Health Reform: Good for Mothers, Good for Families
Posted August 18th, 2009 by Say Ahhh!Julia Kaye is a Health Policy Associate at the National Women’s Law Center and regular contributor at womenstake.org. The following was a guest post she wrote for Say Ahhh!
There is a common misconception that all low-income people–or, at least, all poor parents–are eligible for Medicaid. It may derive from a mistaken comparison with Medicare; an assumption that just as Medicare covers all people above a certain age, Medicaid must cover all people below a certain income level. In fact, only certain, limited categories of low-income people–children and pregnant women are two examples–are currently eligible for Medicaid, and the income threshold for each of these eligible populations varies by state.
While most states do not provide Medicaid coverage to childless adults at all–even those without any income–parents with dependent children are categorically eligible for Medicaid. In other words, states must cover some parents. However, because states are given great flexibility in setting the income eligibility threshold for parents, even very low-income parents often do not qualify for coverage. In Arkansas, a parent is only eligible for Medicaid if her income is below 17% of the federal poverty level (FPL)–$3,112 a year for a family of three. In Alabama, Idaho, Indiana, Louisiana, Missouri, and Texas, a parent of two making more than $5,310/year is ineligible for Medicaid. It’s no wonder that, as Martha Heberlein previously noted, 41% of parents with incomes below 150% FPL are uninsured.
It is important to note that when we talk about “parents” and Medicaid, we’re mostly talking about women. Over 20 million women are covered under Medicaid, comprising the majority (69%) of the program’s adult beneficiaries. Women are more likely than men to qualify for Medicaid because they tend to be poorer and are more likely to meet the program’s stringent eligibility criteria. Women are also more likely to hold low-wage or part-time jobs that do not offer employer-sponsored health benefits, so Medicaid may be their only possible source of coverage.
Health reform must provide coverage to the low-income mothers who are falling through the gaps.
New research conducted by the National Women’s Law Center begins to quantify health reform’s potential impact on low-income women with children–and the findings are dramatic. If Medicaid is expanded to all people with incomes at or below 133% of the federal poverty level (FPL), nearly 4.5 million uninsured women would be newly eligible for coverage–including over 1.6 million uninsured mothers.
Health reform would bring financial relief to moderate-income families as well. If premium subsidies are made available to people with incomes between 133% and 400% FPL, approximately 5 million uninsured women with children stand to benefit (including 4 million uninsured mothers and 1 million mothers currently purchasing health coverage in the individual health insurance market).
The list goes on. Health reform that sets essential benefit standards will help ensure that all women have access to the basic health care services that many plans currently exclude, such as maternity care. Currently, it is very difficult–and sometimes impossible–for women to find coverage for maternity care in the individual health insurance market. In fact, a National Women’s Law Center study found that the majority (59%) of individual health plans did not cover maternity care at all. Health reform recognizes that women don’t just need health insurance in name; they need meaningful coverage.
Health care reform also holds the promise of long-overdue insurance market reforms, many of which are critical for parents. Today, insurers in every state can exclude coverage for certain “pre-existing” conditions. If a woman has previously had a Cesarean section, for instance, insurers may refuse to pay for future C-sections or reject her application altogether. Given that nearly one in three births were by C-section in 2006, hundreds of thousands of women could face coverage exclusions or rejections because of this discriminatory practice. Health care reform will prohibit this unconscionable practice.
Reform that makes health care more accessible and affordable for women, important on its own merits, will also improve health care access for their children. Women make approximately 80% of health care decisions for their families. As Martha pointed out, children’s health and well-being can be significantly affected by their parents’ health and financial stability, and research has shown that providing coverage to parents promotes coverage and access to care for their children as well. Furthermore, it is self-evident why comprehensive maternity coverage (and a prohibition of pre-existing conditions exclusions) is important for children’s health.
Our health care system is failing women and their families. Fortunately, we’re closer to achieving significant reform than ever before. At this critical hour, it is all the more important that we advocate for health care reform that meets women’s needs–it is their health, and the health of their families, that hangs in the balance.
The views expressed by guest bloggers do not necessarily reflect the views of the Center for Children and Families.
8 Comments
MomRising,
Thank you for the email regarding Nichole T’s mother. It is very sad story and we should all hope and pray for this family to receive the help they need.
Our private health care system does need to be reformed and regulated to protect people like Nichole’s mother however I believe that the current bill being concidered is incompetent. Can any of us say that we have faith in government agencies like Social Security, Medicade and Medicare. I am 49 years old and expect that I will never receive any benefit from these agencies. A government run health care system will be aweful, please read my story below to understand my comment.
Our Story:
My spouse was diagnosed with congestive heart failure 6 months ago (very serious, she was hospitalized for 1 week and bed rest for many weeks).
She was deemed by doctors to be disabled and could not return to work. After several months doctors said that she need a defibullator\pace maker. Even though her healthcare insurance had expired and was in question the HMO did the surgery at a cost of $40,000, this cost will be absorbed by private health care if needed. As a private health care members I will cover the cost through premiums and am fine with that, for her, for anyone, thank goodness for private health care. The good news is that we are paying for Cobra coverage and she is fully covered by private healthcare, thank goodness for private healthcare.
NOW HERE IS THE INTERSTING AND VERY SAD PART.
She applied for social security disability benefits 5 months ago (she did not opt for long term disability, I REALLY wish she had). The doctors cannot give her a work release due to her illness and all necessary documentation has been provided to the Social Security Department yet she has been denied twice. Our bills are piling up and we are a bit desperate, there seems to be no hope. If this healthcare bill is passed I believe that it will function in the same way as Social Security. We will all be treated like cattle, passed on to one minimum wage employee after another and left with more questions than answers. I believe in my heart that if the government made the decision about whether or not my spouse would receive the vital defibullator/pace maker she needed it would take months, I may be alone today.
EVERYONE, PLEASE CALL YOUR CONGRESS REPRESTENTATIVE AND SAY NO TO THIS BILL. I DREAD THINK THAT GOING TO A DOCTOR WILL BE LIKE STANDING IN LINE AT THE POST OFFICE.
Everything I have written above is true, I have no reason to lie about this. Please don’t subject us to another government controlled bureaucracy.
If anything we need a simple bill that would cover the uninsured for serious healthcare needs, say no to this bill. The bill is over 1,000 pages long and nobody understands it fully including our President and many in Congress. Please make them go back to the drawing board and author a bill that will benefit the people, not control them. If the plan is so good, why will our government officials NOT be subject to it as well?
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Sue Reply:
August 27th, 2009 at 8:13 am
@Robert Mace,
My heart goes out to you and your wife. But you are absolutely correct in your concerns about how your wife would be treated under a national health plan administered by our government. Our healthcare would go the way of public schools, social security, the IRS, and even the Postal Service. And for those on Medicare, our nation was beginning to see the unraveling of that program until the Advantage program kicked in and members were able to sign up for an efficient MCO.
I hope you wife’s health condition continues to improve. Her survival is no doubt due to recent medical advances in our national healthcare system that enable cases like hers to live longer, productive lives with their families and loved ones. God bless.
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Hechicera, the information that I reference came from an essay by Dr Scott Atlas, a senior fellow at the Hoover Institute and a professor of radiology and Chief of Neuroradiology at Stanford University Medical School. Dr Atlas is a physician with research interests at Hoover Institute centering around issues pertaining to public policy in health care. The information provided in my previous blog pulled from that essay that was posted on the Hoover website entitled “Here’s a Second Opinion” (http://www.hoover.org/publications/digest/49525427.html), which lists 10 reasons why America’s health care system is in better condition that you might suppose.
Dr Atlas is also an editor of the best-selling textbook in the field entitled “Magnetic Resonance Imaging of the Brain and Spine”. He is also editor, associate editor, and a member of the editorial boards of numerous scientific journals and has been a member of the boards of many major scientific societies over the past decade. Dr Atlas has authored more than 100 scientific publications in leading journals and lectures throughout the world on a variety of topics, most notably advances in imaging of the brain and the key economic issues related to the future of such technology-based advances.
Dr Atlas has been named by his peers in The Best Doctors in America every year since its initial publication, as well as in regional listings, such as The Best Doctors in New York, Silicon Valley’s Best Doctors, Top 500 Doctors in the Bay Area, and other similar publications. Prior to his appointments at the Hoover Institution and Stanford University, Dr Atlas was on the faculty of University of California at San Francisco, University of Pennsylvania, and Mount Sinai Medical Center in New York City.
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August 25, 2009 at 11:04 am by HechiceraChris if you use statistics, please back them up with the study. Some mom’s have worked in medical research.
Your statistics are quite misleading. I think they were lifted from some talking points where you never saw the base studies. Your first point is about breast and prostate cancer. Those numbers are listed from the CONCORD study (Lancet Oncology 2008).
- picking the only cancers where the US did better than the UK and ignoring all the other cancers where the UK did better is using statistics to lie
- Cuba did better than the US on these cancers, do you contend I should move to Cuba as, if based on your data source alone as criteria, I would be better there?
- Canada was within 1% of the US on this statistic and beat us in others, I prefer their system to the UK, using your data source (properly) I absolutely shoudl move to Canada if I want the best overall statistical chance to survive cancer
- the data for the US (and Cuba) is not considered reliable. In the US not every citizen is in the health tracking system. Actually, in the US people without insurance aren’t in the data! The CONCORD study specifically points this out.
Nifty! So that survival rate is the US primarily based on those with insurance.
Let’s do more math.
Percentage of uninsured – 15.3%
If uninsured, your death rate will be 100%.
So our statistic has a hidden extra 15.3%.
Mortality of insured: 16.1 %
Mortality of UK (all insured): 31.3 %
Percentage in US that die with uninsured added back in:
31.4%
Ooops. The only difference is how we chose to ration care. Oh and we spend twice what the UK spends as a percentage of GDP to get a number that is .1% worse. Your economy and small businesses want relief from a broken system as well.
Compare to Canada’s system instead of the UKs. The US already cherry-picks it’s data reporting, and then you cherry-picked the one cancer where the US actually did well in it’s cherry picked data, and compared it to the worse country.
Damn lies and statistics.
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August 18, 2009 at 6:05 pm by Chris JohnsonYou are so right about the need to expand Medicaid Services to families and children at higher poverty levels.
The critical issue in the healthcare reform debate is what solution is best for American moms and their families. Can we tweak our system so that more are covered without dismantling existing healthcare systems? And if we are successful in ensuring the 47 million who are uninsured, how will the same number of doctors and hospitals be able to accomodate this influx of new patients; there will no doubt be longer lines and more difficulties in getting appointments for care.
Does a national plan make sense? What does it bring that other insurance plans don’t. Anyone with a high school education should know that the phrase “AFORDABLE HEALTHCARE” means healthcare that doesn’t pay as much for services, or doesn’t pay at all for services. Take Medicaid for example; Medicaid funds cannot be used for cosmetic purposes. So Medicaid members cannot get plastic surgery to repair injuries and birth defects. Additionally, most state Medicaid plans will not cover fertility enhancement drugs or impotency medications. Will Americans agree to having politicians and government decide what is covered and what is not?
We are a melting pot of people who value liberty and freedom. The healthcare solution should uphold those ideals and not burden the American public with overwhelming tax increases. In addition, anything that is proposed that risks freedom and choice is subject to corruption and tyranny.
Finally, Beware of universal and national promises. There is little evidence that they work in the countries that have them. Their citizens are stuck with no other alternatives or options. Americans will not stand for this form of healthcare reform. Nor will Americans accept the lower standards of national healthcare programs throughout the world:
1. Americans have better survival rates that Europeans for common cancers. LISTEN UP MOMS!!! Breast cancer mortality is 52% HIGHER in Germany than in the US and 88% HIGHER in the United Kingdom. Prostate cancer mortality is 604% HIGHER in the UK and 457% HIGHER in Norway. The mortality rate for colorectal cancer among British men and women is about 40% HIGHER.
2. Americans have lower cancer mortality rates than Canadians. BREAST CANCER mortality in Canada is 9% HIGHER than the US; prostate cancer is 184% HIGHER, and colorectal cancer among men is about 10% HIGHER.
3. Americans have better access to treatment for chronic disease than patients in other developed countries. 56% of Americans who could benefit from statin drugs for high cholesterol, diabetes, and heart disease are taking them. Statins are the gold standard of care for cholesterol control. By comparison, only 36% of the Dutch, 29% of the Swiss, 26% of the Germans, 23% of Britons, and 17% of Italians receive them.
4. Americans have better access to preventive cancer screening than Canadians.
– 89% of American women have had a mamogram compared to 72% Canadian women.
– 96% American women have had a Pap smear compared to 90% Canadian.
– 54% American men have had a PSA test compared to 16% Canadian.
– 30% Americans have had a colonoscopy compared to 5% Canadian.
5. Lower-income Americans are in better health than comparable Canadians. 11.7% American seniors with below-median incomes self-report “excellent” health compared to 5.8% Canadians. While white, young Canadians with below-median incomes are 20% more likely than lower-income Americans to describe their health as “fair to poor”.
6. Americans spend less time waiting for care than patients in Canada and the UK. Canadian and British patients wait twice as long – sometimes more than a year – to see a specialist, have an elective surgery such as hip replacement, or get radiation treatment for cancer. Right now, 827,429 people are waiting for some type of procedure in Canada. In the UK, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.
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Anonymous Reply:
August 19th, 2009 at 10:02 am
@Chris Johnson, about the “new influx of patients” and whether doc.s and hospitals can afford them: I would like to know on what basis you assume that the uninsured do not go to doctors and hospitals. We get sick like everyone else. But we have to pay out of pocket. And many of us end up declaring bankruptcy for medical costs. In fact the number of bankruptcies caused by medical bills is ridiculously high. I want to say 63% but the numbers aren’t sitting here in front of me. Re the lower standards of national systems: we may have better cancer survival rates, but we have horrific mother and infant mortality rates by comparison. I disagree, too about better access for chronic conditions. My sister is a type 1 diabetic, without insulin she dies. Her health insurer dropped her. She didn’t do anything wrong, they just dropped her. She is too sick to work full time and therefore can’t get benefits that way. Why is she so sick? Because she cannot get new insurance due to her pre-existing condition and therefore cannot afford treatments that could help with the complications brought on by type 1 diabetes. Type 1 diabetes is unpredictable and unpreventable at the point. She can not get medicaid either. She has tried. While I agree that a public option is preferable to a single payer at this point in time, I feel some of your arguments to be a little weak.
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Chris Johnson Reply:
August 19th, 2009 at 10:52 pm
Dear Anonymous,
I would agree that people without insurance still use the healthcare system, especially the ER. However, those without the capability to pay for their healthcare are not able to access elective services such as preventative care in our health systems, unless they take advantage of numerous free clinics throughout the country. Preventative care is expensive and consumes significant cost, resources and time. If the 50 million new citizens are given the ability to have healthcare through a national insurance plan then they we should expect they would utilize the healthcare system at a proportionate rate similar to all other covered Americans. The demand they will generate for annual physicals, colonoscopies, laboratory tests, etc., will increase, but the number of providers, especially physicians, are not capable of increasing their networks to meet this new demand. Shortages will occur throughout the country and Americans will have difficulty getting timely appointments. This is already a problem for women who are looking for an OB/GYN. Because of numerous factors such as liability, there is already serious shortages of OB/GYNs. Those shortages will have no chance of improving when 50 million, or another 20% of Americans are given health insurance and they then generate demand. And because of the intense training and years it takes to raise up new generations of healthcare professionals to provide the high tech care we expect in the US, the shortages will get worse before they begin to get better.
With respect to your comment on bankruptcies, the percentage of bankruptcies you referenced was highlighted in a study which reported medical problems as being the cause of 62% of all personal bankruptcies filed in the US in 2007. Unfortunately, the researcher of this study took questionable liberties with the results in this study by “doctoring” the findings in order to achieve the 62% number. The study was done by Dr. David Himmelstein, a Harvard researcher and outspokenan advocate for a single-payer health insurance program in the US.
His study surveyed 2,134 random families who filed for bankruptcy between January and April in 2007, using public bankruptcy court records and the survey of 1,032 respondents who were reached by telephone.
Of those respondents, ONLY 29 PERCENT directly attributed their medical bills to their bankruptcies. However, the 62 percent value that was reported in the study’s finding comprised not only those respondents who blamed illness for their bankruptcy, but they added addition respondent information that was collected which showed additional respondents having medical bills totaling more than 10 percent of their family incomes or had reported a loss of income due to illness or some other medical factor. Dr Himmelstein’s team mirepresented the results of their study by discounting the reported 29% that was in direct response to the question of what caused the respondents’ bankruptcies and instead inflated the numbers to make a more dramatic finding by adding additional variables that were not considered attributable by the respondents.
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