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Removal of Pre-existing Conditions provision of the Affordable Care Act: What will happen to the healthcare of America?

This is a guest post by Dr. Jacqueline J. Hill, Associate Dean of Nursing and Allied Health at Southern University and A & M College. Her involvement and advocacy in healthcare and educational issues spans over 20 years.

As you may remember, in 2010 the Affordable Care Act (ACA) or as it’s known Obamacare, was signed into law by President Barack Obama. Of the various provisions included in the Act, one of the more popular provisions was the coverage of pre-existing conditions. That’s the provision that prevents insurance companies from denying coverage for a condition the person had before they tried to get insurance.

Even with the repeal and replace movement of the ACA by the Trump administration, removal of the pre-existing provision was not one of the changes proposed. In November 2016, the Kaiser Family Foundation conducted its health tracking poll to determine if healthcare was a major factor in the presidential election. The survey found that many of the law’s major provisions (e.g., health coverage for 26-year olds and pre-existing conditions) were quite popular, even across party lines –which begs the question, “why would President Trump want to overturn the pre-existing provision of the ACA?”

Initially, I thought this effort was driven by the insurance industry, but after further investigation, my findings revealed that was not the case. It seems that America’s Health Insurance Plans (AHIP), the trade association for health insurance companies, supports the pre-existing condition protections under the ACA. According to AHIP “Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” They plan to file an amicus brief to support the ACA law.

So if insurance companies are supporting it, what’s pushing the movement? Apparently, a lawsuit was filed by 20 states in February 2017 challenging the constitutionality of the individual mandate. Despite the Supreme Court’s ruling earlier this year on the individual mandate, the Republican tax bill eliminates the penalty for not buying insurance, which goes into effect in 2019. To put it simply, the individual mandate is the part of the law that required everyone to have health insurance. The attorney general of Texas, Ken Paxton, asserts that without the individual mandate, which is the cornerstone of the ACA, the ACA is unconstitutional.

If the courts are in agreement with him then that means that persons with pre-existing conditions would be subject to the pre-ACA era of insurance companies denying them insurance coverage. Unfortunately, the Justice Department has refused to defend the ACA law and are leaving it to the courts.

According to Health and Human Services, approximately 130 million people in US under 65 years of age have pre-existing conditions. We all know someone who was denied insurance or could not afford the exorbitant cost of insurance for having a pre-existing condition, e.g., diabetes, hypertension, etc. prior to the implementation of the ACA.

Recognizing the role that the ACA has played in assisting people who were previously unable to be insured justifies the importance of maintaining the pre-existing component of the ACA.

So, what should we as citizens do? We should write our legislators and implore them to not allow this to occur. Recommend that they not tamper with the pre-existing provision, since removing it will negatively impact so many Americans.

Additionally, we should inform key stakeholders such as the insurance companies, nursing associations, and other grassroots organizations and voice our support of the pre-existing provision. As noted earlier, it’s one of the provisions that most people agree is a good one. What we don’t want to occur is go backwards to a time when so many were not afforded insurance.

Dr. Jacqueline J. Hill is Associate Dean of Nursing and Allied Health at Southern University and A & M College. Her involvement and advocacy in healthcare and educational issues spans over 20 years.

July 3, 2018

author: Editorial Staff

4 Comments

This is a guest post by Dr.

Global Health, HealthCetera, Policy

HealthCetera Action News Update

This serves as the third edition of HealthCetera’s global health policy and media action news update curated by the Center’s Katherine (Kayte) Green. This bi-weekly round-up intends to keep our community appraised of up-to-date news, policies, and ideas important to policy and social issues facing national and international health. This selection gathers information from a wide range of sources including, but not limited to: health associations and organizations, news sources, government agencies, academic publications, policy centers, and other national and international experts.

NATIONAL NEWS

SCOTUS

Washington – It has been a busy June for the Supreme Court of The United States. First Amendment Rights hearings have been tried and these cases will affect civil liberties for years to come. These decisions are a continuum of debates in the Supreme Court about how courts analyze First Amendment challenges.

Earlier this month, on June 4th, SCOTUS ruled in favor of a Colorado baker who refused to bake a cake to celebrate the marriage of a same sex couple because of a religious objection. The ruling was 7-2.

Tuesday June 27th’s ruling in favor of California anti-abortion clinics’ first amendment right, stating that these “clinic pregnancy centers” are not mandated to provide information on how to end pregnancies. The vote was 5-4.

Also on Tuesday, Trump’s Travel Ban was upheld handing the president a political victory and validating his power for border and immigration control. The vote was 5-4.

On Wednesday, the Court handed down a major blow to organized labor – ruling that government workers who chose not to join unions won’t have to pay for collective bargaining. The vote was 5-4.

And, the balance of the Supreme Court of The United States is in jeopardy with the announcement on Wednesday June 27th that Justice Anthony K. Kennedy will be stepping down. The bench was tipped right when Trump appointed Justice Gorsuch last year; and with another SCOTUS judge nomination for this administration, the scale will most likely tip further to the conservative right. In the coming years civil liberties will be called into question including: LGBTQ, Affirmative Action, Death Penalty, Abortion, Voting Rights and Gerrymandering, and Immigration.

“On Wednesday, what had seemed a particularly contentious finale to the Supreme Court’s term—with major cases involving union dues, the President’s travel ban, cell-phone location data, and anti-abortion “crisis pregnancy centers”—turned out to be a prelude to a bigger fight, when Justice Anthony Kennedy announced that he would retire at the end of July.”

NPR: Trump Says He Will Nominate New Supreme Court Justice From This List

The Atlantic: Justice Stevens: Roe Will Be Overturned if Kennedy Retires

RESOURCES:

United States Office of Labor

Utility Worker Union of America Education Portal

SCOTUSblog

Obamacare’s Pre-Existing Protections Under Siege, Again

” WASHINGTON — After failing to repeal the Affordable Care Act with a Republican-controlled Congress, the Trump administration is seizing on a different strategy for dismantling the law, one fraught with political risk. It is asking a court to throw out major elements, including hugely popular provisions that protect sick people from being denied health insurance or charged higher rates.” – Abby Goodnough, Robert Pear and Charlie Savage

RESPONSES:

Associated Press: Worker protections seen at risk in Trump health care shift

Reuters: U.S. Justice Department says Obamacare individual mandate unconstitutional

The Commonwealth Fund: The New Obamacare Lawsuit Could Undo Far More Than Protections for Preexisting Conditions

The NYT: Justice Dept. Says Crucial Provisions of Obamacare Are Unconstitutional

VOX: The Trump administration believes Obamacare’s preexisting conditions protections are now unconstitutional

Huffington Post:Trump Administration Takes New Aim At Obamacare’s Pre-Existing Protections

The New England Journal of Medicine: Repealing the ACA without a Replacement — The Risks to American Health Care

Trump’s Zero Tolerance Border Policy and Enforcement

This image of a mother seeking asylum on the Mexico border, who is being arrested for deportation in front of her two-year old daughter, has become the symbol of the devastating effects of Trump’s Zero Tolerance border control. It has been reported that over 2,300 children have been taken away from their families on the Mexican border since the beginning of May. The Zero Tolerance policy has immediate and long-term consequences for the children that are being torn from their families.

RESPONSES:

The Guardian: ‘Dumb, stupid’ family separations harm children, says detention camp manager

Politico: ‘Some Of The Kids I Spoke To Were Traumatized. Some Could Barely Speak.’

Reveal: Migrant Children At Risk Of Disease Outbreaks, Doctors Say

Bloomberg: Immigrant Children Forcibly Medicated While In U.S. Custody, Lawyers Say

The Associated Press: A Day With Border Patrol: Imperiled Infant, Distraught Dad

The Associated Press: Migrant Kids Could End Up In Already Strained Foster System

Time: Donald Trump Border Separation Policy

Newsweek: Immigrant children separated at border could suffer depression, disease and even earlier death, doctor says

The New Yorker: The Courageous Woman Who Is Organizing Separated Mothers Inside an ICE Detention Center

Kaiser Health News: Separating Children From Parents Can Make Them Easy Prey For Traffickers, State Department Report Warns

Michigan Health Lab: What Neuroscience Tells Us About Family Separation

Take a closer look at the detention centers and “tender age” shelters for immigrant children:

Kaiser Health News: 1 In 5 Immigrant Children Detained During ‘Zero Tolerance’ Border Policy Are Under 13

The Associated Press: Young Immigrants Detained In Virginia Center Allege Abuse

The New York Times: The Billion-Dollar, Secretive Business Of Operating Shelters For Migrant Children

GLOBAL NEWS

Migration Crisis in Europe

As the debate over migration in the United States heats up, Europe continues to be torn over what to do with the continent’s long running migration crisis. Many of those entering into the borders of Europe are coming from Northern Africa and crossing the Mediterranean Sea to seek asylum from terrible living conditions in their countries, spurred by economic conditions, political turmoil, and human rights violations.

RESPONSES:

Politico: EU leaders clinch migration deal in marathon summit

ODI: Aquarius, immigration caps and family separation: three lessons for doing migration differently

The Lancet: The displaced: looking for home away from home

BMC: European Union citizens’ views on development assistance for developing countries, during the recent migrant crisis in Europe

The Lancet: Offline: Migration—the new revolution

Devex: EU states push external migrant centers despite IOM doubts

The Washington Post: E.U. leaders agree on outline of migration deal

PAPERS:

Stevens, D. & Dimitriad,A. Crossing the Eastern Mediterranean Sea in Search of Asylum: Re-Evaluating Access, Agency, Policy and Protection. Academia.com.

UN Sexual Misconduct

In the era of the #MeToo movement, the United Nations is not immune to sexual harassment claims and has convened this week to investigate and address sexual misconduct within its organization. UNAids is under scrutiny for the mishandling of serious workplace sexual harassment claims. Female whistleblowers and HIV activists are urging global leadership to demand the Executive Director of UNAIDS, Michel Sidibé’s, step down because of his mismanagement of these claims.

The United Nations Secretary General, António Guterres has promised to make accountability for sexual misconduct a central part of his leadership.

RESPONSES:

Health Policy Watch: Accountability, Sexual Harassment Concerns In Spotlight At UNAIDS Board Meeting

NYT: U.N. Cases Read Like ‘Manual in How Not to Investigate’ Sexual Assault

UN News: UN leaders vow to stamp out workplace sexual harassment

The Guardian: UN sexual misconduct chief was promoted while facing harassment claims

European Food Labeling

PLOS Global Health: Cracking the Codex: the new frontier for nutrition labelling

The Codex Alimentarius Commision has been created by the United Nations World Health Organization Food and Agriculture Organization as the body that has outlined an international food standard. This is a two-prong mandate with the aim to: promote fair trade practices and protect consumer health. Although the standards are voluntary, these types of policies are often guidance for countries looking to develop national policies and could have the potential to show up in trade discussions globally. There will be a general meeting in Rome next week to further a discussion paper about these outlined standards.

“In short: what happens at Codex matters for public health nutrition.” – PLOS

Other News:

EuroHealthNet Annual Report:

” EuroHealthNet is a not-for-profit partnership of organisations, agencies and statutory bodies working on public health, promoting health, preventing disease, and reducing inequalities. EuroHealthNet supports members’ work through policy and project development, knowledge and expertise exchange, research, networking, and communications.” – EuroHealthNet

Global Health Council – ADVOCACY UPDATE ~ JUNE 25, 2018

Global Health News Resources:

NYT Global Health News

CDC Global Health News

Global Health NOW

Global Health Council

STAT

WEEKLY OP-ED

(Unsponsored and unsolicited)

NPR Health: Atul Gawande’s Aim For Health Care: ‘Make It Simpler To Do The Right Thing’

Dr. Atul Gawande, the surgeon-writer-researcher has been named the CEO of a joint health care partnership venture unveiled earlier this year by Amazon, Berkshire Hathaway and JPMorgan Chase. These three prominent employers hope to bring down health costs for their employees. Gawande says his biggest goal is to help professionals “make it simpler to do the right thing” in delivering care to patients.

” The new enterprise will oversee health coverage for about 1.2 million employees of the companies and their families. Gawande said he will focus on the same behaviors by doctors and hospitals that he studies at his Boston-based think tank, Ariadne Labs. One of the biggest problems in health care is that “doing the right thing is incredibly complicated,” he told the Aspen gathering, and one of the biggest sources of waste in the system is that patients are given “the wrong care in the wrong way at the wrong time.” Read More.

Katherine Green works for the George Washington School of Nursing’s Center for Health Policy and Media Engagement. She holds a Master’s Degree in International Relations and Service Development. The focus of her research is gender equity and empowerment. She is passionate about working on unresolved social issues that deal with health, gender rights, LGBTQ, risk reduction, the arts, and justice. She has a background in social sciences and fine arts. Prior to joining GW, Katherine has worked in global and national health advocacy, development, and policy.

To subscribe and submit content to HealthCetera News Action Update email: nursingpolicy@gwu.edu

June 29, 2018

author: Editorial Staff

0 Comments

This serves as the third edition of

Nursing, Policy

Nurse Practitioners in South Dakota Launch Clinic to Deliver High Quality, Affordable Care

This blog post is written by Linda Young, MSN, RN, FRE, a post-graduate student enrolled in George Washington University’s Health Policy and Media Engagement Certificate program. Ms. Young has many years of experience in nursing regulation and acute care nursing practice. Follow her on Twitter @ljy770157106

After South Dakota removed regulatory barriers for nurse practitioners, anyone in Watertown experiencing a non-life threatening illness or injury can see a nurse practitioner at the local urgent care clinic for a reasonable fee, as low as $40, or use private insurance.

Two family nurse practitioners, Melissa Magstadt and Holly York, opened their own urgent Quick Care clinic in Watertown in May 2018. Their goal was to provide quality care quickly offering short wait times with low out-of-pocket costs. Patients can use their private insurance but many opt to pay a baseline, non-insurance charge of $40.

Affordable, accessible care is important to Magstadt who offers reasonable prices to patients who do not meet Medicaid eligibility guidelines. South Dakota is one of a handful of states that has not expanded Medicaid. This leaves many individuals unqualified for Medicaid, making slightly more income than federal poverty guidelines.

According to Magstadt, “We see a lot of the uninsured persons who make too much for Medicaid but don’t have insurance. Or, if insured, it hardly helps when the deductibles are $5000! We had a patient yesterday who said “can I make payments on my bill here?” And I said, “Well, how does a $40 clinic bill sound to you?” And he said, “40 bucks? I can pay that!”

Only urgent care services are provided at their clinic. They refer patients that need ongoing management of a health condition like diabetes to a primary-care provider; and refer or transfer patients with more serious medical conditions like a heart attack to the emergency room. Magstadt says the clinic is a good option for individuals who have an urgent, non-life threatening health problem like an ear infection, sore throat, or sprain. The clinic also offers $85 health examinations for commercial drivers, a huge savings.

Combinations of private insurance and flat fees allow patients to more easily afford care. Conservatively, Magstadt estimates her clinic saves patients $29,000 a month; “We have really started making an impact on the working poor; 90% of patients we have seen decided to pay cash because their deductibles are so high.”

Magstadt says the clinic is doing well financially, “our billing and coding company reminds us we can charge and bill more, and we are “leaving money on the table”, but Holly and I keep telling them, sure we could bill higher, but we don’t need to. We want to be a part of helping with the health care cost crisis.”

In their first month they saw 256 patients and they’re growing, “We have the Lake Area Tech Institute here. Half the students do not have insurance. They are returning to school as non-traditional students to develop a career. The tech school does not have student health so we have partnered with them to provide the $40 clinic visits. Love the excitement and energy of the young students.” In addition Magstadt signed contracts with a major shipping company, a construction company, and a local school district who decided to exclusively use the clinic for required physicals; securing a steady income for their clinic.

Impact of Removing Anticompetitive Barriers

In 2017 South Dakota’s legislature passed new laws in 36-9A authorizing full practice authority for certified nurse practitioners (CNP) and certified nurse midwives (CNM). Major changes included removing physician collaborative agreement requirements, placing the regulation of CNMs and CNPs under the sole jurisdiction of the Board of Nursing, and modernizing scope of practice language. Prior to practicing independently, CNMs and CNPs must practice a minimum of 1,040 hours under a collaborative agreement with an experienced physician, CNP, or CNM.

CNPs and CNMs practice includes conducting advanced assessments, ordering and interpreting diagnostic procedures, establishing primary and differential diagnoses, prescribing, ordering, administering, and furnishing therapeutic measures such as medications, durable medical equipment, or nutrition therapy. They are required to practice within their area of education, licensure, competence, and experience. As health professionals they are accountable to collaborate with other health care providers, refer or transfer patients appropriately.

Both Magstadt and York are family nurse practitioners with many years of experience in urgent care, emergency care, and other areas of medical care. In addition to the urgent care clinic, Magstadt also owns her own medical spa. Having served as a South Dakota state legislator, she is well aware of the impact the legislative process has on removing barriers to practice.

After the law changed, Magstadt and York seized the opportunity to use their skills and experience as qualified advanced practice registered nurses to open their clinic after recognizing a need for urgent care services at affordable prices. Watertown is one of South Dakota’s larger communities with a population of 21,540 (U.S. Census Bureau). Their clinic attracts patients from Watertown and nearby towns and farms. The two NPs see patients on a walk-in basis from 7:00 AM to 7:00 PM Monday through Friday, and on weekends and holidays.

Educating patients on differences between care delivery settings is important. Urgent care clinics are designed to provide for urgent health needs, like ear infections when the primary care clinic is unavailable, while primary-care providers’ manage patients’ health conditions, like diabetes or blood pressure, and provide routine health maintenance checkups. Emergency rooms are for life-threatening concerns like heart attacks. Magstadt and York promote and encourage patients to connect with a primary care provider.

Providing Value-Added, Patient-Centered Care

This clinic is one example of how quality, cost-effective health care can be delivered by CNPs once a state’s restrictive barriers to practice are removed, opening clinic doors and possibilities allowing nurse practitioners to provide health care services within their level of education and experience.

Affordable, accessible care is important for both rural and urban communities. Magstadt and York’s clinic demonstrates how nurse practitioners can make a powerful impact in a community to promote healthy outcomes.

It is time to make legislative changes in all states to reduce barriers and allow flexibility for nurse practitioners to positively impact healthcare for consumers in the U.S.

About the Author

Linda Young, MSN, RN, FRE is a post-graduate student enrolled in GWU’s Health Policy and Media Engagement Graduate Certificate program, she has many years of experience in nursing regulation and acute care nursing practice.

June 28, 2018

author: Editorial Staff

0 Comments

This blog post is written by Linda Young,

Connect with Healthcetera

Removal of Pre-existing Conditions provision of the Affordable Care Act: What will happen to the healthcare of America?

HealthCetera Action News Update

NATIONAL NEWS

SCOTUS

LGBTQ RIGHTS:

ABORTION:

TRAVEL BAN:

UNIONS:

JUSTICE KENNEDY:

Obamacare’s Pre-Existing Protections Under Siege, Again

RESPONSES:

Trump’s Zero Tolerance Border Policy and Enforcement

RESPONSES:

Take a closer look at the detention centers and “tender age” shelters for immigrant children:

GLOBAL NEWS

Migration Crisis in Europe

RESPONSES:

PAPERS:

UN Sexual Misconduct

RESPONSES:

European Food Labeling

RELATED REPORTS:

WEEKLY OP-ED

NPR Health: Atul Gawande’s Aim For Health Care: ‘Make It Simpler To Do The Right Thing’

Nurse Practitioners in South Dakota Launch Clinic to Deliver High Quality, Affordable Care

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