The Presidential Debate, the Supreme Court, and What it Means for the Affordable Care Act

On October 7th, 2020, President Donald Trump went head to head against former Vice President Joe Biden, marking the beginning of the election season and the first debate of 2020. Amongst ongoing chaos, with COVID-19 and racial unrest, this election could make or break the season finale of a monumental year. During the debate, candidates discussed many of the key topics that are at stake during this election, including the open seat in the Supreme Court.

Following the death of Ruth Bader Ginsburg, a feminist icon who has paved the way for women, minorities, and the LGBTQ community since 1993, the Court requires a new member, and whether that takes place before or after this upcoming Presidential Election is up for debate. RBG’s final statement was delivered publicly, days before her passing, “My most fervent wish is that I not be replaced until a new president is installed.”

Breakdown of the Candidate’s Segments:

After nominating Amy Coney Barrett the weekend prior to the debate President Trump vouched for her on stage, stating, “I will tell you very simply; we won the election. Elections have consequences – we have the Senate, the White House, and we have a phenomenal nominee respected by all.” Trump asserted that his remaining months in the White House would allow him to appoint Associate Justice Barrett to the empty Supreme Court seat. In his short response, President Trump expressed that her position and academic background qualified her for the seat, and reasoned that if it were up to the Democratic party, they, too, would push to elect someone of their choice for the empty seat.

Vice President Joe Biden argued that Trump’s stance on this matter is unconstitutional, stating that the “American people have a say in who the Supreme Court nominee is. And that say occurs when they vote for United State Senators and for the President of the United States; they are not going to get that option now. The election has already started.  Tens of thousands have already voted and the thing that should happen- is that we wait. We wait and see what this outcome is.”  Vice President Biden expressed his fear that that the nominee for the Supreme Court, who has written against the Affordable Care Act (ACA) and deemed it unconstitutional, would place the ACA in jeopardy. He raised concerns about the impact this will have on women’s rights, those with pre-existing health conditions, and the overall reasonableness of healthcare expenses. Biden summarized his thoughts, stating that this matter should be decided on after the election in February of 2021.

Fact-Checking: What is True About Their Statements?

According to the Chicago Tribune, Amy Coney Barrett has not, as Biden claimed, stated that the Affordable Care Act is unconstitutional. Barrett has been vocal about her view of the ACA and the laws that upheld it in 2012, but she has not spoken out about whether or not is it constitutionally right within the law.

CNN reported Biden’s concerns about eliminating the ACA would leave approximately 20 million people from having access to affordable health insurance are true. While this appears to be true, and even more so during a global pandemic, the effect of various events of 2020 may have inflated this number. According to a study conducted by the Urban Institute in Washington, which calculated and measured the impact that changing the policy would have on Americans, 20 million people would be without insurance but CNBC reported in August that “up to 12 million Americans may have lost their employer-sponsored health insurance during the pandemic.”

A final point was brought by President Trump about his Supreme Court Nominee, stating that “some of her biggest endorsers are very liberal people.” For example, Barrett has been endorsed by Noah Feldman, a liberal law professor at Harvard as well as some support from former professors of Notre Dame. However, according to Inside Highered, these endorsements sparked a petition from faculty stating, “Many members of the faculty are strongly opposed to Amy Barrett’s nomination,” the letter said. “Many of us do not know her, but she seems to be a kind, decent, and intelligent person. However, we are strongly opposed to her views — as reflected in her writings, opinions, and dissents,” the letter said.

How Will This Impact Americans?

The Supreme Court will eventually be deciding on matters as impactful as the 1973 Roe V Wade decision, which granted women legal access to abortions. Not only does the future of the ACA lie in the hands of the Supreme Court, so do basic civil and human rights. If the ACA overturned, millions of Americans will be left abandoned in the middle of a pandemic with no replacement plan in place. The remaining options of either buying into another insurer with unreasonably heightened prices, or risking getting sick with the coronavirus with little to no support, would no doubt have massive negative impacts on Americans.

Overturning the ACA would also leave the elderly to struggle to pay for their prescriptions, as the ACA currently covers much of the expenses for seniors’ medications. This would also leave women at risk of experiencing gender-based discrimination from insurers who would charge women more than men on insurance coverage. This could lessen women’s job outlooks because businesses with company-covered insurance would view women as more expensive.

On top of impacting various vulnerable populations, America’s current recession may also be worsened if ACA is done away with. Pre-existing health conditions would once again not be covered, and preventative care will need to be paid out of pocket. Among the pandemic, Black, Latinx, and Native Americans are struggling more than ever with the systemic racism that hinders them from receiving care. If ACA is thrown out, this would leave people of color open for further discrimination by insurance companies to higher rates or denial of coverage.  

The Supreme Court has recently made decisions on sex-based discrimination, religious discrimination, and immigration law. With justices’ life-long terms, this could impact the American people for decades. The current Supreme Court balance has five conservative justices and three liberals, so this next nominee could sway the Supreme Court vote to either side, and that will ultimately impact what is brought to the Supreme Court. With all of this in mind, it is imperative that Americans utilize their right to vote during the election.

Amy Comey Barrett was confirmed by the Senate on October 26th, and the Supreme Court will be voting on the constitutionality of the Affordable Care Act on November 10th, 2020.

Connected Commonwealth: Programs for Kentucky Youth Aging Out

Photo Credit: Foster Youth In Action

In May 2016, Anna Shobe-Wallace, program manager for Louisville Metro Community Services said, “Each year, more than 500 young people between the ages of 18-21 age out of Kentucky’s foster care system.” Many youth ‘aging out’ are disconnected from larger society and face barriers to success such as: low socioeconomic status, low educational achievement, unplanned pregnancy, racial segregation, and mental and physical challenges.

A recent study assessed the plight of disconnected youth who are teenagers and young adults between the ages of 16 and 24, and these youths are neither employed, enrolled in or attending school. The study focused on disconnected youth in the following categories: by state, county, congressional district, gender, and by race and ethnicity. Currently, there is approximately 5,527,000 disconnected youth in the United States or 13.8% of young adults.

According to data from the study:

  • Kentucky ranks 36th in youth disconnection rates with 15.2% of youth in this group for a total of 81,850.
  • Cincinnati, OH–KY–IN ranks 44th in youth disconnection among the most densely inhabited areas. The percentage of disconnected youth in this area is 12.8% or 38,312 total. The racial breakdown for this group is 20.6% Black and 11.8% White.
  • Louisville/Jefferson County, KY–IN ranks 56th in youth disconnection. The percentage of disconnected youth in this area is 14.0% with a total of 21,750 disconnected youth. The racial breakdown for this group is 18.5% Black and 13.3% White. This Kentucky county has the lowest percentage of disconnected youth.
  • Kentucky counties with the largest percentage of disconnected youth are as follows: Martin County, Kentucky ranks 2,020th with 47.8% disconnected youth; Union County, Kentucky ranks 2012 with 43.7% disconnected youth; Bracken County, Kentucky ranks 1,998th with 41.4% disconnected youth; Lee County, Kentucky ranks 1,994th with 40.9% disconnected youth; McCreary County, Kentucky ranks 1,992nd with 40.4% disconnected youth; Morgan County, Kentucky ranks 1,985th with 38.7% disconnected youth; and Wolfe County, Kentucky ranks 1,972nd with 37.5% disconnected youth

Researchers from this study concluded that larger urban communities had increased numbers of disconnected youth due to the following indicators: a historical pattern of disconnection, decreased neighborhood well-being rates, low SES, increased unemployment, a lack of academic achievement, and racism.

These alarming statistics clearly indicated systemic issues that impact disconnected youth. Experts from this study proposed that, “Disconnection is not a spontaneously occurring phenomenon; it is an outcome year in the making.” With this thought in mind, the study recommended these steps moving forward:

  • An estimated $26.8 billion dollars was involved with supporting the nation’s 5.5 million disconnected youth— comprising Supplemental Security Income payments, Medicaid, public assistance, incarceration, in 2013. Proposing more beneficial ways to invest in this population would be advantageous to society as a whole.
  • Designing preventive measures to address disconnection by sustaining at-risk parents and investing in quality preschool programs. It is usually more cost effective and compassionate to implement prevention strategies than crisis responses.
  • Re-joining youth and young adults who are secluded from higher education and the job market is more expensive than pre-emptive methods that address disconnection at the outset. However, these young people need another opportunity—considering many came from challenging backgrounds.
  • At the community level, an evident positive correlation was seen between adult employment status and youth’s relationship to education and employment. The amount of education adults had greatly projected the likelihood of young people ages 16 to 24 years old to attend school.
  • Significant headway involves individuals and organizations cooperating to institute specific measurable attainable realistic timely (SMART) goals for decreasing youth disconnection.

Amy Swann, author of “Failure to Launch”, notes that for 2013, the study data indicates that the Louisville Metropolitan Area (which consists of bordering counties) has 14.0 percent of youth ages 16-24 disengaged from employment and education. The study’s emphasis on cities resulted in reporting by Louisville news outlets at the Courier-Journal and WFPL. Media exposure of the status of disconnected youth in Kentuckiana has led to remarkable new efforts that focus on this population.

In light of this compelling evidence: social workers, legislators, and other helping professionals in the state of Kentucky have amassed their efforts to cultivate community partnerships and programs to support disconnected youth on their journey into emerging adulthood.

According to their website, here is a description of each program, and how it addresses the needs of disconnected youth and youth ‘aging out’.

Family Scholar House plans to open its fifth Louisville campus at the Riverport Landings development in southwest Jefferson County. The project goal is to equip families and youth to excel in education and to obtain independence. The new facility is expected to be ready by 2017 and will accommodate low-income families, single-parent families, and young adults formerly in foster care.

Fostering Success is a summer employment program developed by Gov. Matt Bevin that began June 1, 2016. The program provides job training via the Kentucky Department for Community Based Services for youth ages 18 to 23 years old. The program will run for 10 weeks and culminate with meetings with college and career counselors to prepare participants for future education and employment goals. Approximately 100 youth will be employed full-time at a rate of $10.00 dollars per hour. Fostering Success is one of the seminal programs in the state to target youth aging out.

Project LIFE serves 60 kids across Kentucky, including 25 in Louisville and offers an empowering environment to prepare them for success. Youth are given a housing voucher, along with social supports to improve access to education, employment, and income management skills.

Coalition Supporting Young Adults (CYSA) is an initiative created to address the barriers faced by Louisville’s disconnected young people. The mission is to develop: a standard agenda that meets the needs of Louisville’s vulnerable youth and young adults; common measurement tools that define collective goals and strategies; mutually supportive activities that create new partnerships and execute thoughtful programs; effective communication that creates a viable structure; foundational support that stimulates growth, responsibility, and dependability.

Transition Age Youth Launching Realized Dreams (TAYLRD) is an effort to create a unique program for young people born out of the federal government’s proposal called “Now is the Time” Healthy Transitions Grant Program. The Department of Behavioral Health (DBH) in Kentucky requested and received funding and Seven Counties was chosen as a venue to open drop-in centers where young people can foster relationships and access support /services to achieve their future goals. Youth Peer Support Specialists (YPSS) and Youth Coordinators work together with clients to define what concerns are most important, and then appropriate services/supports are brought into the drop-in centers. Some of the supports/services offered include: case management, life skills development, employment services, academic support, legal support, and therapy.

True Up founded by foster care alum Frank Harshaw, is a nurturing group of foster care alumni who have overcome obstacles to employment, pursuing education, gaining independence and solidifying healthy relationships. They have chosen to pay it forward through mentorship. True Up empowers foster youth through academic and hands-on learning in the following areas: Mobility & Transportation, Career Mapping, Financial Management, Relationship Building Skills, and Educational Achievement.

These are just a few of the innovative programs and resources available in the state of Kentucky. As helping professionals and the broader community create data driven programs for disconnected youth and youth aging out, expected outcomes will be much more positive in the near future.

Why Coverage of Prescription Contraception Matters for Men As Well As Women

Though the federal Affordable Care Act requires health insurers to cover many types of contraception, a vasectomy is not one of them.

Contraception – who should be able to use it, and the role of government in its provision – has become a contentious issue, in part due to disagreements over the Affordable Care Act mandate positing that all private insurance plans must cover prescription contraception for women. The issue is not trivial, because nationally representative surveys show that more than 10 million women in the United States use the pill as their current method to prevent pregnancy. The pill is the most popular form of reversible birth control.

Across the political spectrum, both citizens and public officials tend to understand birth control as a “women’s issue” rather than as a healthcare or social policy issue. Usually, birth control is discussed as a matter of reproductive health and rights or treated as an aspect of women’s personal responsibility for managing their own sexuality.

But where do men fit? How do they benefit from the availability and use of prescription birth control coverage? Could a better understanding of the ways prescription birth control coverage benefits heterosexual couples improve bipartisan discussions about coverage for contraception? My research provides insight into both of these questions.

Women’s Contraceptive Use and Couples’ Protection from Pregnancy

Contraception presumes the sexual involvement of couples, but surveys typically ask individual people about what method(s) they as individuals use to prevent pregnancy. By default, a woman who uses the pill for contraception also provides her partner with protection from pregnancy; and if her partner wears a condom, then both participants benefit. Contraception and condoms can be used together, but research shows that, in practice, couples in long-term relationships often move from using condoms to relying solely on prescription contraception.

Notably, interviews I conducted revealed that women who use prescription contraception for long periods of time rarely receive financial help from partners in purchasing it. Thus, although women’s birth control covers men, too, the men do not have to pay for this coverage and its benefits.

Men reap the positive effects of women’s use of prescription contraception in at least three ways: they gain protection from pregnancy without much effort; they avoid using condoms when couples transition to solely using prescription contraception, and they can spend money they might have spent on contraception on other items and pursuits.

There is also another way that men benefit from female contraceptive use that is not often mentioned. Women must deal with the downsides of whatever type of prescription birth control they use – including downsides such as physical side effects like nausea or depression and hassles like having to repeatedly refill prescriptions at the pharmacy. Their male partners are freed from such issues.

Contraceptive Use and the Unequal Burdens of Dissatisfaction

Preventing pregnancy is generally not something that couples enjoy, because it can be stressful, costly, and bothersome. Although public attention focuses on men’s dissatisfaction with condoms, much less attention is paid to women’s dissatisfaction with prescription birth control methods. My research using survey data finds that nearly 40% of women ages 23 to 44 who had ever used hormonal contraception had stopped using it at some point because they were dissatisfied.

Yet even though many women stop using a particular type of prescription contraception, they rarely stop contraception use altogether. They try various methods – different pills, or long-acting reversible contraception devices like implants and intrauterine devices – until they find something that feels right for them. As my in-depth interviews show, although many women experience dissatisfaction with side effects of particular birth control methods, they still believe that they should continue using some kind of prescription method.

Discussions that focus only on the benefits that prescription contraceptive coverage provides to women hide the ways that prescription birth control is very much like other medications – it can cause unpleasant and consequential side effects. By persisting despite dissatisfactions in their search for effective ways to prevent pregnancy, women provide tangible benefits for their partners, who get to avoid pregnancy without sharing such costs.

Even when women find it difficult or unpleasant to use certain methods, they cannot always count on getting male partners to wear condoms – or otherwise take responsibility for the couple’s contraception. This may explain why data from nationally representative surveys show that women who experience dissatisfaction with contraception are at higher risk of unintended pregnancy. When the burden of responsibility for birth control is too great, male partners cannot be counted on to pick up the slack.

What Does the Full Picture Mean for Debates about Contraception Coverage?

Recognizing that men as well as women benefit from prescription birth control coverage is crucial for appropriately evaluating the costs of rolling back the Affordable Care Act mandate for prescription contraception coverage. A nationally representative survey shows that only a very small percentage of people recognize that married women are the most likely to use prescription birth control. This may be because many of us are conditioned to see birth control as something affecting women rather than couples.

Public debates might very well change if more Americans understood all the ways that women, men, and society at large benefit from women’s access to prescription birth control – and their willingness to use it despite dissatisfaction. Too often, pundits and partisan debates treat contractive coverage as simply a women’s issue or benefit.

But if women, especially married women or women in long-term relationships, lose access to the most popular form of reversible contraception, so will men. Both men and women will experience new frustrations and costs.

Obama’s Contributions to Social Change Will Leave a Lasting Legacy

History is already attempting to rewrite Obama’s presidency. Over his eight years in office, Obama never exuded anything less than class, intelligence and an apparently endless appetite for hope and optimism. He frequently spoke about the progress toward a more perfect union and never publically condemned the colleagues who chose to hold him back.

Our former President spent most of his second term under siege from an uncompromising, myopic and greedy political party that controlled Congress and its purse strings. Perhaps no American president has had to endure so many vicious attacks on his character and “agenda,” most of which is planted firmly in the realm of common sense.

Look Beyond the Propaganda

During his time in office, Obama attempted to:

  • Sign a comprehensive infrastructure bill that would have rejuvenated America’s failing roads and other essential construction projects.
  • Sign a bipartisan transportation and housing bill.
  • Sign bills requiring equal pay for women and an overdue increase in the Federal minimum wage.
  • Sign a law that would limit offshoring and outsourcing, to keep American jobs in America.
  • Sign a law that would rehire 400,000 teachers, police officers, paramedics and firefighters.
  • Sign a law reforming student loan to make it more manageable and less punitive.
  • Sign a law that would have extended unemployment benefits for the most desperate Americans in times of hardship.
  • Sign a law that would have guaranteed millionaires pay similar tax rates as working Americans.
  • Sign a law that would have repealed subsidies for Big Oil.

If you’ve relied on television for your news — or even the major outlets with a digital presence — you’re probably familiar with tragically few of Obama’s efforts to reverse a generations-old trend toward ever-worsening inequality. He wanted to build an America that actually chose to rise to our potential instead of squandering it.

But Republicans stopped all of it from happening. They said they were halting the slippery slope toward tyranny — and they said it with a straight face.

What did we get instead? Eight years of Obama standing before the nation begging for a reasoned conversation about how to fix the middle class and create a government and nation that works for all of us, rather than only working for the rich. Eight years of Republicans saying “No.” The above is only a tiny sampling of GOP efforts to sabotage Obama — there are hundreds more examples.

None of this is to say Republicans — or even “conservative thinking” — is necessarily the problem here. The point is this: When evil wants to halt real social progress in its steps, the GOP is the tool it most frequently uses to do so. The Democratic Party might be out of touch these days, but the GOP is a deadly tumor that’s slowly killing us.

The ‘Signature’ Issue: Obamacare

No accounting of Obama’s tilting at the windmills of progress is complete without a word about The Affordable Care Act, or “Obamacare.” It’s his signature accomplishment, after all.

And yes, it’s complicated. Portions of it aren’t quite working as intended, but the goal of the law was to insure folks who’d never previously had insurance, either because their genetic code disqualified them or because they couldn’t afford it. By these standards, Obamacare has been a remarkable success. Twenty million Americans now have health insurance who did not previously have it, despite Republican efforts in Congress to literally steal the money meant to pay for it all.

You can’t be an informed citizen and still believe the ACA is some kind of albatross around the neck of America’s economy. It’s not socialized medicine. Hell, it’s not even universal healthcare. But it did move the Overton Window in a big way. The Overton Window is that magical spectrum that houses all of the ideas mainstream America is willing to entertain at any given time. Thanks to Obama’s presidency, the Overton Window now includes the concept of universal, unconditional healthcare. Other nations took the lead, and America took a while to catch on, but now we’re there.

Whether our current administration follows the painfully obvious bread crumb trail toward the only healthcare fix that makes any kind of sense today — a single-payer, Medicare-for-all system — is the only unanswered question.

Missed Opportunities

After we spend a couple more years toiling under the American Taliban we call Congress, Americans are probably going to start missing Obama in a big way. His story is a frustrating one, given where things are headed, but his actions speak far louder than bluster, outrage, vitriol, and smear campaigns. If you look at his record objectively, you’ll see a man who frequently stood alone against impossible odds on your behalf and mine.

And yes, it’s a touch tragic. In his book “The Audacity of Hope,” Obama writes elegantly and sadly about the compromises implicitly expected of a would-be politician. He admits:

“I can’t assume that the money chase [of seeking reelection] didn’t alter me in some ways … Increasingly I found myself spending time with people of means … [who] reflected, almost uniformly, the perspectives of their class: the top 1 percent or so of the income scale that can afford to write a $2,000 check to a political candidate … I know that as a consequence of my fund-raising I became more like the wealthy donors I met, in the very particular sense that I spent more and more of my time above the fray, outside the world of immediate hunger, disappointment, fear, irrationality, and frequent hardship of the other 99 percent of the population — that is, the people that I’d entered public life to serve.”

Reading these words hurts when they were written by a man who campaigned relentlessly on the idea of hope and change. It’s here that Obama’s only real failure resides, but it’s not an upworthy, sexy or outrageous topic, so we don’t talk about it. And Republicans don’t talk about it either, because they’ve made a science of taking the kind of bribes Obama spends his time here lamenting.

Instead, we get politicians like Chris Christie who use oxymoronical phrases like “feckless tyrant” to discuss Obama in front of a live TV audience. Bluster and hatred have attempted to overshadow the real story of Obama’s presidency.

And that real story is called measurable social progress. In addition to laying the groundwork for a brand-new healthcare system, Obama also managed to:

  • Oversee a 5.4% drop in unemployment over the course of six years.
  • Pass a $787 billion Recovery and Reinvestment package to see the middle class through the Great Recession.
  • Be instrumental in the LGBT community’s fight for equal rights and the official recognition of same-sex marriage.
  • Lay the groundwork for U.S. energy independence by the year 2020 and become a world leader in a 200-country climate change accord.
  • Help keep immigrant families together by expanding work permit programs.
  • Impose consumer protections and reform efforts on Wall Street.
  • Reduce the United States’ unconscionable use of torture.
  • Normalize our relationship with nearby Cuba.
  • Impose stricter fuel efficiency standards on American automobile manufacturers.
  • Take better care of returning veterans with a $78 billion G.I. bill.

The list goes on, and anyone who’s honest with themselves couldn’t possibly remember this man’s time in office as a failure. In fact, in the uncompromising light of these encouraging facts, even the phrase “missed opportunity” starts sounding a little quaint and hysterical.

Most New to Medicaid Have No Other Option if Affordable Care Act Repealed

“Lots of Ohioans support the ACA — but where do @ohiogop #OHGOV candidates stand on Medicaid expansion? #SaveACA” via Twitter @kirstinalv

Almost everyone covered through Ohio’s Medicaid expansion would have no other viable insurance option should the Affordable Care Act be repealed, a new study has found.

Law and public health researchers from The Ohio State University determined that 95 percent of newly enrolled beneficiaries would be without a plausible pathway to coverage. The research appears online in the American Journal of Public Health.

“Many of these people have nothing else to turn to,” said Eric Seiber, lead author and associate professor of health services management and policy in Ohio State’s College of Public Health.

“Their choice is Medicaid or medical bankruptcy.”

Ohio is one of 31 states (and Washington D.C.) to expand Medicaid eligibility as part of the Affordable Care Act. The move, which came in January 2014, made eligible those adults with incomes below 138 percent of the federal poverty level. (In 2015, that was about $16,243 earned annually for an individual.)

Prior to the ACA, Ohio generally did not grant Medicaid eligibility to childless adults unless they were pregnant or disabled. Parents qualified for Medicaid only if their family income was below 90 percent of the federal poverty level. By October of last year, enrollment under expansion in Ohio had reached about 712,000 people.

Efforts to repeal or substantially restructure the ACA reforms are under way.

Seiber and Micah Berman, assistant professor of public health and law at Ohio State’s College of Public Health and Moritz College of Law, evaluated data from 42,876 households that participated in Ohio’s 2015 Medicaid Assessment Survey. The telephone survey includes a set of questions to identify coverage immediately before Medicaid enrollment.

The new Ohio State research was driven by this question: “If the ACA is fully or partially repealed, who would lose their coverage and what would happen to them?”

The researchers found that the vast majority would find themselves without insurance in the case of a full ACA repeal.

Though 17.7 percent of survey participants had private health insurance prior to Medicaid enrollment, most had lost their jobs (and their coverage) or were ineligible for employer-sponsored group health plans at the time of enrollment. The researchers found that 4.8 percent of the new Medicaid recipients were eligible for insurance through their jobs, leaving 95.2 percent of new enrollees with no feasible alternative.

Seiber and Berman also found that a rollback would predominantly affect older, low-income whites with less than a college education.

“The impact of insurance is about a lot more than health care,” Berman said. “For people newly enrolled in Medicaid, it means that should they have a major health-related event, they can still pay for food, have stable housing, get out of debt. These are all things that make a huge difference in quality of life.”

A recent Ohio Medicaid analysis, which was conducted with help from Seiber and Berman and mentioned in the new study, found that that the expansion increased access to medical care, reduced unmet medical needs, improved self-reported health status and alleviated financial distress – all results found in other states that have expanded access to government coverage.

The new study shows that the majority of adults newly enrolled in Medicaid did not drop private insurance in favor of the government coverage, Seiber said.

“These are very low-income adults, many of whom lost their jobs and have nothing to go back to,” he said.

Said Berman, “It counters this perception that people have health insurance but then go on Medicaid to save money. That’s just not what the data show.”

That did happen, to an extent, with expansion of Medicaid coverage for children. But that was a different scenario because children’s eligibility begins at much higher family income levels than those in place for new adult enrollees, Seiber said.

Seiber and Berman said they hope the study offers some scientific data that will be useful during discussions of ACA repeal or revision and what it could mean for Americans now covered by Medicaid.

“I don’t think everyone realizes that if you repeal the ACA, that at the same time eliminates the Medicaid expansion,” Seiber said.

One potential weakness of the study is that the researchers were not able to evaluate how many people on Medicaid had the option to move to private insurance – because they were newly employed, for instance – but did not go that route. That type of analysis was not possible with the state-gathered data, Seiber said.

“While it is possible that some portion of these enrollees have since been hired by an employer that offers (insurance), it is unlikely that this would meaningfully improve the insurance outlook for this population,” he and Berman wrote.

The researchers said it’s important to consider the demographics of those covered under Medicaid expansion, including the fact that many are older and already have chronic health conditions that will become more costly and problematic without regular care.

“It’s a really broad cross section, and tends to be older and whiter and more rural than many would expect,” Seiber said.

Researchers Find Improved Preventive Care From Obamacare Medicaid Expansion

Medicaid proponents rally in Ohio (Credit: Columbus Dispatch)

BLOOMINGTON, Ind. — More Americans are taking steps to prevent disease because of the insurance expansions of the Affordable Care Act, according to a new, groundbreaking study by Indiana University and Cornell University researchers.

With Congress considering the future of the ACA, also known as Obamacare, this research is the first to estimate the impact of the ACA-facilitated expansions of Medicaid on preventive care and health behaviors.

Kosali Simon Photo Credit: Indiana University

Researchers Kosali Simon and Aparna Soni of Indiana University and John Cawley of Cornell University determined that low-income childless adults have benefited in numerous ways from the Medicaid expansions: They are 17 percent more likely to have health insurance, 7 percent more likely to have a personal doctor and 11 percent less likely to report that cost was a barrier to their health care. Their self-assessed health also improved, and they reported fewer days of poor health or restricted activities.

Participants were also more likely to undertake preventive care such as getting a flu vaccination, having an HIV test or visiting a dentist. The ACA mandates that health insurance plans, including Medicaid, cover these preventive services without cost-sharing.

“Our findings indicate that the Medicaid expansions under the ACA succeeded in some of their goals, but other goals remain hard to achieve,” said Simon, a health economist at IU’s School of Public and Environmental Affairs. “More people are seeing doctors and taking steps to safeguard their health. But there’s been no detectable reduction in obesity, smoking or heavy drinking, at least through our study period.”

Conversely, there was no worsening of those risky behaviors; one might be concerned that the newly insured would be more likely to engage in risky behaviors because they now pay less out of pocket for health care. There was no evidence of this phenomenon, which economists call moral hazard, in the data.

The data for the research came from the Behavioral Risk Factor Surveillance System telephone survey conducted by the Centers for Disease Control and Prevention and state governments, through the end of 2015. Thirty states and the District of Columbia expanded Medicaid benefits in 2014.

Their article, “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions,” is scheduled for publication in the Journal of Policy Analysis and Management and is available online.

New analysis shows 2.5 million Americans currently buying individual health coverage off-Marketplace may be eligible for Affordable Care Act premium tax credits

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HHS encourages consumers to evaluate Marketplace options during upcoming Open Enrollment
Since the Affordable Care Act became law, millions of Americans gained coverage or found more affordable options thanks to premium tax credits available through the Health Insurance Marketplace. Today, the U.S. Department of Health and Human Services (HHS) released data showing that 2.5 million Americans who currently purchase off-Marketplace individual market coverage may qualify for tax credits if they shop for 2017 coverage through the Marketplace. Six states (California, Texas, Florida, North Carolina, Illinois, and Pennsylvania) each have more than 100,000 individuals enrolled in off-Marketplace individual market coverage whose incomes may qualify them for Marketplace tax credits.

“More than 9 million Americans already receive financial assistance through the Health Insurance Marketplace to help keep coverage affordable, but today’s data show millions more Americans could benefit,” said Secretary Sylvia M. Burwell. “We encourage everyone to check out their options on HealthCare.gov or their state Marketplace and see if they qualify for financial assistance. Marketplace consumers who qualify for financial assistance usually have the option to buy coverage with a premium of less than $75 per month.”

Today’s analysis estimates that about 6.9 million individuals currently purchase health insurance in the off-Marketplace individual market. Of those, about 1.9 million either have incomes that would qualify them for Medicaid or place them in the Medicaid coverage gap or are ineligible to purchase Marketplace coverage due to immigration status, while the remainder could enroll in Marketplace qualified health plans (QHPs).

Counting both Marketplace and off-Marketplace consumers, more than 70 percent of all QHP-eligible individuals currently insured through the individual market have incomes that could qualify them for tax credits. If the Marketplace-eligible uninsured are included as well, today’s analysis indicates that almost 80 percent of all Americans eligible for Marketplace coverage could qualify for tax credits based on their income.

Many consumers remain unaware of the financial assistance available to them through the Marketplace. For example, a recent Commonwealth Fund survey found that only 52 percent of uninsured adults were aware that financial assistance is available through the Marketplaces.

Tax credits available through the Marketplace are designed to both improve affordability and protect consumers from the impact of rate increases. Consumers may be eligible if their incomes are between 100 and 400 percent of the federal poverty level (about $100,000 for a family of four). If all premiums in an area go up, the large majority of Marketplace consumers will not have to pay more because tax credits will increase in parallel. A recent HHS analysis – PDF found that, in a hypothetical scenario where all 2017 rates increased by 25 percent, 73 percent of current Marketplace consumers would be able to purchase coverage for less than $75 per month thanks to tax credits.

During the upcoming Open Enrollment, HHS will be placing new emphasis on making sure people currently buying individual market coverage off-Marketplace know their options. For example:

For the first time, our decisions about where to target our outreach efforts – from regional TV and radio to search and digital marketing – will be based in part on where we can reach these consumers, supplementing our continued use of data to target the remaining uninsured.
We are strengthening our relationships with agents and brokers. Agents and brokers are a critical channel for reaching off-Marketplace consumers, who often purchase coverage with the help of an agent or broker. Changes this year, such as offering agents and brokers new Marketplace training tools and faster registration, will make it easier for agents and brokers to enroll people in Marketplace plans. Improvements to agent and broker education and resources will ensure that they and their customers know all their options.

We are working with issuers to provide consumers with more and better information about the Marketplace. This includes updating standard notices to make them shorter, simpler, and more user friendly.

We are making it easier for issuers to facilitate transitions from a parents’ plan into the Marketplace. Specifically, recent guidance from the Department of Labor makes clear that the sponsors of employer plans can – and are encouraged to – provide additional information that will help young adults understand their options and enroll in Marketplace coverage as appropriate.

To read today’s brief, visit: https://aspe.hhs.gov/pdf-report/people-who-currently-buy-individual-market-coverage-could-be-eligible-aca-subsidies

What Will a Trump Presidency Mean for Americans

Photo Credit: www.donaldtrump.com
Photo Credit: www.donaldtrump.com

The Indiana, Nebraska, and West Virginia primaries have all ended, and Republican voters have made it clear who they want their presidential nominee to be – Donald Trump. In light of Trump’s crushing victory in the Indiana polls, Ted Cruz, a Republican senator from Texas and presidential hopeful, has reportedly dropped his presidential bid leaving Trump a clear path to earning the official Republican nomination at the party convention this June.

Seeing Trump this close to winning the Republican nomination is astounding in the least. Just under a year ago, when Trump announced his candidacy for president, various reporters, political insiders, and politicians from the right declared it impossible for this businessman from New York with no political experience to be successful on the campaign trail. Only recently have political analysts began to realize a Trump presidency could be looming in the future of the United States.

The reality of Trump being a viable presidential candidate has many social workers, counselors, physicians, and other helping professionals asking what a Trump presidency would mean for healthcare and mental health in our country. The answer to this question can be found by reviewing Trump’s views on these topics.

Trump on Healthcare

Healthcare remains one of the fastest-growing occupations in the United States with a projected total of 163,537.1 million people working in the healthcare sector by 2020. The Affordable Care Act (ACA), signed into law in 2010 by President Obama, has allowed citizens to access health services they may not have been able to afford before the legislation was made law. More people are receiving healthcare, more physicians, nurses, and other medical professionals are providing services, and employment in the healthcare sector still remains desirable as professionals continue to navigate and settle in to the new healthcare environment created by the ACA.

If elected president, Trump reportedly has plans to eliminate the Affordable Care Act (ACA) and create a new system.

“I would end Obamacare and replace it with something terrific, for far less money for the country and for the people,” said Trump

On the surface, a better system for less cost sounds great. However, in a healthcare environment still stabilizing from the most recent changes brought with the ACA, an upheaval of these new policies without a strategic replacement plan would be detrimental for professionals, their clients, and the healthcare workforce as a whole.

A quick look at Trump’s platform on healthcare policy reveals a plan to overturn the ACA, open up a free market insurance system, and allow people access to Health Savings Accounts (HSAs), but completely neglects to inform the public about how this plan will be enacted or what effects it might have on individuals and families who would lose their insurance coverage completely with the repeal of the ACA. The obscurity and lack of any evidential basis in his overall plans leaves healthcare professionals in the dark about how exactly this ‘new’ system would impact them and their clients.

Trump on Mental Health

Each year approximately 1 in 5 adults in the United States will experience mental illness. The current mental health workforce of social workers, psychologists, psychiatrists, and behavioral health specialists is unable to keep up with public need, subsequently causing 4,071 geographic areas in the country to be designated as having a severe mental health professional shortage. While many public leaders agree the deficit in the mental health workforce should be addressed, few seem to be actively doing anything to create such change.

Trump is no exception. In previous interviews and news reports Trump only brings up the lack of mental health service provision as being a significant issue in this country when addressing the wave of gun violence the country has experienced recently. If fact, the only reference Trump makes to mental health in his platform is cited in his views of Second Amendment Rights on how mental health issues should be addressed but should not impede citizens on their gun ownership rights. While Trump claims our country needs to fix the “broken mental health system”, he clearly lacks any willingness or concrete plans to do so.

So what exactly would a Trump presidency mean for healthcare and mental health professionals? From the look of it, we could expect to see (1) a significant increase in people who are uninsured or severely underinsured; (2) a decrease in access to needed health and mental health services; (3) a continued deficit in the mental health workforce; and (4) a system which overall is not adequately able to serve the people living here in the U.S.

Trump’s plan for the healthcare and mental health systems (or lack thereof) in this country doesn’t create any positive solutions to our current issues; making him unfit for the job of President of the United State of America. Our country needs a leader with a strategic plan to enact clear and concise legislation, to increase the effectiveness of our current systems, and to recognize the deficits and fill the gaps in service where needed.

As Americans who are concerned for the future of this country, we must set aside our assumptions, biases, and prior convictions to unite and vote for the candidate who is going to continue the progress we have worked so hard for. We must vote for the democratic candidate, and ensure we never have to experience a Trump presidency.

Failure to Expand Medicaid: Are We Failing Our Most Vulnerable Citizens

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We often hear politicians make promises about what they will do their first day in office if elected, but how often do we actually hear about them keeping those day one promises after being elected? Newly elected Democratic Louisiana Governor, John Bel Edwards, on his first full day in office reversed the decision of his Republican predecessor, Bobby Jindal, to not expand Medicaid for the state’s poorest citizens.

As illustrated by the map above, there are currently 16 States primarily located in the South, and they all have in common Republican-led state legislatures that are still refusing to expand Medicaid and adopt the provisions of the Affordable Care Act (ACA). Despite winning two Supreme Court challenges and being signed into law six years ago, Congressional Republicans have voted to repeal the Affordable Care Act approximately 60 times as recently as August 2015.

According to the United States Health and Human Services (DHHS), the Affordable Care Act is working despite not being implemented in all 50 States as it was originally designed. DHHS states the ACA is “working to improve access, affordability and quality in health care.” Additionally, DHHS states the ACA has helped 16. 4 million Americans who were uninsured gain access to insurance and affordable health care.

According to Kaiser,

In states that have not expanded Medicaid, 3.1 million poor uninsured adults fall into a “coverage gap” and will likely remain uninsured. These individuals would have been eligible under the Medicaid expansion. However, in the absence of the expansion, they remain ineligible for Medicaid and do not earn enough to qualify for premium tax credits to purchase Marketplace coverage, which begin at 100% FPL (Figure 2). Most of these individuals are likely to remain uninsured as they have limited access to employer coverage and are likely to find the cost of unsubsidized Marketplace coverage prohibitively expensive.

Over 1.7 million adults of color fall into the coverage gap, and uninsured Black adults are disproportionately likely to fall into the gap. Overall, about one in ten (11%) or 3.1 million of the total 27.5 million uninsured adults fall into the coverage gap in the 20 states that have not adopted the ACA Medicaid expansion. This group includes over 1.7 million adults of color. Uninsured Black adults are more than twice as likely as White and Hispanic uninsured adults to fall into the coverage gap. Read the Full Report

Researchers have found five medical conditions that are higher in non-Medicaid expanded states which include high blood pressure, heart problems and cancer.

Also, if you fall into the Medicaid expansion gap and ACA plans are too expensive for you, you may be able to access an income based community health clinic in your area. You can look up local resources using this link.

What Can We Do

First, we must advocate to ensure our most vulnerable citizens are protected. The National Health Care for the Homeless Council has put together an extensive resource list and tool kit to help you better advocate on behalf of citizens in your state. Secondly, we must encourage social innovation within our current health care models.

The links between poverty and poor health are well known: Food insecure children, now numbering 17 million in the United States, are 91 percent more likely to be in fair or poor health than their peers with adequate food, and 31 percent more likely to require hospitalization.5 Children under age 3 who lack adequate heat (another 12 million) are almost one-third more likely to require hospitalization.6 And families with difficulty paying rent and housing-related bills face increased acute care use and emergency room visits.7 – Read Full Article

Most of the time, our first responders who tend to the social needs of patients such as social workers and case managers are overloaded due to a shortage of manpower, funding and resources. According to the National Association for Social Workers (NASW), social workers provide 60 percent of the mental health services in the United States. Currently, the NASW is proactively seeking to “promote the inclusion of social workers as essential members of health care teams in coordinated care models” through advocacy and policy initiatives.

Most importantly, we must work collaboratively for collective impact in an effort to add protective factors and increase outcomes for our most vulnerable citizens.

Opportunities for Social Workers Expand Under Obamacare

Millions of Americans breathed sighs of relief upon hearing the Supreme Court’s decision to leave in place subsidies in the Affordable Care Act (ACA) for the insured in states where the federal government created the marketplace exchanges. Six of the nine justices believed it was Congress’s intention to provide a healthcare system that would cover as many Americans as possible. Among those waiting to exhale were social workers who are a critical component in the reformation of the healthcare system under the ACA.

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President Obama reacts to hearing news of the Supreme Court’s decision (Official White House Photo by Pete Souza)

President Barack Obama celebrated the validation of his signature legislative accomplishment with his closest staff. Conservatives were appalled by the decision that—for all intents and purposes—institutionalizes a system they derisively named and now is commonly known as Obamacare.

Most Americans know the law for providing healthcare insurance for millions more Americans through affordable premiums and expanded Medicaid. On a larger scale, the ACA is transforming the entire way we look at health and healthcare.

While discussing social workers involvement in the transformation of the nation’s healthcare system with Dr. Darla Spence Coffey, President and CEO of the Council on Social Work Education (CSWE), she pointed out that since the enactment of the ACA the focus of health and healthcare has moved from individualized medical care to an integrated model that includes behavioral health as well as primary care while factoring in social determinants of health.

This is social work’s approach to healthy living that takes into account the biopsychosocial and spiritual dimensions of human existence. As a result of the new direction for healthcare, there is a greater appreciation of the value social workers bring to the process.

CSWE and the National Association of Social Work (NASW) are partnering on a number of initiatives that will expand social work in healthcare settings. One that includes the Society for Leadership Social Work Leadership in Health Care (SSWLHC) is an agreement with the Centers for Medicare & Medicaid Services (CMS) to train Certified Application Counselors (CACs) to enroll the millions of Americans eligible for healthcare insurance who have not yet signed up. Another initiative funded by the New York Community Trust called Social Work HEALS: Social Work Healthcare Education and Leadership Scholars Program, provides scholarships for social work students at 10 universities.

Social workers are receiving training through the Health Resources Services Administration’s (HRSA) $26.7 million Behavioral Health Workforce Education and Training for Professionals program. Sixty-two schools of social work received $19 million of the funding that will allow about one-fourth of accredited MSW programs to provide scholarships to 4000 students at $10,000 each over the next three years. Additionally, CSWE’s Gero-Ed Center presented a series of five webinars on opportunities for social workers under the Affordable Care Act.

Dr. Coffey says the shift to more integrated healthcare service delivery has spurred greater interest in inter-professional education. CSWE’s annual survey which will be released soon, found that 40 of the 223 masters programs that offer joint degrees reported having a MSW/MPH dual degree option. She reports the number of students specializing or pursuing a concentration in healthcare is on a steady incline. The health and integrated health field setting is the second most common setting after mental health. The health/integrative health and mental health setting for baccalaureate students is now the fifth most populated setting—moving up from sixth last year with 400 more students reported for that setting.

Social workers are regaining influence in discharge planning in hospitals as the determinants of health are understood to be more than a menu list of medications and activities. “There is a greater appreciation for social workers in hospital settings,” Dr. Coffey explained, “because hospitals will be penalized for excessive readmissions under the Affordable Care Act.” The ACA contains a provision that reduces Medicare payments to hospitals with higher readmission rates. Having social workers involved in case management and discharge planning should help reduce the number of readmissions.

The demand for medical or healthcare social workers has increased dramatically. According to the Bureau of Labor Statistics (BLS), employment of social workers is expected to rise by 19 percent between 2012 and 2022, greater than the average of all other occupations combined. While BLS puts the average salary for social workers at $44,200 (2012) annually, they report the average annual salary for healthcare social workers as $53,590 (2013) with some states paying significantly higher wages.

Driving this demand is the aging of baby boomers and the expansion of healthcare by the ACA. Now that Obamacare will remain the law of the land, social workers will play a major role in the transformation of the nation’s healthcare.

Will the Supreme Court Deal a Fatal Blow to ObamaCare?

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All eyes are on Republicans gaining control of the Senate and affirming their commitment to repealing the Affordable Care Act as known as ObamaCare. However, the decision by four Supreme Court justices to hear arguments in King v. Burwell challenging premium subsidies on healthcare exchanges operated by the federal government could deal a blow to the ACA if the Supreme Court rules against the subsidies. The Internal Revenue Service provides subsidies in the form of tax credits to consumers purchasing health insurance under the Affordable Care Act whose incomes are below 400 percent of the poverty threshold. However, opponents of the law say that wording in the ACA stipulates that these subsidies can only be provided to consumers purchasing health insurance on exchanges “established by states” and that they are not available to people purchasing health insurance on federally managed exchanges.

To date, 13 states and the District of Columbia have established their own exchanges. There are an additional 18 states that have established exchanges in some form of partnership with the federal government. The remaining 19 states are those who have refused to participate in the process and have exchanges run exclusively by the federal government. Much is at stake. According to the Department of Health and Human Services (DHHS) 86 percent of people enrolled through federally operated exchanges rely on the subsidies to reduce their premiums to an affordable level. The Urban Institute estimates 7.3 million people could lose $36.1 billion in subsidies if the Supreme Court strikes them down.

The Supreme Court’s decision to hear the case surprised many because traditionally the Court will only take up a case if there is a split on the issue at the Circuit Court level. The U.S. Court of Appeals for the Fourth Circuit upheld the legality of the subsidies for federally managed exchanges in its ruling in King v. Burwell. However, in another challenge, Halbig v. Burwell, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit ruled against the use of the subsidies. Judge A. Raymond Randolph, appointed by President George H. W. Bush in 1990, and Judge Thomas B. Griffith, appointed by President George W. Bush, voted against the subsidies.

Judge Harry Edwards, appointed by President Jimmy Carter, voted to uphold the subsidies. At the request of the Obama Administration, the full court agreed to revisit the decision. With seven of the 11 authorized judges currently on the court appointed by Presidents Clinton and Obama, it seems likely the full court would support the subsidies effectively eliminating the split. The Supreme Court however decided to revisit King, despite the Obama Administration’s request that it wait for the decision by the full D.C. Circuit Court.

Hardline conservatives saw last week’s evisceration of Democrats during the midterm elections as a fatal blow to Barack Obama’s presidency. They believe he is a lame duck who is weakened both domestically and internationally. They see the Affordable Care Act, which they derisively coined as “Obamacare”, as his only significant legislative accomplishment and it sticks in their collective craw. Although the law remains unpopular with 53 percent of respondents in the Gallup Poll having a negative view of the ACA while 41 percent views the law favorably, it is losing ground as an important concern for the public. According to exit polls most voters in the 2014 midterm election—59 percent—said their vote had nothing to do with the Affordable Care Act compared to 28 percent who cast ballots to express displeasure with the law. During the 2010 midterms 45 percent said they cast their ballots as an expression of their displeasure with the law.

Doomsday forecasts about the Supreme Court’s ruling on subsidies in the Affordable Care Act may very well be overblown. Over at the Washington Center for Equitable Growth—my favorite blog by the way—economist Brad DeLong says even if the Supreme Court rules against federal subsidies, conservatives may not get the results they desire. He believes the 31 states with either state-run exchanges or working in partnership with the federal government will largely be unaffected. He wonders if politicians in the 19 states with exchanges solely operated by the feds will be willing to deny their middle class residents nearly $40 billion in subsidies to purchase health care insurance.

I believe the Affordable Care Act is here to stay. Republicans will waste their time and taxpayers’ money on fruitless attempts to repeal the law knowing full well a law repealing the ACA cannot get past the President’s veto pen and may not get out of the Senate without relying on budget reconciliation as a strategy which is a recipe for disaster. Then imagine what Republicans would do if they could repeal the Affordable Care Act. They have no credible idea about what they would do to replace it.

The Affordable Care Act (ACA) and Preventative Health for Women

 

diverse-group-of-womenThere are several elements of the Affordable Care Act (ACA) that will majorly impact our healthcare system, but one of the most important new provisions is preventative measures for women’s healthcare.  Although certain preventative measures are allowed under the ACA, there are still certain employers who are exempt when it comes to providing contraceptive coverage in their healthcare plans. However, there are plenty of measures that are covered under the plan and will truly benefit women all over the country including well woman exams, breast exams, STI & HIV screenings and counseling and screening and counseling for domestic violence. These types of preventative measures can only provide positive results for women with health insurance.

I can’t help but think about the millions of Americans without health insurance and the women who will not benefit from these services. Breast cancer is the 2nd most common cancer death in women after lung cancer. Over 200,000 women get diagnosed annually and 40,000 die. Early detection can reduce the chances of getting breast cancer and having preventative screenings included in the ACA can reduce the number of women dying due to breast cancer.

STI and HIV Counseling and Screenings

According to the Guttmacher institute, 19 million new sexully transmitted infections (STI) are reported annually and half of these are among 15-24- year olds. It is estimated that 65 million Americans have a viral STI, with the most common one being genital herpes and it is not curable. Most STIs have no symptoms and can be very hard to detect with a doctor’s visit and many people have no idea they are infected with an STI. Some of these STIs, when left untreated, can lead to more serious illnesses such as pelvic inflammatory disease and cervical cancer. Having access to STI and human immunodeficiency virus (HIV) counseling and screenings included in the ACA is extremely important.

In the United States, we have varied opinions on sex, but the reality is our population is not retarding in growth. Sex can be as basic a desire as water, food and oxygen for some Americans. Evidence based research has uncovered that many Americans, especially younger adults and adolescents, do not have access to the factual information about STIs and HIV. In our media, we constantly glorify sex and adolescents are exposed to several television programs that include casual sex with multiple partners.

However, comprehensive sexual health education is not a standard in our country’s public schools. The ACA includes education and information about STIs and HIV, but the hard part is getting people to go to the doctor for this information. With the ACA enacted, there is an opportunity to start encouraging Americans to get annual screenings and to obtain prevention care in order to educate themselves on these issues.

Domestic Violence

One in four women will experience some type of domestic violence in their lifetime, and it is estimated that one-third of female homicide victims that police records have reports of are killed by their intimate partner. This is unbelievable and unacceptable to me. Domestic violence, rape, and sexual violence need to be brought to the forefront of Americans minds. This is a serious issue that needs to be addressed and I believe should be taught in schools along with sexual health information. The fact that the ACA covers screenings and counseling is incredible and this needs to be known. Women may not even know that their health insurance covers these types of things.

Family Planning

This brings me back to the ACA exemptions where certain employers are not required to provide contraceptive counseling and prescriptions. If employers, even those with religious beliefs do not support contraception, want a diverse body of people to be employed at their organization, they need to provide diverse healthcare plans that not only include basic health care, but specific healthcare pertaining to women including contraceptive coverage. It is estimated that nearly 99% of all women have used some sort of contraceptive method in this country.

Birth control can prevent unplanned pregnancies and abortions which saves our country money. Not all women want kids, so having these options are vital to their healthcare plans. Overpopulation is our number one social problem in this country, and it leads to many other issues including water shortages, food shortages and a large population of children being placed into foster homes or adoption agencies because of unplanned pregnancies. Having birth control be easily available and affordable will go a long ways toward prevention.

Income Inequality

Additionally, we must touch on is the gap between the rich and poor and how hard it is for millions of Americans to even obtain affordable health insurance. The ACA is a large step towards providing healthcare to the uninsured in our country, but it needs to be expanded further. It’s not perfect and many Americans are being caught in the Medicaid gap where they don’t make enough money to qualify for subsidy, yet they are in a State which refuses to expand Medicaid. If more Americans can received annual checkups and screenings, many may be able to identify and access preventive care to prolong life. Right now, it seems that the majority of Americans only go to the doctor when it is an emergency which needs to change.

Preventative healthcare is one of our country’s solution to address our nation’s growing healthcare problems. Hopefully, the ACA will lead to more systematic healthcare reforms in order to change the ways our country handles health issues and social problems. Feel free to share this with organizations that work with adolescents, schools, sexual health clinics, etc.. BeYouBeHealthy.org 

How the Affordable Health Care Act is Saving My Life-Part I

I knew that pursuing this degree would be costly, but what I didn’t know is that it could potential cost me my life. Three years ago, I was accepted to one of the top five Schools of Social Work in the country.

I was already working as a Child Protective Services Investigator when I decided to pursue my MSW, and I thought it would help me to advance in my field. However, as a CPS investigator and a Master level student, I was forced along with others in my cohort to make a decision between finishing school and my job. Both worlds were colliding, and I was caught in the middle.

It’s crazy how a social work student with no work experience can work in Child Welfare to fulfill their 900 hour internship requirement. However, someone already working in Child Welfare doing the same job does not receive credit and is required to do an additional field placement. In what world is this fair!

I was already invested in both time and money to just walk away from school. So, I quit my job working at a Human Service Agency in order to work for free at another Human Service agency in order to fulfill my internship requirements. As a working practitioner, I knew that I could not manage my caseload, class work, and another 16 hour per week internship to be completed in another department. Initially, my agency was going to give me some concessions while in school, but all it takes is for someone to quit or go on FMLA.

Yes, I knew that I had a pre-existing health condition, but I was going to a university with one of the best health care systems in the country. It never occurred to me, not even once, that the program in which I was accepted would not offer me a healthcare plan.

The summer before my last semester, I started getting sick. Everyday, I would park in the deck of the Medical Center to walk to class at the School of Social Work while I was being relegated to free clinics for my health care. The last semester, my school made some changes to the health care plans. I have a healthcare plan…. Now, I can get the care that I desperately need. Right? Wrong!!!

The health insurance provider stated that I needed proof of continuous coverage in order to receive coverage because I had a pre-existing condition. Guess what….I didn’t have proof because I had been uninsured for a year. Ok….I thought. I am an advance standing student….I will be back to work in no time. Everything will be alright. Right? Wrong!!! It would be a year after graduation before I would gain employment and health insurance again.

Two years and one pre-existing condition later, in May 2012, I began getting the tests I needed years ago to determine whether I have cancer or not. Not having health insurance in this country is a death sentence. In the last six months, I know two African-American women who died from complications from preventable issues because they did not have health insurance. Despite my degrees and my accomplishments, I was just another unemployed, black woman with no health insurance, and I was treated as such.

Today, my insurance carrier is covering the majority of cost for my tests and surgery, and I don’t think it would have been possible without the ACA. With health insurance, I have Dr. Randall Scheri the world-renown surgical oncologist at Duke University Cancer Center performing my surgery later this week. The prognosis is good because the cells have not turned cancerous….Thank God!!! They are taking every precaution in case something is found during the surgery. However, I believe everything is fine, and I am planning for a speedy recovery.

President Obama made it possible for those without healthcare to have the ability to get health insurance and be covered. He did it despite the difficulty and the unpopularity of the bill, and I am thankful that he did. Now, my hope is that the Council for Social Work Education will reform their current internship requirements, so it is not oppressive and create further hardships on students who just want to help others. No other profession mandates a 900 hour unpaid internship with no guarantees of health insurance in order to obtain a degree. So why is social work doing it?

It’s been difficult to not be bitter and not to be angry. No one should have to choose between basic human needs in order to pursue higher education for a better life. After my surgery and I am on the road to healing, I plan to advocate on behalf of students who may find themselves in similar situations or for those who may choose not to go back to school for social work because of the barriers. Change is needed.

*Part II soon to come…

Captain’s log stardate 74906.5, June 10th, 2021, Part II was never written. Cancer was found during the surgery, and it has been a long journey to recovery. However, this platform would not have been created without that experience. I use this platform to create awareness and advocacy on a variety of issues, but at its core, our goal is to help register people to vote on the matters important in their lives and their loved ones.  I am a firm believer that pain and suffering breed empathy and compassion. As a result of my pain, it further ignited my desire to help more people navigate their pain as well as support their purpose.

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