Health Care For America Now

It came via certified mail, which was enough to make her nervous, but a quick glance at the return address actually made her stomach drop.  A certified letter from a health insurance company—could that ever mean good news?  For my close friend Margaret it most definitely did not.  Her health insurance company—one of the largest in her state and in the country—had begun digging into her medical history to scrutinize her original health insurance application.  Nine months had passed since she was approved and enrolled in the health plan, but now the company had some concerns. Enter the “Dear Health Plan Enrollee” letter.

When Margaret called me two weeks ago, letter in hand, she was confused and a little angry, but she was mostly just terrified.  Was the company allowed to do this? Why were they doing it now? Would she lose the health insurance that she so desperately needed?

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Today, April 28th, is Blog for Fair Pay Day. In recognition of this important day, our guest post by Lisa Codispoti, Senior Counsel for Health and Reproductive Rights, National Women’s Law Center, relates to health care and equal pay.

Between 2000 and 2006, health insurance premiums increased 87.5 percent—4 times more than wages. In addition to the burden of inflated health care costs, women are still paid only 78 cents for every dollar earned by men—with women of color earning even less. In a world where women are earning significantly less than men for comparable work, how can they also afford health care?

Pay inequity for women compounds the issues that already exist with our broken health care system. This is a system that makes unfair practices by insurance companies flourish, such as allowing health to be more expensive for women. For example, women pay higher premiums than men when they try to buy health insurance directly from an insurance company through the individual health insurance market (a practice known as gender rating.) Even worse is that many of these health plans do not cover maternity care or expect women to pay an additional fee (what is called a rider) to gain maternity coverage. Women are then left trying to stretch their already smaller paycheck for a much larger health care bill.

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Rural Americans, such as those that make up 65% of Montana's population, are being hit hardest by America's health care crisis.

We are far more likely to pay higher out-of-pocket medical costs and incur greater expenses for emergency room care, and we are 70% more likely to be underinsured, according to a research paper published in Health Affairs entitled "Out of Pocket Health Spending and the Rural Underserved." As Lil Anderson, Jim Paquette, and Nicholas Wolter - all Montanan health care providers - explained in the Billings Gazette last week, one in five Montanas is uninsured, rising health care costs are squeezing even families that have health insurance, and Montana's small businesses and by extension, our families, are suffering:

We all have a stake in fixing the health care system, and the fix is one vital step toward reviving the U.S. economy. As the economy falters, businesses - especially small businesses - are struggling under the weight of rising health costs. Many businesses are forced to choose between providing health coverage or eliminating jobs. And families are forced to spend more of their incomes on health care. We need to get the economy back on track and develop a health care system that protects human dignity while delivering high-quality, affordable care to everyone.

Montanans are suffering in a large part because there is no meaningful competition in our state's health care market. According to the American Medical Association [pdf], one insurer, Blue Cross Blue Shield of Montana, controls 75% of the market. With competition like that, no wonder prices are soaring even faster here than in other regions of the country!

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Comprehensive health care reform is front and center in the nation's policy debate.  As President Obama has said, "Health care reform cannot wait, it must not wait, and it will not wait another year."

Now, you have an opportunity to help shape health care reform to meet the needs of working families.

The AFL-CIO and Working America want to know about your experiences with America's health care system-what's working, what isn't, what costs too much and more. Make your voice heard by taking the 2009 Health Care for America Survey.

Tallied results of the survey, sponsored by the AFL-CIO and its 2.5 million-member community affiliate Working America, will be shared with national and state leaders and the media. Congress, the administration and the media are hearing plenty about health care reform from drug makers and insurance companies - they need to hear from working families, too.

Millions of working families are paying a steep price for a health care system that's just not working anymore:

• Forty-one percent of working-age Americans had problems paying medical bills in 2007, and four in 10 of those used all their savings to pay their health care bills.
• About half the families that file for bankruptcy do so at least in part because of health care debt.
• In December and January, nearly 50 million people had no health insurance. About 14,000 people a day lost their coverage during those months.
• Uninsured adults are 25 percent more likely to die prematurely than adults who have insurance.

The survey asks specific questions about your household's health care coverage and costs. Does you family have health care coverage? Does your health insurance cover the care you need at a price you can afford? Has an insurance company denied you coverage or treatment because of a pre-existing condition? What should be included in health care reform?

The 2009 survey also provides an opportunity to tell your health care story in your own words-in writing or in a video.

While individual survey responses are confidential, the AFL-CIO will share the compiled results with Congress, the Obama administration and state lawmakers, as well as print and broadcast media. Last year, more than 26,000 people completed the 2008 survey, and 7,500 shared poignant stories about their families' health care experiences. That survey gained widespread media coverage and kept health care at the top of the national agenda during the 2008 elections. The 2009 Health Care for America Survey is expected to receive even more responses and media attention as health care reform moves forward.

Take the survey here. Encourage your friends, co-workers and family members to do so as well. No one can make America's leaders understand what working families go through in today's health care system like you can.

At 12:30 this afternoon, I joined a line of people that had formed by the White House gate, eager to enter and begin the critically important task of debating and advancing the effort to achieve health care reform this year. A beautiful, warm day, the talk was of the thaw in Washington — and not only regarding the weather. I had the chance to talk with leaders on health care reform in the House and the Senate, from both parties and with varying positions and approaches, and to press them and the many others who were there to address the needs of women and their families. There were close allies of the National Women's Law Center sitting next to those with whom we do not often agree, trading ideas and business cards.

While it would be foolhardy to think that all differences will magically disappear, the tone was constructive (dare I say even friendly), the mood hopeful and the setting a powerful reminder that the public good must prevail. What was striking was that a positive tone existed, not only in front of the cameras but in private conversations throughout the day. Wanting to read it tonight, one Republican member of the House asked me for my own copy of the Center’s report on the outrageous practice of many insurance companies to charge women more than men when they buy insurance directly — even with maternity coverage excluded! This “gender-rating” practice underscores how unfair and arbitrary the system can be, and the extra hurdles that women have to overcome.

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Mitch McConnell and several GOP Senators wrote a letter to President Obama in opposition to a public health insurance option saying:

“Forcing free market plans to compete with these government-run programs would create an unlevel playing field and inevitably doom true competition,” the letter stated.

It is ironic that McConnell would claim that true competition would be doomed because true competition currently does not exist in the health care market. According to the American Medical Association, a single insurance company controls 50% or more of the market share in 64% of the nation's 313 health care markets. In 96% of the nation's markets, one health insurance company controlled at least 30% of that region's health care market.

Due to the lack of competition, there is little motive to control costs in order to compete - meaning that many folks simply can't afford health insurance. A recent study by Families USA showed that 1 out of 3 Americans under 65 (people over 65 automatically qualify for Medicare) lacked health care for some or all of 2007-2008. The biggest irony is that that of that group, 4 out of 5 were in a household with a full time worker and still could not afford health care. With so many Americans uninsured and health care costs causing someone to file for bankruptcy every 30 seconds, it's clear that there is not adequate competition for providing working families with quality, affordable health care.

Jacob Hacker recently released a proposal calling for a public health insurance option. A public health insurance plan would not only provide a quality, affordable guaranteed backup plan for all Americans, but would force the monopolistic insurance industry to provide better and cheaper plans. A public health insurance option would improve private health insurance plans by providing the competition necessary to spur the needed cost containment and quality improvements for all health insurance options. Furthermore we can afford to do it as Hacker points out that a public health insurance option could save the United States $65 billion dollars a year.

To read more about the public health insurance option visit here or read this excellent interview Jacob Hacker gave with Ezra Klein of the American Prospect here. In the meanwhile, call your Congressman and Senator and tell them to support the inclusion of a public health insurance option so that all Americans can have access to quality, affordable health care.

(also posted at Yinzer Solidarity)

This post is part of a series on Women and Health Reform.

African American women aren’t any more likely to get a cancer diagnosis than white women (in fact, incidence rates for some cancer types—like breast cancer—are considerably lower among African Americans) but they are more likely to die from it. According to a new report from the American Cancer Society, the cancer death rate for African American women is 16 percent higher than the rate for their white peers. This racial disparity reflects poorer survival due to later stage at diagnosis and less access to appropriate and timely treatment, with the authors concluding that this type of health inequity is the result of “social and economic disparities more than biological differences associated with race.”

The disparity in death rates among the two groups is even greater when you examine rates for specific cancers. Compared to white women, African American women are more than twice as likely to die from cancers of the stomach and cervix. They’re nearly 40 percent more likely to die from breast cancer—the most common cancer diagnosis for women of both races. These statistics might be a little less distressing if the disparity gaps were shrinking over time, but they are not. Over the past three decades, the gap in overall cancer death rates between African American and white women has barely budged; for colorectal and breast cancers it has actually grown.

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An editorial in last week’s New York Times called attention to problems in the field of home health care, noting that health paraprofessionals who provide direct care to the elderly and disabled (“direct-care workers”) represent one of the fastest-growing occupations in the country yet remain unprotected by basic labor standards.  As such, the home health field—whose workers the NYT piece describes as among the “lowest paid and most exploitable”—suffers from very low job retention, with annual turnover of 40-60 percent on average.

The challenges that direct-care workers face are familiar to us.  Ninety percent of these workers are women.  Moreover, direct-care workers provide the bulk of the long-term care received by the nation’s elderly and disabled, and women comprise 2/3 of all long-term care consumers.  Women are heavily represented on both the giving and receiving ends of this type of care, and disproportionately feel the negative effects of poor-quality jobs for direct-care workers.

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Yesterday, The Institute for America’s Future hosted a conference, “Thinking Big Forward: A Conference on America’s Future.” The keynote speaker was renowned economist, Paul Krugman. In his speech he talked about how for 30 years this country has been dominated by a political movement that believes that government is not the solution, but is the problem.

Thinking like this leads to decisions like classifying ketchup as a vegetable in school lunches in 1981. Much hay was made of that huge gesture of disregard for future of health of America’s children, but in the final analysis that type of thinking won. We still only spend $2.57 per lunch for children in public schools over twenty years later.

Krugman explained that what you lose when a society is dominated by this type of thinking is investment. We lost investment in the things that raise the quality of life and general health and welfare for everyone in America. However, this economic crisis offers an opportunity to reopen the discussion about investment in the future. We spent the 30 years short changing public investment and Krugman believes that “it’s about time to start moving that pendulum back in the other direction.”

The Institute for America’s Future released a report that outlines what types of investment we need to make, including significant investment in a health care infrastructure that will provide quality, affordable health care for all.

The U.S. House Ways and Means Committee has put out legislative language for their version of an economic stimulus. As expected, the health components include increased Medicaid matching funds for states, subsidies to help the unemployed pick up COBRA coverage, and investment in health information technology. All of these are appropriate given the economic crisis: They will provide help and coverage to people losing insurance because of the recession and they will quickly increase government spending to stimulate the economy. But what makes the provisions particularly promising is that they represent a "first round" of health reform.

For example, a big problem in getting medical providers to move towards electronic record-keeping–which cuts down on medical errors and improves efficiency–is that they don't want to shoulder the cost. Now government will be bearing a lot of that cost. The increased Medicaid match for states will help prevent many of them from making proposed cuts in public programs–which, needless to say, is counter-productive at a time when we're trying to expand coverage.

The most exciting proposal that acts as a "down payment" on health reform is the provision that will allow states to expand Medicaid, temporarily, for unemployed adults. Many people think our public coverage programs cover the poor, but the truth is that they only cover some of the poor. Medicaid largely covers low-income children and parents, and the "aged, blind, and disabled." But there are many adults who don't have a child at home, who are not eligible for any public program-even if they are under the poverty level, which is $10,400/year for an individual, $14,000 for a couple. Sometimes called "medically indigent adults," they are left to whatever their county decides to provide in terms of a safety-net service.

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