While I do not miss the rigors of residency, I do miss my Dansko clogs. Twice now I've completely wiped out when I've twisted my ankle on one of my heels (both times the left one- I've learned that my left ankle is weaker than the right. This knowledge has come both from wearing heels while walking to the Metro and doing yoga.) The first wipe out came when I was running to the last day of the conference. It was a Saturday morning and the light was about to change. I thought, "I can make it!" and I jogged past the intersection. Just as I was approaching the other side to victory feeling like a real city-girl I twisted my left ankle and fell in the intersection. My shoe flew off (like two feet in front of me) and I dropped my bag. A girl was jogging the other way and asked, "Are you hurt?"
"Just my pride", I answered. I gathered up my stuff and got into the conference as quickly as possible.
The second wipe out was on Tuesday. I bought some very pretty Nine West black heels for a great price and was so excited about them! They are mules with about a 2 inch heel. Well, walking down the hill to the metro, again my left ankle turned and I fell right onto my left knee and dropped my bag. This time there was a woman walking behind me who asked, "Are you ok?" and I replied that I was.
As she walked past me I heard her say to the party on the other end of her cell phone, "No, no, the woman who was walking in front of my just fell down." When I got to the office and examined the damage I had skinned my knee pretty good BUT I did not tear my beloved black Express pants! Score! I'll take the skinned knee, it will heal.
So I've learned that my left ankle is weak and that I'm not great in heels, but better honestly than I thought I would be.
I've learned that I hate, hate, hate wind, especially cold wind! I'll take 115 any day over 18 with a blistering wind that rips your face off bit by chilly bit.
I've learned why people get mugged- because you always have to carry cash! For the Metro, for a taxi, etc. When you're not just hopping into your car, you need to have some cash on you.
I've learned that if I have a 30 minute commute to work I'd rather be on a train than on a highway.
Handing out your business card in DC is the equivalent of a handshake. When you walk into a meeting, everyone's card gets passed around. It's the standard greeting.
I've learned that while there are few physicians on the Hill, we are in good hands with our Lobby teams. Every specialty I've seen has been very well represented by their Lobbyists. They are well-versed and truly do work for us.
I'm learning to coordinate clothes each morning and how to not rely on scrubs every day.
Food in DC is incredibly expensive.
Driving in DC sucks.
I like the city (though prefer not to drive myself).
I'm sure I'll think of some more... but here are things I've learned besides politics and legislation.
Friday, February 20, 2009
Thursday, February 19, 2009
State Legislative Activities and Insurance Premiums
Since I have been working these 5 weeks on Federal Issues I haven't had much time to look at individual State issues, even in Arizona. But there is some good information on the ACOG website that I wanted to bring to your attention. Go to ACOG, click on Advocacy and select State Legislative Issues. There are some great talking points on issues such as emergency contraception, contraceptive equity, medical liability reform, and abortion.
Also, h is a great report I found while browsing through some conference materials. It's called premiums vs. paychecks and it shows what families are typically paying for health care premiums in each state. For example, premiums rose 3.5 times faster than median earnings in the state of Arizona, and 5 times faster in the state of Kansas.
Here's the link:
http://www.familiesusa.org/assets/pdfs/premiums-vs-paychecks-2008/arizona.pdf
You can substitute another name in for the state if you want to look at a different state. This is from the FamiliesUSA organization.
Also, h is a great report I found while browsing through some conference materials. It's called premiums vs. paychecks and it shows what families are typically paying for health care premiums in each state. For example, premiums rose 3.5 times faster than median earnings in the state of Arizona, and 5 times faster in the state of Kansas.
Here's the link:
http://www.familiesusa.org/assets/pdfs/premiums-vs-paychecks-2008/arizona.pdf
You can substitute another name in for the state if you want to look at a different state. This is from the FamiliesUSA organization.
Support Prevention First!!
Prevention First is an act introduced by Senate by Majority Leader Harry Reid (D-NV) and in the House by Representatives Louise Slaughter (D-NY) and Diana DeGette (D-CO). The Act is intended to reduce the number of unintended pregnancies in the United States by focusing on successful prevention methods. It aims to do this through 8 separate parts:
- Increase Funding for the National Family Planning Program (Title X)
- Expand Medicaid Family Planning Services
- End Contraceptive Insurance Discrimination Against Women
- Improve Awareness about Emergency Contraception (EC)
- Improve Access to EC for Rape Victims
- Reduce Teen Pregnancy
- Ensure that Federally-Funded Programs Provide Medically Accurate Information
- Provide Comprehensive Sex Education (REAL or Responsible Education About Life)
You can look it up on thomas.gov as we did the previous bills, but this one is pretty long. Anyway, it's got lots of important measures to help us care for women and you can send a letter to your Congress Members in 5 minutes through the ACOG website! Here's how!
Go to the ACOG website and click on the advocacy tab and choose Legislative Action Center
There you will find a green box with information on the Prevention First Act. Read it and while you're here sign up for the Action Alerts above the box.
Click on the green Take Action button. Just fill in the information and click SEND! Just like that you have notified all your Representatives to Congress that you support this Act and encourage them to do the same! It's that easy!
To the right of the green prevention first box there are some other categories worth browsing. The Capitol Hill basics has some tips for writing and visiting your Members.
Finding and Following Legislation, Staying Aware!
I was planning on trying to attack and digest some big issues like Medicare while I am still here in the office and have access to the huge shared drive and the brains of the staff. However, I think since the Women's Health Care Resolution was introduced last week and I met with a couple offices about a bill regarding post-partum depression we should talk about legislation and how to find it and follow it.
If you haven't browsed the Legislative Primer, please do so. Just browse through it while on a plane or over dinner. It's a pretty quick read and will give you the basics. To order a copy click here.
So, you might be as surprised as I was to realize that most of the legislation that is introduced in either the House or the Senate goes no further than a committee. So once a piece of legislation is introduced it is assigned a number (H. 1 in the House, S. 1 in the Senate). The Member who introduces the bill may seek the support of other Members to Co-Sponsor a bill. Let's look at the Women's Health Care Resolution. If you go to http://www.thomas.gov you can find any piece of legislation that has been introduced. The Resolution is H Con Res 48 so click on bill number and type that in your search box. (Later, after you've played on the site a little, just type in women's and see if you can find it without the bill number since many times you will probably not have the actual number). You can see near the top that the bill was introduced by Representative Schakowski and had 10 co-sponsors (though I do know that Representative Kilroy of Ohio co-sponsored also after we talked last week! Whoo Hoo!!) You can see that S Con Res 6 is the related bill in the Senate.
Click on the text of legislation box and read it! It's not that long and it has some surprising statistics and good points in it! This is what we're asking Congress to consider on behalf of our patients so please get familiar with it!
Next click on all congressional actions. You will see that the bill has been sent to the House committee on energy and commerce. That is the committee that has jurisdiction over health issues. Once the bill is in the committee it is up to the chairperson to schedule further consideration. This is often the bill graveyard. Bills die here and any bill still in committee when the Congress ends and a new Congress begins,the bill dies with the previous Congress. If a Sponsor really wants to push a bill they have to work with the committee chair to get it considered and voted on. A nearly identical bill was introduced in the last Congress and died in committee when the Congress ended. If you go to thomas.gov in the middle of the page there is a place to search multiple, previous Congresses. Click here and search the 110th Congress to see if you can find the bill number(s) for the Women's Health Care Resolution introduced in the last Congress! (Hint:search for women's).
While a bill is in committee, there can be a Hearing, where people talk about the bill and related issues, and it can undergo a markup where edits and additions are made. If a bill makes it out of the committee it can go to the floor. In the House, the bill may still die if the Speaker of the House does not give the bill a place on the calendar. In the Senate, it gets scheduled for consideration but it can be placed on "hold" by any Senator which threatens a filibuster.
If the bill gets floor consideration it is discussed and amended by the House or Senate as a whole (and there are lots of rules around this). Then it is voted on. If passed, it must go to the other Chamber. If the two Chambers pass the same version of the bill it goes to the President. If not, it goes to the Conference Committee to be discussed by Members in both Chambers and the new version on is voted on by both Chambers before going to the President who can sign it into law, or veto it. Please note that this is a very watered down version of the process but I have to keep it simple for myself.
If you want to see how the entire process took place to to thomas.gov and type in HR 1, which was the stimulus bill. Click on all congressional actions and you can see how the entire process took place in detail. You can even click the vote record and see how each Member voted. For a quicker version click on Major Congressional Actions rather than All Congressional Action.
Another good use of this website is to look up legislation sponsored or co-sponsored by a particular Legislator. So if you wanted to look up all bills introduced by Senator John McCain of Arizona you can select his name from the Choose a Senator tab. If you want to see what bills he has co-sponsored you can go to advanced search and choose Senator McCain and click on Sponsor and Co-Sponsor. So if you are going to meet with a Member or their Staff you can look up any legislation they have introduced or co-sponsored this session.
Let's try one more. There is a bill asking for funding and treatment support for post-partum depression. It's been called the Melanie Blocker Stokes MOTHERS Act. So type MOTHERS into the search box. Go to the advanced search and see how many times it's been introduced- I found it as far back as the 107th Congress and it hasn't made it out of the Committee. It is amazing how long it takes something to become law. This bill has been reintroduced every Congress since 2001. The language of a bill is also of utmost importance. It can take months to change an "and" to "includes". Every word is important, and a huge package like the stimulus can be 700+ pages. The whole process is amazing.
Here is a list of things affecting the viability of legislation that I got from Nevena.
If you haven't browsed the Legislative Primer, please do so. Just browse through it while on a plane or over dinner. It's a pretty quick read and will give you the basics. To order a copy click here.
So, you might be as surprised as I was to realize that most of the legislation that is introduced in either the House or the Senate goes no further than a committee. So once a piece of legislation is introduced it is assigned a number (H. 1 in the House, S. 1 in the Senate). The Member who introduces the bill may seek the support of other Members to Co-Sponsor a bill. Let's look at the Women's Health Care Resolution. If you go to http://www.thomas.gov you can find any piece of legislation that has been introduced. The Resolution is H Con Res 48 so click on bill number and type that in your search box. (Later, after you've played on the site a little, just type in women's and see if you can find it without the bill number since many times you will probably not have the actual number). You can see near the top that the bill was introduced by Representative Schakowski and had 10 co-sponsors (though I do know that Representative Kilroy of Ohio co-sponsored also after we talked last week! Whoo Hoo!!) You can see that S Con Res 6 is the related bill in the Senate.
Click on the text of legislation box and read it! It's not that long and it has some surprising statistics and good points in it! This is what we're asking Congress to consider on behalf of our patients so please get familiar with it!
Next click on all congressional actions. You will see that the bill has been sent to the House committee on energy and commerce. That is the committee that has jurisdiction over health issues. Once the bill is in the committee it is up to the chairperson to schedule further consideration. This is often the bill graveyard. Bills die here and any bill still in committee when the Congress ends and a new Congress begins,the bill dies with the previous Congress. If a Sponsor really wants to push a bill they have to work with the committee chair to get it considered and voted on. A nearly identical bill was introduced in the last Congress and died in committee when the Congress ended. If you go to thomas.gov in the middle of the page there is a place to search multiple, previous Congresses. Click here and search the 110th Congress to see if you can find the bill number(s) for the Women's Health Care Resolution introduced in the last Congress! (Hint:search for women's).
While a bill is in committee, there can be a Hearing, where people talk about the bill and related issues, and it can undergo a markup where edits and additions are made. If a bill makes it out of the committee it can go to the floor. In the House, the bill may still die if the Speaker of the House does not give the bill a place on the calendar. In the Senate, it gets scheduled for consideration but it can be placed on "hold" by any Senator which threatens a filibuster.
If the bill gets floor consideration it is discussed and amended by the House or Senate as a whole (and there are lots of rules around this). Then it is voted on. If passed, it must go to the other Chamber. If the two Chambers pass the same version of the bill it goes to the President. If not, it goes to the Conference Committee to be discussed by Members in both Chambers and the new version on is voted on by both Chambers before going to the President who can sign it into law, or veto it. Please note that this is a very watered down version of the process but I have to keep it simple for myself.
If you want to see how the entire process took place to to thomas.gov and type in HR 1, which was the stimulus bill. Click on all congressional actions and you can see how the entire process took place in detail. You can even click the vote record and see how each Member voted. For a quicker version click on Major Congressional Actions rather than All Congressional Action.
Another good use of this website is to look up legislation sponsored or co-sponsored by a particular Legislator. So if you wanted to look up all bills introduced by Senator John McCain of Arizona you can select his name from the Choose a Senator tab. If you want to see what bills he has co-sponsored you can go to advanced search and choose Senator McCain and click on Sponsor and Co-Sponsor. So if you are going to meet with a Member or their Staff you can look up any legislation they have introduced or co-sponsored this session.
Let's try one more. There is a bill asking for funding and treatment support for post-partum depression. It's been called the Melanie Blocker Stokes MOTHERS Act. So type MOTHERS into the search box. Go to the advanced search and see how many times it's been introduced- I found it as far back as the 107th Congress and it hasn't made it out of the Committee. It is amazing how long it takes something to become law. This bill has been reintroduced every Congress since 2001. The language of a bill is also of utmost importance. It can take months to change an "and" to "includes". Every word is important, and a huge package like the stimulus can be 700+ pages. The whole process is amazing.
Here is a list of things affecting the viability of legislation that I got from Nevena.
- Number of bill co-sponsors (obviously if you have many people co-sponsoring a bill it will probably get more attention and consideration).
- Bill has been introduced in both Chambers (House and Senate)
- Bipartisan support (this one takes a lot of work and strategy I have learned)
- Grassroots support/pressure on Members by their constituents
- Time of year; in a re-election year Members may be even more sensitive to constituent support or opposition
- Who is the President?
Approximately 400 our of 14,000 introduced bills will become laws during a 2 year Congress!
ACOG has been very involved with the Women's Resolution so I would recommend following that particular legislation. Another way to stay on the issues is to sign up for ACOG's newsletter The Inside Scoop. Click the link to sign up and stay informed!
Tuesday, February 17, 2009
C-SPAN and NASCAR
So watching C-SPAN with Joe is like watching NASCAR with my brother, Jason. I am not a NASCAR fan, don't really get watching the cars drive around and around in circles. The blowouts are cool and I shudder when cars collide for fear that someone will really get hurt but those instances are few and I can't really do anything but sleep for 4 hours straight at a time. However, when I watch NASCAR with my brother it's cool. He explains why a driver took a pit at that time and what they have to do to stay in first, why another driver is changing lanes, and how that blowout affects the race.
So there is a TV in the office to watch C-SPAN. I have (big surprise) never been a fan of C-SPAN. But watching C-SPAN with Joe is like watching NASCAR with my brother. I can ask him why they're arguing, he explains the different rules and procedures for amendments and votes, we laugh when the Senate President has to call the Senate to order 4 times before everyone is quiet. And I have to admit, that last week when Joe was out of the office and the stimulus bill was being debated in the Senate... that I watched C-SPAN... by myself.
So there is a TV in the office to watch C-SPAN. I have (big surprise) never been a fan of C-SPAN. But watching C-SPAN with Joe is like watching NASCAR with my brother. I can ask him why they're arguing, he explains the different rules and procedures for amendments and votes, we laugh when the Senate President has to call the Senate to order 4 times before everyone is quiet. And I have to admit, that last week when Joe was out of the office and the stimulus bill was being debated in the Senate... that I watched C-SPAN... by myself.
Monday, February 16, 2009
What Residents Can Do
The last day of the conference I also heard Steve Hildebrand, Deputy National Campaign Manager of President Obama's campaign who talked about applying grassroots initiatives to health care reform. This lecture was great!
Regarding health reform:
"You all know what you're up against, the
special interests, the powerful groups, the easy messaging that
the opponents tend to always have. I really believe the way we
get this done is not here in Washington and it’s not by a bunch
of interest groups on our side here in Washington, but it’s by
regular people in communities who have stronger voices than
anybody else in this country right now."
"But what if 100 uninsured people came
together built by you, and they called upon John Thune (SD) to meet
with them, and he showed up with a video camera and he
videotaped that entire discussion where John Thune has to have
a discussion with 100 uninsured people. And what if some of
those folks say, you know what, Senator, we appreciate what
you’re doing, but you have health insurance and we don't. And
your health insurance is paid by the taxpayers, and we’re
taxpayers. We want what you got, nothing more, nothing less,
we want what you got."
I think there are so many people in the general public who truly don't know the power they have by being voting Constituents. He discouraged walking in as "We are the X coalition" but rather as voting members of that Congressman's district or state whom they are accountable too. I will definitely watch his talk again and here is the link. Click on the am session, there is also a transcript of the session if you just want to read it.
I approached Mr. Hildebrand after the lecture and asked what could WE do as residents and health care providers. I explained that it had to be the best bang for our time- that when working 80 hours a weeks we barely have time to shop for groceries, but if we could do one thing what would it be? He said for each of us to have a story or two of an uninsured person/family that we've encountered and explain the difficulty for that patient to get the care they needed, or explain the poor outcome that could have been avoided. And then ask, "What do you plan to do about this?" He actually thanked me for being involved and said that the representation on of the health care providers was essential and important.
So let's do it! Dr. Manriquez and I have discussed planning a meeting or two with Members. Get your stories together and join us!
Regarding health reform:
"You all know what you're up against, the
special interests, the powerful groups, the easy messaging that
the opponents tend to always have. I really believe the way we
get this done is not here in Washington and it’s not by a bunch
of interest groups on our side here in Washington, but it’s by
regular people in communities who have stronger voices than
anybody else in this country right now."
"But what if 100 uninsured people came
together built by you, and they called upon John Thune (SD) to meet
with them, and he showed up with a video camera and he
videotaped that entire discussion where John Thune has to have
a discussion with 100 uninsured people. And what if some of
those folks say, you know what, Senator, we appreciate what
you’re doing, but you have health insurance and we don't. And
your health insurance is paid by the taxpayers, and we’re
taxpayers. We want what you got, nothing more, nothing less,
we want what you got."
I think there are so many people in the general public who truly don't know the power they have by being voting Constituents. He discouraged walking in as "We are the X coalition" but rather as voting members of that Congressman's district or state whom they are accountable too. I will definitely watch his talk again and here is the link. Click on the am session, there is also a transcript of the session if you just want to read it.
I approached Mr. Hildebrand after the lecture and asked what could WE do as residents and health care providers. I explained that it had to be the best bang for our time- that when working 80 hours a weeks we barely have time to shop for groceries, but if we could do one thing what would it be? He said for each of us to have a story or two of an uninsured person/family that we've encountered and explain the difficulty for that patient to get the care they needed, or explain the poor outcome that could have been avoided. And then ask, "What do you plan to do about this?" He actually thanked me for being involved and said that the representation on of the health care providers was essential and important.
So let's do it! Dr. Manriquez and I have discussed planning a meeting or two with Members. Get your stories together and join us!
Thursday, February 12, 2009
State Health Facts, On the Issues, My Busy Week!
Hello Everyone! I have not forgotten about the blog, I have just been terribly busy. Those of you who attend the CLC will see my handiwork in the agenda book. I've made state fact sheets for all 50 states and D.C. They include information such as birth rates, percentage of preterm births, death rate from diabetes, obesity, percentage of women who have had pap smears, etc. They are useful when talking to the Staffers or the Congressmen to show them the status of their own state.
Just in case you are interested and have a need or desire to look up an individual state here is the website I've been using:
http://www.statehealthfacts.org/
There is some really good info. Another good website with state-specific numbers that is good for us is the March of Dimes website they have a tab for "professionals and researchers" here:
http://www.marchofdimes.com/professionals/681.asp
and the peristats is a great resource and the medical references has some really good patient information sheets. By the way, the March of Dimes estimates that a preterm delivery costs the private insurer $41,610 for an average stay of 16.8 days. As Anita mentioned earlier, that does not include long term care for the child, production lost from the parent, or take into account the devastation of divorce, depression, etc on the family. But you give that number to someone in Congress and let them know how many preterm births their state had and you get their attention. I figured it out for Kansas and it was over $200 million dollars in 2006.
Now my big project that I will finish tomorrow is putting together information sheets on all the new Congressmen in the 111th Congress- there are about 64 Members so this is a huge project. One website I've used for this is http://www.ontheissues.org/ On this site you can click on your state, then choose a Congressman (or woman) and see how they've voted and read quotes on different issues. I'm trying to put each person's stance on health care reform on these sheets so I've used this especially for new Senators who were previously US Representatives. Another site that I have come to like is Congresspedia.com
http://www.sourcewatch.org/index.php?title=Congresspedia
In addition to these two projects this week I've attended two meetings that the Alliance of Specialty Medicine (which ACOG is a part of) have had with Member's Staff. The biggest topics at these meetings seem to be Health IT and Physician Reimbursement. I went to an International Family Planning Coalition meeting, which I will blog more about. On Wednesday I attended a press conference announcing the introduction of a legislative resolution that was introduced in both the House and the Senate yesterday that ACOG has been a big part of (I'm going to give everyone a link so you can follow the progress of this legislation). I also attended a lunch meeting with several physician organizations and Representative Burgess from TX who is an ob/gyn. Then this morning I attended an AMA event where multiple physician groups casually met with many of the new Freshman Democrats. It was really fun! I got to meet lots of Staffers and several Representatives and it gave me some face time to talk about this new resolution and encourage them to co-sponsor it. I'm finally at a point where I know enough about what is going on that I can speak on my own if needed. Too bad next week is my last week! I would really love to stay longer. Tomorrow I'm going to a Medicaid briefing.
Hopefully this weekend I'll get more time to blog. The posts take me a while because I'm digesting and assimilating information in order to present it. I started a piece on Individualized Health Plans and how they are terrible options for women. It's almost done so look out for it- it's really important stuff!
Just in case you are interested and have a need or desire to look up an individual state here is the website I've been using:
http://www.statehealthfacts.org/
There is some really good info. Another good website with state-specific numbers that is good for us is the March of Dimes website they have a tab for "professionals and researchers" here:
http://www.marchofdimes.com/professionals/681.asp
and the peristats is a great resource and the medical references has some really good patient information sheets. By the way, the March of Dimes estimates that a preterm delivery costs the private insurer $41,610 for an average stay of 16.8 days. As Anita mentioned earlier, that does not include long term care for the child, production lost from the parent, or take into account the devastation of divorce, depression, etc on the family. But you give that number to someone in Congress and let them know how many preterm births their state had and you get their attention. I figured it out for Kansas and it was over $200 million dollars in 2006.
Now my big project that I will finish tomorrow is putting together information sheets on all the new Congressmen in the 111th Congress- there are about 64 Members so this is a huge project. One website I've used for this is http://www.ontheissues.org/ On this site you can click on your state, then choose a Congressman (or woman) and see how they've voted and read quotes on different issues. I'm trying to put each person's stance on health care reform on these sheets so I've used this especially for new Senators who were previously US Representatives. Another site that I have come to like is Congresspedia.com
http://www.sourcewatch.org/index.php?title=Congresspedia
In addition to these two projects this week I've attended two meetings that the Alliance of Specialty Medicine (which ACOG is a part of) have had with Member's Staff. The biggest topics at these meetings seem to be Health IT and Physician Reimbursement. I went to an International Family Planning Coalition meeting, which I will blog more about. On Wednesday I attended a press conference announcing the introduction of a legislative resolution that was introduced in both the House and the Senate yesterday that ACOG has been a big part of (I'm going to give everyone a link so you can follow the progress of this legislation). I also attended a lunch meeting with several physician organizations and Representative Burgess from TX who is an ob/gyn. Then this morning I attended an AMA event where multiple physician groups casually met with many of the new Freshman Democrats. It was really fun! I got to meet lots of Staffers and several Representatives and it gave me some face time to talk about this new resolution and encourage them to co-sponsor it. I'm finally at a point where I know enough about what is going on that I can speak on my own if needed. Too bad next week is my last week! I would really love to stay longer. Tomorrow I'm going to a Medicaid briefing.
Hopefully this weekend I'll get more time to blog. The posts take me a while because I'm digesting and assimilating information in order to present it. I started a piece on Individualized Health Plans and how they are terrible options for women. It's almost done so look out for it- it's really important stuff!
Monday, February 9, 2009
How Individualized Health Plans Discriminate Against Women
Health Care providers- please read this post!!!
The last day of the Health Action 2009 Conference was probably my favorite! One of the sessions that I attended was meeting the health care needs of women. The talk was given by several organizations including the National Women's Law Center (NWLC). I've interacted with NWLC during several coalition meetings and at the conference and they are a strong group. Their mission is to protect and advance the progress of women and girls at work, in school, and in virtually every aspect of their lives. They do a lot of good work with equality issues and reproductive choices. I'm going to focus this post on the Individual Insurance Market with links to that, but will post more useful information from the Center in another post.
In some reform plans there is a push to move to an individualized market where the consumers (patients) shop for and purchase their own health insurance from competing companies. Also, some employers are replacing employer-sponsored coverage with fixed sums to buy insurance through the individual market. We will discuss why this option is MUCH more expensive for women.
Women are more likely than men to use health services. They have reproductive health needs, are more likely to take a prescription drug, are more likely to have a chronic condition, and certain mental health problems affect more women than men. Women are also more likely to spend more than 10% of their income on out-of-pocket costs, to avoid necessary health care due to cost, and are more likely to be underinsured. Employers are not allowed to charge employees of different sex different premiums. However, the insurance company will charge the employer different premiums due to the make-up of their employees. So if two companies each have 50 employees and one company is comprised of 90% women this company will pay much higher insurance premiums than a company that is comprised of 90% men. (Though I've seen no data, I can't help but wonder if this doesn't influence hiring practices in small companies?). This difference is called "gender rating". In the individualized health plans gender rating is legal in most states and women of reproductive age are charged between 4% and 48% more than men of the same age for the same coverage. At first it was thought that this difference was for maternity care- but guess what? 59% of the programs offer no maternity coverage and an additional 20% offer a supplemental maternity coverage. An example of supplemental coverage is an additional $100 per month (in addition to the base premium for the general plan) and covers the first $2,000 of maternity charges for the first two years. The average cost of a vaginal delivery is about $7,500 and the average cost of a cesarean is about $13,000 so as you can see, this $2,000 in coverage leaves a women terribly underinsured. Ten states have banned gender rating and two states have limited gender rating, but women are not protected in the other 38 states, or in D.C. Only 5 states are have laws requiring insurers in the individual market to include maternity coverage.
Here is the part I found the most disturbing and the most shocking. Women who shop the individual market can be rejected for health insurance for having a prior cesarean section (it's a previous condition- what kind of predicament would that put us in as ob/gyns if in addition to the regular VBAC questions we had to wonder if we were setting women up to be ineligible for insurance?). And in 9 states and D.C. women can be denied insurance for being survivors of domestic violence!
So you can see that if women are expected to purchase their own insurance directly they will pay a significantly higher premium than men and if employers offer a flat sum to purchase insurance with, rather than provide health insurance, that money will be worth less for women than for men. Also, there are proposals to open the insurance markets so people in one state can buy insurance from a company in another state. However, then the insurance company is only held to the state mandates in effect in the state where the company is located. So a company can locate itself in a state with minimal regulation and sell to people all over the country.
While a majority of women are covered by employer-based insurance at this time, more women than men are insured through a spouse making their coverage dependent not only on the spouse keeping their job but also on the marriage remaining intact. As mentioned above, there are proposals that push the individual market, which is not susceptible to the same anti-discriminatory laws that the employer-based market it. This is bad news for women. These are also things to keep in mind when you are casting your vote for a State Insurance Commissioner!
For more information read the NWLC Nowhere to Turn: How the Individual Health Insurance Market Fails Women. (Click the Title, it's the link).
The last day of the Health Action 2009 Conference was probably my favorite! One of the sessions that I attended was meeting the health care needs of women. The talk was given by several organizations including the National Women's Law Center (NWLC). I've interacted with NWLC during several coalition meetings and at the conference and they are a strong group. Their mission is to protect and advance the progress of women and girls at work, in school, and in virtually every aspect of their lives. They do a lot of good work with equality issues and reproductive choices. I'm going to focus this post on the Individual Insurance Market with links to that, but will post more useful information from the Center in another post.
In some reform plans there is a push to move to an individualized market where the consumers (patients) shop for and purchase their own health insurance from competing companies. Also, some employers are replacing employer-sponsored coverage with fixed sums to buy insurance through the individual market. We will discuss why this option is MUCH more expensive for women.
Women are more likely than men to use health services. They have reproductive health needs, are more likely to take a prescription drug, are more likely to have a chronic condition, and certain mental health problems affect more women than men. Women are also more likely to spend more than 10% of their income on out-of-pocket costs, to avoid necessary health care due to cost, and are more likely to be underinsured. Employers are not allowed to charge employees of different sex different premiums. However, the insurance company will charge the employer different premiums due to the make-up of their employees. So if two companies each have 50 employees and one company is comprised of 90% women this company will pay much higher insurance premiums than a company that is comprised of 90% men. (Though I've seen no data, I can't help but wonder if this doesn't influence hiring practices in small companies?). This difference is called "gender rating". In the individualized health plans gender rating is legal in most states and women of reproductive age are charged between 4% and 48% more than men of the same age for the same coverage. At first it was thought that this difference was for maternity care- but guess what? 59% of the programs offer no maternity coverage and an additional 20% offer a supplemental maternity coverage. An example of supplemental coverage is an additional $100 per month (in addition to the base premium for the general plan) and covers the first $2,000 of maternity charges for the first two years. The average cost of a vaginal delivery is about $7,500 and the average cost of a cesarean is about $13,000 so as you can see, this $2,000 in coverage leaves a women terribly underinsured. Ten states have banned gender rating and two states have limited gender rating, but women are not protected in the other 38 states, or in D.C. Only 5 states are have laws requiring insurers in the individual market to include maternity coverage.
Here is the part I found the most disturbing and the most shocking. Women who shop the individual market can be rejected for health insurance for having a prior cesarean section (it's a previous condition- what kind of predicament would that put us in as ob/gyns if in addition to the regular VBAC questions we had to wonder if we were setting women up to be ineligible for insurance?). And in 9 states and D.C. women can be denied insurance for being survivors of domestic violence!
So you can see that if women are expected to purchase their own insurance directly they will pay a significantly higher premium than men and if employers offer a flat sum to purchase insurance with, rather than provide health insurance, that money will be worth less for women than for men. Also, there are proposals to open the insurance markets so people in one state can buy insurance from a company in another state. However, then the insurance company is only held to the state mandates in effect in the state where the company is located. So a company can locate itself in a state with minimal regulation and sell to people all over the country.
While a majority of women are covered by employer-based insurance at this time, more women than men are insured through a spouse making their coverage dependent not only on the spouse keeping their job but also on the marriage remaining intact. As mentioned above, there are proposals that push the individual market, which is not susceptible to the same anti-discriminatory laws that the employer-based market it. This is bad news for women. These are also things to keep in mind when you are casting your vote for a State Insurance Commissioner!
For more information read the NWLC Nowhere to Turn: How the Individual Health Insurance Market Fails Women. (Click the Title, it's the link).
Thursday, February 5, 2009
Health Action Continued- Dr. Gawande
Friday morning the opening session included E.J. Dionne, a syndicated columnist and Dr. Atul Gawande. I found this session particularly interesting. For one Mr Dionne is clever and quite funny. Dr. Gawande is a surgeon and a writer who previously worked as an adviser to the Clinton administration on health policy. He told a gripping story of a woman who found out that her health insurance was going to be resolved in a few days due to her job closing. She was carrying a term pregnancy and she convinced her obstetrician to induce her labor since she feared the reality of going into labor with no insurance coverage. During the induction she had dangerous vaginal bleeding and underwent an emergency cesarean section. Her insurance company denied her claim and she received a bill for over $17,000. Dr. Gawande urges that bankruptcy from medical debt must end, that it cannot be an economic crisis for business, and that physicians, hospitals, and drug companies must all be held accountable for making health care better, safer, and to contain costs.
I would encourage the physicians to listen to Dr. Gwande's talk. Go to the plenary on January 30 and if you don't want to listen to Mr Dionne (though his talk is also very good) forward to 32:20.
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=3099
As an addition, Dr. Manriquez has read both of his books and stated, "He's one of my favorite writers!" I haven't read them yet, but if you're interested, the titles are Complications and Better. Here is a link to his website.
http://www.gawande.com/
I would encourage the physicians to listen to Dr. Gwande's talk. Go to the plenary on January 30 and if you don't want to listen to Mr Dionne (though his talk is also very good) forward to 32:20.
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=3099
As an addition, Dr. Manriquez has read both of his books and stated, "He's one of my favorite writers!" I haven't read them yet, but if you're interested, the titles are Complications and Better. Here is a link to his website.
http://www.gawande.com/
Richard Comes Tomorrow!
Yay! Richard is coming to D.C. tomorrow! I am so excited to see him and for him to see where I've been living, to ride the metro with me, and most of all to meet Alisa. He wants to see the Holocaust Museum and the Spy museum so we're going to tour those for sure. We'll probably also tour the monuments (I hear it's supposed to be 50-60's this weekend) and do some ice skating and some good eating. I heard there's a place called Porter's in Dupont Circle that shows all the KU games so we might hit that as well. Can't wait!
Wednesday, February 4, 2009
Health Action 2009
On Thursday, Friday, and Saturday of last week I attended the Health Action 2009 Conference. The conference is hosted by Families USA. On the front page of their website they state, "Since 1982, Families USA has worked to promote high-quality, affordable health care for all Americans." They are a really neat group. Here is a link to the website- it has a LOT of info and can be daunting. I'm going to include bits that I have found particularly helpful in future posts but if you want to check out the entire organization here it is.
http://www.familiesusa.org/
Families USA works to promote health care for all. The whole conference was about health care reform, advocacy, and grassroots organization. The workshops included such things as: medicare, immigrants and health care, medical research, funding advocacy work, state reform, and long-term care (just to name a few). There were people in attendance from 45 states and D.C. People from small business groups, disease-specific groups, public health foundations, hospitals, law groups, not-for-profits and more. Interesting to me was that there were very few physicians or physicians groups! We're talking health care reform, and we provide health care, and we are just not there. It's so amazing to see all the work that goes on behind the scenes. Not just in Washington, but in the entire nation. There were a few hundred people, many who work on this full time, working for our patients that they may have access to us. There is just so much time put into this it made me want to do my part!
I had a morning meeting on the Hill Thursday morning so the first session I made it to was Representative Henry Waxman, who is the Chairman of the Committee on Energy and Commerce, under which most health issues fall. He discussed his views on health care reform and to sum it up he stated that reform should:
http://www.familiesusa.org/
Families USA works to promote health care for all. The whole conference was about health care reform, advocacy, and grassroots organization. The workshops included such things as: medicare, immigrants and health care, medical research, funding advocacy work, state reform, and long-term care (just to name a few). There were people in attendance from 45 states and D.C. People from small business groups, disease-specific groups, public health foundations, hospitals, law groups, not-for-profits and more. Interesting to me was that there were very few physicians or physicians groups! We're talking health care reform, and we provide health care, and we are just not there. It's so amazing to see all the work that goes on behind the scenes. Not just in Washington, but in the entire nation. There were a few hundred people, many who work on this full time, working for our patients that they may have access to us. There is just so much time put into this it made me want to do my part!
I had a morning meeting on the Hill Thursday morning so the first session I made it to was Representative Henry Waxman, who is the Chairman of the Committee on Energy and Commerce, under which most health issues fall. He discussed his views on health care reform and to sum it up he stated that reform should:
- Build on what we have. It should build on and protect the employer-based insurance that we currently have and strengthen and improve the Medicare/Medicaid/CHIP programs.
- Ensure quality care for all.
- Incorporate Health Information Technology
- Stress the importance of preventive care.
I was excited because these are all part of ACOGs Reform Agenda. If you would like to see the Congressman/Chairman's talk link here and choose lunch session:
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=3098
I didn't get to make it to the morning session but I hear it was very good as House Majority Leader Steny Hoyer and Sen. Debbie Stabenow both spoke.
Tuesday, February 3, 2009
My Meeting with Representative Moran and Capitol Tour
I can't thank you enough for all the support you've shown me for my blog. I've gotten many emails and the fact that so many friends back home are reading encourages me to keep it up!
Last Wednesday (Jan 28th) I met with Representative Jerry Moran, 1st district, Kansas.
http://www.jerrymoran.house.gov/
It's a very large district encompassing most of the state, and the county I will likely return to after residency is on the eastern edge of this district. At the beginning of the meeting the LA said to me, "The Representative would like to come in and meet you if he has time if that's okay." I sure wasn't going to say no! We had a very good meeting and she was interested in all I had to say. We discussed rural health and prenatal care at length. Then Representative Moran came in and we chatted. We talked Kansas colleges (Rock Chalk Jayhawk!) and what a unique community Junction City is.
After chatting for a bit he asked, "Can I take a picture with you?" Again, I sure wasn't going to say no!
I piped up, "I have my camera as well, do you mind if we take two?" Of course he didn't but I then realized that my camera had turned on in my bag (on video of all things) and my batteries were dead. So I had to email his office to send me the photo, but there I am hanging out with the Congressman.
Afterwards, I received a tour of the Capitol by one of the Representative's staff members. I was disappointed that I did not have batteries in my camera for the tour because there are places you can go with Staff that you can't go to as general public. The Staff Assistant in the office found some batteries for me but they were rechargable and needed to be charged up. Saddened by what seemed like my last hope of getting pictures failing I was about to leave when he asked, "Hey! Why don't you just put your memory card in the office camera and take it, then when you get back you can switch the cards out." So that's how I got pictures of the Capitol. The staff member who took me on my tour was very nice and very patient as well. Especially since I sat in the House and then the Senate chambers for quite a while. It had snowed and iced so the ACOG office was closed for the day. I spent the whole afternoon touring the Capitol and watching the House debate the stimulus package. Photos are not permitted in the House and Senate Floors but I got some good pictures of other things in the Capitol.
Here is the first Supreme Court
A Photo of the Rotunda in the Capitol- did you know the Statue of Liberty could fit into the Rotunda of the Capitol?
Walking into the Rotunda...
Want to know who your representatives are? Go to ACOG--> Advocacy--> Legislative Action Center and put your zip code in the spot to the right of the green box. Or click here to take you to that page:
http://capwiz.com/acog/home/
For those of you who are not ob/gyns and want to know, go to Project Vote Smart
http://www.votesmart.org/
Last Wednesday (Jan 28th) I met with Representative Jerry Moran, 1st district, Kansas.
http://www.jerrymoran.house.gov/
It's a very large district encompassing most of the state, and the county I will likely return to after residency is on the eastern edge of this district. At the beginning of the meeting the LA said to me, "The Representative would like to come in and meet you if he has time if that's okay." I sure wasn't going to say no! We had a very good meeting and she was interested in all I had to say. We discussed rural health and prenatal care at length. Then Representative Moran came in and we chatted. We talked Kansas colleges (Rock Chalk Jayhawk!) and what a unique community Junction City is.
After chatting for a bit he asked, "Can I take a picture with you?" Again, I sure wasn't going to say no!
I piped up, "I have my camera as well, do you mind if we take two?" Of course he didn't but I then realized that my camera had turned on in my bag (on video of all things) and my batteries were dead. So I had to email his office to send me the photo, but there I am hanging out with the Congressman.
Afterwards, I received a tour of the Capitol by one of the Representative's staff members. I was disappointed that I did not have batteries in my camera for the tour because there are places you can go with Staff that you can't go to as general public. The Staff Assistant in the office found some batteries for me but they were rechargable and needed to be charged up. Saddened by what seemed like my last hope of getting pictures failing I was about to leave when he asked, "Hey! Why don't you just put your memory card in the office camera and take it, then when you get back you can switch the cards out." So that's how I got pictures of the Capitol. The staff member who took me on my tour was very nice and very patient as well. Especially since I sat in the House and then the Senate chambers for quite a while. It had snowed and iced so the ACOG office was closed for the day. I spent the whole afternoon touring the Capitol and watching the House debate the stimulus package. Photos are not permitted in the House and Senate Floors but I got some good pictures of other things in the Capitol.
Here is the first Supreme Court
A Photo of the Rotunda in the Capitol- did you know the Statue of Liberty could fit into the Rotunda of the Capitol?
Walking into the Rotunda...
Want to know who your representatives are? Go to ACOG--> Advocacy--> Legislative Action Center and put your zip code in the spot to the right of the green box. Or click here to take you to that page:
http://capwiz.com/acog/home/
For those of you who are not ob/gyns and want to know, go to Project Vote Smart
http://www.votesmart.org/
Monday, February 2, 2009
My Story for the Congressmen (Links to Arizona)
So on Tuesday (Jan 27th) I had my first meeting with the Health Legislative Assistant (LA) in Senator Kyl's office. Joe went with me to help me out in case I froze, forgot my name, my organization's name, or said something dumb. I was nervous but I did okay. Here's the basics of my spiel.
I tell them that I am an ob/gyn in Phoenix, AZ and that I would like to discuss a couple issues with them. The first is the ACOG Health Reform Agenda. I gave him a copy along with a fact sheet I had made with multiple health indicators/stats (number of women with high blood pressure, number of pre-term deliveries, women who have had a mammogram within the past year, number of teen pregnancies, etc) compared to the Nation's numbers. (By the way- Arizona is huge on teen pregnancies, big surprise.) I discuss with them that it is essential that we provide prenatal care. I explain that 40% of all births in the US are Medicaid assisted, and that 13% of all pregnancies are uninsured. I tell them that pregnant women, whether they come for prenatal care or not DO come to the hospital to deliver, often with many complications, so we are paying for their care anyway and I urge that we provide prenatal care rather than just emergency and birth care. Then I give them two examples.
1. Is a woman who was sent to us in Phoenix from a rural area of Arizona. The ob/gyn in the rural town is in a solo practice and has many uninsured patients. In discussions with him I know that he only provides care that the patients can pay for because he cannot afford to cover so much of the cost himself. So if they can pay for the labs, they get labs etc. This patient ended up in the hospital very, very sick and was transferred to us because she was also pregnant. Upon exam it was discovered that she had a recto-vaginal fistula from a rectal cancer. But because of her inability to pay her diagnosis was delayed despite seeing a doctor. When I spoke with her doctor, he felt absolutely terrible and I could hear in his voice and in his words how hard it was for him to even maintain his practice with so little support and resources.
2. A woman that I took care of not long ago who had no prenatal care. She was quite ill and had an emergency c-section upon arrival to the hospital for very elevated blood pressures. We lost the mother and the baby remains in an intensive care unit. She had no prenatal care and no insurance. Had she come in earlier, I'm not sure we would have had a better outcome for the baby because her pressures were so high she probably would have delivered prematurely no matter what. But maybe we could have caught how sick the mother was sooner.
According the the March of Dimes, a premature birth costs the private insurer $41,610, and that is based on an average of 16.8 days in the NICU. So you can just imagine how much this baby, who has been in the NICU for over two months is costing the system. I use these stories to show them not only how difficult it is to provide good care, especially in rural areas, but how much we are paying for birth and emergency care and that is why covering prenatal care is essential! Lastly, I ask them to look over the Reform Agenda that there will be many ob/gyns in Washington over March 1-3 for the Congressional Leadership Conference and that we will be discussing these issues with them again.
I have given this speech (in addition to the Health IT and Comparative Effectiveness requests listed in previous blog) to 4 health LAs now. Senator Kyl's office, Senator McCain's office, Representative Moran (1st district Kansas), and Representative Shadegg's office (3rd district Arizona). Representative Moran's LA was very interested in what kind of tests, labs, and exams we did during the prenatal period. She was interested in what diseases and conditions we looked for that could possibly provide better outcomes and less NICU time. I went through a lengthy list of everything from the killers like pre-eclampsia, to diabetes, to domestic violence. She seemed impressed. It dawned on me that our officials may not understand that prenatal care is more than just checking a woman's weight and screening for diabetes- that we are monitoring for life-threatening conditions. It is so important for us to educate them on how important these services are and the extent of what we do since they don't have the advantage that we do of being in the clinic each day.
Ob/gyns- I urge and encourage you to make a list of the cases you see. Patients who could have had much better outcomes had they received care, patients who slipped through the system, patients you wanted to help but felt bound for whatever reason. Just jot them down and have a couple salient in your mind for any time you get an opportunity to advocate for your patients. These are the stories that our elected officials need to know about!
Here are the links to the Members I have met with from Arizona. I will do a separate entry for Representative Moran in Kansas. I have found these links helpful as you can quickly read their biographies, recent statements, recent legislation, etc. They are also good if you are ever going to visit Washington as there are some tours you have to arrange through your member of Congress, so they all have links for constituent services as well.
Senator Kyl- http://kyl.senate.gov/
Senator McCain- http://mccain.senate.gov/public/
Representative Shadegg- http://johnshadegg.house.gov/
I tell them that I am an ob/gyn in Phoenix, AZ and that I would like to discuss a couple issues with them. The first is the ACOG Health Reform Agenda. I gave him a copy along with a fact sheet I had made with multiple health indicators/stats (number of women with high blood pressure, number of pre-term deliveries, women who have had a mammogram within the past year, number of teen pregnancies, etc) compared to the Nation's numbers. (By the way- Arizona is huge on teen pregnancies, big surprise.) I discuss with them that it is essential that we provide prenatal care. I explain that 40% of all births in the US are Medicaid assisted, and that 13% of all pregnancies are uninsured. I tell them that pregnant women, whether they come for prenatal care or not DO come to the hospital to deliver, often with many complications, so we are paying for their care anyway and I urge that we provide prenatal care rather than just emergency and birth care. Then I give them two examples.
1. Is a woman who was sent to us in Phoenix from a rural area of Arizona. The ob/gyn in the rural town is in a solo practice and has many uninsured patients. In discussions with him I know that he only provides care that the patients can pay for because he cannot afford to cover so much of the cost himself. So if they can pay for the labs, they get labs etc. This patient ended up in the hospital very, very sick and was transferred to us because she was also pregnant. Upon exam it was discovered that she had a recto-vaginal fistula from a rectal cancer. But because of her inability to pay her diagnosis was delayed despite seeing a doctor. When I spoke with her doctor, he felt absolutely terrible and I could hear in his voice and in his words how hard it was for him to even maintain his practice with so little support and resources.
2. A woman that I took care of not long ago who had no prenatal care. She was quite ill and had an emergency c-section upon arrival to the hospital for very elevated blood pressures. We lost the mother and the baby remains in an intensive care unit. She had no prenatal care and no insurance. Had she come in earlier, I'm not sure we would have had a better outcome for the baby because her pressures were so high she probably would have delivered prematurely no matter what. But maybe we could have caught how sick the mother was sooner.
According the the March of Dimes, a premature birth costs the private insurer $41,610, and that is based on an average of 16.8 days in the NICU. So you can just imagine how much this baby, who has been in the NICU for over two months is costing the system. I use these stories to show them not only how difficult it is to provide good care, especially in rural areas, but how much we are paying for birth and emergency care and that is why covering prenatal care is essential! Lastly, I ask them to look over the Reform Agenda that there will be many ob/gyns in Washington over March 1-3 for the Congressional Leadership Conference and that we will be discussing these issues with them again.
I have given this speech (in addition to the Health IT and Comparative Effectiveness requests listed in previous blog) to 4 health LAs now. Senator Kyl's office, Senator McCain's office, Representative Moran (1st district Kansas), and Representative Shadegg's office (3rd district Arizona). Representative Moran's LA was very interested in what kind of tests, labs, and exams we did during the prenatal period. She was interested in what diseases and conditions we looked for that could possibly provide better outcomes and less NICU time. I went through a lengthy list of everything from the killers like pre-eclampsia, to diabetes, to domestic violence. She seemed impressed. It dawned on me that our officials may not understand that prenatal care is more than just checking a woman's weight and screening for diabetes- that we are monitoring for life-threatening conditions. It is so important for us to educate them on how important these services are and the extent of what we do since they don't have the advantage that we do of being in the clinic each day.
Ob/gyns- I urge and encourage you to make a list of the cases you see. Patients who could have had much better outcomes had they received care, patients who slipped through the system, patients you wanted to help but felt bound for whatever reason. Just jot them down and have a couple salient in your mind for any time you get an opportunity to advocate for your patients. These are the stories that our elected officials need to know about!
Here are the links to the Members I have met with from Arizona. I will do a separate entry for Representative Moran in Kansas. I have found these links helpful as you can quickly read their biographies, recent statements, recent legislation, etc. They are also good if you are ever going to visit Washington as there are some tours you have to arrange through your member of Congress, so they all have links for constituent services as well.
Senator Kyl- http://kyl.senate.gov/
Senator McCain- http://mccain.senate.gov/public/
Representative Shadegg- http://johnshadegg.house.gov/
ACOG's Reform Agenda: Health Care for Women, Health Care for All
ACOG has a full reform agenda. For a downloadable packet click below.
http://www.acog.org/departments/govtrel/HCFWHCFA-Packet.pdf
I encourage ALL the ob/gyns to take a look at it. It doesn't take very long to go through and it has some great information. It even has a glossary of terms (which I've found helpful) and a layout of ACOG's plan versus the Presidential Candidates' Plans.
Here are some basics (this can all be found in the packet linked above, including references)
15.8% people in the US are uninsured
13% of pregnant women are uninsured
Uninsured pregnant women have a 31% higher likelihood of experiencing an adverse health outcome after giving birth.
The uninsured rate for women of childbearing age is greater than for all Americans under age 65.
Uninsured women with breast cancer are 30-50% more likely to die from the disease.
Women pay 68% more than men for out-of-pocket medical costs.
Many private insurers do not cover contraception.
The principles:
1. Cover Everyone
2. Guarantee Benefits. Promote prevention, prenatal care, and contraception, continuity of care, and a medical home for women.
3. Engage employers, individuals, and governments. Build on the strengths of our current systems.
4. Make Coverage Affordable, including for small businesses, the self-employed, and low-income families. Eliminate gender discrimination. Fix the medical liability system.
5. Enhance Quality and Patient Safety.
I will have more information for you about some of the blatant discrimination against women. But get familiar with the information above! Download it and take a look!
http://www.acog.org/departments/govtrel/HCFWHCFA-Packet.pdf
I encourage ALL the ob/gyns to take a look at it. It doesn't take very long to go through and it has some great information. It even has a glossary of terms (which I've found helpful) and a layout of ACOG's plan versus the Presidential Candidates' Plans.
Here are some basics (this can all be found in the packet linked above, including references)
15.8% people in the US are uninsured
13% of pregnant women are uninsured
Uninsured pregnant women have a 31% higher likelihood of experiencing an adverse health outcome after giving birth.
The uninsured rate for women of childbearing age is greater than for all Americans under age 65.
Uninsured women with breast cancer are 30-50% more likely to die from the disease.
Women pay 68% more than men for out-of-pocket medical costs.
Many private insurers do not cover contraception.
The principles:
1. Cover Everyone
2. Guarantee Benefits. Promote prevention, prenatal care, and contraception, continuity of care, and a medical home for women.
3. Engage employers, individuals, and governments. Build on the strengths of our current systems.
4. Make Coverage Affordable, including for small businesses, the self-employed, and low-income families. Eliminate gender discrimination. Fix the medical liability system.
5. Enhance Quality and Patient Safety.
I will have more information for you about some of the blatant discrimination against women. But get familiar with the information above! Download it and take a look!
Sunday, February 1, 2009
What are your asks?
So on Monday I got to meet the director of the Government Relations Department of ACOG, Lucia DiVerne as we had a staff meeting. She is poised, smart, and organized. There is a lot going on in the office right now with the new administration, the stimulus package, health care reform around the corner, and the CLC coming up at the beginning of March. (Side note- I am so very excited for the CLC and to have some other PIROGers here with me! It's going to be so much fun and such an amazing learning experience!).
I had my first Hill visit scheduled for the next day with Senator John Kyl's health Legislative Assistant and I was really nervous and had no idea what I was supposed to talk about. I figured by this time that if I seriously knew nothing of this world, the person I would be talking with who works here in Washington dealing with all these acronyms and abbreviations would know little of mine. It's quite true. We do not have to be experts on the legislation- that is for the lobbyists to know. We are the experts on our patients. We know the stories we see day after day. The mom who couldn't afford the amniocentesis when her triple screen indicated a chromosomal abnormality, the elderly woman who never had that post-menopausal bleed that occurred two years ago worked up because she didn't have insurance who is now hemorrhaging and almost surely has cancer, the post-partum woman who has depression but you don't know how you'll follow up with her because her post-partum visit is the last visit medicaid will pay for... the woman with no prenatal care who died of organ failure after an emergent delivery. These are the stories of each Congressperson's constituents, and it's up to us to share them.
So, on Monday I met with Joe and Nevena, the two lobbyists, and we discussed what my "asks" would be when meeting with Staff on the Hill. Here's what we decided:
1. Whatever health care reform takes place, we need to have prenatal care included.
2. Health IT- it's in the stimulus package as it currently stands. And in the bill, in order to qualify for the Medicare EHR bonus payments a physician has to be a "meaningful EHR user". What does that mean? What does it look like? We are asking for clarification of who will decide the parameters and what it might look like for an ob/gyn.
3. Comparative Effectiveness Research is also in the Stimulus package. We agree with the need for evidence-based research but we want to ensure that this research will address eh specific needs of sub populations. We don't want, "drug A works well and it's the cheapest so that is what will be covered" when drug A may not be safe to use in pregnant women, or elderly woman, or may not work well in a specific minority group.
So, there are my asks! Prenatal care, who will set up the parameters for "meaningful EMR" and what will that look like, and getting some language put into the comparative effectiveness research for sub populations.
I had my first Hill visit scheduled for the next day with Senator John Kyl's health Legislative Assistant and I was really nervous and had no idea what I was supposed to talk about. I figured by this time that if I seriously knew nothing of this world, the person I would be talking with who works here in Washington dealing with all these acronyms and abbreviations would know little of mine. It's quite true. We do not have to be experts on the legislation- that is for the lobbyists to know. We are the experts on our patients. We know the stories we see day after day. The mom who couldn't afford the amniocentesis when her triple screen indicated a chromosomal abnormality, the elderly woman who never had that post-menopausal bleed that occurred two years ago worked up because she didn't have insurance who is now hemorrhaging and almost surely has cancer, the post-partum woman who has depression but you don't know how you'll follow up with her because her post-partum visit is the last visit medicaid will pay for... the woman with no prenatal care who died of organ failure after an emergent delivery. These are the stories of each Congressperson's constituents, and it's up to us to share them.
So, on Monday I met with Joe and Nevena, the two lobbyists, and we discussed what my "asks" would be when meeting with Staff on the Hill. Here's what we decided:
1. Whatever health care reform takes place, we need to have prenatal care included.
2. Health IT- it's in the stimulus package as it currently stands. And in the bill, in order to qualify for the Medicare EHR bonus payments a physician has to be a "meaningful EHR user". What does that mean? What does it look like? We are asking for clarification of who will decide the parameters and what it might look like for an ob/gyn.
3. Comparative Effectiveness Research is also in the Stimulus package. We agree with the need for evidence-based research but we want to ensure that this research will address eh specific needs of sub populations. We don't want, "drug A works well and it's the cheapest so that is what will be covered" when drug A may not be safe to use in pregnant women, or elderly woman, or may not work well in a specific minority group.
So, there are my asks! Prenatal care, who will set up the parameters for "meaningful EMR" and what will that look like, and getting some language put into the comparative effectiveness research for sub populations.
A Book Without Obstetrics or Gynecology in the Title?
On Friday I took my CREOG exam with the Howard University Ob/Gyn residents. They were very kind and hospitable but it was a LONG day! I got there before 8 but the test didn't start until 937. Over the weekend I finished the book Song of Solomon by Toni Morrison. That's right! I read a book that was not related to ob or gyn. I did do some reading for work, but I went to yoga and attended church over the weekend as well. It's going to be really hard to go back to residency work hours after this. :(
Saturday, January 31, 2009
Abbreviations and Mandates and Bills, Oh My! (Link to Government Primer)
So on Thursday it was time to get to work. I dressed in my brand new winter clothes and new coat (remember, I live in Phoenix) and took the Metro to the ACOG office so excited to start my learning experience. I was beaming and smiling at the passers-by until I realized none of them were smiling back. In fact, some of them looked at me like I was selling them crack. I realized that I am not in the midwest/southwest anymore and pondered this as I walked two blocks in the wrong direction.
When I got to the office everyone was very friendly (most of them are from Ohio- go Midwest!). I did take note at first that they are all young! At the welcome breakfast I thought, "I could seriously be the oldest person in here." They are all bright, professional, and hard-working, and are quite an impressive group. I have my own desk and computer and I share an office with Joe, who is one of the two lobbyists. Bless his heart! All day I am calling out over the partition between us and patiently he answers all my questions.
I already had a pretty fully schedule for my first full week (if anyone knows how to load a word document, I'll post it.) I was overwhelmed on Day 1. I sat in on a conference call with Joe with some other womens' organizations and he had us on mute while the call took place.... Global Gag Rule.... "Do you know about that?" He asked me.
"No" I replied. And he explained it. Prevention First...
"Are you familiar with that legislation?"
"No."
And it kept going. I didn't know about any of this stuff. My goodness! It's a whole different world. Yet this world controls my practice, my salary, my malpractice, how I treat my patients... I had a lot to learn. I went home and looked up every acronym and abbreviation I had heard during that call.
FOR ALL YOU OB/GYNS - get this primer from ACOG. (It's free!). It will give you a refresher of your high school US Government class and get you acquainted with some topics that ACOG is focused on. It's a quick read too.
http://www.acog.org//departments/govtrel/LegislativePrimerPromo.pdf
When I got to the office everyone was very friendly (most of them are from Ohio- go Midwest!). I did take note at first that they are all young! At the welcome breakfast I thought, "I could seriously be the oldest person in here." They are all bright, professional, and hard-working, and are quite an impressive group. I have my own desk and computer and I share an office with Joe, who is one of the two lobbyists. Bless his heart! All day I am calling out over the partition between us and patiently he answers all my questions.
I already had a pretty fully schedule for my first full week (if anyone knows how to load a word document, I'll post it.) I was overwhelmed on Day 1. I sat in on a conference call with Joe with some other womens' organizations and he had us on mute while the call took place.... Global Gag Rule.... "Do you know about that?" He asked me.
"No" I replied. And he explained it. Prevention First...
"Are you familiar with that legislation?"
"No."
And it kept going. I didn't know about any of this stuff. My goodness! It's a whole different world. Yet this world controls my practice, my salary, my malpractice, how I treat my patients... I had a lot to learn. I went home and looked up every acronym and abbreviation I had heard during that call.
FOR ALL YOU OB/GYNS - get this primer from ACOG. (It's free!). It will give you a refresher of your high school US Government class and get you acquainted with some topics that ACOG is focused on. It's a quick read too.
http://www.acog.org//departments/govtrel/LegislativePrimerPromo.pdf
Do I Really Want to Eat the President's Head?
Yes, that is our President on a cookie. I've never seen so much stuff with one person's face in all my life! Obama water, Obama cookies. You can get a hat with Obama's face in rhinestones. You can get t-shirts, scarves, posters, postcards, buttons, calendars, letter openers, chocolate bars, key chains, pencils, and much, much, much more including a picture of yourself next to an Obama cut out... for a fee of course.
Inauguration Day!
First I'm going to start with the craziness that was at the front door in the morning.
There were busses and people and more busses and more people. All the other house guests got up early and stood out in the COLD- and it was cold- for the inauguration. I chose to hang out at the church with Alisa and watch it there.
There were probably 100 people who gathered in the basement of the church to watch the ceremony. Many were part of a large group that had bussed down the previous night from a church Alisa had worked with in Charlotte, NC prior to moving to D.C. this summer. They arrived at about 3am and slept in the church.
There were busses and people and more busses and more people. All the other house guests got up early and stood out in the COLD- and it was cold- for the inauguration. I chose to hang out at the church with Alisa and watch it there.
There were probably 100 people who gathered in the basement of the church to watch the ceremony. Many were part of a large group that had bussed down the previous night from a church Alisa had worked with in Charlotte, NC prior to moving to D.C. this summer. They arrived at about 3am and slept in the church.
During, and more importantly, after the inauguration Alisa opened the church doors to anyone who needed a bathroom, a warm up, a cup of coffee, or a bowl of soup. Several members of the South Tryon Church from Charlotte as well as many members of CHUMC manned the church and served the visitors. I got the lucky job of greeting people at the door. There had to be 500+ people through that door! They were cold, many had been standing outside for 7+ hours. They were weary. One family had their 79 year old grandmother with them who'd been outside all day and had walked blocks and blocks. Some of the metro stations had closed down due to overcrowding and people falling on the tracks, leaving these visitors with no option but to keep walking. The busses weren't running on the hill and there were many chartered busses that could not get back into the city. There were two groups who sat in the sanctuary of the church until after 8pm because their busses weren't permitted back into the city. I have no idea where these people would have waited had CHUMC not been there and open. Carol, the CHUMC member who I was greeting with would throw the doors open when she saw someone with an elderly person in their party, or a child, or a person with a cane and call out to them to come warm up. There were droves of people. I talked with people from the Bahamas, Canada, North Carolina, Arizona, Georgia, Indiana, Maryland, Massachusetts, New York and more... And everyone was so thankful. It was so touching to see America come together in this way. People chatted with strangers, helped people they had never met with directions and information. They shared what few cabs could be obtained late in the day. I heard multiple times, "This is what the house of the Lord should look like." It was truly an honor to serve my fellow Americans that day and see a glimpse of all sorts of people gathered in hope, peace, and joy.
Monday Morning- The New York Times
I arrived late in the evening Sunday, January 18th. I was ecstatic to see Alisa and when I saw her pull up at the airport I realized that I would get to hang out with her for FIVE whole weeks! It just so happened that my time here in Washington (that was scheduled for me last April or May) fell over the inauguration. So, not only was I staying with Alisa but the other closest friend that I have (Melissa) who was my roommate for four years was here as well with Aileen, a friend from work. They were visiting DC in order to attend the inauguration. What a great time to be in Washington!
So like I said, Alisa is the pastor of CHUMC and there is another United Methodist Church a block away that is traditionally a predominantly African American church. The churches have a long history of having separated and segregated more than 180 years ago. In light of the inauguration of our first African American president the New York Times had followed Alisa (and subsequently Melissa and Aileen) for three days as they were running a story about the churches, racial reconciliation, and the work that these two churches are doing together now. So Monday morning as us girls were lounging around laughing and catching up, the New York Times photographer dropped by to take some photos! Seriously..? Yes. And just so you know, if the NY Times calls or texts and you don't answer, they will find you. It was surreal.
And on Monday morning there was the article on the FRONT page of the NY Times.
To read it, click on the link below and near the bottom left of the page where it says "Multimedia" and "Anticipation on a City Block" is the interactive piece that is very, very well done. The first picture is Aileen. When you click to advance to the next set of pictures, Alisa is the second one. Click on each picture to hear their statements.
That afternoon I attended a Rev. Martin Luther King, Jr. memorial service at Ebeneezer Church, which they held along with CHUMC. It was amazing to feel the hope in the air and the buzz of excitement for the following day's inauguration. Though the group was small, there were people in attendance from all over the nation. This is truly a historic time in our nation.
Then we dressed Alisa up for the Illinois state inaugural ball. She did not get to see President Obama, but she sure looked gorgeous! The photo above is Alisa with a parishioner from her former church in Charlotte, NC who came to visit for the inauguration (yes, there was a very full house!)
My Internship in Washington
Greetings! Thanks for checking me out. I'm a third year ob/gyn resident in Phoenix, AZ and I am using my selective time to go to Washington, D.C. for five weeks to work with the American College of Obstetricians and Gynecologists (ACOG). I am working with the government relations department and will be visiting Capitol Hill talking with Congressmen about....."doctor stuff", I guess. This is a whole new world for me but I am really excited because I know NOTHING about how the government works (okay, okay, I DO know there are three branches, two houses in Congress, etc. I learned a little something in junior high) but I certainly don't know enough to speak on health care politics in any intelligent manner. However, these laws and systems that are decided in a large part by people who have never seen a patient, affect the way I practice, what tests I can order, who I can see, and how and when I get paid. So off I go!
During my time in Washington, I will be staying with Alisa, my best friend from college. We've known each other *choke* going on 15 years. She is currently the pastor at Capitol Hill United Methodist Church (CHUMC) and is an amazing and talented woman, friend, preacher.
http://www.chumc.net/
I know we are going to have an amazing time staying together and I'm so excited! I will also preface this first blog with the following... I am a Christian and some of my posts will be about faith. I do have great hope for changes in our nation, and I do believe we NEED health reform. I'm not here to argue politics (I probably don't know enough yet to put up a really good argument anyway). You're welcomed to disagree and even to post comments of disagreement but my plan is not to turn this into a forum for debate. Rather, to share my experiences away from the 80 hour work weeks in the desert and to provide links/tools to fellow residents who might be interested in this information.
Hugs!
During my time in Washington, I will be staying with Alisa, my best friend from college. We've known each other *choke* going on 15 years. She is currently the pastor at Capitol Hill United Methodist Church (CHUMC) and is an amazing and talented woman, friend, preacher.
http://www.chumc.net/
I know we are going to have an amazing time staying together and I'm so excited! I will also preface this first blog with the following... I am a Christian and some of my posts will be about faith. I do have great hope for changes in our nation, and I do believe we NEED health reform. I'm not here to argue politics (I probably don't know enough yet to put up a really good argument anyway). You're welcomed to disagree and even to post comments of disagreement but my plan is not to turn this into a forum for debate. Rather, to share my experiences away from the 80 hour work weeks in the desert and to provide links/tools to fellow residents who might be interested in this information.
Hugs!
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