- Bullock includes Medicaid expansion in budget (billingsgazette.com)
- Medicaid, health care issues likely to be contentious at 2013 Legislature (missoulian.com)
- Groups push for Medicaid expansion (thegazette.com)
- Republican Governors Opt-In to Medicaid Expansion (my.firedoglake.com)
- UM economist touts Medicaid expansion; legislator says Montana solution needed (missoulian.com)
The terrible events in Newtown sent my mind racing this weekend. I kept coming back to where we in Montana stand on preventing gun violence in our state. It was clear that we’re not just moving in the wrong direction on preventing gun violence in Montana we’re racing in the wrong direction.
The best way to illustrate this point is by looking at the work of Sen. Dave Lewis (R-Helena). Last session, Sen. Lewis chaired the Senate Finance & Claims Committee (the primary Senate budget committee), and, as chair, he slashed funding for crucial services- including mental health services. He and his Republican colleagues maintained that the state didn’t have enough money to pay for treating and providing support for those with mental illness (and some other issues as well).
While Lewis was busy slashing services for Montanans, he sponsored a bill that would have given tax cuts to gun ammunition manufacturers to “ensure availability.”
So in Sen. Dave Lewis’ world, we have enough money to give ammunition manufacturers tax cuts, but we don’t have the money to provide mental health counselling for Montana’s most vulnerable people.
While I do find Lewis to be one of the most detestable political figures in Montana history, this post isn’t about him. It’s about the fact that through their decisions, Montana’s elected officials are making our communities more vulnerable to the types of gun violence we’ve seen throughout the country over the past few years.
In the 2011 legislative session, there were 13 bills introduced related to guns and firearms. Only 2 of these bills could be construed as gun control measures. The rest would have done things to allow guns in banks, bars and other buildings. These bills would have allowed people to carry concealed weapons (simply by telling themselves they were allowed to), and would have even allowed students in public schools to bring guns on campus.
We as a state, much like the country, have to get beyond partisan dogfights over guns and gun violence, and have an honest effort to pass policies that will keep our communities safer. These policies must deal with not only rules about who, when, and where you can carry guns, but they must also deal with ensuring adequate mental health services for all Montanans.
I’ll be honest, I don’t expect our elected officials to display the courage to push responsible gun control laws. But I do think we have an opportunity to tackle the mental health aspect of the puzzle.
The Medicaid expansion that is part of the Affordable Care Act is our best chance to expand mental health coverage to tens of thousands of currently uninsured Montanans. This expansion is the part of the Affordable Care Act(ACA) that the US Supreme Court ruled states had the option of whether or no to implement.
Unfortunately, this expansion is sure to get marred by political games by Republicans who refuse to vote in support of anything related to the ACA. While Republicans may hold majorities in the legislature, Democrat Steve Bullock will hold the Governor’s office, and its bully pulpit and veto pen. He should use this bully pulpit and veto pen to ensure the Medicaid expansion is implemented in our state.
Governor Schweitzer accounted for the expansion in his final budget proposal, but thus far Bullock hasn’t said whether or not he’ll push for the expansion.
I hope that the horrible events of Friday will provide Bullock with a little more incentive to champion the expansion of Medicaid as a means of preventing gun violence in our state, without taking on a battle over gun control laws that he almost certainly cannot win with the legislature. If Bullock does this, we’ll begin to finally take small steps towards preventing gun violence in Montana.
- CNN Anchor: It Doesn’t Matter That Gun Violence is Down – Katie Pavlich (gds44.wordpress.com)
- Do Gun-Free Zones Work as Planned? (reason.com)
- Bob Costas’ gun violence comments draw controversy (metronews.ca)
- Guest Commentary: How we can reduce gun violence and suicide (denverpost.com)
A new brief from the Kaiser Family Foundation reports that President Obama’s health care reform represents a significant step forward for Americans with HIV, helping to expand health insurance to many HIV-positive individuals who would be “otherwise unable to access affordable and stable health care coverage.” Representing hugely important tactics to continue addressing the HIV/AIDS epidemic, several of Obamacare’s provisions will have a directly positive impact on the estimated 1.1 million Americans who live with the HIV virus:
- Obamacare will prevent insurance companies from denying HIV-positive Americans coverage simply based on their HIV status. The health care reform law prohibits insurance companies from discriminating based on pre-existing conditions, including HIV. Before Obamacare, Americans living with HIV often struggled to find insurance companies willing to take them on — according to the Kaiser Family Foundation, just 13 percent of HIV-positive individuals were covered under private insurance in 2010.
- Obamacare’s expansion of the Medicaid program helps low-income Americans with HIV who otherwise wouldn’t qualify for coverage. Over 40 percent of HIV-positive Americans accessed their health insurance through the Medicaid program in 2010, and expanding Medicaid even further will extend additional coverage to this community. Furthermore, under Obamacare, HIV-positive individuals do not have to have to be diagnosed with AIDS as a precursor to qualifying for Medicaid coverage. Although this was an old eligibility requirement for the program, the health reform law ensures the states that accept Obamacare’s Medicaid expansion will not have to impose this restriction on Americans living with the HIV virus.
- HIV-positive Americans will no longer reach limits on the amount of treatment their insurance companies are willing to cover. Obamacare eliminates lifetime coverage caps and phases out annual limits, which will help all Americans with chronic conditions — including the Americans who rely on treatment for HIV infections — continue to be able to afford the care they need without reaching an arbitrary cut-off set by their insurance companies.
- HIV testing will likely be covered under Obamacare. This year, the U.S. Preventive Services Task Force is expected to recommend routine HIV screenings as a part of regular preventative care, similar to a routine blood pressure test. Since the health reform law requires insurers to cover the preventive services recommended by the Preventative Services Task Force, a new standard for HIV testing could ensure that it becomes a standard part of annual check-ups. The Centers for Disease Control estimates that about 20 percentof the total population of Americans who are infected with HIV don’t know they have the virus, so regular tests that don’t incur an out-of-pocket expense could help encourage more Americans to learn their status.
- Since Obamacare helps close the prescription drug coverage gap for Medicare beneficiaries, HIV-positive individuals will be more likely to afford their drug treatments for the virus. By closing the “donut hole,” or the gap in coverage for expensive prescription drugs under the Medicare program, Obamacare will help ensure that older Americans living with HIV aren’t unable to afford any of the 26 antiretroviral drug treatments that can be used to combat HIV infections. Twelve percent of Americans with HIV relied on Medicare for their health coverage in 2010, and that number may rise significantly as the population of HIV-positive Americans continues to age.
- Obamacare increases resources for HIV research and prevention. The health care reform law allocates $10 billion over ten years for a new fund that focuses on prevention, wellness, and public health activities. In 2010, $30 million from that fund was awarded to the Centers for Disease Control for HIV prevention activities, including new investments in HIV surveillance and testing among high-risk populations.
- How Obamacare Helps Americans Living With HIV (thinkprogress.org)
- Most HIV-Positive Americans Lack Regular Medical Care (dgsmith.org)
- By 2015, Half Of HIV-Positive Americans Will Be Over The Age Of 50 (thinkprogress.org)
- Health Department Warns of HIV-Positive Prostitute (stlouis.cbslocal.com)
- A Guide to Oral Care and HIV/AIDS (topdentists.com)
Medicaid expansion under the Affordable Care Act is contentious- mostly because Republicans don’t want to give President Obama any credit- for anything. But if this study, reported today by the New York Times, is any indication, not going forward could be deadly.
Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died.
The study, published online Wednesday in The New England Journal of Medicine, comes as states are deciding whether to expand Medicaid by 2014 under the Affordable Care Act, the Obama administration’s health care law. The Supreme Court ruling on the law last month effectively gave states the option of accepting or rejecting an expansion of Medicaid that had been expected to add 17 million people to the program’s rolls.
Seems fairly reasonable. So why would anyone reject the expansion?
Medicaid expansions are controversial, not just because they cost states money, but also because some critics, primarily conservatives, contend the program does not improve the health of recipients and may even be associated with worse health. Attempts to research that issue have encountered the vexing problem of how to compare people who sign up for Medicaid with those who are eligible but remain uninsured. People who choose to enroll may be sicker, or they may be healthier and simply be more motivated to see doctors.
The New England Journal study reflects a recent effort by researchers to get around that problem and allow policy makers to make “evidence-based decisions,” said Katherine Baicker, an investigator on the study who served on former President George W. Bush’s Council of Economic Advisers.
“I think it’s a very significant study in part because of the paucity of studies that have really looked at health outcomes of insurance coverage,” said Karen Davis, the president of the Commonwealth Fund, a nonpartisan research foundation. “Actual mortality studies are few and far between. This is a well-done study: timely, adds to the evidence base, and certainly should raise concern about the failure to expand Medicaid coverage to people most at risk of not getting the care that they need.”
A Republican-appointed official calling this “evidence based”- will it be enough? Probably not. But the evidence is still there:
“So often you hear, ‘Oh well, poor people just shoot each other, and that’s why they have higher mortality rates,’ ” said Diane Rowland, executive vice president of the Kaiser Family Foundation, a nonprofit group. “In the midst of many claims about what Medicaid does and doesn’t do, it actually shows that it cannot only be beneficial for health, but in preventing some of the premature deaths of the uninsured.”
Janet M. Currie, director of the Center for Health and Well-Being at Princeton, said the new study, combined with the Oregon research, should help transform the Medicaid debate into one about dollars, rather than over whether covering poor people improves health.
“This says, well there is benefit to giving people insurance,” Dr. Currie said. “Maybe you don’t want to pay the cost, but you can’t say there’s no benefit.”
- Medicaid Expansion Likely to Lower Death Rates, Study Says (nytimes.com)
- CBO: If States Opt Out of Medicaid Expansion, $84B Saved (crooksandliars.com)
- CBO Confirms: The Health Care Law Reduces the Deficit (whitehouse.gov)
Wondering about the Supreme Court’s decision on HIV/STD prevention and care? Some help from The National Coalition Of STD Directors:
As you consider the impact of today’s Supreme Court ruling on the Affordable Care Act on different populations, I would like to share with you the impact of today’s ruling on our fight to prevent and treat sexually transmitted diseases.
Sexually transmitted diseases (STDs) remain a major epidemic in the United States. Each year, there are approximately 19 million new cases of STDs, approximately half of which go undiagnosed and untreated[i], giving the United States the highest STD rate in the industrialized world.[ii]
STDs cost the U.S. health care system $17 billion every year—and cost individuals even more in immediate and life-long health consequences, including infertility, higher risk of acquiring HIV, and certain cancers.[iii]
- Young people will continue to have expanded coverage under their parent’s insurance. Young people bear a disproportionate burden of STDs—those aged 15-25 make up half of the STDs contracted annually, but make up only one-fourth of the sexually active population.
- Private insurance will continue to have to cover prevention services with no cost out-of pocket costs to patients. Many of those who visit STD clinics are low-income and would not be able to receive prevention sexual health services without coverage by insurance. While there is still work to be done for certain at-risk populations, such as men who have sex with men, expanded STD testing and STI counseling will be covered by insurance under this expansion of preventative care in the law and it is a great start.
- The continued need for safety-net service providers is underscored. With the narrowing of the Medicaid expansion provisions, the very real possibility exists that many low-income individuals will not have access to affordable health care coverage. Patients at STD clinics are young, minority, and poor—populations that are bear a much higher burden of STD disease—and may be left without coverage in a state that may choose not to expand their Medicaid coverage.
HIV-specifics from Lambda Legal:
“This is a victory for all Americans, but in particular, the Court’s decision today will save the lives of many people living with HIV – as long as states do the right thing. The Affordable Care Act will finally allow people living with HIV to access medical advancements made years ago but that have so far remained out of reach of many. With continuing prevention education, early detection, and quality care for everyone living with HIV, we have the power to stem the HIV/AIDS epidemic.
“But this is not a complete victory, because today’s decision allows states to opt out of the Medicaid expansion that would provide insurance coverage for many low-income people who cannot otherwise afford it. Our continuing challenge will be to make sure that states opt to expand Medicaid so that more low-income people, and particularly those with HIV, can get the health care they urgently need.”
- Who should go for a STD test? (healthnfitnesstips.typepad.com)
- Teens don’t identify with STD messages (futurity.org)
- Affordable Care Act a lifeline for people with pre-existing conditions (king5.com)
- Obama: ‘National HIV Testing Day highlights the importance of HIV testing and the fight against HIV/AIDS’ (miamiherald.typepad.com)
(We) believe that a civilized society must ensure the provision of basic healthcare to its citizens regardless of their ability to pay for it. (We) further believe it is a moral imperative that all levels of government institute programs that ensure the poor receive such care. (We) believe Medicaid expansion under the Act is critical to the communities (we) serve.
Predictably, some “Catholic” websites are leading with headlines like “Liberal Nuns Support Obamacare”, and “Liberal Activist Nuns Want Socialized Medicine”.
Sigh. What’s wrong with these people? What do they think Jesus would charge for healthcare? And they’re theologically out of step with their church.
As further proof that conservative efforts to paint President Obama as the enemy of religion are a red herring, nearly two dozen leading Catholic nuns filed a brief in the Supreme Court last week supporting the president’s signature legislative accomplishment. The Catholic sisters who joined the brief include the leaders of many prominent religious orders providing health care and other services to the needy.
These nuns have unique stature to explain why their support for the Affordable Care Act flows from their faith, given that so many of them have devoted their lives to providing care to those most in need. Nevertheless, their views are hardly unique within their church’s hierarchy. Pope Benedict XVI called health care an “inalienable right,” and added that it is the “moral responsibility of nations to guarantee access to health care for all of their citizens.”
Duh. “Is the Pope Catholic?” may no longer be a rhetorical question- especially for catholic fanatics.
Oh- and Jesus healed for free….
- Rick Santorum Tries To Explain Why He Does Not Agree With The Catholic Church On Health Care Reform (thinkprogress.org)
- Often Overlooked, Sisters on The Forefront Of Equality (dgsmith.org)
- The Nail On The Head (dgsmith.org)
- Catholics defend The President (From Eternity To Here)