Tagged Women’s Health

Change In Texas Medicaid Payments Helps Cut Number Of Premature Births

Even though the health risks to babies born before they reach full term at 39 weeks have long been recognized, nearly 1 in 10 babies in the United States is born prematurely. Texas decided to try to change that.

In 2011, the Texas Medicaid program was the first in the country to take steps to curb elective early deliveries by refusing to pay providers who induced early labor or performed a cesarean section that wasn’t medically necessary before 39 weeks. In the first two years after that, Texas reduced the rate of unnecessary early delivery by as much as 14 percent. The state’s efforts also led to an increase in the length of pregnancies by nearly a week, with infants weighing on average nearly half a pound more, a new study found.

Those reimbursement changes were part of a Texas Medicaid payment reform law. Before it took effect, 10.63 percent of Medicaid single births in the state were early elective deliveries, according to the study, which was published in the March issue of Health Affairs.  After the law passed, the percentage of unnecessary early deliveries declined 2.03 percentage points.

Michelle AndrewsInsuring Your Health

About half of the decline was due to the payment reforms, while the rest could be attributed to other efforts to reduce early deliveries, unrelated trends and the economy, said Heather Dahlen, a research associate at Medica Research Institute in Minnetonka, Minn., and the study’s lead author.

Still, “in order for the rate to fall that much, there was a relatively significant effect on the target population,” Dahlen said.

The impact on early elective delivery was greatest for Latinos, whose rate declined 1.77 percentage points to 8.14 percent. The rate for non-Latino blacks declined 1.4 percentage points to 9.57 percent, while non-Latino whites saw a much smaller decline — 0.72 percentage point, to 8.43 percent.

Infants born before 39 weeks are more likely to have a range of health problems, including respiratory disorders, sepsis and feeding issues, and to be admitted to hospital neonatal intensive care units. Doctors and expectant mothers who opt for early delivery may not realize the risk or choose to go ahead for convenience. In some rural areas, women may be encouraged to schedule early deliveries to ensure they’re able to get to the hospital in time.

For the study, researchers analyzed data from 2009 to 2013 on the national Vital Statistics System’s Natality Detail Files, which is derived from information reported on birth certificates.

The federal-state Medicaid program for low-income people pays for roughly half of all births in the United States. After Texas passed its law, five other states passed similar laws in 2013: Georgia, Michigan, New Mexico, New York and South Carolina.

Reducing preterm births generally, and early elective deliveries in particular, is a priority for many groups, including health care providers, hospitals and patient-advocacy organizations. In addition to payment reform, these groups have employed other strategies such as educational programs for health care providers and patients and “hard-stop” policies that prohibit doctors from scheduling early elective deliveries unless they meet medical necessity standards.

“The Medicaid program was paying doctors for doing things that actually harm babies,” said Dr. Paul Jarris, chief medical officer at the March of Dimes, which publishes an annual report card that ranks states based on their preterm birth rates. “These payment changes actually make huge differences if they’re done right.”

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Categories: Insuring Your Health, Medicaid, Public Health, States

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Americans Not Sold On Cost And Coverage Claims In GOP’s Health Bill

A majority of the public is skeptical the Republican health plan would be an improvement over the Affordable Care Act, with widespread concerns that insurance costs would increase while people lost coverage, according to a poll released Wednesday.

The dour public assessment, from interviews with 1,206 adults conducted March 6-12, came before the Congressional Budget Office released its projections on Monday. The nonpartisan budget analysts predicted that the GOP’s American Health Care Act would leave 24 million people without insurance as it retracted Medicaid coverage for the poor and made premiums too high for many older people to afford.

The Kaiser Family Foundation poll found that 48 percent of the public thought the GOP plan would decrease the number of people who have health insurance. Another 30 percent expected the insured rate would stay the same, and 18 percent thought the number of covered people would increase. (Kaiser Health News is an editorially independent program of the foundation.)

One-fifth of Republicans think their party’s plan will lead to fewer people with insurance, the poll found. (Kaiser Family Foundation)

The public doubted pledges from President Donald Trump and Republicans that the proposal would lower the costs of coverage for people who buy their own insurance. Forty-eight percent thought policies would become more expensive, while 23 percent thought they would drop. The rest thought insurance costs would stay the same.

People were also dubious that deductibles would get smaller: Only a quarter of people thought so. Respondents also were doubtful the GOP plan would be a boon even for the wealthy. About the same number of people expected the plan would increase costs for high-income people as those expecting a decrease.

For all the suspicion about the GOP approach, the public remained ambivalent about the ACA, with 49 supportive and 44 percent opposed. The public was also split about whether the ACA should be repealed.

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Republicans, not surprisingly, were more optimistic than Democrats that the GOP plan would have positive effects. But it was not unanimous: 1 in 5 thought their party’s plan would lead to fewer people with insurance. A fifth of Republicans also said they expected insurance costs to rise under the plan.

Provisions of the GOP plan that would change women’s health care have strong opposition, including its ban on federal funds for Planned Parenthood to help it provide birth control and other non-abortion care to lower-income people. Three-quarters of the public thought Medicaid should continue to fund Planned Parenthood’s non-abortion services. The law already prohibits Medicaid spending for abortion, but the pollsters found that only a third of the public is aware of that.

The poll reported that 4 of 5 Americans strongly support provisions in the ACA that prohibit private insurers from denying coverage to pregnant women and from charging women more than men for policies, as well as those that require mammograms and cervical cancer screenings be provided with no out-of-pocket costs. Nine of 10 Americans support the ACA’s requirement that insurers pay for maternity care.

The poll’s margin of error was +/- 3 percent.

Categories: Insurance, Repeal And Replace Watch, Syndicate, The Health Law

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Families To Pay Price If Maternity Care Coverage Meets GOP Knife

Christie Popp, who is pregnant with her third child, is hoping hard that the maternity coverage she has through the Affordable Care Act doesn’t go away.

That coverage is written into the health law as a requirement for every plan sold on the individual market. But that could change if Republicans get their way to repeal the ACA and remake health care.

Popp knows firsthand how difficult it was to find such coverage before most of the federal health law’s provisions took effect in 2014. When the 37-year-old lawyer from Bloomington, Ind., had her first child in 2011, she had health insurance through her job at a nonprofit legal clinic. Because the insurance carried a high deductible, she and her husband paid $6,000 out-of-pocket during the pregnancy and delivery.

By 2013, when her second son was born, she’d moved to individual coverage purchased after setting up her own practice. “It was really bad insurance, and it was really expensive,” she said. What’s worse, to add pregnancy coverage to the policy, she would have had to start paying extra premiums — generally hundreds of dollars a month — for a so-called maternity rider long before she got pregnant. “So you had to really plan in advance to take advantage of that,” which they hadn’t, she said. To lower their out-of-pocket expenses, she and her husband decided to have a home birth with a midwife, though she still paid thousands of dollars to the physician she used as a backup.

For baby No. 3, the couple’s calculations will be different, she said: “This time I have real good coverage, so it’s great.”

If it lasts, that is.

Republicans say they want to jettison the maternity coverage requirement, which is part of the ACA’s list of 10 “essential” benefits. It’s a valuable benefit, and removing it outright won’t be easy since it would take complicated maneuvering in the Senate to do so. It remains intact in the bill moving through Congress, but that is due to budget rules, not because Republicans want to keep it.

The total price charged for pregnancy and newborn care ranges widely but averaged about $30,000 for a vaginal delivery and $50,000 for a cesarean section, with commercial insurers paying out an average of $18,329 and $27,866.

Still, the idea of the federal government requiring insurers to offer types of coverage is anathema to many Republicans averring it interferes with companies’ and patients’ choice.

“We’re going to repeal ObamaCare once and for all, and eliminate its mandates, taxes, and intrusion into your businesses and your lives,” tweeted Vice President Mike Pence on Feb. 25.

Seema Verma, the consultant on private health insurance who was nominated to head the agency that oversees the health law, said at her Senate confirmation hearing Feb. 16 that she does not necessarily support keeping maternity care as a requirement for insurance plans.

“Women have to make the decisions that work best for them and their family,” she said. “Some women might want maternity coverage, and some women might not want it.”

Backers of the coverage requirement say that’s a fundamental misunderstanding of how insurance works.

“Anytime you allow people to pick and choose, you’re making the care they don’t pick more expensive,” said Debra Ness, president of the National Partnership for Women & Families.

And making maternity coverage optional can raise costs not just for pregnant women and their families but society at large.

“People become more expensive when they don’t get the care they need,” said Ness. For example, “if you don’t provide good prenatal care, that leads to worse outcomes” for both mother and baby.

Christie Popp gives an after-school snack to sons Aaron and Adam Bullman in Bloomington, Ind. Popp is pregnant with her third child, due in October. She worries the health insurance coverage she has now could be lost if Obamacare is repealed. (Philip Scott Andrews for Kaiser Health News)

Before the Affordable Care Act made maternity coverage mandatory in the individual market, most plans did not cover it. “Only 12 percent of plans on the individual market covered maternity” before the health law, said Janel George, director of federal reproductive rights at the National Women’s Law Center. “So women were saddled with having to pay for this because insurance companies didn’t have to.” Although many plans offered optional maternity riders, these could cost close to $1,000 per month. They typically had separate deductibles and higher cost sharing (up to half the total cost of the care) than regular insurance. What’s more, they had to be purchased before a women became pregnant; afterward, it would be regarded as a preexisting condition.

Conservatives argue that the health law’s requirement for certain benefits has caused premiums to skyrocket. But the law’s supporters argue that may not be the case.

Sherry Glied, a former Obama administration health official and a dean at New York University, said that when you look at the main drivers of increases in health care spending, “most of the costs are in the conventional stuff,” like inpatient hospital and doctor care.

2016 study for the Blue Cross and Blue Shield Association backs that up. It found that cost increases in the individual market in 2014 and 2015 were driven not by inclusion of new benefits, but by the fact that people with serious illnesses, who had been previously shut out of the market, were quick to sign up and get expensive care. By contrast, maternity care, said Glied, “comes out to something under 5 percent” of the average premium.

In practice, changing the health law to do away with the requirement for maternity coverage entirely would be politically hard. Among other things, it would likely need 60 votes in the Senate, including eight Democrats. Democrats fought hard for the inclusion of maternity and other women’s health coverage in the ACA. Most analysts think Republicans can’t change the essential health benefits as part of the budget bill they are working on that requires only a simple majority for passage in the Senate.

“I don’t think they could cut it back very much,” said Timothy Jost, a professor at Washington and Lee University School of Law in Virginia and a backer of the ACA. Jost said many states adopted their own individual laws or regulations after the ACA passed to make maternity and other coverage mandatory. Many of those would have to be repealed separately as well.

Popp reads to Aaron at home. (Philip Scott Andrews for Kaiser Health News)

Still, the Trump administration could potentially weaken the requirement, by allowing states more leeway to accept less generous plans when determining if adequate benefits are being covered.

Under the ACA, states have flexibility to choose what level of those “essential” benefits must be offered, so the required benefits more closely match what is already being offered in each state. The administration “could modify those regulations,” possibly leading to less comprehensive coverage, George said.

Ness said the administration also “could allow states to define their own essential health benefits standards. That would put states in the driver’s seat in deciding what benefits are covered and what aren’t.” That wouldn’t give states a green light to allow insurers to drop maternity coverage altogether — because it is written into the federal law — but “there could be some plans that offer maybe less generous coverage.” For example, plans could offer less prenatal coverage or require separate deductibles for maternity care.

Such a scenario would bring back the days of women who have babies and wind up covering more of their own bills.

Christie Popp, who’s due in October, said she “more than hopes” nothing happens before then.

Categories: Insurance, Repeal And Replace Watch, Syndicate, The Health Law

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