That’s what a lot of young adults and employers used to think, which is why 1/3 of young adults were uninsured until 2010, the largest proportion of uninsured for any age group. As someone who is currently in this age group, I find the lack of coverage scary. This means that we were at higher risk for huge medical bills when we were working hard to pay off student loans or just trying to make ends meet living on our own for the first time. Just because we are young doesn’t mean accidents can’t happen or we can’t get sick: a distracted driver could hit us on the road, we could get hurt at work, or catch something from friends or co-workers. If we get really hurt or sick, the median hospital cost per person in 2008 was $18,142, and I don’t know about you but I certainly don’t have that much money lying around (http://www.facethefactsusa.org/facts/hospital-costs-nearly-double-in-decade/).

Some good news is that if your parents are insured, you can stay on their policy until you turn 26. This is because of the Affordable Care Act (ACA), the health reform law passed in 2010. But what if your parents aren’t insured? Or if you are over 26? Why should you spend your money on health insurance you might not need? There are many reasons, but I’ll highlight two.

First, it will likely save you money. The ACA made insurance companies cover a lot of preventive services for free, like well-visits and flu shots. As someone who did a lot of babysitting during school, I will tell you that a flu shot is a very important thing to have because I caught everything from those kids! Also, ladies, insurance companies are now required to cover birth control for free. That means it will cost you absolutely nothing to fill your prescription, or get an IUD or a hormonal implant.

Second, it will keep you healthier for longer because you won’t have to worry about being able to afford a doctor. You will have access to preventive care which means you can have regular conversations with the same doctor about any health concerns that you have, and you won’t have to worry about being able to afford a prescription or doctor’s visit when you are sick. If you have always had insurance, then this may not seem like a big deal, but it is. Not being able to see a primary care doctor on a regular basis means that conditions could go undiagnosed and untreated, which makes your health outcomes worse. If you get sick and don’t have insurance, you would potentially have to pay full price at an urgent care center for a strep throat diagnosis, and then full price for the prescription, which means you could pay over $100 for something that could have cost you $20 with insurance. Having to pay this much money would likely discourage you from going to get an illness checked out, meaning you would get sicker, miss more work, and it would cost more money to get better. Not an ideal situation if you are living paycheck to paycheck or trying to put some money away for a future purchase.

If your parents are uninsured or you are over 26, you don’t get insurance through work, and you make more than $15,000 a year, there is a health insurance option coming your way in October. This fall begins the enrollment in the Health Insurance Marketplace, an online marketplace for you to buy health insurance on your own. You simply fill out a three-page application, you are guaranteed approval, and you would get money from the government to decrease your premium if you make less than $45,000 per year. There is even a super cheap plan only for people under 30 (doesn’t cover much, but really cheap). The whole process will probably take you less than 10 minutes, and you will have health insurance. This means that if you get sick or get hurt, your biggest concern will be getting better, not how you will pay your bills. For some more information, check out our Young Adults fact sheet or www.healthcare.gov.

May is Mental Health Awareness Month and Americans use this opportunity to sponsor events and activities in communities across the country to help raise awareness about mental illness, reduce stigma, and bring attention to the inequity in coverage for treatment of mental illness. 

Mental illness is a real set of conditions that includes depression, bipolar disorder, anxiety disorder, attention deficit hyperactivity disorder and schizophrenia, among dozens of other disorders. Mental illness is also treatable. For too long, mental health has taken a back seat to physical health in our health insurance system, though it is just as important as physical health.  Mental health parity laws, including the Mental Health Parity and Addiction Equity Act of 2008, have taken important steps forward to stop the insurance company practice of arbitrarily limiting care for mental health or substance use disorders. Unfortunately, it can still be difficult for people with mental health disorders to find affordable, quality coverage.  Estimates show that one-fifth to one-third of the uninsured are people with mental and substance use disorders.

In 2014, the Affordable Care Act will provide one of the largest expansions of mental health and substance use disorder coverage in a generation. Beginning in 2014, all new small group and individual market plans will be required to cover ten Essential Health Benefit categories, including mental health and substance use disorder services, and will be required to cover them at the same level as medical and surgical benefits. In addition, substance abuse or mental illness can no longer be used by insurers to deny coverage as a “pre-existing condition” – and insurers also won’t be able to use those conditions to raise your premiums.

Thanks to the protections and expansion of coverage made possible by the Affordable Care Act our new health insurance marketplace will be more accessible and affordable for people with mental health and substance abuse disorders.

Elizabeth Blackwell's Women's Medical College 

At the tail end of Women’s History Month, we thought it appropriate to do a brief examination of women in health care, and their roles as providers as well as patients. 

Historically, women were looked to for medical care because it was considered a nurturing profession, and therefore “women’s work.” As western medicine began to develop, female health care workers were pushed further and further towards the margins into caregiving roles and their work focused on women and children.  In fact, the first modern female doctor was Elizabeth Blackwell, who graduated medical school in 1849.  Dr. Blackwell was rejected by 16 medical schools before her eventual acceptance, and went on to establish a hospital that specialized in treating women and children, as well as establishing a medical school for women.  Later that century, the chemist Marie Curie was instrumental in the development of using radiation to treat various illnesses, including cancer.  In 1970, a book entitled “Our Bodies, Ourselves” was published by women, for women.  This book was revolutionary because it addressed women’s health concerns head on and dispelled myths that women often thought were true about their own bodies. We have come a long way since these women in opening up the field of medicine to female physicians, but there is still a long way to go.  Though women, particularly mothers, are still the go-to source for health information in most extended families, only 27.8% of doctors are women.

Though there were many female pioneers in the field of health care, there was little understanding of what women actually needed out of health care.  According to physicians in the 1800s, the only differences between male and female bodies were reproductive organs, something we know to be false today. Even once physicians started to recognize the differences between male and female anatomy, progress in understanding the effect of those differences was halted in 1977 when the FDA banned early drug testing on women of child-bearing age.  Though this may seem like it was a good idea, this meant that drugs were being put on the market that had not been tested on about half of the population.  Women of child-bearing age were still being prescribed these drugs that had never been tested on someone like them, leaving them open to unknown side effects.  This ban remained in place effectively until 1993. Hopefully, the Affordable Care Act will continue progress into our understanding of women’s health.  Because of the ACA, insurance plans will be required to provide maternity coverage whether they are in the individual or group markets. Mammograms to women over 40 and some prenatal tests are now provided to women with no co-pay. Multiple forms of birth-control are also now available without co-pay.  These policies are significant improvements to women’s access to health care, and well worth the recognition during this month of celebrating women and their contributions to society.

Resources:

http://www.womenshealth.vcu.edu/pdfs_2009/Research-%20in-Women's-Health-History-and-Importance9-23-09FINAL.pdf

http://www.radiology-schools.com/women-healthcare.html

http://www.everydayhealth.com/womens-health-pictures/key-moments-in-the-history-of-womens-health.aspx#/slide-3 

Several years ago, a woman walked into my grandmother’s room at a nursing home to schedule a mammogram for her. Grandma told us she said something like this: “Are you crazy! I am 85 years old and I have been living in this place for five years already and you are worried about me having breast cancer?!” She lived in the facility several more years before succumbing to complications related to dementia. Dying today is quite different than it was a generation or two ago thanks to medical technologies that have extended life but frequently make dying an unnaturally long and slow process.  Unlike my grandmother, most of us are not as sure about what we want when it comes to our late life care and many of us have difficulty accepting death as an unavoidable transition in life.

Our rapidly growing aging population will need to give careful thought to medical care choices to ensure that wishes and needs are met throughout our lives, including during the final weeks, days and hours. With consideration of a time when it may be more difficult for us to express our wishes, it is important to put more emphasis on advance planning while we are still healthy and clear-headed enough to make reasoned choices. There is evidence that, done properly, guided discussions about those choices and advance planning can greatly increase the likelihood that patients get the care they really want throughout their lives. And, as a secondary benefit, planning ahead can help avoid costly tests, procedures and other heroic measures that steal time and resources that we can instead share with our loved ones.

These discussions and decisions are difficult ones but there are trusted sources we can turn to for guidance.  Faith communities offer significant, unrealized potential for outreach and emotional support around the complex issues of serious illness, caregiving, and grief.  A sizable majority of patients indicate that religious beliefs play a major role in the medical decisions that people make.[i]  Given that two thirds of Americans are members of religious congregations and 60% attend religious services at least monthly,[ii] faith communities seem to be a reasonable place for discussions around life-long care to begin.  

While faith communities vary widely in their ability to support people living with illness and grief, most faith communities express a desire to help during this important time. [iii]  There is tremendous potential for developing a common ground for education, dialogue and partnership among the health care community, families and faith representatives to prepare individuals and families for choices around health care, caregiving, dying and grief. The first step is to acknowledge the role that faith communities can play and then to look for ways to formalize that role. Once educated and prepared, faith communities can guide discussions about treatment and preferences in a productive and sensitive way. The faith community has a lot to contribute to the health and health care of our patients. Learning how to sensitively and appropriately take advantage of this resource in terms of health education, disease screening, and health promotion is a major opportunity for our health care system in the 21st century.

1. The Medicaid expansion for Virginians up to 133% of the poverty line
2. The development of the new insurance Marketplace

There were many steps in that process, but the final result was that certain reforms need to be implemented before Medicaid is expanded. Reforms include changes to Medicaid that mimic traditional commercial insurance, including limits on non-essential benefits, copays and wellness programs. The implementation of the reforms will be monitored by a special Medicaid Innovation and Reform Commission, made up of 5 senators, 5 delegates, the Secretary of Health and Human Resources, and Secretary of Finance, with the secretaries having no vote.  The 10 legislators will have the final say in when we expand Medicaid, likely no earlier than July 2014. 

Extending Medicaid means that:

• Adults making up to 138% of the Federal Poverty Level (approximately $15,500/year for a single adult) will be eligible to receive health insurance, including access to preventive health minimizing the need to seek care in the hospital emergency departments.
• Virginia will benefit with an estimated $2 billion in federal funds for Virginia's healthcare sector, 30,000 jobs, economic development, and new state tax revenues.

Besides the Medicaid expansion, there was also legislation that passed regarding the Health Insurance Marketplace that will start enrolling consumers in October.  Though Governor McDonnell said we are to have a federally controlled Marketplace, the General Assembly decided that it would be beneficial for Virginia to still have control over insurance plan management and rate review.  This means that Virginia will be able to pick which plans are available in the Marketplace for Virginians and will retain the ability to control the rise in insurance prices offered on the Marketplace.

ARLINGTON, Va. — The patient had been managing his high blood pressure with medicine prescribed by his doctor until he lost his job and his insurance. As a childless adult, he did not qualify for Medicaid under Virginia's formula, so he cut his medications in half to extend his supply.

What happened next is one example of why the legislature's upcoming vote on revising Medicaid qualifications matters so much to so many.

The patient “had a severe headache and was taken to the emergency room,” said Dr. Basim Khan. “He had suffered a stroke." The stroke left him paralyzed, thereby qualifying him for Medicaid. The state is now picking up half of his Medicaid tab.

Khan, a physician at Alexandria's Neighborhood Health Services, Inc. a clinic in Arlington, VA, said he sees many cases like this–people who make just enough money to be above Virginia's threshold to trigger Medicaid assistance, but not enough to afford health care insurance.

Khan says his clinic serves 13,000 patients a year, 80 percent of whom are uninsured. Another 150,000 uninsured patients attend clinics in nearby counties.

"By and large, these patients are the working poor. They work low-wage jobs, driving taxis, working in restaurants or fast food chains, working in department stores or other small businesses. They make a little bit of money but they don't get insurance and they certainly don't have the money to purchase it," Khan said.

Latino Virginians top the list of the state's uninsured, according to Deshundra Jefferson of Virginia New Majority. Although they represent only 8 percent of the state's population, Latinos represent 33 percent of its uninsured, followed by African and Asian Americans, each at 17 percent, and European Americans at 11 percent.

Jefferson and Khan argued the case for expanding Virginia's Medicaid formula at a recent convening of ethnic media hosted by the Virginia Interfaith Center for Public Policy. Estimates are that Medicaid expansion could put health care within reach of 400,000 uninsured Virginians.

Revising the Medicaid formula is now part of a larger partisan debate in the state legislature over multiple issues, including increased transportation funding and automatic restoration of voting rights for non-violent ex-felons.

The partisan vote count on Medicaid is shifting towards expansion but timing is crucial. The legislative session ends on Feb. 22. A few of the 20 Republican senators, including the influential Senate Finance chair, joined 20 Democrats to craft a bi-partisan budget amendment that passed Medicaid expansion by voice vote. The state's lieutenant governor, a Republican, also supports the expansion.

The newly proposed Senate budget would require Virginia to put in an initial $1.1 billion into next year's budget but get reimbursed by the federal government under the Affordable Care Act. The state would still have to cover $137 million in administrative costs spread over the next 10 years. Marco Grimaldo, CEO and president of the Virginia Interfaith Center for Public Policy, says the benefits Medicaid expansion would bring to the state are compelling — including making health insurance available to the elderly, disabled and childless couples like the stroke victim.

"Virginia is stingy when it comes to helping low income people with Medicaid," says Grimaldo. Only six states have a more restrictive Medicaid formula according to data from the Kaiser Family Foundation.

Most of those who will benefit from Medicaid expansion in Virginia earn between 30 percent and 100 percent of the Federal Poverty Level (FPL). The FPL takes into account family size. For example, in Virginia, if the adults in a family of three collectively gross $5,800 a year, or just slightly more than 30 percent of FPL, the family is ineligible for Medicaid assistance. Up to a yearly gross income of $19,090, or 100 percent of FPL for a family of three, the state would still not provide Medicaid assistance.

If Virginia opts in for Medicaid expansion now, the federal government will pick up the full costs of covering those in the gap for three years, from 2014 through 2016. Thereafter, the state will never pay more than 10 percent of those costs, "a very good deal for Virginians," Grimaldo notes.

The governor had stripped the $1.1 billion out of his submitted budget, so Medicaid expansion advocates like Grimaldo, Khan and Jefferson are urging the entire legislature to restore those funds as the Senate has done. If it does, the governor could veto the budget, requiring another legislative vote to override.

Grimaldo is optimistic. "On really key votes on certain occasions," he says,"we have seen bipartisan agreement."

New America Media, Video, Article: Khalil Abdullah / Video: Min Lee, Posted: Feb 15, 2013

For some of us, this season could also be the first one without a relative who died because of a lack of health insurance.  Estimates vary, but between 26,000-45,000 Americans die every year because they did not have health insurance or the money to cover medical costs.  When people can’t afford to go to the doctor, they live with symptoms until they can’t take it anymore and end up in the emergency room.  Once in the ER, many of them get life-threatening diagnoses like cancer, which could have been treated more successfully if caught earlier.  If these people had health insurance, their chances of affording treatment and surviving their illnesses would have been higher.   Comedian Chris Rock shared his experience with the health care system:

“My father got sick when I was 22…and I was poor… my father had an ulcer. And, it exploded and you know all these toxins get in your blood, and basically, you know, my father died, whatever,  50 days after.   So I had a father get sick while I was poor.  My mother got sick, while I was rich. And my mother…my mother was sicker than my father, okay, and my mother’s alive, my mother’s fine…If the average person really knew the discrepancy in the health care system, there would be riots in the streets.” If you want to watch the video, here it is: Chris Rock Talks Health care (strong language)

Photo courtesy Huffington Post (strong language in video)

In order to help prevent these deaths, the Affordable Care Act has provisions to help make health care more affordable to those with lower incomes, including a Medicaid expansion.  Medicaid is a health care program for low income families, the elderly, and disabled that is a partnership between the state and federal government.  In Virginia, childless adults are ineligible and parents are only eligible if they make less than $10,000 a year in a family of 4.

As a result of the Supreme Court decision this past June, states have the choice to expand Medicaid to 138% of the federal poverty level or not.  This would mean that childless adults making less than $15,000 per year and families making less than $30,000 per year would be eligible for healthcare.  If Governor McDonnell decides to expand Medicaid, over 420,000 Virginians would be able to get health care, about half of our uninsured population.   

Governor McDonnell is going to release his budget next week, and with it his decision about whether he wants to expand Medicaid or not.  We are hoping that Governor McDonnell will embrace the spirit of the season and give the gift of health care to 420,000 Virginians. 

Posted November 29, 2012

Dr. Chris Lillis practices primary care medicine in Fredericksburg, Virginia. His patients range from 14 to 102, with about 40 percent of his practice being Medicare enrollees. He loves primary care medicine because “you really get to know your patients. … I get to help them stay healthy through good times and navigate the health care system through difficult times.”

Because of the health care law, Dr. Lillis says his patients can get affordable health coverage and are better able to pay for their prescriptions.

“The Affordable Care Act absolutely is making a difference for my patients—the young folks who can stay on their parents’ insurance plans [and] my Medicare beneficiaries who can now afford their medicines more easily, especially when they fall into the coverage gap, the so-called ‘donut hole,’” said Dr. Lillis.

“In years past, I can remember patients who chose to avoid their screening mammogram or their screening colonoscopy because a deductible or copay was just too high and they had to make a decision between [paying] for the gas in the tank of their car or [getting] a preventive screening that could potentially save their life,” Dr. Lillis says. “Thanks to the Affordable Care Act, people don’t have to make those choices any more. They can receive their preventive care screenings without out-of-pocket costs, which is the best kind of care we can deliver as primary care doctors.”

And importantly, the Affordable Care Act encourages doctors to coordinate care for patients. The health care law is “going to help us focus on quality, not quantity. I want my patients to get the health care I think they need. The Affordable Care Act does that. It’s knocking down barriers to care,” he says.

BY KATHY MAY