly the rights of poor women, have taken a beating.

So it was a complete and pleasant surprise when the Institute of Medicine announced its proposed guidelines for what women’s health services would be covered under the Affordable Care Act with no out of pocket expense to those covered. (As a side note ‘no out of pocket expense’ is not the same as ‘free’)

The guidelines proposed that eight services be covered for all US women. These include birth control (including sterilization), screenings for gestational diabetes, cervical cancer and HPV, counseling to help women prevent pregnancies and to help women space pregnancies further apart, counseling and equipment to promote breastfeeding, annual well-woman visits, counseling and screening for HIV and other STDs, and screening and counseling for domestic violence.

Women’s groups including Planned Parenthood praised the guidelines, while certain religious groups, including so-called ‘pro-life’ groups and the Family Research Council, condemned them.

I say ‘so-called’ pro-life in this context because by any standard, the guidelines would clearly save lives, and improve the lives of women and children. When an organization stands against improved health care for women, it cannot accurately be termed ‘pro-life’.

These groups are raising the old argument that they shouldn’t have to pay taxes for something they’re morally opposed to. Hey, what a great idea! I propose that those of us who are really pro-life stop paying our taxes toward:

Wars in Afghanistan and Iraq
The imprisonment of large numbers of US citizens for non violent drug offenses in the so-called ‘war on drugs
Subsidies to oil companies, mining companies, and others who through negligence cause the deaths of thousands of humans and other creatures on a regular basis
‘Faith based’ ‘pray away the gay’ therapy paid for with Medicaid funding that has been shown to actually be harmful to participants.
Part of living in a democracy (or democratic republic) is that our taxes sometimes pay for things we don’t approve of. It’s the nature of the beast. If you don’t like it, you’re free to lobby against it, you’re free to protest, you’re free to attempt to get representatives to lead you that will support your viewpoint – but you’re not free to pretend that a democratic republic is rule by consensus. It is not. Consensus requires 100% agreement.

A democracy rules by majority, and that means that no matter who you are, no matter what your political views are, sometimes you will not agree with the laws you live under. Deal with it or not, but don’t come crying martyr to me. I pay my taxes, too. And I happen to think that making it easier for women to get health care is seriously pro-life.

Hospital Merger To Affect Women’s Health Services

The merger of University Hospital with Jewish and St. Mary’s is creating some controversy.

The hospital group will be 70 percent owned by Catholic Health Initiatives, and the merging systems have agreed to honor the Catholic Church’s rule against sterilizations.

That means a woman having her tubes tied as part of a C-section delivery would not be an option at University Hospital.

“No one should fear that they will not be able to get the full range of reproductive health services. We are a public university and we will serve the people from whom that support comes,” said Dr. Edward Halperin of the UofL School of Medicine.

That’s one of several promises the University of Louisville has made in a pending merger with Jewish Hospital and St. Mary’s healthcare.

The university also says it will honor the Catholic Church’s rules against reproductive procedures, such as tubal ligations, vasectomies and in-vitro fertilization.

“How is it possible? The same way it’s been possible in multiple other mergers in US and their various structures one does to maintain CHI’s wish to not be in violation of the Council of Bishops and our promise to provide service,” Halperin said.

UofL said faculty will continue to conduct abortions, tubal ligations, vasectomies, and stem cell research, though not within the merged facilities.

Officials would not elaborate on how those hospitals have solved the issue of women delivering by C-section and wanting their tubes tied in the same surgery, saying they are still exploring a number of possibilities.

“That’s one of hundreds of questions to be solved, but it will be solved,” Halperin said.

“Obviously, women’s health is not a priority to the university of Louisville Hospital,” said Honi Goldman.

Goldman said since 10 a.m. Wednesday, hundreds of people have signed up protesting of the merger stipulation.

“It is just amazing what happens when you get when you have people that are angry about something and they band together, and that’s exactly what happened,” she said.

Their names will be displayed in an ad along with information on contacting the hospital leaders.

“We want UofL to go back to the table and say, ‘This provision, this stipulation is not going to happen; it’s off the books,’” she said.

Officials said it would be about a year before the merger takes effect.

The ad in protest runs this weekend.

Health Group: Get Mammograms At 40, Not 50

One of the nation’s biggest women’s health groups is changing its position on breast cancer screenings.

The American College of Obstetricians and Gynecologists is now telling women to start getting annual mammograms when they turn 40 years old rather than 50.

By making the change, the group is siding with the American Cancer Society and the American College of Radiology.

A government panel however, is standing by its controversial recommendation against routine screenings for women in their 40s.

Why One IOM Committee Member Dissented on Women’s Health Report

The Institute of Medicine’s much-anticipated recommendations for which women’s health services should be covered by health plans without co-pays or deductibles came out yesterday. Among the eight services it recommends insurers cover at no extra charge — HHS will make the final decision — are all forms of approved contraception, breastfeeding support and breast-pump rentals and domestic-violence screening.

One member of the committee charged with coming up with the recommendations, however, had several issues with how the report was developed — so much so that he filed a dissent rather than endorsing the report.

You can read the dissent by economist Anthony Lo Sasso, a professor and senior research scientist in the division of health policy and administration at the University of Illinois at Chicago’s School of Public Health, on p. 207 of the report. It’s followed by a response from the other 15 committee members.

We caught up with Lo Sasso by phone today and chatted with him about his objections. First, he thinks the time frame provided for coming up with recommendations was too short — “barely six months” from the time the group came together to when the final report was submitted, his dissent says.

Lo Sasso also objects to what he calls a lack of a systematic approach to weighing the evidence for different services. His dissent says it’s “impossible to discern what factors were most important in the decision to recommend one service versus another.”

And he tells us the recommendations reflect “a mix of objective evidence combined with subjective evidence” that reflected the preferences of committee members. Lo Sasso wouldn’t go into specifics, saying that the members of their committees and their affiliations are a matter of public record.

Lo Sasso also thinks cost-effectiveness and other non-clinical analyses, while not part of the committee’s charge, should have been considered. For example, one rationale for preventive services is that they will reduce the need for more intensive inpatient services later on. If that doesn’t actually happen in real life for a given service, that should be part of the conversation about whether to require it be covered, he says.

“In general, when you have mandates in health insurance coverage for particular services, one needs to … worry about unintended consequences,” he tells the Health Blog. Otherwise premiums could end up going up for everyone.

The committee’s response to the dissent notes that while cost considerations were “outside the scope” of the committee’s charge, HHS may consider cost when it develops its coverage decisions. It also says the dissent includes “inaccurate statements regarding the committee process and its approach.” And it notes that “no other member shares the opinion that report recommendations were not soundly evidence-based.”

Committee chair Linda Rosenstock, dean of the UCLA School of Public Health, noted on a conference call with reporters yesterday that there was “an extremely strong consensus” on the report’s findings.