Since the Affordable Care Act (ACA) became law, millions of Americans no longer face coverage denials, higher costs, or coverage carve outs because of their medical histories. A new analysis from the U.S. Department of Health and Human Services provides a first look at what happened to uninsured rates for Americans with pre-existing health conditions when the ACA’s major insurance market reforms took effect in 2014. It finds that, between 2010 and 2014, the share of Americans with pre-existing conditions who went without health insurance all year fell by 22 percent, meaning 3.6 million fewer people with pre-existing conditions went uninsured.
While data for individuals with pre-existing conditions are available only through 2014, the uninsured rate for all Americans has fallen by an additional 22 percent through mid-2016, and Americans with pre-existing conditions have likely seen similar additional gains.
“Today, thanks to Affordable Care Act protections, the uninsured rate is at its lowest level in history and millions of Americans with pre-existing conditions like asthma or cancer no longer have to worry about being denied coverage because of their medical history,” said HHS Secretary Sylvia M. Burwell. “This is clear and measurable progress, and we shouldn’t turn the clock back to a time when people were denied coverage.”
The new analysis estimates that 51 percent of non-elderly Americans, or 133 million people, have a pre-existing health condition under the definition insurers used for underwriting purposes before the ACA. Among the most common pre-existing conditions are: high blood pressure (46 million people); behavioral health disorders (45 million people); asthma or chronic lung disease (34 million people); heart conditions or heart disease (16 million people); diabetes (13 million people); and cancer (11 million people). Because the likelihood of having a pre-existing condition increases with age, the ACA’s protections are especially important to middle-aged and older Americans. Up to 84 percent of Americans between age 55 and 64, and up to 75 percent of Americans between age 45 and 54 have a pre-existing condition that could have been the basis for insurer discrimination prior to 2014.
Today’s analysis confirms that the ACA’s insurance market reforms are having a major impact on coverage for Americans with pre-existing conditions. After passage of the Affordable Care Act, uninsured rates declined by almost 20 percent or more among non-elderly Americans with high blood pressure, behavioral health disorders, asthma or chronic lung disease, and osteoarthritis.
The analysis also sheds light on proposals that would restrict pre-existing condition protections to people who meet standards for continuous coverage, rather than protecting anyone who signs up during an annual open enrollment period. The analysis finds that tens of millions of people with pre-existing conditions go uninsured for at least short spells due to job changes, other life transitions, or periods of financial difficulty. In the two-year period beginning in 2013, almost one third of people (44 million) with pre-existing conditions went uninsured for at least one month.
The Affordable Care Act achieved dramatic improvements in coverage for people with pre-existing conditions through three fundamental reforms: first, requiring insurance companies to cover people with pre-existing conditions; second, providing financial assistance linked to premiums and income to help make coverage more affordable; and third, by requiring all Americans to get coverage if they can afford it. Prior to the Affordable Care Act, states that tried to protect people with pre-existing conditions without other measures such as financial assistance and an individual responsibility requirement saw premiums skyrocket as not enough healthy people entered the risk pool. Under the Affordable Care Act, the number of people in the individual market has grown, and most HealthCare.gov enrollees can select a plan for less than $75 per month in premiums.
To read today’s report, visit: https://aspe.hhs.gov/pdf-report/health-insurance-coverage-americans-pre-existing-conditions-impact-affordable-care-act
New Study Looks at End-of-Life Decision-Making for People with Intellectual Disabilities
A new study by researchers at the University at Buffalo provides a groundbreaking look at how advance care planning medical orders inform emergency medical service (EMS) providers’ experiences involving people with intellectual disabilities.
Most states in the U.S. have programs that allow terminally ill patients to document their end-of-life decisions. In New York, the Medical Orders for Life-Sustaining Treatment form (MOLST) allows individuals to document what measures health care providers, including EMS providers, should take near the end of a patient’s life.
Studies suggest that this approach to person-centered advance care planning can alleviate a dying patient’s pain and suffering, according Deborah Waldrop, a professor in the UB School of Social Work and an expert on end-of-life care. Yet little research on end-of-life decision-making has been done on the growing population of older Americans with intellectual disabilities, which the American Association on Intellectual and Developmental Disabilities defines as a disability characterized by significant limitations in learning, reasoning, problem solving, and a collection of conceptual, social and practical skills.
Waldrop and Brian Clemency an associate professor of emergency medicine in the Jacobs School of Medicine and Biomedical Sciences, authored one of the first scholarly examinations of how pre-hospital providers assess and manage emergency calls for patients who do not wish to be resuscitated or intubated. Jacqueline McGinley, a doctoral candidate in UB’s School of Social Work, joined their research team and served as first author for their most recent work.
Through a series of interviews with five different emergency medical service agencies in upstate New York, the researchers asked EMS providers specifically how forms like the MOLST shape what they do in the case of someone with an intellectual disability.
“The best available research before our study suggested that as of the late 1990s, fewer than 1 percent of people with intellectual disabilities had ever documented or discussed their end-of-life wishes,” says McGinley. “But with this study, we found that about 62 percent of the EMS providers we surveyed had treated someone with an intellectual or developmental disability who had these forms.”
That disparity points to the need to illuminate this understudied area of how people with intellectual disabilities are engaging in end-of-life discussions, according to McGinley.
She says the EMS providers’ charge is to follow protocol by honoring the documents, their directions and organizational procedures. The MOLST, as its name implies, is a medical order that providers are professionally bound to respect. Their procedures are identical for all emergency calls involving someone who is imminently dying regardless of a pre-existing disability, the study’s results suggested.
But questions remained.
“We heard from providers who wrestled with the unique issues that impact this population, including organizational barriers when working across systems of care and decision-making for individuals who may lack capacity” says McGinley.
There are approximately 650,000 adults age 60 and older in the U.S. with intellectual disabilities, according to Census Bureau figures from 2000. Demographers expect that figure to double by 2030, and triple within the foreseeable future.
Person-centered advance care planning specifically involves the individual in discussions about their health history, possible changes to their current health status and what future options might be available in order to best inform that person’s end-of-life decision-making.
The results, published in the Journal of Applied Research in Intellectual Disabilities, suggest that medical orders largely favor efforts to prolong life. This may be due to a reluctance to discuss advanced care planning in this population. Still, this sociocultural context must be strongly considered as future research explores how people with intellectual disabilities engage in end-of-life discussions.
Since January 2016, Medicare pays for patients to have advance care planning conversations with medical providers. In fact, at least once a year, as part of a service plan through the state, people with intellectual disabilities have face-to-face discussions with their service providers, according to McGinley, who notes the importance of this built-in opportunity to have conversations about serious illness and the end of life.
“What’s most important in all of the work we do is knowing that people can die badly,” says Waldrop. “We know we can make changes that illuminate some of the uncertainties and improve care for people who are dying. Knowing how forms, like the MOLST, are applied in the field is an incredible step in the right direction.”
CHIP Demise Devastating to Millions of American Children
Congress allowed the federal Children’s Health Insurance Program (CHIP) to expire Oct. 1, leading to the demise of one of the most successful government programs ever implemented, said an expert on health economics at Washington University in St. Louis.
“CHIP has led to a substantial reduction in the uninsured rate for children, to the point where children now have only a 5 percent uninsured rate — the lowest ever,” said Tim McBride, professor at the Brown School and director of the Center for Health Economics and Policy. He also serves as chair of the oversight committee for Missouri’s Medicaid program called MOHealthNET.
An estimated 9 million children are now covered by the CHIP program across the U.S. In Missouri, more 624,000 children are covered by a combination of CHIP and Medicaid, though most children are covered by Medicaid.
What if funding is not restored?
A move to rescue the program hit a snag in the U.S. House of Representatives this week, lowering hopes that it might be restored quickly.
“In the short run, most states can continue to pay for the program for at least a few weeks if not months, using funds carried forward from previous years,” McBride said. “But at some point, those funds will dry up and states will face cutting the program, which will mean children will lose their health insurance.
“States likely do not have the funds to make up for the loss of federal dollars. The impact of this would be devastating, to say the least, on these children and their families. But it would create a huge financial problem for the health care system — physicians, providers and those who care for them.
“It should be obvious that this is a great investment in our future because if medical problems can be avoided when children are young, they are much more likely to do better in school, be more productive members of society,” McBride said. “Also, it would be penny-wise, pound-foolish to not deal with this problem now, since covering children is a lot cheaper than covering anyone else, and it costs more if medical care is delayed.”
The state of Missouri reportedly would not run out of funding to finance the CHIP program until the first quarter of 2018, if not a little later, he said. But, in other states, the end of federal funds for CHIP will come considerably sooner, maybe within weeks.
Will Congress eventually come around?
“I would bet that Congress eventually will do something to reauthorize the program, based on previous experience, and I know they are working on legislation right now,” McBride said. “They have had to reauthorize this program many times before, and it has garnered bipartisan support.
“However, these days there is so much partisanship, and Washington is much less functional, so I am afraid to make any definitive predictions now.”
Self Help Tips and Advice For Social Workers
There is no denying the positive impact social workers have on hundreds of families and individuals throughout their career. They will tell you about the rewarding experiences they have helping others in need. Unfortunately, for every success, there is at least one case in which they could not help. Social workers see the best and the worst of society every day, and even the strongest among us can crack under the pressure. That is why self-care is so important. Being mindfully aware of your needs as well as the needs of those around you can keep you healthy and able to be there when you’re needed.
What is Self Care and How Can You Do It Every day?
Self-care is a practice that becomes a lifestyle. Understand and commit to the idea that it is not something you do once, it is something you do every day. The key is to be mindful and aware.
It is important to be mindful of where you are and what you are doing as you go about your day. Whether you are in a meeting or at the grocery store, notice how you are feeling in the moment. This can range from listening to your body and noticing your state of health to recognizing an emotional situation in your life.
Become aware of your breathing. When we are feeling stressed, emotional, or run down, we forget how to breathe. Our breath can become fast and shallow which deprives our bodies of the oxygen it needs. Pay attention to your breathing and focus on slowing it down. Allow the air to fill your abdomen, not just your lungs. You will find that mindful breathing exercises calms your thoughts, allows for greater clarity, and lessens your anxiety.
Now That You Are Aware, How Do You Improve?
It’s one thing to be mindful and aware of how you are feeling, but doing something about it is another matter. Improving your physical and emotional state requires some life changes as well.
Many social workers have the stress relieving habit of smoking or grabbing an unhealthy snack from the vending machine. It makes us feel like we’re taking a moment for ourselves. Instead of grabbing a cigarette or a bag of chips, try an e-cigarette starter kit or grab a granola bar. This gives you a moment away while making healthier choices through controlling the nicotine and sugar you intake. The idea is not to deprive yourself but to make small changes that will make you feel better over time.
Changing the way you approach daily tasks is another life change that will give you some added peace of mind. For decades we have been taught to multitask but all we’ve learned is how to start tasks but not finish them in a timely manner. By focusing on one task at a time you’ll allow yourself to finish a job before moving onto something else. This creates a sense of accomplishment and boosts your confidence at the job you are doing.
Maintaining Your New Found Awareness
Creating a support system is important when attempting to care for yourself. By relying on your friends and family you are willingly accepting love and nurturing that you simply cannot give to yourself. When meditating on an issue in your life doesn’t result in answers, one of the best things we can do is turn to our support system for help. It’s not necessary to face every challenge alone and often times, they can see from a perspective that you cannot. You may also find that the more willing you are to receive care from others, the easier it becomes for you to provide care for the people you’re working to help.
Self-care is difficult for those who spend their lives taking care of others. By allowing yourself the care you need you will find that it not only feeds your soul but it will improve your ability to care for the people around you.
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