Pacific Progressive

Future Choices II: An Update on the Legal, Statutory, and Policy Landscape of Assisted Reproductive Technologies

This article was published by the Center for American Progress.

By Jessica Arons and Liz Chen 

Endnotes and citations are available in the PDF version of this report.

Download the report: PDF

Download introduction & summary: PDF

Read it in your browser: Scribd

In 2007 the Center for American Progress released its report “Future Choices: Assisted Reproductive Technologies and the Law,” which described a range of assisted reproductive technologies and their legal and regulatory background. The report also examined the policy implications of the largely unregulated field of reproductive technology, especially in the context of traditional feminist positions on reproductive rights. If a woman has the ultimate right to decide whether or not to bear a child when she is pregnant, for instance, does that principle hold true when she would like to become pregnant with the use of specific embryos? Is surrogacy a noble pursuit undertaken by autonomous, well-informed, and altruistic women, or is it a practice that exploits the low-income and vulnerable?

What is Medicaid's Impact on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight on the Evidence

This material was published by the Henry J. Kaiser Family Foundation.

Julia Paradise and Rachel Garfield

Introduction

Medicaid, the nation’s main public health insurance program for low-income people, now covers over 65 million Americans – more than 1 in every 5 – at least some time during the year. The program’s beneficiaries include many of the most disadvantaged individuals and families in the U.S. in terms of poverty, poor health, and disability. The Affordable Care Act (ACA) provided for a broad expansion of Medicaid to cover millions of low-income uninsured adults whom the program has historically excluded. However, as a result of the Supreme Court’s decision on the ACA, the Medicaid expansion is, in effect, a state option. Almost half the states are moving forward with the Medicaid expansion. But the others, which are home to half the uninsured adults who could gain Medicaid coverage under the ACA, have decided not to expand Medicaid at this time or are still debating the issue.

Controversy about the Medicaid expansion has been stoked by an assertion that first appeared in a Wall Street Journaleditorial a couple of years ago and has since resurfaced periodically, that “Medicaid is worse than no coverage at all.”^{1 2 3 4 56} This claim about Medicaid is sharply at odds with the authoritative findings of the Institute of Medicine (IOM) Committee on Consequences of Uninsurance, detailed in Care Without Coverage: Too Little, Too Late, the second of six reports the IOM issued on the subject in the early 2000’s.⁷ Based on a comprehensive review of the research examining the impact of health insurance on adults, the IOM charted the causal pathway from coverage to better health outcomes, concluding:

2013 Employer Health Benefits Survey

This material was published by the Henry J. Kaiser Family Foundation.

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and other relevant information.  The 2013 survey included almost three thousand interviews with non-federal public and private firms.

Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits Survey.

News Release

• A news release announcing the publication of the 2013 Employer Health Benefits Survey is available here.

Summary of Findings

• The Summary of Findings provides an overview of the 2013 survey results and is available under the “Summary of Findings” tab or as a pdf file in the “Download” box to the right.

Full Report

• The complete Employer Health Benefits Survey Report includes over 200 exhibits and is available under the “Report” tab or as a pdf file in the “Download” box to the right. The “Report” tab contains 14 separate sections. Users can also download each section separately from the “Download” box or download the complete set of section exhibits from the bottom of the respective section page.

Health Affairs

• The peer-reviewed journal Health Affairs has published an article with key findings from the 2013 survey: Health Benefits in 2013: Moderate Premium Increases in Employer-Sponsored Plans.

Key Exhibits – Chartpack

• Twenty overview slides from the 2013 Employer Health Benefits Survey are available as a slideshow or as pdf.

Additional Resources

• Standard errors for selected estimates are available in the Technical Supplement here.
• Employer Health Benefits Surveys from 1998-2012 are available here. Please note that historic survey reports have not been revised with methodological changes.
• Researchers may request a public use dataset here.

Researchers at the Kaiser Family Foundation, NORC at the University of Chicago, and Health Research & Educational Trust designed and analyzed the survey.

Visualizing Health Policy: A Short Look At Long-Term Care for Seniors

This material was published by the Henry J. Kaiser Family Foundation.

The August 2013 Visualizing Health Policy infographic provides an informational snapshot of long-term services and support (LTSS) for seniors in the United States. This includes information about the number and proportion of seniors who will need LTSS because of physical and cognitive impairment, the role of unpaid family caregivers in providing the majority of LTSS, the role of Medicaid (not Medicare) as the primary payer for LTSS, the shifting of Medicaid spending from institutional-based care toward community-based care, and the fact that only 35% of US adults 40 years or older say they have set aside money for their long-term needs.

Visualizing Health Policy is a monthly infographic series produced in partnership with the Journal of the American Medical Association (JAMA). The full-size infographic is freely available on JAMA’s website and is published in the print edition of the journal.

View related Slideshow

 

Health Coverage for the Black Population Today and Under the Affordable Care Act

This material is from the Henry J. Kaiser Family Foundation.

 Philethea Duckett and Samantha Artiga

As of 2011, 37 million individuals living in the United States identified as Black or African American. Blacks currently comprise the third largest racial or ethnic group in the United States after non-Hispanic Whites and Hispanics (Figure 1). While it is projected that the nation will become increasingly diverse and the Black population will grow over the next few decades, Blacks are anticipated to maintain a consistent share of the population. The Affordable Care Act (ACA) has important implications for Blacks as they face longstanding and persistent disparities in health and health care.

Quantifying Tax Credits for People Now Buying Insurance on Their Own

This article was published by the Henry J. Kaiser Family Foundation.

 Larry Levitt, Gary Claxton and Anthony Damico

A number of states have recently released information on what premiums will be in the individual insurance market in 2014, when significant changes in that market take effect due to the Affordable Care Act (ACA). In some cases, states have provided estimates of how those premiums compare to what people buying their own insurance are paying today.

However, these premiums are in effect “sticker prices” that many people will not pay because they will be eligible for federal tax credits under the ACA to offset the cost of insurance. In this data note, we explain how the tax credits will work and estimate how much premium assistance people now buying their own insurance will be eligible for in 2014.

Why Premiums in the Individual Market Will Change

There are a number of reasons why individual market premiums will change, both overall and for any given individual now buying coverage:

• Prohibiting discrimination against people with pre-existing health conditions will tend to raise premiums as higher cost individuals who have previously been excluded from the market buy coverage. This may be offset by an influx of younger and healthier people, due to the ACA’s individual mandate and premium subsidies for low- and middle-income people buying insurance in new health insurance marketplaces (also known as exchanges).

How the Hyde Amendment Discriminates Against Poor Women and Women of Color

This article was published by the Center for American Progress.

By Jessica Arons and Lindsay Rosenthal

In 1973 the Supreme Court decided in the landmark case Roe v. Wade to recognize the constitutional right to abortion for all women. Forty years later, however, this guarantee remains an empty promise for thousands of poor women and women of color thanks to the Hyde Amendment, an annual appropriations measure first passed in 1976. This provision intentionally discriminates against poor women by prohibiting Medicaid, the health-insurance program for low-income individuals and families, from covering abortion care.

Because of the intersection in our country between race, ethnicity, and socioeconomic status, this restriction also has a disproportionate impact on women of color. Due to a number of root causes related to inequality, women of color are more likely to qualify for government insurance that restricts abortion coverage, more likely to experience higher rates of unintended pregnancy, and less likely to be able to pay for an abortion out of pocket. The Hyde Amendment therefore does not only undermine gender equity, but it also violates principles of racial and economic justice.

The Hyde Amendment discriminates against poor women

• Congress passed the Hyde Amendment in order to deny poor women access to abortion. Former Rep. Henry Hyde (R-IL), the law’s sponsor, admittedduring the debate of his proposal that he was targeting poor women. “I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman,” he said. “Unfortunately, the only vehicle available is the … Medicaid bill.”

Is the ACA a Jobs Killer?

This article is from the Center for Economic Policy Research.

Opponents of the Affordable Care Act (ACA) of 2010 have claimed the bill is having a negative impact on employment. In doing so, they argue that the sanctions to be applied under the bill to firms who do not provide insurance to their full-time workers are causing employers to change their hiring patterns. One claim is that firms will keep their number of employees under 50 so that the sanctions do not apply to them. Opponents of the bill also claim that employers are cutting workers’ hours to just under 30 hours a week to avoid penalties. A new issue brief from the Center for Economic and Policy Research finds that only 0.6 percent of workers are working just below the 30-hour cutoff and this number was actually lower in the first four months of 2013, when it was thought the sanctions would apply, than the first four months of 2012. (The penalties were scheduled to apply to employers in 2014 based on 2013 employment patterns; however the Obama administration announced earlier this month that the penalties would not be imposed until 2015.)  

Ensuring Health Coverage for All

This article was published by the Center for American Progress.

By Eleni Towns

This issue brief contains corrections.

Endnotes and citations are available in the PDF version of this issue brief  - Download the report:  PDF  Read it in your browser: Scribd

While several provisions of the Affordable Care Act have gone into effect, there is still one large hurdle to ensuring full implementation of the law in 2014: expanding Medicaid programs in all 50 states. Without this expansion, 11.5 million Americans whose incomes are too high to qualify for existing Medicaid coverage but too low to afford participation in the new health care exchanges set up by the law could go without insurance.

In June 2012 the Supreme Court ruled that Medicaid expansion was an optional provision of the Affordable Care Act, or ACA, and that states could not be penalized for refusing to expand their programs. House Republicans, however, have harshly criticized all components of the ACA, including the Medicaid expansion. The House of Representatives has voted more than 30 times to repeal the legislation, and already 13 states have refused to expand their Medicaid programs, despite the fact that the costs to the states will be modest. In some cases, states will even experience a net gain.

Faith in Values: A Godsend to Reproductive Health Clinics

This article was published by the Center for American Progress.

By Sally Steenland

Two posters hang on my office wall. One says, “Jesus never shamed women.” The other says, “Pray to end sidewalk bullying.”

I got the posters from Faith Aloud, a counseling and advocacy group that connects faith with reproductive justice. It’s an important connection but one that is rarely seen in today’s political battles over women’s reproductive health, especially when the focus is abortion. Despite that invisibility on the public stage, religion is ever-present in the lives of most women who come to clinics for reproductive health care, including abortion.

More than 7 in 10 women who get an abortion in this country claim a religious affiliation such as Protestant or Catholic, according to the Guttmacher Institute. Furthermore, Catholic women have a higher abortion rate than Protestant women—22 for every 1,000 women, compared to 15 for every 1,000 women, respectively.

Faith Aloud works with health clinics across the country to provide spiritual counseling to women considering an abortion, as well as postabortion counseling for them and for their family and friends who come with them to the clinic. Through faith-specific videos, free confidential telephone counseling with clergy, events, and more, women receive compassionate and nonjudgmental care for their spirit and soul during a difficult time in their lives.

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

This article is from the Henry J. Kaiser Familhy Foundation. 6/12/13

 Gretchen Jacobson, Patricia Neuman and Jennifer Huang

While much of the health policy world is focused on the health coverage developments in store as the Affordable Care Act of 2010 (ACA) is implemented, private insurers are also gearing up for the next Medicare Advantage open enrollment season. Four months from now, just as exchange enrollment swings into action, Medicare beneficiaries will have the option to enroll in a Medicare Advantage plan (or switch plans) during the annual open enrollment period. And, earlier this month, each of the insurers participating in the Medicare Advantage program submitted what is known as a “bid” to the federal government that essentially indicates whether they will offer more or fewer Medicare Advantage plans in 2014 than in 2013and how they will change their plans’ benefits and premiums, which could ultimately affect how many Medicare beneficiaries enroll in Medicare Advantage plans in 2014 and future years.

During the debate about the ACA, there was much discussion about whether and to what extent reductions in federal payments to Medicare Advantage plans would affect seniors. Some questioned whether plans would pull out of markets across the country leading to a drop in Medicare Advantage enrollment, as occurred after Congress reduced payments for Medicare plans as part of the Balanced Budget Act (BBA) of 1997 (see Exhibit 1).

Exhibit 1. What is the future outlook for Medicare Advantage?

Scarlet Letters: Getting the History of Abortion and Contraception Right

This article was published by the Center for American Progress.

By Ranana Dine

If recent legislation passed in Arkansas and North Dakota is allowed to stand, it will be harder for women to get an abortion in those states than it was in New England in 1650. Legislators in Little Rock and Bismarck have passed new restrictions that ban abortions according to when a fetal heartbeat is detected, which can occur as early as six weeks into a pregnancy. Federal judges have blocked the new restrictions until legal challenges to their constitutionality are settled. But the six-week deadline contrasts starkly with early American abortion law, where the procedure was legal until “quickening”—the first time a mother feels the baby kick, which can happen anywhere from 14 weeks to 26 weeks into pregnancy.

Abortion was not just legal—it was a safe, condoned, and practiced procedure in colonial America and common enough to appear in the legal and medical records of the period. Official abortion laws did not appear on the books in the United States until 1821, and abortion before quickening did not become illegal until the 1860s. If a woman living in New England in the 17th or 18th centuries wanted an abortion, no legal, social, or religious force would have stopped her.

That, however, is not the way the anti-abortion movement likes to paint the history of abortion in the United States. Anti-abortion organizations such as the National Right to Lifespin a narrative in which legal abortion is a historical anomaly and an unnatural consequence of modern America’s loose moral standards. On the National Right to Life’s website, for example, a page titled “Abortion History Timeline” describes “a few rogue doctors and midwives” performing abortions in early America, only “as far back as the 1850s.” In reality, trusted midwives and medical practitioners performed abortions from the beginning of American colonial life and throughout world history. Fox News also falsifies American abortion history on its website. On a page titled “Fast Facts: History of U.S. Abortion Laws,” it claims that abortion in the American colonies “was ruled a misdemeanor if performed prior to quickening.”

Beyond Rebates: How Much Are Consumers Saving from the ACA’s Medical Loss Ratio Provision?

This article is from the Henry J. Kaiser Family Foundation. 6/6/13

 Cynthia Cox, Gary Claxton and Larry Levitt

Most of the conversation around the Affordable Care Act’s Medical Loss Ratio (MLR) provision has centered on the requirement that insurers issue consumer rebates when they fall short of spending a certain portion of premium dollars on health care and quality improvement expenses.  This makes sense as rebates are one of the more tangible ways consumers have benefited from the law so far, and it likely contributes to the MLR provision being among the more popular aspects of the health reform law.

However, as we’ve written before, rebates represent only a portion, albeit the most concrete portion, of the MLR rule’s savings to consumers.  The primary role of an MLR threshold is to encourage insurers to spend a certain percentage of premium dollars on health care and quality improvement expenses (80 percent in the individual and small group market and 85 percent in the large group market).  The MLR rebate requirement operates as a backstop if insurers do not set premiums at a level where they would be paying out the minimally acceptable share of premiums back as benefits.  Only if those thresholds are not met are insurers required to provide rebates to consumers or businesses. (You can read more about the MLR rule here).

Consumers and businesses, therefore, can realize savings in two ways as a result of the MLR requirement: by paying lower premiums than they would have been charged otherwise (as a result of lower administrative costs and profits), or by receiving rebates after the fact. So while insurers paid out considerable amounts for rebates – last year’s rebates totaled $1.1 billion – this is not the whole story for consumers.

The Flip Side of Higher Premiums: Better Coverage

 Larry Levitt and Cynthia Cox 

This article is from the Henry J. Kaiser Family Foundation, 3/21/13.

Time Magazine’s recent cover story on health care – “Bitter Pill” by Steven Brill – has focused attention on hospital prices, especially for people paying out of their own pockets. This is not a new issue, but certainly one that deserves attention.

However, what has been lost in the ensuing commentary on high hospital prices is that Brill’s article is as much about inadequate insurance, which is the reason why the patients he writes about were paying the bulk of their own hospitals bills. One of them was uninsured, but the rest had private insurance. The problem was that the insurance plans these policyholders had ultimately covered very little of their care.

The main culprit seemed to be caps on the dollar amount of coverage, such as

• A non-group plan that covered only up to $2,000 per day in a hospital.
• An employer-sponsored plan through Cigna’s Starbridge subsidiary that capped coverage for any hospital stay at $2,500 total.
• A union plan that limited annual benefits to $60,000.
• A student policy that capped benefits at $50,000.

The Threat of Self-Insured Small Businesses to People of Color

This article was published by the Center for American Progress.

By Andrea-Gale Okoro and Emily Oshima Lee

Despite the Affordable Care Act’s, or ACA, sweeping reforms, which are making health care more accessible and bringing Americans greater protections and increased benefits, people of color may still be at risk of facing the problems that plagued the system before. Under the ACA, millions of Americans have already gained coverage and protections that they did not have previously, saving many from some of the hardships of illness or injury. Unfortunately, employees of small businesses—particularly minority employees—may not enjoy the positive changes that the ACA is bringing to the country. Evidence shows that small-business employers may be considering a practice called self-insurance, which could jeopardize the quality, affordability, and accessibility of health care for employees of color.

When offering health care plans to their employees, employers can choose to fully insure or self-insure, meaning that the business either buys health insurance from a traditional provider or the business itself acts as the insurer. When employers buy insurance from a traditional insurer, the insurer takes on the financial risk of employees accumulating more in health care costs than what they pay into the plan. In a self-insured structure, that financial risk is put on the business, but the business does not have to pay premiums to a traditional insurer; during times when employees are healthy and pay more into the plan than they take out, the business—not an outside insurer—gets to keep those savings. This can make a self-insured plan appealing to a small business, especially if it has a young or generally healthy staff. But self-insured plans can have negative consequences for employees, especially those of color.