Entries in Affordable Care Act (14)


Transgender Man Denied Cancer Treatment; Now Feds Say It's Illegal

Courtesy Jay Kallio(NEW YORK) -- Jay Kallio, a former EMT who is disabled with kidney failure, rheumatoid arthritis and now cancer, has struggled to get good medical care, but being transgender stood in the way.

At the age of 50, Kallio transitioned from female to male but never had gender reassignment surgery, only hormone treatment.

When a suspicious lump was found in his breast and tested positive for cancer, the surgeon was so shocked that Kallio's body didn't match his gender identification -- not knowing whether to address him as "he" or "she" -- that he couldn't bring himself to tell his patient the grim biopsy results.

Now, the U.S. Department of Health and Human Services has said that under the Affordable Care Act, it is against the law to discriminate against transgender and LGBT patients in federally funded healthcare programs.

The policy follows a landmark 2010 U.S. Equal Employment Opportunity Commission ruling on sex discrimination in the workplace.  LGBT and transgender advocacy groups pursued a clarification from HHS for harassment and gender stereotyping in healthcare settings.

Kallio, who is now 56 and lives in New York City, learned "accidentally" that he had breast cancer when the lab technician called to ask how he was doing with his diagnosis.

"Which diagnosis?" Kallio asked, horrified.

And it happened a second time, when the medical oncologist was "hostile" and refused to advise him on treatments.

Later, said Kallio, the doctor apologized, stating, "I don't think it interfered with the quality of your care."

In fact, it did.  Having to find new doctors delayed the start of chemotherapy beyond the so-called "therapeutic window" for Kallio's particularly aggressive form of breast cancer.

"Our community needs medical providers to know what their obligations are and passing a law is the strongest and clearest way to do that," said Mara Keisling, director of the National Center for Transgender Equality (NCTE).

The U.S. Census and other federal agencies do not keep track of data pertaining to gender identification and many who are transgender do not go public.  But NCTE estimates that between .25 and 1 percent of the population is transgender.

Copyright 2012 ABC News Radio


'Obamacare' Ruling Puts New Emphasis on State Governments

(WASHINGTON) -- There are very few certainties in politics, but the Supreme Court's ruling on the Affordable Care Act, the controversial health care law colloquially referred to as "Obamacare," resulted in one of those rare sure things: It assured that the debate surrounding the law will rage on for the foreseeable future.

Almost immediately after the Supreme Court announced its ruling, Mitt Romney vowed to repeal the law if elected in the fall. Republicans in the House and Senate got a new talking point -- Republican control of both chambers will greatly improve their ability to facilitate this repeal.

And several Republican governors, including Bobby Jindal of Louisiana and Scott Walker of Wisconsin, said that they would wait until November to take any sort of action to begin actually to implement the law.

Democrats need to maintain control in only one of the following three places -- the White House, the Senate, or the House of Representatives -- to, at the very least, seriously hinder Republicans' ability to repeal the law entirely. If Romney is elected president, there are a handful of legal options he can take unilaterally, without the help of Congress, to go after the law, but he'll be greatly limited. And Republicans will face a time crunch, given that the law will take full effect in 2014.

If the Affordable Care Act continues to be the law of the land, however, state governors will have the job of implementing several requirements outlined by the reform. For example, under the law, each state is required to set up state exchanges where residents can, if they choose, select a healthcare plan (residents can also go through employer if that is an option for them). The exchanges do not need to be up and running until 2014, but states are required to demonstrate by Jan. 1, 2013, that their exchanges are in progress, and will be operational by the 2014 deadline. If they fall behind, the Department of Health and Human Services would then come in and set up the exchanges.

"If the state decides not to establish an exchange, then the federal government establishes the exchange for them. So it's kind of a pick-your-poison scenario, if you will," said Renee M. Landers, a professor of law at Suffolk University Law School in Boston. Presumably, governors who are resistant to setting up exchanges would be more resistant to the federal government establishing the exchanges for them.

Under the law, as it was written, governors would also oversee an expansion of Medicaid within their states. However, the Supreme Court ruled that states could opt out of this expansion. The legal procedure for deciding whether to go forward with the expansion will differ by state. It would be paid for entirely by the federal government for the first several years, and afterward states would only be required to chip in 10 percent of the cost.

The governors might not be acting alone.

"States might need to have legislation to be able to take advantage of the expansion," said Landers. "It's really impossible to generalize accurately because each state situation is so different. A governor can possibly make some kind of administrative changes, but certainly if it's going to take more money than they would need to go through the legislature."

It's not known what the governors in these states might do about the expansion of Medicaid, but many states that joined the suit against the law have Republican-controlled legislatures, and that's unlikely to change.

In Louisiana, for example, members in both the state house and senate have four-year terms, and are currently serving out their 2012-2016 term. In Michigan, no state senators are up for re-election this year, and house Republicans have a 16-seat majority.

In Virginia, the state senate has 20 Republicans and 20 Democrats, but the state's Republican lieutenant governor serves as the tie-breaking vote. The Virginia state legislature won't hold elections again until fall 2013, when there will also be a gubernatorial race in the state.

Several states could end up opting out of the Medicaid expansion -- and in that case, Landers says, the ACA would not meet all of its goals.

"It will mean that the Affordable Care Act will fall short of achieving some of its goals, because the Medicaid expansion was supposed to address low income people," Landers said.

Low-income residents of a state that opts out of the expansion will likely not be required to pay the fee for not having insurance.

"Their incomes will be too low to pay the tax. Unless a person has an income that meets the federal threshold for filing a tax return, they don't have to meet the individual mandate requirements" said Landers. "And even if you have the income that's above that level, if there are hardship requirements or you can show that there is no affordable product on the market for you to pay that's not less than 8 percent of your income, also can get an exemption."

The federal threshold for filing a tax return is an income of at least $9,350 annually for a single filer, $18,700 for a married couple with no dependents, and $22,350 for a couple with one dependent. After that it increases by an amount of $3,650 per dependent.

The National Journal estimates that the 26 states that opposed the health care law represent a majority -- 55 percent -- of Americans who have no medical insurance.

Copyright 2012 ABC News Radio


Medical Organizations Applaud Health Care Ruling

Mark Wilson/Getty Images(NEW YORK) -- The U.S. Supreme Court's ruling on Thursday that the Affordable Care Act, with its individual mandate, is constitutional has elicited a wide range of opinions from across the medical community.

Most major national medical organizations -- including the American Medical Association, the National Physicians Alliance, the American Academy of Pediatrics, and the Association of American Medical Colleges -- hail the ruling as a victory.  Many of these organizations have been strong supporters of the ACA since Congress passed it in 2010.

"The American Medical Association has long supported health insurance coverage for all, and we are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy," said Dr. Jeremy Lazarus, president of the American Medical Association.

"At last, the country is moving in a healthy direction on health care," said Dr. Valier Arkoosh, president of the National Physicians Alliance.

However, a handful of medical organizations are not as enthusiastic.

"We cannot overlook provisions like the Independent Payment Advisory Board that threaten the doctor-patient relationship and the administrative burdens within the law that could greatly hinder providers' ability to deliver quality care by infringing upon exam room time," said Dr. John Tongue, president of the American Association of Orthopaedic Surgeons.

"We are concerned that there are key aspects to this law that will, ultimately, hurt this nation's ability to provide widespread are for its citizens," the American Urological Association, the American Association of Clinical Urologists, and the Large Urology Group Practice Association said in a joint statement.

The U.S. Supreme Court has upheld the individual mandate, which states that all Americans must have health insurance or else pay a fine.  The Court stated that the fine is essentially a tax, giving the government the right to impose it.  However, the Court limited the law's ability to expand Medicaid, deciding that the U.S. government cannot withhold a state's Medicaid money if the state doesn't want to participate in the expansion.

The ACA, initially passed through Congress in 2010, could potentially cover more than 30 million people who are currently uninsured in the United States.

The law also has support from a wide range of patient advocacy groups, including the American Cancer Society, the National Organization for Rare Diseases, the American Heart Association, Consumer Reports, and the March of Dimes.

The parts of the law that have already been implemented will not be changed. Thus, children can stay on their parents' health insurance until they turn 26, and patients will not have to provide co-payments for preventive care.  However, the key piece of the law -- the individual mandate -- will not commence until 2014.

Copyright 2012 ABC News Radio


Supreme Court Curbs Health Reform Expansion of Medicaid

iStockphoto/Thinkstock(WASHINGTON) -- While the Supreme Court narrowly ruled the Affordable Care Act constitutional, it did place some important restrictions on a Medicaid expansion that is a backbone of the law’s efforts to insure more Americans.

In addition to requiring citizens to buy health insurance, the law also expanded Medicaid and tied federal funding to that expansion of state programs. In order to provide insurance to more poor people, the law said that states who did not accept the Medicaid expansion would risk losing existing Medicaid funds.

Today the Court said that as long as states who chose not to participate in the law’s expansion of Medicaid do not lose existing funds, the Medicaid the expansion is constitutional. The vote was 5-4 with Chief Justice John Roberts joining the liberal bloc.

The end result could be that more states opt out of the Medicaid expansion, which won’t be enacted until 2014, and the law could end up insuring fewer currently uninsured Americans.

The bottom line from Roberts: “The Court today limits the financial pressure the Secretary may apply to induce States to accept the terms of the Medicaid expansion.As a practical matter, states may now choose to reject expansion; that is the whole point.”

But what is interesting is that liberal justices like Elena Kagan and Stephen Breyer joined the five conservatives to insist that the states couldn’t be threatened with a loss of funding.

“Although many will be surprised that Chief Justice Roberts joined the Court’s progressive bloc to uphold the mandate, the far bigger surprise is that two members of that bloc-Justices Breyer and Kagan-joined the conservatives in holding that the Medicaid expansion exceeded Congress’s power,” says Stephen Vladeck, of American University Washington College of Law.” As a matter of precedent rather than politics, the Breyer and Kagan votes on Medicaid are likely to be far more significant going forward than the Roberts vote on the mandate,” he said.

Paul Clement, an attorney for the states called this part of the ruling a “significant victory." He said, “The states will have a chance to make the choice. They will no longer have the gun to their head.”

Renee M. Landers of Suffolk University Law school says the impact of today’s ruling, “could reduce the number of people who will be eligible for Medicaid because it is easier for the states to opt out.”

Copyright 2012 ABC News Radio


Pelosi Remains Confident in Upcoming Supreme Court Health Care Ruling

Chris Maddaloni/CQ Roll Call(WASHINGTON) -- With the Supreme Court’s decision on the Affordable Care Act about to be handed down within the next week, the focus has turned to how each political party will react, depending on how the justices rule.

House Minority Leader Nancy Pelosi, who shepherded the bill into law during her tenure as speaker of the House, had previously denied Democratic discussions of a contingency plan, but earlier this week Democratic Whip Steny Hoyer led reporters to believe that Democrats had in fact discussed the range of opinions that could be issued by the Supreme Court.

“Of course we’ve discussed it,” Hoyer, D-Md., said Tuesday. “But it is our conviction that the Supreme Court is going to uphold the plan.”

Thursday, Pelosi maintained her denial that she has participated in discussions of a contingency plan in the event that the Supreme Court strikes down part or all of the health care law.

“The only meetings that I have been party to have been those where we have heralded the benefits of the plan, that tens of millions of people have already benefited from it,” Pelosi, D-Calif., said as she ticked off a list of gains written into the law.

Pelosi once against reiterated her belief that the justices will rule in the Democrats’ favor, calling the law “ironclad” on both its merits and constitutionality. Still, when pressed whether the legislation could survive if the court strikes down the individual mandate, she admitted that popular provisions of the law, such as keeping young adults on their parents’ health care, would be “unsustainable” without the mandate.

“Just to borrow a Supreme Court metaphor, you have to eat your vegetables. You have to have the mandate in order for this to work from a financial standpoint,” she said. “The insurance companies even say that they really can’t do that unless the premiums skyrocket.”

Pelosi, who emphasized that she prefers not to speculate on hypothetical scenarios, suggested one solution to making up for lost revenue created by the individual mandate would be to adopt Democratic pay-fors first proposed during the health care reform debate before the final version of the Affordable Care Act was passed and signed into law.

“What could that be?” she said. “There could be something passed in the Congress similar to what we had originally in the House bill, which was a surcharge on the wealthy to pay for aspects of that. That was our pay-for.”

She also said states could follow the examples of California and Massachusetts to take their own action on health care.

“We’re right now in the world of speculation, and I don’t usually like to go in that world. But you’re asking, what are some of the things that could happen,” she said. “Let’s hope and pray that the court will love the Constitution more than it loves broccoli, and that we will have a decision that is based on the merits and the Constitution of the United States.”

The justices must rule on the health care reform law before the Supreme Court term ends at the end of the month. After not ruling on the case earlier Thursday, the next time they are scheduled to issue opinions is Monday.

Copyright 2012 ABC News Radio


Support for Health Care Law Reaches New Low

Comstock/Thinkstock(WASHINGTON) -- The Kaiser Family Foundation released a new poll finding a significant drop in favorable views of the new federal health care law to their lowest since the law was passed in March 2010.

Just 34 percent of Americans now view the Affordable Care Act favorably, down seven points from last month.  It was about this low, 35 percent, in July 2010. Fifty-one percent now view the law unfavorably, numerically a new high.

Kaiser says the drop occurred mainly among Democrats, who, while they still are more supportive of the law than are other Americans, have grown less so. It suggests glum economic views are a factor and also notes persistent criticism of the law in the GOP debates.

Just 18 percent of Americans now think the law will improve things for them personally, down from 27 percent in September. And just 28 percent think it’ll make things better for the country - another new low, and down from 38 percent.

Copyright 2011 ABC News Radio


Study: Government Should Prepare for Contingencies in Medicaid Expansion

Comstock/Thinksto(WASHINGTON) -- The federal government will bear a heavier financial load when it comes to Medicaid as the number of Americans who receive aid jumps under the Obama administration’s health care plan, according to a new study.

The research, published in Health Affairs, found that the number of additional people enrolling in Medicaid may vary by more than 10 million, which would require federal government to spend an additional $58 billion on the program annually. According to the report, more than 7,000 new doctors could be needed because of the expansion.

“Our results indicate that policy makers should prepare to handle a broad range of contingencies in the Medicaid expansion under health reform,” the report concluded.

The report’s figures vary slightly from those of the Congressional Budget Office, which estimated that 16 million individuals will enroll in Medicaid in 2019, and those of the Centers for Medicare and Medicaid Services, which put the figure at 18 million.

“Research indicates that extending Medicaid coverage to uninsured people increases their access to care,” the report stated. “However, because of low provider reimbursement rates, people who shift from private coverage to Medicaid may actually experience greater difficulty finding providers willing to treat them.”

The Affordable Care Act requires states to expand Medicaid eligibility by 2014 to all Americans whose incomes are at or below 133 percent of the federal poverty line. The federal government will bankroll much of the initial costs.

Another study published in the same journal found that even without the individual mandate -- perhaps the most controversial aspect of the bill -- the health care law would still cover 23 million Americans that wouldn’t have had insurance without the law, and insurance premiums would rise less than projected.

If the mandate was lifted, premiums in the individual market would increase by 12.6 percent, with 7.8 million people losing coverage, according to the study.

The Democrats’ health care law has come under increased scrutiny by critics. Most Republican presidential candidates support repealing the entire law, even Mitt Romney, under whose governorship Massachusetts passed a law that became the model for the national bill.

Several programs in the Affordable Care Act have also run into hurdles. Earlier this month, the Obama administration announced it would drop the provision that would have provided long-term care insurance. The plan would’ve eased the burden on Medicaid but officials said they could not come up with a viable, financially sustainable model for it.

Copyright 2011 ABC News Radio


Affordable Care Act Credited with Reducing Ranks of Young Uninsured

Stockbyte/Thinkstock(WASHINGTON) -- President Obama’s 2010 overhaul of the nation’s health insurance system appears to have helped significantly reduce the number of uninsured American young adults, according to a new Gallup survey and U.S. Census data.

The percentage of 18- to 25-year-olds without health insurance dropped 3.6 points since the third quarter of 2010, when a key provision of the Affordable Care Act allowing many young adults to remain on their parents’ health plans first took effect, Gallup found.

Roughly one quarter -- 24.4 percent -- now report being uninsured, down from 28 percent late last year. The decline represents nearly one million more young adults who now have health insurance, according to official estimates based on the Gallup data.

“Going without coverage puts every young American just a car accident or surprise diagnosis away from a lifetime of medical debt or worse,” said Health and Human Services Secretary Kathleen Sebelius. “The good news is today one million young adults are no longer living with that fear and uncertainty.”

The Gallup findings were corroborated by a separate U.S. Census analysis released earlier this month that also noted a decline in uninsured young adults and simultaneous increase in those with coverage. Both studies attributed the change to the Affordable Care Act.

Democrats and the White House have hailed the findings as evidence the controversial health care law is having a positive effect, despite popular skepticism of the law and a Republican-led campaign to repeal it.

Half of all Americans oppose the law, fearful of a perceived negative impact on the economy and federal deficit, a recent ABC News/Washington Post poll found. Fewer -- just 37 percent -- said they favor repealing all or part of the law.

Some provisions, including the mandate allowing young adults under age 26 to remain on their parents’ health insurance and a ban on restrictions for preexisting conditions, remain popular.

Administration officials said Wednesday that an individual insurance mandate and other measures aimed at expanding insurance options would have the biggest impact on reducing the overall number of Americans without health insurance when they take effect in 2014 -- but they’re also among the most unpopular.

The mandate alone faces constitutional challenges in several ongoing cases that will likely reach the U.S. Supreme Court. Republicans have also vowed to do everything they can to hamstring implementation of that part of the law.

Nearly one in five Americans 25 to 64 years old does not have health insurance, according to Gallup -- that's roughly 30 million Americans.

Copyright 2011 ABC News Radio


Health Law Could Require Coverage of ‘Full Range’ of Birth Control

Stockbyte/Thinkstock(WASHINGTON) -- A report released Tuesday and requested by the government recommends that the “full range” of birth control methods, including the “morning after pill” known as Plan B as well as oral contraceptives, should be offered to “all women with reproductive capacity” at no cost under the Affordable Care Act.

The Department of Health and Human Services requested the study to determine which preventative services are vital to women’s health and well-being and should be added to the co-pay free list.

HHS Secretary Kathleen Sebelius will make a decision by Aug. 1 on whether or not to include the recommendations.  They would go into effect one year after Sebelius makes her decision.

“This report is historic,” Sebelius said in a statement Tuesday. “Before today, guidelines regarding women’s health and preventive care did not exist.”

Planned Parenthood lauded the report in a statement.

“Millions of women, especially young women, struggle every day to afford prescription birth control,” said Cecile Richards, president of Planned Parenthood Federation of America.  “Today’s recommendation brings us a step closer to ensuring that all newly insured women under the health care reform law will have access to prescription birth control without out-of-pocket expenses.  This would be a tremendous stride forward for women’s health in this country.”

But social conservative groups said it would lead to government-sponsored abortion.

The Family Research Council, a Christian advocacy group, said including Plan B in the Affordable Care Act’s insurance coverage “essentially would mandate coverage for abortion.”

The Guttmacher Institute, a research group that advocates for abortion rights,  estimated that unintended pregnancies cost taxpayers about $11 billion per year because two-thirds of them are funded by public insurance such as Medicaid.

Other services recommended by the committee include STD and HIV counseling, gestational diabetes screening for pregnant women, counseling and equipment to promote breast feeding, screening and counseling to help prevent domestic violence, yearly preventative care visits, and human papillomavirus testing for women older than 30 to help prevent cervical cancer.

The study particularly focused on women because reproductive and gender-specific conditions lead to women using more preventative care than men on average. Therefore, women face higher out-of-pocket costs, the report noted.

Copyright 2011 ABC News Radio


Most Medicare Patients Not Taking Advantage of Free Care

Brand X Pictures/Thinkstock(WASHINGTON) -- The Obama administration is trying to boost awareness of the free benefits of Medicare now that the Centers for Medicare and Medicaid Services (CMS) on Monday released a report showing that only one in six Americans take advantage of free check-ups offered each year.  

Preventative benefits are now available at no charge to Medicare patients due to the Affordable Care Act.  Part of these preventative benefits allows those on Medicare to take part in an Annual Wellness visit, breast and prostate cancer screenings and bone density screenings, but CMS says people are not taking the free care, likely due to a lack of information.  Now, CMS has launched a public outreach campaign called "Share the News, Share the Health" to inform physicians and patients about the available services.

"The Obama Administration is committed to helping increase the number of Americans who are healthy at every stage of life," CMS administrator Donald Berwick, M.D., said Monday. "…With the new free Annual Wellness Visits and free preventative care, people with Medicare have the tools to take common sense steps to take control of their health."

CMS says these services offered without cost-sharing can help save Americans an estimated two-thirds of the $2 trillion spent on treating long-term illnesses by taking steps to prevent them altogether.  

"Share the News, Share the Health," which will include online ads and community events all over the U.S.. will run throughout the summer.

Copyright 2011 ABC News Radio

ABC News Radio