The path to mental health reform – National Consumers League

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By Stephanie Sperry, NCL health policy intern

Mental illness in the United States is a public health crisis. On March 7, 2018, the Center for American Progress hosted a discussion between Sacramento Mayor Darrell Steinberg and New York City First Lady Chirlane McCray, covering the efforts of cities and states on the path to mental health reform.

Mental illness is not limited by age, gender, race, or geographic location, and proposed cuts to Medicaid and the Affordable Care Act will severely limit treatment options for those in need. Research done by the National Institute of Mental Health showed that annually, 1 in 6 adults in the United States experience mental illness. In the absence of national leadership efforts and support on the mental health front, First Lady McCray pioneered the ThriveNYC framework in 2015 to initiate an agenda for mental health reform, while Mayor Steinberg set about to change the delivery of mental health services by authoring the California Mental Health Services Act (Proposition 63) in 2004.

ThriveNYC aims to “reduce the toll of mental illness, promote mental health, and protect New Yorkers’ resiliency, self-esteem, family strength, and joy.”  It was built on 6 guiding principles: changing the culture of mental health; acting early with interventions; closing treatment gaps with wider access to care; partnering with communities to create solutions; using data better to provide accurate information and tools to City agencies, treatment providers, and others; and strengthening the government’s ability to lead through expectations of accountability and responsibility. First Lady McCray gave examples of current efforts, including the incorporation of screening for maternal depression during physician visits and training 250,000 people in mental health first aid. She explained that early detection is valuable, because 50% of the time, symptoms of mental illness emerge by age 14, and 75% of the time by age 24.  Early treatment can greatly reduce the long-term adverse consequences of mental illness, while saving both time and money.

Sacramento Mayor Steinberg called mental health the “under-attended issue in our time and in our society.” After both the Community Mental Health Act, signed by President John F. Kennedy in 1963, and the Lanterman–Petris–Short (LPS) Act, signed by Governor Ronald Reagan in 1967, failed to deliver on their promises to address mental health for over 50 years, Steinberg took action. He was instrumental in the creation and passage of the California Mental Health Services Act (Proposition 63, 2004). This Act imposed a 1% tax on personal income more than $1 million, with revenue going into the “Mental Health Services Fund”. This Fund aims to support county mental health programs and monitor progress toward statewide goals, with an emphasis on prevention, early intervention, and the expansion of programs serving affected or at-risk individuals.

In addition to dedicated funding, technology has a unique part to play in strengthening mental health reform. Mayor Steinberg noted the innovative work of Mindstrong Health, which uses digital phenotyping to collect biomarker measurements from smartphone use to provide information about an individual’s mood, cognition, and behavior. This can deliver insights to patients and providers, helping to diagnose and manage mental illness by establishing a baseline and spotting and analyzing deviations from it.

The discussion between Mayor Steinberg and First Lady McCray was a fascinating snapshot into state and local efforts to tackle the monumental challenge that mental illness presents in society. The National Consumers League applauds these two local leaders – and their counterparts across the country – for launching initiatives to improve prevention, detection, and treatment of mental illness, and laying the groundwork for better mental health outcomes.

Strategies to improve rural health care – National Consumers League

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Stephanie_Sperry.jpgBy Stephanie Sperry, NCL health policy intern

Stephanie is a 4th year Public Health Policy student at the University of California Irvine, interning at NCL as part of the University of California Washington DC Academic Internship Program.

“Just because we live in rural areas in this country, we shouldn’t have to settle for anything less than the best health care services” – Darrold Bertsch, CEO, Sakakawea Medical Center

The rural health care landscape in the United States is vastly different from the health care found in urban and suburban areas. On January 17, 2018, the Bipartisan Policy Center (BPC) and the Center for Outcomes Research and Education (CORE) held a briefing at which they released a report on the current state of rural health care in seven Upper Midwest states (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming) and identified opportunities for improvement. The panel included Senator Heidi Heitkamp (D-ND); Senator Mike Rounds (R-SD); Keith Mueller, Ph.D., Interim Dean, University of Iowa College of Public Health and Director, RUPRI Center for Rural Health Policy Analysis; John Dunn, R.N., MPA, Director Physician Services, Nebraska Methodist Health System; Heidi Duncan, M.D., Physician Director of Health Policy, Billings Clinic; and Darrold Bertsch, CEO, Sakakawea Medical Center. The BPC/CORE report focused on four key areas: rightsizing health care services to fit community needs, creating rural funding mechanisms, building and supporting the primary care physician workforce, and expanding telemedicine services.

The Centers for Medicare and Medicaid Services (CMS) has implemented programs to monitor the quality of health care and drive its improvement. However, many of these programs are not tailored for rural areas, and in turn, rural facilities often lack resources to provide more advanced procedures. As Senator Rounds noted, people in rural areas end up overpaying for their health care – the quality of which would not be accepted in urban areas. Health care policies should not come in a “one size fits all” option, but should be tailored to fit the needs of the community. Senator Heitkamp argued that flexibility from CMS would allow health care professionals in rural areas to provide higher quality care, like incorporating care options for the elderly that wouldn’t require relocation.

Funding for rural health care (and health care as a whole) is a recurring challenge. The current passage of short-term continuing resolutions does little to provide financial stability for health care delivery, hospitals, and any organization in a contract with the federal government. According to Senator Rounds, the best course of action to address this issue will start with Congress passing a budget for more than three weeks at a time, to provide stability for organizations that depend on federal funding.

Rural areas face different types of challenges in health care delivery, with transportation and shortage of workforce personnel presenting major struggles. The distances that must be travelled to reach necessary health services in rural areas place an added burden on the rural population. Not only are people spending more time to travel, they spend more money making the trip. To address this issue, the BPC and CORE study suggests an expansion in the use of telemedicine services. Senators Heitkamp and Rounds praised the work of the Helmsley Trust in the areas of e-pharmacy and telemedicine. Telemedicine relies on high-speed broadband connectivity, the current state of which Senator Rounds criticized when he said “if you can watch your favorite college team on TV or on a computer, you ought to be able to also provide appropriate connections in emergency situations, between professionals and institutions with huge capabilities, to make contact with people in rural areas.” Senator Heitkamp uses Netflix as her benchmark for measuring successful broadband connectivity, believing that “there isn’t any millennial who is going to live in any community where they can’t stream Netflix. So, if you don’t have it, then we’re failing.”

Dwindling numbers of primary care physicians have placed an added strain on rural health care accessibility. BPC and CORE support the encouragement of completion of medical residencies in rural areas, thus paving the way for more practices to be established nearby. Because less than 8 percent of all physicians and surgeons choose to practice in rural settings, the hope is that increased exposure to rural communities during medical training will increase the number of physicians who choose to stay upon completion, as noted by Heidi Duncan, Physician Director of Health Policy at the Billings Clinic. Physician Assistants, guided by physicians via broadband connectivity, present another promising option – utilizing the expansion of telemedicine to provide the same essential services to rural communities that would otherwise be easily accessible in an urban setting.

As detailed in the BPC/CORE report, additional strategies to build a diverse and sustainable rural health workforce include distributing Graduate Medical Education (GME) positions to rural institutions and reauthorizing the Primary Care Residency Expansion and Area Health Education Center programs. Loan-forgiveness programs could also be expanded to include dental therapists and community paramedics.

In alignment with the strategies outlined by BPC and CORE, the National Consumers League is working with the Patient Access to Pharmacists’ Care Coalition (PAPCC) to build support for the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/S. 109), which would amend Medicare to increase medically underserved seniors’ access to health care through pharmacist-provided care. Since nearly 95 percent of the population lives within 5 miles of a pharmacy, improving access to pharmacists’ services can help to improve the care of our nation’s rural residents.

Ambulance costs need regulation, transparency – National Consumers League

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One worry people facing life-threatening emergencies shouldn’t have is the cost of an ambulance. Yet a recent article in the Washington Post highlighting a study by Kaiser Health News notes the wildly varying charges of taking an ambulance and the emergence of venture capital firms in owning ambulance services, of which there are 14,000 across the country.

One patient was billed $3,606 for a 4-mile ride; another was charged $8,460 for a ride from one hospital and then to another. These are generally out-of-network charges that patients can neither predict nor control, resulting when the insured’s company can’t come to an agreement on proper reimbursement for the ambulance and so it is left to outside services to charge whatever they want.

Think about this: most ambulances use to be free! Provided by local volunteers or town fire departments. But today, private companies or venture capital firms often run what have become lucrative businesses, putting patients at risk of exorbitant bills they aren’t able to pay. Two scenarios are particularly common: calling 911 or being transferred between hospitals.

Once the service is provided and billed to the patient, the insurance company pays what it deems to be a fair charge and leaves the patient with the balance. The Better Business Bureau received 1,200 complaints on ambulances over three years. And United Health Care has said: “Out of network ambulance companies should not be using emergencies as an opportunity to bill patients excessive amounts when they are at their most vulnerable.” Yet that is exactly what is happening to unwitting patients who think calling 911 is a service provided by their municipality.

There’s also evidence of waste and fraud in the ambulance business, where providers bill Medicare or Medicaid for rides never provided or rides to the wrong facilities to the tune of $50 million. But the Kaiser Health News report is focused on the fleecing of patients who need an ambulance and are unaware  of the  outrageous charges they will be asked to pay. The biggest ambulance company, American Medical Response, charged a man $7,109 for a 20 mile ride between hospitals. When he couldn’t pay it, they sent the bill to a collections agency. Kaiser Health News documents how debt collectors hound patients for the extra fees once their insurance company pays a base amount.

California passed a law in July that protects consumers from surprise medical bills by out-of-network providers that could offer some protections. Congressman Lloyd Doggett  (D-TX) has been pushing a bill to protect patients from out-of-network charges, but it doesn’t seem to be moving.

Patients should check with their local fire department, which might provide ambulance services and with their health plan to see what ambulances are in network. Without those protections, patients are vulnerable to being fleeced by ambulance providers in it for the money. Bottom line: Ambulance services are there to save lives. They should not be a lucrative profit center for venture capitalists or anyone else.

Women can’t be complacent about their Medicare choices – the cost is too high – National Consumers League

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This post originally appeared at Huff Post.

With all the news and controversy surrounding the Affordable Care Act (ACA) enrollment period, it’s easy to lose sight of the fact that Medicare open enrollment is also in full swing from now through December 7. This is the time for retirees to decide whether they should remain on their current Medicare plan or switch to another.

Ideally, the process should entail assessing your medical needs for the coming year, reviewing the details of your current plan to make sure it covers what you’ll need going forward, and considering whether there’s a better plan that will provide the right coverage at the right price. But unfortunately, that’s not how it usually works. In fact, a new survey sponsored by WellCare Health Plans, called the Cost of Complacency, shows that only about a third of seniors comparison shop for a Medicare plan at all.

Those harmed the most by not doing so are women: 26 percent more women than men ages 65 and older report feeling burdened by the cost of healthcare. It’s no wonder; there are several reasons for this. Women live longer than men—by an average of about 7 years. Longevity should be good news, but coupled with the fact that women typically have lower incomes and fewer financial assets—and have more chronic conditions requiring medical care than men—women often spend those extra years in a precarious financial situation.

Given these realities, it’s critical that older women have healthcare coverage that will meet their medical needs—not threaten their financial health. That’s not to say that figuring out what you need and which plan will best serve you is easy. As the WellCare survey found, 29 percent more women than men find the process of reviewing and comparing plans painful and frustrating. But the stakes are too high for women to not engage in the critical process of ensuring they are getting coverage that will protect both their health and their finances.

The reason it’s important to review and reassess your plan each year—even if you’ve been satisfied with your past coverage—is that it likely won’t be the same in 2018. Most plans change every year and some of those changes can be significant. Your health also changes (inevitably with greater costs as you age), so it’s especially important to consider how your current health conditions and whether the plan you’re currently on will provide adequate coverage if you are likely to need more diagnostic tests, different drug regimens, or more health care visits.

The basic rules of reviewing your plan include determining out-of-pocket costs, which consist of your premium, deductible, and cost-sharing charges, whether they may be copayments or co-insurance. You should also make sure that the pharmacies, health care providers, and hospitals you use are covered by the plan’s network or—if they aren’t—decide that you’re willing to switch to those that are.

For women on traditional Medicare (Part A & B), it’s also important to understand the gaps and limitations of that coverage. For instance, if you currently have or have had cancer in the past, you should be aware that there is a lifetime limit to the amount of diagnostic testing Medicare will cover. With treatments now enabling people to live with cancer for years as a chronic disease, you can quickly hit that maximum if there’s a need for expensive annual tests such as PET-CT scans. If you reach the Part B cap, you could be looking at exorbitant out-of-pocket costs.

With older women having higher rates of cognitive impairments, such as memory loss and dementia as they age, the Medicare limits on services associated with those conditions can have a particularly negative impact. While Medicare covers assessments for cognitive and neurological decline, it does not help with related ongoing services including daily care, care management, and home companions who can be incredibly costly, especially if needed for an extended period of time.

There are also significant coverage gaps in cataract treatments and no coverage at all for corrective eye exams, hearing exams, hearing aids, or common dental work.

About half of all women fill some of these gaps by enrolling in private plans, such as a supplemental Medigap insurance policy or a Medicare Advantage Plan that provides both Part B coverage as well as additional benefits.

So, there’s a lot to consider and yes, it can be overwhelming, which is why you shouldn’t do it alone. But, as the Cost of Complacency survey showed, most women do try to power through the process on their own, which could be why so many give up on doing it altogether. Instead, get together with a friend, your spouse, child, or grandchild and look to do the following: 

  • Review your current plan’s paperwork, including benefits and any limitations;
  • If you have them, review your medical receipts from the year to determine how much money you spent, and on what services;
  • Create a priority list for a Medicare plan, including not just “must haves,” but also “might needs”;
  • Use the Medicare Plan Finder tool on Medicare.gov to research plans based on your needs. Also, access community resources, such as senior centers, the State Health Insurance Assistance Program (SHIP), or the toll-free numbers provided by the plan providers to ask questions; and
  • Don’t try to review everything in one day. Do a little bit each day until the December 7 deadline.
You still have time to review, compare, and choose a plan that will serve your health needs for the coming year! It may be one of the most important things you can do to protect your health and your financial wellbeing.

Chronic disease: Costly, deadly, and preventable – National Consumers League

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Written by NCL Intern Sierra Hatfield

This summer, at a panel discussion sponsored by the Partnership to Fight Chronic Disease (PFCD) titled “Turning the Tide in Health Care Starts with Chronic Disease,” the distinguished panelists included Dan Crippen from the MIT Center for Finance and Policy, Douglas Holtz-Eakin from the American Action Forum, and Kenneth Thorpe of the Department of Health Policy & Management at Emory University.

The topic of discussion was the cost of chronic disease to society. Why? Chronic disease is the number one cause of death, disability, and rising health care costs in America. More than 191 million Americans have at least one chronic disease, and 90 cents of every dollar spent on health care goes towards the treatment of someone with a chronic disease. From an economic standpoint, a 90 percent growth in Medicare spending can be attributed to chronic disease alone, with the total cost of chronic disease projected to reach $42 trillion by 2030.

In addition to Medicare, the panelists discussed the costs to the states of mental illness, since an estimated 41 percent of adults have at least one mental health condition, and mental health treatment costs the states an estimated $3.5 trillion. Some states, such as Vermont, have introduced community health teams statewide who help with prevention and care coordination initiatives. According to Thorpe, these teams save the state money in two ways: (1) by integrating existing systems which were previously isolated; and (2) by integrating social services into healthcare as part of a care plan.

From a public health perspective, an estimated 1.1 million American lives could be saved annually through better prevention measures. Unfortunately, younger generations face a higher burden of chronic disease than previous generations, illustrating the need not only for a better healthcare system but also an urgency to understand how better prevention methods can be utilized.

For this reason, PFCD focuses its efforts on prevention and advocates for better access to health care services, early detection, medication adherence, and integrating social services and health care. Thorpe recommended scaling and replicating the European model where more GDP spending is on social programs than on health care, citing the practice as a good example of successful integration of the two. The panelists also advocated for the education and empowerment of local communities to take charge of their health

For our part, the National Consumers League (NCL) works to ensure affordable, quality health care for all Americans. In addition, NCL’s Script Your Future Medication Adherence Campaign provides tools and resources to help consumers with chronic diseases such as diabetes, cardiovascular disease, and respiratory disease to take their medications as directed in order to protect their health. To “Take the Pledge to Take Your Meds,” please visit scriptyourfuture.org/pledge.

Public breastfeeding legal but stigmatized – National Consumers League

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Written by NCL Intern Trang Nguyen

Breastfeeding has long been hailed as the best source of food for infants, providing the perfect mix of nutrition in an easily digestible form and lowering the risk of certain syndromes, diseases, and allergies.

For the mother, breastfeeding reduces uterine bleeding after birth, lowers the risk of breast and ovarian cancer, and helps moms lose their pregnancy weight faster. With those significant advantages, it is no wonder that organizations dedicated to maternal and children’s health and wellness recommend breastfeeding exclusively for the first 6 months, and supplemented with other sources of nutrition for at least 12 months and up to 2 years of age and even beyond. Health experts estimate that if new mothers exclusively breastfeed for at least six months, the U.S. would save $13 billion in healthcare and other costs each year. With those incredible benefits, over the last 25 years, the Surgeons General of the United States have been calling for greater incentives to protect and promote breastfeeding. As a society, we need to do all we can to create an environment in which women feel safe and comfortable breastfeeding.

In the United States, 81.1 percent of mothers begin breastfeeding their babies at birth. Yet, only half of the babies are still breastfed at 6 months of age and roughly 30 percent by 12 months. The fall-off is understandable, given the sadly negative feelings too many Americans attach to breastfeeding in public – ALERT: breastfeeding mothers are just feeding their babies, not engaging in a sexual act! Sadly, many mothers are more likely to stop breastfeeding if it means they can socialize outside of the home without fear of hiding in public bathrooms to feed their children.

Breastfeeding should be welcomed and encouraged in public spaces. We need to encourage mothers to do what is best for their babies by making sure infants continue to be breastfed for the recommended optimal time period. It is a fundamental part of sustaining a new life. Indeed, most mothers make every effort to be discreet. Unfortunately, many mothers are still facing discrimination and harassment for breastfeeding in public.

State and federal laws are lacking in protecting breastfeeding mothers. While 49 states already recognize the importance of breastfeeding and have laws explicitly allowing women to breastfeed in any public and private location where the mother can legally be present (e.g., Massachusetts allows breastfeeding in any place open to the general public such as a park or theater), new moms’ rights are often violated when they are asked to stop or relocate, and they have no recourse. In recent years, there have been far too many incidents of breastfeeding mothers being asked to leave places like a Springfield church, Nordstrom bathroom, courtroom, Target store, and many others, despite the fact they were not doing anything illegal.

Furthermore, only 29 states exempt breastfeeding from public indecency, which means even in states that recognize mothers’ rights to nurse in public, they can still be prosecuted for public indecency. In 2003, Jacqueline Mercado was arrested and temporarily lost custody of her children because she was photographed breastfeeding her 1-year-old. She was prosecuted for “sexual performance of a child,” a second-degree felony punishable by up to 20 years in prison. It took her six months to get the charges dropped and resume her children’s custody. This incident happened in Texas, where “a mother [has been] entitled to breast-feed her baby in any location in which the mother is authorized to be” since 1995.

There are also countless examples of nursing mothers being asked to relocate despite the property having no policies against public breastfeeding. In 2013, Amber Hinds was asked by a lifeguard to relocate herself to the locker room when she was breastfeeding in the county pool. She later called the pool manager and found out they were aware of the Wyoming state law protecting a woman’s right to breastfeed and had no policy against breastfeeding.

Nursing mothers even have to put up with derogatory and humiliating comments from their colleagues and employers when they pump breastmilk in the workplace despite the protection of the law. In 2010, the Affordable Care Act (ACA), Section 4207 amended The Fair Labor Standards Act (FLSA) of 1938 (29 U.S. Code 207) to specify that a mother has the right to take reasonable break time to express breast milk at work for one year after childbirth. Employers must also provide a private space, other than a toilet stall, for that employee to express breast milk. In spite of the benefits nursing has to businesses, including reducing the time a mother may miss work because of baby-related illnesses and encouraging her to come back to work earlier after birth because she is less concern about the effect it would have on the nursing relationship, we still hear heartbreaking stories of how nursing employees are not supported in the workplace. The Washington Post recently shared tales of how women have to pump milk in ant and roach-infested storage rooms, or have the CEO announce everyone of her pumping by playing Joe Budden’s Pump It Up. Under such stress and lack of support, many working mothers, like officer Victoria Clark, had no other choice but to stop breastfeeding altogether.

Incidents like this show that there is still much to do to protect the rights of nursing mothers. States need to revise their laws, adding legal remedies and removing public breastfeeding from the public indecency list. Meanwhile, public accommodations need to better train their staffs on policies and state laws that protect the rights of mothers to breastfeed in public. Even if this is merely a mistake on the staff’s part, and does not reflect the view of the property or the managing board, it can still leave detrimental consequences for new and inexperienced mothers. Mothers who have been yelled at or singled out in public might feel ashamed of breastfeeding in public and might abandon doing so altogether. Overall, we need to improve the public’s perception of breastfeeding so that nursing mothers will not have to go through emotional stress and abuse to feed their children.

As many women and men continue to fight for the right to breastfeed in public, mothers might equip themselves by better understanding state laws on public breastfeeding at https://www.ncsl.org/research/health/breastfeeding-state-laws.aspx and feeling empowered to state their right to be free of any harassment or discrimination they might face for breastfeeding in public. Even if the law has no enforcement mechanism, it is helpful for breastfeeding mothers to cite their rights when making complaints, calling for support, or contacting legislators.

NCL’s Breastfeeding Mothers’ Bill of Rights – National Consumers League

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breastfeeding-crop.jpgWritten by NCL Intern Trang Nguyen

Breastfeeding is a safe, healthy and natural act through which mothers provide nourishment to their children. Breast milk is the best nutrition a child can receive and ultimately promotes better health outcomes, in the short and long term, for not only the child, but also the mother. A mother’s right to breastfeed has long been recognized by the Court in Dike v. School Board of Orange County 650 F.2d 783 (5th Cir. 1981). The National Consumers League supports a mother’s right to breastfeed and believes mothers should be encouraged, supported and protected through law and policy. This support and protection should be extended regardless of race, national origin, sexual orientation, gender identity or expression, or source of payment for healthcare.

The National Consumers League issues the following Bill of Rights for breastfeeding mothers, including three key prongs we believe should be universal:

1.   Rights to breastfeeding information

  • A mother has the right to request breastfeeding information from her healthcare provider.  

  • Healthcare providers should inform mothers of the option of breastfeeding and her rights, proactively and upon request.

2.   Breastfeeding in a maternal healthcare facility

  • A mother has the right to have the baby stay with her and breastfeed after birth.

  • A mother has the right to request and receive assistance with breastfeeding.

  • A mother has the right to decide how her baby is fed and her decision should be respected by workers of the facility and other people. She has the right to refuse other methods of feeding unless the health of the baby is at risk.

  • A mother has the right to know about and refuse drugs or treatment that might affect her safety and ability to breastfeed.

  • Any health care facility that provides birthing services and maternity care should implement an infant feeding policy that promotes breastfeeding and equips itself with breastfeeding tools and educational resources.  

3.   Breastfeeding in public

  • A mother has the right to breastfeed her child in any public or private establishment or place where the mother and child are legally present, without harassment, discrimination or prosecution of any kind. A mother breastfeeding in public should not be asked to relocate.

  • These rights deserve full enforceable recognition and protection of local, state and federal laws. Explicit and encoded laws should give nursing mothers clear protection against discrimination. They also help shape public opinions on breastfeeding in public and thus help create an environment where women feel safe and encouraged to breastfeed.

  • No public or private establishment or place should enact an ordinance or rule that prevents breastfeeding a child.

  • Breastfeeding in a public or private location should not be considered lewd, immoral or indecent in any way; rather it is a natural and basic act to nurture a young child which must be encouraged in the interests of maternal and child health. Breastfeeding mothers should not be told to only do so in a discreet manner.

  • The Affordable Care Act (ACA), Section 4207 amends The Fair Labor Standards Act (FLSA) of 1938 (29 U.S. Code 207) to specify that a mother has the right to take reasonable break time to express breast milk for one year after childbirth at work. Employers must also provide a private space, other than a toilet stall, for that employee to express breast milk. Surveys have shown mothers are increasingly stopping their breastfeeding before recommended periods of time because of work-related reasons. Studies also show mothers who continue to breastfeed miss less time off from work because of baby-related illness. So, to promote the health and social benefits for mothers, their children, employers, and society, employers may not discriminate against mothers who choose to express breast milk at work. Employers should further adopt a written policy supporting breastfeeding practices in the workplace, including the space and equipment to clean and store expressed breastmilk.

  • The ACA requires new insurance plans to provide coverage for the cost of breastfeeding support, supplies and lactation counseling.

The American Health Care Act’s effect on mental health care coverage – National Consumers League

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American doctor talking to businesswoman patient

Written by NCL Intern Taylor Zeitlin

As the month of May comes to a close, so does Mental Health Awareness Month. With a staggering 17.9 percent of the U.S. population suffering from some form of mental disorder as of 2015, the topic of mental health care coverage is more pertinent than ever. Meanwhile, the House has voted to pass the American Health Care Act (AHCA), which is intended to give both individuals and health care providers more choice when it comes to health coverage.

To some of you, this concept of free choice may be appealing, but the ramifications of such a bill could have grave consequences. The AHCA gives insurers the power to severely limit what is covered under health plans and allows companies to charge higher premiums to those with pre-existing conditions. Major news outlets have been reporting about the tumultuous decline of health care coverage that may result in the event that the American Health Care Act passes into law.

But, what does this mean for those who seek treatment for mental health issues? Under the AHCA, insurers can choose to completely disregard mental health conditions and treatments, suggesting major headaches for sufferers. For those who will be affected, it’s important to know what to expect if the AHCA becomes law.

1.  Those suffering from mental illnesses (i.e. depression) will pay higher premiums.

  • Insurance companies now have the right to charge higher premiums to people who have been diagnosed with depression (also known as Major Depressive Disorder). In the same vein, other ailments such as anxiety or bipolar disorder will be at a financial disadvantage when it comes to coverage. Insurers cannot deny people with pre-existing conditions outright (insurers were allowed to do this before the Affordable Care Act and luckily the House Republicans opted to not bring this back for the AHCA), but mentally ill people seeking insurance will have to pay significantly higher premiums for care.

2.  Mental health care may no longer be protected under health plans.

  • When it came to the topic of essential health benefits (EHB), the AHCA gave the decision-making power back to the states. Under the ACA, addiction and mental health issues were classified as EHBs, and therefore, had to be covered by all insurance plans, including Medicaid. The complete unraveling of the ACA essentially nullifies the right to coverage for these conditions. This means that insurers can opt out of covering mental health care completely in some states and many may be at risk of losing coverage for these critical services. Additionally, the repeal of the subsidies approved by the ACA will allow insurers to charge higher premiums to those seeking mental health care.

3.  Employers will have the ability to purchase health plans that do not cover mental health care.

  • As if it could get any worse, employers will get the right to deny employees care for mental illnesses via the health care packages they choose to provide. So, people will still receive health benefits from their employer, but they will be stripped of the financial support for mental health care that employers were unable to deny before.

The consequences of denying mental health coverage can be fatal. Suicide is the tenth leading cause of death among U.S., while it is the second among teens. Additionally, suicide rates in the United States are at a thirty-year high, making services like therapy and medication more important than ever. Mental health already faces a huge amount of stigma in this country, and the AHCA’s blatant insensitivity towards the issues faced by sufferers is disheartening. Our President and the Senate have a moral prerogative to make sure the AHCA in its current state does not pass into law. Our country should not sacrifice the wellbeing of its citizens for the ease of choice; lives are at risk.

 

Make your health a priority: Enroll in Marketplace health insurance by the January 31 deadline – National Consumers League

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There is considerable anxiety over the future of healthcare in the face of our new Administration. However, the most important thing that consumers can do right now to protect their health is to enroll in or change their Marketplace health insurance plan by the January 31, 2017 deadline.

Consumers can go to HealthCare.gov to find a plan that best fits their needs and budget.

Why is having health insurance important?

  • It protects you and your family from unexpected medical costs. No one plans to get sick or hurt, but health insurance gives you important financial protection, just in case.
  • Marketplace health insurance gives you access to essential health benefits (like emergency services, maternity and newborn care, and prescription drugs) and preventive health services (like vaccines and screening tests) at no cost to you.
  • Marketplace plans may be more affordable than you think. About 85 percent of Marketplace consumers qualify for tax credits to assist with costs. At HealthCare.gov, you can find out if you qualify for financial help with your premium costs.

Contact HealthCare.gov’s Marketplace Call Center toll-free at 1-800-318-2596 for assistance with enrolling. If you have more questions about health insurance, we encourage you to visit MyHealthPlan.Guide, a joint project of NCL and America’s Health Insurance Plans, which provides helpful tips about choosing and using your health insurance plan.

Don’t miss out on your chance to get covered–enroll by the January 31 deadline. Make your health a priority–you owe it to yourself!

A threat to public health: Resurfacing of the anti-vaccine movement in Trump presidency – National Consumers League

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clare.jpgGuest blog by Clara Keane, a graduate of Drew University, Madison, NJ.

In the midst of a news avalanche in recent days as the Senate holds hearings for cabinet positions and new information breaks out related to Russian hacking, it is easy to miss what may be the most dangerous development of the incoming Administration: reopening vaccine skepticism and linking vaccinations to autism.On Tuesday, January 10, just ten days before President-elect Trump’s inauguration, Robert F. Kennedy Jr., an anti-vaccine crusader with no medical training who alleges causation between vaccines and autism, said that he accepted the position of chair to a new commission on vaccinations. In a statement from the transition team, spokeswoman Hope Hicks did not confirm Kennedy’s claims, although she did say that Trump is considering creating a commission on autism.

President-elect Trump has spoken out against vaccines multiple times in the past, although it was not discussed in great detail on the campaign trail. As is the case for determining Mr. Trump’s beliefs on many issues, Twitter provides some insight. In a tweet from 2012, Mr. Trump wrote: “I’m not against vaccinations for your children, I’m against them in 1 massive dose. Spread them out over a period of time & autism will drop!” Mr. Trump shows an alarming disregard to the facts, both in scientific research and in current medical practices.

The only study ever published that connected vaccinations to autism appeared in a 1998 issue of the Lancet and has since been completely discredited as a fraud. The study, which included only 12 handpicked cases, now serves as a textbook example of the danger of poorly executed experiments and the importance of sample size and representation in scientific studies. Returning to the warnings of a “massive dose,” a quick look at the CDC’s childhood vaccine schedule reveals that vaccines are administered in precise intervals from birth through age six.

Sadly, President-elect Trump is not alone questioning solid science. According to a national survey conducted by the National Consumers League in 2013, while most survey respondents (87 percent) say they support mandatory vaccination of school-aged children in theory, 64 percent of adults say parents should have the final say about whether or not to vaccinate. In addition, 33 percent think there’s a link between vaccines and autism.

How did we get to the point where vaccines—one of the greatest public health achievements of the 20th Century that have, among other things, eradicated smallpox globally and polio in the U.S.—are being considered by some as unnecessary or even damaging to their children’s wellbeing? Two equally dangerous contributing factors at play are the distance that vaccination success has granted us from the cruel reality of these diseases and the continued stream of false claims linking vaccines with autism.

It is easy to take for granted the security we enjoy from devastating diseases like polio, which was declared eradicated in the U.S. in 1979. However, it is important to remember that in the 1950’s, polio outbreaks caused more than 15,000 cases of paralysis each year in the United States. Parents during these dark times witnessed their children becoming paralyzed and were told there was nothing doctors could do to help. We are fortunate not to have these worries today. But in order to maintain the luxury of a polio-free nation, we must continue to have full participation in vaccinations. The Disneyland California measles outbreak of 2014 is but a small example of what can happen when people choose to stop vaccinating their children. According to a CDC report, among the 110 California patients, 45 percent were completely unvaccinated and only one percent had the full three doses that are recommended.

The reason for opting out of vaccinations may have felt safe for parents because those children had been protected by the surrounding children who were fully vaccinated. This concept is known as “herd immunity.” However, when large numbers of people stop vaccinating, disease breaks into the herd, as was the case in California. Indeed, the California outbreak led pediatrician and California state Senator Dr. Richard Pan, who was honored by NCL at our 2016 Trumpeter Awards Dinner, to sponsor legislation in California doing away with the “personal exemption” option for parents who don’t want to vaccinate their children.

The CDC lists some individuals who should forego vaccination, such as people with cancer and those with compromised immune systems. Because these people have no choice but to rely on herd immunity, members of the herd who are not vaccinated because of personal choice are causing an even bigger public health risk to those who are advised not to be vaccinated.

We must not take for granted the privilege of living in a society where parents no longer have to worry about a child’s death or disability from polio, whooping cough, diphtheria, hepatitis, measles, mumps, chicken pox, or influenza. It is remarkable that we have access to enough vaccines for the entire population and at no cost to parents. We cannot sacrifice this security. For this reason, we reject the messages of those fanning the flames of false information and promote fear of these life-saving vaccines.

So what might the new Administration mean for vaccine laws? Stat News provides a useful guide to what the President-elect can and can’t do. Of course, he will not be able to control vaccination schedules, but he may appoint agency officials who raise questions about vaccine safety. This should trouble all Americans because it puts our children and all immune-compromised Americans at risk of illness and even death. NCL plans to speak out in support of mandatory vaccinations and against false connections between vaccines and autism. We will continue to remind Americans how lucky we are in 2016 not to have to worry that any of us—but especially our children—will become sick, crippled or die of diseases. We have very safe and very effective vaccines to thank for that reality.