American Forum Op-Ed

NEW MEXICO EDITORIAL FORUM

By Margarita Mercure Hibbs

Living in rural regions supports a lifestyle that many families, small businesses and retirees appreciate. However, securing access to affordable, quality health care -- especially during a recession -- can be a challenge. With roughly one-third of its 2 million residents living in rural areas, New Mexico has an especially severe challenge.

According to studies by the Rural Health Research & Policy Center, the Flex Monitoring Team, and Kaiser, there are 42 hospitals in New Mexico, only 29 of which are located in rural areas, and six of which are critical access hospitals.

What does this mean for rural New Mexicans? These numbers show that although they occupy the largest geographical territory in the state, folks in rural New Mexico only get about half the medical resources. These statistics are devastating to our state and are completely unsustainable.

Adding to the special challenges facing New Mexicans is the fact that our state has some of the highest unemployment and uninsured rates in the nation. The rural-urban disparity in insurance coverage is exacerbated by the fact that incomes are generally lower and fewer rural companies offer private health insurance.

These special challenges are why the changes brought about by the Patient Protection and Affordable Care Act are so important to New Mexicans. The Act addresses many of the health care issues that so many rural Americans face and ensures that they will now have affordable access to necessary health care that was once unavailable to them.

Historically, rural New Mexicans faced with catastrophic injuries or illnesses have had a greatly diminished chance of survival due to the lack of emergency, urgent care, and first responder resources.

The Patient Protection and Affordable Care Act creates a system that is fair for rural communities -- one that will grow rural health care workforces by making necessary investments in training, recruitment and facilities, so that rural populations have greater access to doctors, nurses, dentists and paramedics.

Health care reform sets important guidelines which address the care of our most vulnerable members of society. Under the Act, people with pre-existing conditions, children and youth, small businesses and seniors will be the first groups to directly benefit.

Beginning in 2104, insurance companies will finally be held accountable and may no longer refuse coverage to a person simply because he or she has a medical history. Until then, a pre-existing condition insurance plan serves as a bridge to meet the needs of those individuals who have already been denied insurance coverage and have been uninsured for at least 6 months.

Children can’t be denied coverage for any reason and family coverage will be extended for young adults through the age of 26.

Seniors, who have fallen into the prescription coverage gap (the “donut hole”) since 2007, will receive assistance with paying for medications, and will also have access to cheaper ones.

Most importantly, everyone will also have greater access to preventive care, which will help avoid expensive and unnecessary treatments later.

Establishing a fair playing field for small and independent businesses is a key component of reform. In New Mexico, agriculture and tourism are cornerstone industries – related small businesses contribute greatly to the economy. But typically, in rural areas, one large insurance company dominates the market, so there is no guarantee of choice or competitive pricing.

To remain viable, these small businesses must be able to attract and keep good employees by being given the opportunity to provide health insurance (large corporate businesses currently pay, on average, 18 percent less for comparable insurance plans). In the past, only 35 percent of small business owners were able to offer health insurance to their employees, but this year, more than 88.9 percent of New Mexico small businesses (24,800) with fewer than 25 employees will be eligible for tax credits to help pay the cost of necessary employee health insurance coverage.

Many New Mexicans are already benefiting from reform. Health Action New Mexico, a statewide health advocacy organization, provides information to folks in order to better explain what the health care plan does and doesn’t do. Access to this information is an important piece of reform, so we strongly encourage you to contact them directly at www.healthactionnm.org or (505) 867-1095.
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Hibbs is a rural advocacy specialist and former first lady of Estancia.
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Copyright (C) 2010 by New Mexico Editorial Forum. 10/10

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Barber is director of the Mississippi Human Services Agenda.
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Copyright (C) 2010 by Mississippi Forum 8/10

TENNESSEE EDITORIAL FORUM
By R.C. Braun, MD

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Braun is a medical doctor in Pleasant Hill.
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Copyright (C) 2010 by Tennessee Editorial Forum. 8/10

TENNESSEE EDITORIAL FORUM
By R.C. Braun, MD

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Braun is a medical doctor in Pleasant Hill.
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Copyright (C) 2010 by Tennessee Editorial Forum. 8/10

MISSOURI FORUM

By Dr. Stephen Radinsky

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Radinsky is a retired radiologist.
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Copyright (C) 2010 by the Missouri Forum. 6/10

LOUISIANA FORUM

By Mike Stagg

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Stagg is a Lafayette-based healthcare information technology consultant and editor of the newsletter Democratic Louisiana.
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Copyright (C) 2010 by Louisiana Forum 6/10

GEORGIA FORUM

By Timothy Sweeney and Alan Essig

For more than a year, federal efforts at reforming the nation’s health insurance system have been controversial to say the least. Now that the president has signed health reform into law, the partisan debate should come to an end.

It is incumbent upon policymakers to begin planning for the implementation of the national reform law so that Georgians can benefit as much as possible from all its provisions.

Instead of working on implementing reform and focusing on the ways the reforms make needed improvements for Georgians, both with and without health insurance, state policymakers have continued their political rhetoric, misinformation, and exaggeration about its effect on Georgia.

One of the worst examples of such exaggeration is the claim that the national healthcare reform legislation will cost Georgia $1 billion yearly and break the state budget.

Certainly, covering the nearly 500,000 uninsured Georgians who will be newly eligible for Medicaid will not be free; however, a closer look reveals that it will be quite a bargain for Georgia.

The Medicaid expansion does not take place until 2014 and it will be fully federally funded for the first three years. Even after those three years, Georgia’s contribution will only be 5 percent in 2017 before it ramps up to 10 percent in 2020 and beyond.

The generous federal contribution means that Georgia and the state’s healthcare system will benefit greatly from billions of dollars in new federal funding. Even when the state’s 10 percent share is fully phased in, new costs to the state will likely represent only a modest (likely less than 10 percent) increase in state Medicaid spending compared to what the state would spend on Medicaid without the expansion.

The Medicaid expansion itself will actually ease the state’s financial obligations in other areas. For example, many uninsured patients who receive state-funded mental health services will soon get that coverage through Medicaid. In addition, as the number of uninsured Georgians drops, the state will spend less money reimbursing hospitals for treating them. In fact, this healthcare, known as “uncompensated care,” is projected to cost 40 to 50 percent less over the next 10 years due to the reform.
Finally, it is also important for state policymakers not to let political rhetoric get in the way of discussing the important insurance reforms that provide greater economic security to Georgians who already have health insurance, as well as to those who now will be able to get health insurance.

In the first year, insurance policies will have to cover dependent children up to age 26 even if they are not full-time students, and insurance providers will no longer be able to refuse to cover pre-existing conditions for children. In addition, insurers will no longer be able to rescind coverage when someone gets sick (except in cases of fraud) or impose lifetime benefit caps.

Over the following years, insurance companies will be required to cover pre-existing conditions for adults and will no longer be permitted to cap yearly benefits.

In addition to covering more uninsured people through Medicaid, the reform package will provide hundreds of millions of dollars in health insurance tax credits for middle-income individuals and families beginning in 2014. Tax credits to help small businesses provide coverage to their employees take effect this year.

The political fight over passing reform should end; it’s now time for policymakers around the state to implement reform so that it best benefits the people of Georgia.

Instead of exaggerating the costs to fight yesterday’s political battle, state leaders should develop honest and credible cost projections that can help us plan for the future. The benefits of expanding insurance coverage to nearly 500,000 Georgians far outweigh the marginal costs. National health reform is a great bargain for Georgia.
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Sweeney is the senior healthcare analyst and Essig is the executive director of the Georgia Budget & Policy Institute, a nonpartisan, independent think tank that seeks to build a more prosperous Georgia by rigorously analyzing budget and tax policies and providing education to inspire informed debate and responsible decision-making. Visit www.GBPI.org for more info.
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Copyright (C) 2010 by Georgia Forum. 4/10

TENNESSEE EDITORIAL FORUM

By Tony Garr

We are facing tough times. We’ve faced them before and pulled our neighbors and ourselves through by making people a priority. This is what the state needs to do now.

More than a quarter million Tennesseans have lost their jobs and their health insurance since the recession began. It is estimated that more than a million Tennesseans are uninsured and have few options for changing that in the near future. Yet, the state seems determined to continue to whittle away at public health programs that combine to serve as the medical safety net. It’s time to get our priorities straight.

Times are tough in each state, yet Tennessee is the only state to cease enrollment in the Children Health Insurance Program, which we call CoverKids and is viewed as a good program by policymakers from both the Right and Left. Forty-nine other governors understand that this is not time to be blocking health care coverage for children of low- to moderate-income working families. Tens of thousands of Tennessee children are eligible for CoverKids and Tennessee gets three federal dollars for each state dollar it invests in the program, so closing it to enrollment is simply penny-wise, pound foolish.

The state has promised since 2005 to reopen the Medically Needy (aka Spend Down) TennCare program. This program is designed as a bridge, like COBRA, for eligible children, elderly, caregivers and those with disabilities to get a year of TennCare after they spend a significant portion of income toward medical bills; thus, they “spend down” to eligibility. It’s estimated that this program would help about 100,000 Tennesseans facing medical debt and lacking coverage.

Also, the state must not continue viewing county jails as part of the mental health safety net. Cuts to state mental health programs passes a huge burden onto local governments, which have neither the financial nor medical means to deal with the complexities of mental health services. State cuts to mental health result in a system that is throw-back from a century ago, with people with mental health challenges being locked up rather than receiving the compassionate and effective care we have come to know as a basic human right.

Tennessee has a $400 million TennCare Reserve and $700 million Rainy Day Fund. For too many years the state has siphoned the TennCare Reserve to shore up other areas of the state budget while losing out on the 2-to-1 federal match. This year the state must get its priorities straight and use monies designated for TennCare to reopen the Medically Needy category which the administration has been promising to do this since 2005.

It has been raining on Tennessee’s working poor for a long time, now is the time to provide families and individuals with some shelter from rain. Let’s invest some of the Rainy Day fund into the medical safety net to help communities with physical and mental health services.

A state budget, like any budget, is about priorities. This year, let’s make vulnerable Tennesseans a priority. The good news is that, despite tough times, we have a TennCare Reserve and a Rainy Day Fund, both designed to be there to meet human need in tough times. So, let’s do the wise and decent thing and use them for their intended purposes.
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Garr is executive director of the Tennessee Health Care Campaign.
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Copyright (C) 2010 by the Tennessee Editorial Forum. 1/10

By Mark Mellman

COLORADO EDITORIAL FORUM

By Emilie C. Ailts and Vicki Cowart

As national health care reform faces its next hurdle -- a conference committee bill that reconciles the House and Senate bills -- we believe it's critical to draw attention to a provision contained in the House bill. This provision, brought by Reps. Bart Stupak (D-Mich.) and Joe Pitts (R-Pa.) and known as the Stupak abortion coverage ban, would create barriers to women's reproductive health care far worse than any encountered since the Supreme Court's 1973 Roe vs. Wade decision legalizing abortion.

This new abortion coverage ban makes insurance coverage for abortion virtually unavailable for millions of women purchasing insurance plans through the newly created health insurance exchange.

Federal law already bans use of federal funds for abortions, but the Stupak measure goes much further. It denies use of private money -- not just public money -- to cover abortions.

Six of Colorado's nine-member congressional delegation, Sens. Mark Udall and Michael Bennet and Reps. Diana DeGette, Jared Polis, Betsy Markey and Ed Perlmutter, understood the danger posed by the Stupak abortion coverage ban and its Senate companion and voted against it. The remaining three, Reps. Doug Lamborn, Mike Coffman and John Salazar, voted for the House Stupak provision, choosing to strip women of health insurance benefits they already have and imposing further restrictions on their access to a full spectrum of reproductive health care services.

The Stupak amendment has real-life implications for all women obtaining health insurance through the new health insurance exchange. This exchange is intended to provide a source of affordable, quality health insurance coverage for Americans who are uninsured, self-employed or work for small businesses. In Colorado, small businesses vastly outnumber large employers and are a major force in the state's net increase of new jobs. Because so many women potentially will be insured through the exchange, millions of women would lose reproductive health care benefits they now have.

As the health care reform debate continues, our goal is clear -- to pass health care reform while stopping the Stupak abortion coverage ban. The Senate's health care proposal maintains the status quo, ensuring that no federal funds pay for abortion. While we fundamentally do not agree with this, as since 1976 this policy has codified discrimination against low-income women, we acknowledge a compromise is necessary to advance the health care reform package. Yet, we strongly oppose going beyond the status quo, which the Stupak abortion coverage ban does.

Since the onset of health care reform, President Obama often has articulated a central tenet that no one lose benefits she or he currently has and likes. The Stupak abortion coverage ban would break this promise.

Defenders of the House amendment say that women who purchase health insurance through the exchange will be allowed to buy a single-procedure insurance policy, sometimes called a "rider," providing abortion coverage. Such a provision is as discriminatory as it is illogical, and it contradicts a basic objective of health care reform -- to ensure that all Americans have the health insurance they need.

Insurance by definition should protect us from the unexpected. As with diabetes or prostate cancer, both unplanned pregnancies and complications late in wanted pregnancies are unexpected events. Women who need a legal medical procedure in these situations should not be denied coverage any more than individuals with other unexpected health needs.

We all have different opinions about abortion. However, the debate about health care reform shouldn't focus on those differences. And real health care reform shouldn't cause women to lose insurance coverage they already have for a legal medical procedure.

Health care reform provides an opportunity to advance women's health.

With the exception of the Stupak abortion coverage ban, federal health care reform efforts include many provisions of benefit to women.

They include banning gender discrimination of premium rates, protecting survivors of breast cancer from being denied coverage because of a "pre-existing" condition, and covering preventive care, e.g. cancer screenings.

The President and Congress have moved us closer than we've ever been to achieving affordable, quality health care for all. But health care reform won't be fair -- and will not succeed -- if it comes at such high cost to women.
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Ailts is executive director of Denver-based NARAL Pro-Choice Colorado. Cowart is CEO & president of Planned Parenthood of the Rocky Mountains.
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Copyright (C) 2009 by the Colorado Editorial Forum. 12/09
12/09

NEW MEXICO EDITORIAL FORUM

By Max Bartlett and Jose Aguilar

One issue has generated little discussion during the heated health care reform debate: whether states should have the right to develop their own approaches to universal coverage.

The Health Security for New Mexicans Campaign wants to see language included in the national proposal that gives states flexibility to develop their own approaches to solving rising health care costs and growing numbers of uninsured.
The focus of current health care reform proposals is to create “insurance market exchanges.” These one-stop-shopping insurance exchanges must offer consumers -- primarily the uninsured -- choices of different insurance products, including some type of public option. A less than robust public option is in the proposal passed by the House of Representatives. The Senate is in the process of negotiating an alternative to the House version.

Unfortunately, the health care reform debate has skirted the issue of whether states can take a different path that reaches the same goals. States always have been laboratories for innovation. Women’s suffrage, civil rights, child labor and minimum-wage laws were developed in the states first and then became federal law. Why shouldn’t states be allowed to continue that role in health care reform?

If a state can develop an approach that is not based on the insurance market exchange model, an approach that still provides comprehensive health coverage for its residents and contains rising health care costs, why shouldn’t it be encouraged to do so?

The recently passed House bill contains no language enabling states to develop anything other than an insurance market exchange. The merged Senate bill now under consideration mandates that by 2014, states must set up an insurance market exchange and experiment with it for three years before requesting any waivers.

Why should states be forced to go through a long, expensive, complex and time-consuming process when they already may be working on approaches more appropriate to their circumstances?

In New Mexico, the Health Security Act offers a different solution from that based on an insurance market exchange. It is a “home-grown” solution that has earned enormous public support -- 146 diverse organizations are part of our coalition, and 32 New Mexico counties and municipalities have passed resolutions endorsing it.

The Health Security Act would enable New Mexico to set up its own health care plan that automatically covers most New Mexicans, provides comprehensive benefits and guarantees freedom of choice of doctor even across state lines.

Instead of creating a system of competing insurance plans, each with different provider networks, this proposal would shift the role of private insurance companies to provide supplementary coverage – as they do with the original Medicare program. Any individual, employer or group wishing to purchase additional coverage could do so. A non-governmental, geographically representative citizens’ board would be in charge of the plan.

Two separate studies have concluded that if such a health plan were established in New Mexico, health care costs would be reduced by hundreds of millions, if not billions, of dollars within five years.

Why is this so? Because this approach simplifies a very complex private insurance system with its hundreds of policies, different benefits, co-pays and deductibles, all of which affect administrative overhead of doctors, hospitals and clinics – and which, in turn, negatively affect health care costs.

In a state such as ours, with a small population, it makes economic sense for most residents to be covered under one health risk pool.

Coalitions in other states -- California, Minnesota, New York, Pennsylvania, Washington and Oregon, to name a few -- have been working on proposals that are not based on an insurance market exchange and are adapted to the particular needs of those states.

Acknowledging these developments, the National Conference of State Legislators recently passed a resolution containing a provision asking that states be allowed to create solutions that go beyond any federal requirements. New Mexico was counted as one of the resolution’s supporters.

In addition, New Mexico State Sen. Dede Feldman and others from the House and Senate sent a letter to our five-member congressional delegation, which included a request that states be given flexibility to develop their own comprehensive plans.

Health care reform should clearly encourage state experimentation. Aside from the need for state flexibility language in the national legislation, the Health Security for New Mexican Campaign believes states deciding to develop their own health plans also should have the right to access the same federal dollars as those states choosing to set up their own insurance market exchanges.

At this critical juncture, Congress needs to tackle this issue.

MISSOURI FORUM

By Timothy D. McBride

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McBride is Associate Dean for Public Health in the Brown School at Washington University in St. Louis.
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Copyright (C) 2009 by the Missouri Forum. 12/09

NORTH CAROLINA EDITORIAL FORUM
by Melissa Reed

By M. Patricia West, MSSW

Elected officials' religious views should be their own private affair, neither imposed by them upon the nation, nor imposed by the nation as condition to holding public office. This means their private religious views should not be imposed via the current debate over health care reform.

Important life decisions are responsibilities of individuals and families, not of government or religious groups. On that, most of us can agree. There is also a strong history of separation of church and state in America, and one of our founding principles is of freedom from religious intolerance. That's why I was deeply offended when Roman Catholic Church bishops lobbied Congress on health care reform in order to deny millions of women access to abortion.

As an American I am proud of our constitutionally guaranteed right to worship or not as one sees fit, and of our prohibition of government-imposed state religion. But what started out to be about health care for all has morphed into a referendum and debate on abortion unduly influenced by the church. Health care legislation passed by the House of Representatives compromises our personal choices and subverts the principle of abortion neutrality.

The Stupak-Pitts amendment potentially goes farther than any other federal law to restrict a woman's access to abortion. By prohibiting women who receive partial federal subsidies from buying insurance plans that cover abortion, the Stupak amendment bans abortion coverage by any insurer participating in the health exchange. The amendment favors one religious view of abortion and enlists the federal government as enforcer. As such, it is an egregious assault on the rights of women and an enormous step backward for those who believe in separation of church and state.

President Obama has said, "If you're happy and satisfied with the insurance that you have, it's not going to change." But this House proposal potentially reduces health care coverage for the more than 80 percent of typical employer-based insurance plans that now cover abortion.

Women supposedly will be able to obtain abortion coverage by purchasing a separate, single-service "rider." However, according to the National Women's Law Center, in the five states that currently require a separate rider for abortion coverage, there is no evidence that plans offer such riders. Furthermore, women are unlikely to buy a rider to cover abortion, because they do not plan for unplanned pregnancy or one that is needed for medical or health reasons.

A number of national polls have shown that Americans strongly believe health insurance should include complete women's reproductive health services and that women have a full range of choices offered. A recent poll commissioned by Moving Forward, a values-based research initiative developed by the Women Donors Network and the Communications Consortium, found that a majority, 56 percent, believe those receiving subsidies should be able to purchase a health insurance plan that covers abortion. The House proposal does not reflect that view.

Meaningful reform has the potential to bring health care to more American women and their families than ever before. But Congress should not be in the business of restricting choices for women, particularly for religious reasons. As presidential candidate, John F. Kennedy said, "I believe in an America where the separation of church and state is absolute ... where no public official either requests or accepts instructions on public policy from the pope, the National Council of Churches or any other ecclesiastical source -- where no religious body seeks to impose its will directly or indirectly upon the general populace or the public acts of its officials ..."

Instead of kowtowing to Catholic bishops, Congress should stand up for what the majority of Americans want in health care reform -- and they want choices, not limitations.
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West is a public health consultant who lives in Philadelphia. She is a member of the Women Donors Network and involved with their Moving Forward initiative.
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Copyright (C) 2009 by the American Forum. 11/09

COLORADO EDITORIAL FORUM
By Robin Baker

The excise tax on so-called “Cadillac” plans is a central feature of the Senate Finance Committee's health proposal. Most often, Cadillac plans are described as the "overly generous" or "gold-plated" plans offered to Wall Street types.

In theory, levying a tax on these gold-plated plans will encourage lower spending and help slow the growth rate of health insurance and health care costs.

In addition, the revenue generated from the tax on insurers would provide a significant source of funding for subsidies to help families with low to moderate incomes afford health insurance. The Congressional Budget Office (CBO) estimates revenues will be about $5 billion in 2013 and increase to $53 billion by 2019.

At the outset, most Americans would not be affected by the tax, but that could change over time.

The Senate Finance Committee's proposal would impose an excise tax on employer-sponsored insurance beginning in 2013 for plans with costs above $8,000 for an individual and $21,000 for a family. In Colorado, the average annual premium cost in 2008 for an individual was $4,900 and $11,952 for a family.

It seems like a reasonable plan, but like so many other pieces of health care, it's complicated.

A brief by Milliman Inc., the world's largest independent actuarial and consulting firm, notes that high-cost plans have as much to do with the beneficiary's geographic location, profession, age, gender and health status as with the richness of benefits.

Milliman uses the example that a typical employer-sponsored plan for a family of four in Miami in 2009 is $20,282. In comparison, the cost of plan for a similar family in Phoenix is less than $15,000. Given that the medical costs have grown between 7 percent and 10 percent over the last few years, it is possible that benefits in some geographic areas could exceed the tax trigger by 2013.

Those in high-risk professions, such as firefighters and coal miners, have higher utilization costs and would easily be subjected to the excise tax. A new provision, however, would increase the allowable benefit amount to $9,850 for an individual and $26,000 for a family.

Age and gender also make a difference in the cost of premiums. Milliman notes that the national average per-member, per-month cost for a 30-year-old male is $155 per month – less than $2,000 per year. But the cost for a 60-year-old female is $717 per month, or $8,604 annually, which exceeds the tax threshold.

Age is a significant factor, especially with the percentage of workers 55 and older increasing and remaining in the labor force longer. It is estimated that 93 percent of the growth in the labor force from 2006 to 2016 will be among workers ages 55 and older.

As people age, health care premiums increase and it is possible that those that did not exceed the threshold in 2013 may be taxed in the future. The cost of plans could become a problem for employers with an older workforce.

In 2014, the taxable amount would increase by inflation as measured by the Consumer Price Index for Urban Consumers (CPI-U). The problem is that heath care inflation has grown at a faster pace than general or consumer inflation for more than a decade. In 2008, CPI-U actually decreased 1.5 percent while health care costs increased 7.4 percent -- the lowest increase in five years.

Because health insurance premiums will outpace the tax threshold, more plans will be subject to the excise tax over time.

The Milliman report argues that the dramatic increase in the CBO's estimates of the tax revenue in a six-year period – from $5 billion in 2013 to $53 billion in 2019 – suggests that the excise tax will "dip substantially further into the mainstream of health plans."

This isn't necessarily bad. The existence of a ceiling will likely encourage insurers to create products that are under the cap. Insurers though may look to create a plan that does not exceed the threshold but instead increases co-pays, co-insurance or deductibles based on minimum benefit levels. How benefits are put together and the ratio of benefit value to the total cost (actuarial value) is something to watch.

In the end, we must ask if we have a societal responsibility to protect the health and well-being of our fellow citizens – this includes making health care accessible and affordable for all. To do this we need to cover the cost. There may be other ways, but an excise tax on insurers offering high-cost plans can provide a significant source of funding for subsidies.
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Baker, is a senior policy analyst and director of the health project at the Bell Policy Center, a nonprofit, nonpartisan policy research center.
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Copyright (C) 2009 by the Colorado Editorial Forum. 11/09

GEORGIA FORUM

By Kathie McClure

It can be challenging to find an organ donor for someone who needs a transplant.

But when a donor and desperately sick person are matched up, living donors should not be “punished” for their gift, especially by the health insurance industry.

This is a little-known aspect of the health care debate that should be brought to light -- the fact that there is nothing that prevents health insurance companies from either denying coverage or charging higher premiums to those who donate an organ by categorizing them as people with “pre-existing conditions.”

This lack of regulation makes it potentially difficult for donors to get health insurance after giving the gift of life.

Here is my story. I met Dan Krinsky and his wife in 2000 when they opened their restaurant in our neighborhood. My husband and I loved their wonderful cooking and over the years we bonded and became good friends.

Shortly after hearing in 2008 that he had developed polycystic kidney disease I ran into Dan at our local taco stand. I could see instantly he was deathly ill and needed a kidney transplant, I told him then and there I would give him one of mine.

Of course even though I was serious, I wasn’t sure I was a match.

But on July 14, after two days of extensive medical tests, I was pronounced 100 percent healthy and able to donate a kidney to my friend.

There was a long silence at the other end of the phone when I told Dan that I had been approved to give him a kidney. He could hardly find words to express his gratitude, amid his relief that after two years on the transplant list and a year on dialysis, the wait for a healthy organ was over.

Yet the very next day I was given good reason to rethink my decision when I read a report in the Los Angeles Times that despite my perfect health, donating a kidney could put me at risk for being denied health insurance or charged more because insurers may consider organ donation a “pre-existing condition.”

Deterring potential donors from giving the gift of life is deadly business. According to the National Kidney Foundation, demand for kidneys far outstrips supply.

More than 80,000 people are waiting for a kidney, of which about 4,500 die each year. Living donation rates have declined recently, with only about 6,000 donations last year.

By threatening potential donors with a lifetime of increased premiums health insurance companies have stooped to a new low of corporate self-interest. For them, the profit motive clearly reigns supreme.

Whatever health-care reform is enacted, we need to ensure that all Americans, including living donors, are not charged higher premiums or denied coverage by insurance companies for having pre-existing conditions.

The National Kidney Foundation’s “End the Wait” Campaign includes additional proposals to protect living donors as part of a broad array of recommendations to increase donations, improve transplant outcomes, and improve the transplant system throughout the country.

Steadfast in my promise to Dan to give him a kidney, I have redoubled my fight to protect organ donors and ordinary Americans from discrimination by health insurance companies. It’s past time we put a stop to these abuses.

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McClure, an Atlanta attorney and the founder of VoteHealthcare.org, successfully donated a kidney to Dan Krinsky in August.
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Copyright (C) 2009 by the Georgia Forum. 11/09

By Anne R. Davis, MD, MPH

Every day, I hear from another woman who is losing her job and her health insurance. Every day, I worry. As an obstetrician/gynecologist, I know firsthand what can happen when a woman can’t afford reproductive health care, whether she has lost her insurance or her insurance doesn’t cover women’s basic needs. Cervical cancer develops unnoticed. Pregnant women go without critical prenatal care. Sexually transmitted diseases progress unchecked. We see the results in the emergency room.

Congress must give women a better shot at staying well. Health care reform must change the rules: Health insurance must be affordable to all women, and the insurance we buy must cover our reproductive health care.

In my own life, I’ve always had good health insurance. I go to my ob/gyn each year for a well-woman exam, my birth control is covered, and my hospital bills were paid when I had my two children. These are medical fundamentals -- women’s health care 101-- yet I consider myself lucky to have them. Too many women are not as fortunate. According to the Guttmacher Institute, more than one in four women or their partners have lost their jobs or health insurance in the past year. The institute also reports that one in four women delayed an ob/gyn visit in the last year to save money.

Since the recession began, dozens of women have made emergency appointments with me because they have been laid off and are on the brink of losing their health insurance. They wouldn’t bother if they didn’t depend on the prescriptions and treatments I provide. I always talk to them about how to get emergency care if the need arises, assuring them that I will help them navigate the system. Then we cross our fingers.

Melinda came to see me just before she lost her job and her insurance. She had large fibroids—benign tumors—in her uterus that made her bleed heavily. I prescribed birth control pills, which controlled the bleeding. Then, as sometimes happens with fibroids, the pills stopped working. She bled so heavily she was dizzy and unable to walk. After seven hours of bleeding, Melinda called our office, and we advised her to get to the emergency room immediately. She was in shock; the ER staff gave her a blood transfusion that saved her life.

The next step in her care would be an operation to remove the fibroids. But once Melinda was stable, the doctors discharged her without surgery. Hospitals are required to try to keep every patient alive, but they do not have to provide non-emergency care to people who can’t pay. The staff advised Melinda to apply for Medicaid and schedule the operation once she was covered. But because she receives unemployment benefits, Medicaid deemed Melinda too wealthy for assistance.

Melinda’s bleeding will return. I am her physician, but I can’t give her the treatment she needs. This makes me furious. I am trying to work around the system to get her care, and I know many other doctors who have done the same for patients in crisis. We don’t always succeed.

Sometimes my colleagues and I find ourselves unable to help some women who want to be mothers, like Christine. Christine came in for an IUD. She is 40 and had been pregnant recently. She and her husband have two children, and they wanted to have another baby. Her doctor estimated that even an uncomplicated birth would cost thousands more than they could afford. Christine’s insurance doesn’t pay for labor and delivery, and her family’s income was too high for Medicaid. She had an abortion and then came to me for long-term birth control—neither was covered by her insurance.

Christine’s health insurance policy, like many others, seems to be based on the premise that the reproductive system doesn’t exist, that reproductive health has nothing to do with our overall health. Explain that to her and Melinda.

I am fortunate to have had insurers that cover the essentials for reproductive health. But health care shouldn’t be a matter of luck. All of my patients deserve comprehensive reproductive health services as much as I do.

For too long, women in this country have been sicker than we should be, with far-ranging effects on the jobs we hold, the families we care for, and the society we live in. Congress now has an opportunity to improve the health of women dramatically. Our senators and representatives must put insurance within every woman’s reach.

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Davis, MD, MPH, is the medical director of Physicians for Reproductive Choice and Health and an obstetrician/gynecologist in New York City.
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Copyright (C) 2009 by the American Forum. 11/09