Thursday, June 28, 2012

ACA upheld!

I am happy and relieved that the Affordable Care Act was upheld today - for both public health and doula-related reasons! To illustrate just a few of the reasons why, I point you to this article from the American College of Nurse-Midwives:
Before implementation of the new health care reform provisions, many uninsured young women have not been eligible for Medicaid or other insurance coverage until becoming pregnant. For example, a nine-state study found that from 17 to 41 percent of childbearing women lacked insurance prior to pregnancy, with 13 to 35 percent transitioning to Medicaid at some point during pregnancy (3). Lack of insurance before pregnancy has limited the ability of a large segment of childbearing women to use health services to plan a successful pregnancy. ...Three PPACA provisions will dramatically change this situation.
Preconception care is a huge issue. Many pregnant women end up getting access to coverage via Medicaid, but there is only so much prenatal care do when you already had poorly controlled diabetes and high blood pressure prior to pregnancy.
In the past, uninsured pregnant women have largely been ineligible to purchase private insurance or, if they could purchase insurance during their pregnancies, the coverage generally did not include maternity care for the present pregnancy. More recently, some insurers have deemed women who had a previous cesarean birth to be ineligible for maternity care coverage (6), and there are anecdotes of similar practices, such as excluding coverage of pelvic floor problems among women who have had an episiotomy. Such practices will be illegal in 2014.
This is huge! It is essentially impossible for pregnant women to buy health insurance; if you don't qualify for Medicaid, you are totally out of luck. The denial of coverage to women who have had prior c-sections is hugely problematic, and will be banned along with other "pre-existing conditions".
In recent years, Medicaid beneficiaries in some states have lost access to birth center coverage, and many freestanding birth centers have been threatened with closure due to loss of Medicaid reimbursement. Although birth centers have traditionally been reimbursed within Medicaid programs, some state Medicaid programs had recently begun to deny birth center claims and legislation had not mandated such coverage for Medicaid beneficiaries. A PPACA provision requires coverage of care in freestanding birth centers that meet state regulatory requirements, beginning in 2010.
Straightforward and much-needed. Birth centers are part of making care more effective and affordable!
Beginning in 2010, all new health plans are required to offer, at no extra cost to the patient, all services and screenings recommended by the U.S. Preventive Services Task Force. For childbearing women, the recommended services include folic acid supplementation, breastfeeding counseling before and after birth, tobacco use counseling, and screening for several conditions
This includes reimbursement for lactation consultants!
The act directs employers to provide new mothers with a reasonable break time to express milk for a nursing infant for 1 year after the birth and a private place that is not a bathroom for doing so.
This is one of the provisions that very few people outside the breastfeeding advocacy community paid a lot of attention to, but one of the things that will make a HUGE difference for pumping moms in the workplace. People I know who work with universities who are building out their campuses say that they are hearing more and more about making sure that every building has a mother's room. There is so much more - some that not even I was aware of. Read it here!"

Saturday, June 23, 2012

"The only good abortion is my abortion"

I may not be writing much, but I can link! And I really wanted to share a post from BoingBoing. The posts there range from technology, science, art, and culture to unicorns and funny cats, and occasionally more personal posts from the group of authors who contribute.

This post is very personal, and that's why I think we should be grateful that it's being made very public: "The only good abortion is my abortion":

The heart hasn’t sped up. The fetus hasn’t grown. The egg yolk is now bigger than the fetus, which usually indicates a chromosomal abnormality. Basically, this fetus is going to die. I am going to have a miscarriage. It’s just a matter of when.

Because of these facts—all these facts—I get special privileges, compared to other women seeking abortion in the state of Minnesota.

Nobody has to tell my parents. I am not subject to a 24-hour waiting period. I do not have to sit passively while someone describes the gestational stage that my fetus is at, presents me with a laundry list of possible side-effects (some medically legit, some not), lectures me on all the other options that must have just slipped my mind, or forces me to look at enlarged, color photographs of healthy fetuses.

Because I have health insurance, I can afford a very nice OB/GYN whom I chose and who does not exercise her right to deny me this option. Thankfully, I don't live in a state where she can legally lie to me about the status of my fetus, to dissuade me from having an abortion.

Most importantly, from my perspective, I have the privilege of a private abortion in a nondescript medical office. I will not have to go to an abortion clinic. I will not have to walk by any protesters—not even Charlie, the one guy who is paid to protest every day outside Minneapolis’ abortion clinic, where I have volunteered as an escort in the past.

Most of these privileges boil down to the fact that, as far as my doctor and my medical billing are concerned, this is not an elective procedure.

But here’s the thing. It is elective.

The comments, from both men and women who have experienced a pregnancy loss of their own or of their partners, are almost universally compassionate and often share very difficult stories of their own. I think it's important reading.