The Interfaith Disability Advocacy Coalition (IDAC) launches compendium of resources on mental health and gun violence. American Muslim Health Professionals is a member of IDAC. Together, we have created a guiding document to prevent stigmatization of mental health in th backdrop of gun violence.
WASHINGTON, DC: April 15, 2013 –The Interfaith Disability Advocacy Coalition (IDAC), a program of the American Association of People with Disabilities (AAPD), is proud to release Grounded in Faith: Resources on Mental Health and Gun Violence; available online at http://www.aapd.com/assets/grounded-in-faith.pdf
“Grounded in Faith: Resources on Mental Health and Gun Violence” is a compendium of resources to be used by congregational leaders, disability advocates and other concerned persons who wish to ensure that the ongoing debate on gun control does not do great harm by stigmatizing people with mental illness or depriving them of their rights and freedoms. Immediately following this introduction are two sections prepared by the Interfaith Disability Advocacy Coalition (IDAC)—Section Two: Statistics and Perspectives on Mental Health and Gun Violence and Section Three: Positions and Policies of IDAC Members and Others on Mental Health Issues. The six appendices highlight the perspectives of experts and organizations in the field as well as summaries of legislative proposals and current state and federal laws.
The relationship of current discussions about mental illness and gun violence is of great concern to IDAC, which prepared this report. IDAC is a nonpartisan advocacy coalition of 32 national faith-based organizations, including representatives from the Christian, Jewish, Muslim, Hindu and Sikh traditions, whose core spiritual values affirm the rights and dignity of people with disabilities.
The compendium is a resource for congregational leaders, disability advocates, and other concerned persons who wish to ensure that the on-going debate around gun violence prevention does not stigmatize people with mental illnesses, and deprive them of their rights and freedoms.
1- Grounded in Faith (PDF file)
2- Official Grounded in Faith Press Release
Compensation: Unpaid, Part-time (Approximately 10-15 hours/week)
Organization Description: American Muslim Health Professionals (AMHP) is a national nonprofit organization which empowers Muslims in the health profession to improve the health of all Americans broadly and the health of Muslim Americans in particular. Since the organization’s founding almost a decade ago, AMHP has been at the forefront of public health and policy issues—mobilizing Muslims during the health reform debates at the start of the Obama Administration, championing community-based anti-obesity measures, and most recently, elevating the discussion on mental health.
Position Description: The Summer Intern will work directly with AMHP’s President and Chair of Mental Health Education. This high-profile role requires a high degree of professionalism, organization and communication skills. The Intern must have the ability to navigate ambiguous environments and meet time-sensitive deadlines.
The AMHP Summer Intern will play a critical role in coordinating a number of critical webinars, meetings, and events including, but not limited to, the following:
1. Matters of the Mind Webinar (late June): The third in a series, this webinar with focus on the mental health challenges of Muslim adolescents and young adults in the US (with a particular focus on the aftermath of the Boston Marathon bombings). Partners for this webinar include the Islamic Society of North America (ISNA) and the Department of Health and Human Services (HHS).
2. AMHP Partnership Iftar (early Ramadan/July): AMHP will host its first iftar in Washington. Invitations will be sent to key partners in the area and community leaders.
3. Mental Health Convening at HHS (Aug. 30): Last year, AMHP mobilized top scholars, health practitioners, and faith leaders from across the nation to share their insights with HHS policy-makers in a forum entitled “Addressing Behavioral Health in American Muslim Communities”. AMHP is developing a follow-up forum on August 30 to coincide with the 50th annual ISNA Convention.
4. ISNA Panel Coordination (Aug. 30-Sept. 2): AMHP anticipates moderating at least one panel at the ISNA Convention and will need assistance to handle the logistical details for the event.
5. Muslim Health Forum (Sept. 1): In 2012, AMHP launched this “TED-Talk style” forum with Muslim thought leaders on the frontiers of their health careers. AMHP will host another forum to coincide with the ISNA Convention to focus on health entrepreneurship in healthcare delivery, technology, and consulting.
6. Mental Health First Aid for Muslims (mid September). AMHP will convene this day-long workshop with a certified trainer to build capacity among Washington Metro area imams, chaplains, youth and community leaders.
Qualifications: Must be enrolled in or recently completed an undergraduate or graduate program in a health-related discipline.
Application: Submit cover letter and resume to firstname.lastname@example.org
Deadline: Tuesday, May 14, 2013
Duration: 3 Months (June 3 – Sep 3, 2013)
Website: For details on AMHP’s programs and partnerships, please visit the AMHP website (www.amhp.us) or access the 2012 annual report (http://amhp.us/AnnualReport2012.pdf)]]>
Recent estimates as of January 2013 have put the Syrian death toll at 60,000 to 70,000 lives lost. We did not know what to expect when we arrived at the rehabilitation camp, a few kilometers from the Syrian border. As we drove through the town, Dr. Ahmed pointed out landmarks including a small waterfall at the foot of one of the Syrian mountains. Many Syrians came by daily to view, touch, and drink the water that cascaded from Syria.
We spent 5 days and nights in the camp, taking care of patients in wheelchairs and casts, patients with single and multiple limb amputations, paraplegics, quadriplegics, and a few women who lost their eyes. We helped in the makeshift urgent care, determining if new patients could stay at the camp for continued care or be transferred to a local hospital by ambulance. As we spent time with these brave men and women, we heard their stories of pain, loss of loved ones, but hope. And sadly, as we cared for their wounds, we began to realize that we had seen many of these injuries and mental traumas before, not from other international medical missions, but from a part of the world closer to home: our own domestic war zones. Our training during medical school and residency in U.S. trauma centers had prepared us for what we witnessed and experienced almost half a world away.
Anyone who has worked in a level-one trauma center wedged in the watersheds of several inner cities has seen wounds produced by multiple mechanisms of violence. Per the Center for Disease Control (CDC), injuries and violence are the number one cause of American deaths in the first half of life. This does not include the millions of Americans who are injured and survive to be faced with long term medical, psychological, and social consequences. As an example, two adolescent brothers were brought into Andrew’s hospital late one summer night. One was fortunate enough to be shot in the leg with a “flesh wound” while the other was shot in the chest and died within 30 minutes. The brother who survived suffered from post traumatic stress disorder and major depressive episode and required significant amounts of counseling. What effect this violence will have on this 17 year old boy, his family and future, we cannot know. Multiply this story by 30,000 Americans who die by guns every year , and it is not surprising why gun violence has been labeled a public health crisis by President Obama himself. Sadly, it has required several mass shootings covered by a sensationalized news-media conglomerate to grab the nation’s collective attention.
Since returning home from Syria to a raging debate regarding gun control, we are concerned about why this dialogue is occurring only now. Gun violence represented by the recent highly publicized mass shootings is nothing new for America’s metropolitan and inner city neighborhoods, the hardest hit segments of our population. A review of recent literature revealed several disturbing trends that may explain why we, as Americans, know so very little about our fellow citizens who are shot to death every day.
In their recent JAMA article, Silencing the Science on Gun Research, Kellermann et al. discuss an ambitious effort by pro-gun members of congress to eliminate the National Center for Injury Prevention and Control, a branch of the CDC. In 1996, $2.6 million in funding were removed from the CDC’s budget, a figure that corresponded with the amount of money spent the year prior on firearm injury research. The long term effect has been a sharp decline in firearm injury research. The authors note that “even today, 17 years after this legislative action, the CDC’s website lacks specific links to information about preventing firearm-related violence.” Less research going into this area translates into fewer elucidated opportunities where counselors, social workers, health care providers, and policy makers can step in and intervene to prevent gun-related deaths.
By stark contrast, alcohol-related research has received continual support, and to good effect. Through funding from the National Institutes of Health (NIH), several studies have identified opportunities for screening and early intervention, translating into reduced drinking and alcohol related traffic accidents among college students and underaged individuals. Additionally, multiple NIH-funded studies performed throughout the past 30 years have proven that raising the minimum legal drinking age to 21 reduces both drinking and alcohol-related vehicular accidents among persons under age 21, a policy change which is estimated to prevent about 1,000 traffic deaths each year.
Instead of support, the Florida Bill HB115 (2011), as one example, was enacted to restrict physicians from asking patients about firearm ownership and intentionally entering this information into medical records. The bill has been defended as a guardian of patient privacy and protection from harassment. However, it is baffling that health care providers can freely inquire about smoking, drinking, and drug use, all of which are personal items of information with direct and indirect implications on personal and public health, but questions on gun ownership are deemed an invasion of privacy, which somehow nonsensically outweighs its potentially lethal consequences. Similar bills have been proposed in 7 other states.
Furthermore, a brief provision in the Affordable Care Act that received little attention until a Washington Post article was published in late December 2012, limits the ability of physicians and insurers to collect information on patient gun use. The cumulative effect of the lack of federal funding for research and infringements on health care providers’ abilities to discuss firearm safety is creating a disturbing challenge to treat firearms as a public health crisis.
As healthcare providers, we have a responsibility to care for and protect the wellbeing of our fellow members of society. In light of this public health crisis and the challenges that pro-gun policy makers have put in our way, we must combine our efforts to help reduce gun-related violence in America. Below are some suggestions proposed by Doctors for America that we should be aware of when considering the areas in which to act:
We also encourage you to become more informed and contact your Congressional representatives via http://www.drsforamerica.org/take-action/gun-violence-prevention.
During the 2011 NBA Finals, Miami Heat star Lebron James murmured, “that’s retarded” after listening to what he felt was a “stupid question” at a post-game press conference. Fortunately, Lebron later apologized publicly after disability groups complained about its offensive nature. However, only last year, right-wing personality Ann Coulter posted a Twitter message referring to President Obama as a “retard,” and later went on to defend her usage of the term to mean “loser”. The fact that even celebrities use the word so flippantly as synonymous with “stupid” and “loser” highlights the fact that many see this as a non-issue.
The effect that language can have on people is indisputable. Just as words can move us, inspire us or even heal us emotionally, they can insult, exclude and dehumanize. These latter painful impacts that the “r-word” has on those with disabilities is the impetus behind the Special Olympics campaign “Spread the word to end the word” to persuade individuals to stop using it, “as a starting point toward creating more accepting attitudes and communities for all people.” This past Wednesday, March 6th, was a national day of awareness of this effort, but the movement is an ongoing one whose goals are much broader than simply not using the r-word. It is a revolution to increase consciousness, change attitudes and become more accommodating in our mindsets about a population that has been largely hurt and ignored throughout history.
While statistics may vary, in 2011, the American Community Survey of the U.S. Census Bureau reported a prevalence of 12.2 percent – almost 38 million – of individuals with disabilities in the United States. Despite these large numbers, individuals with disabilities often face stigmatization that serves as a barrier to inclusion and growth. The Americans with Disabilities Act addressed structural barriers by prohibiting discrimination and ensuring equal opportunity for those with disabilities. Almost two decades later, President Obama passed Rosa’s Law, changing the terms “mental retardation” and “mentally retarded” in federal health, education and labor laws to “intellectual disability” and “individual with an intellectual disability”, respectively. This step displayed recognition of the concept that legitimate clinical entities were being delegitimized by the pervasive negative connotations of the “r-word”. Yet policy change is only one part of the strategy towards inclusivity and does not address individual perceptions.
There are many people who are caring, sensitive individuals who do not view the use of “retard” as disrespectful or heartless, particularly when used as a joke or when not referring to someone who actually has a disability. I would know; in my teens, I was one of them. The problem is not necessarily with intention; it is about consciousness. It is the recognition that whether one’s intent is cruel or well-meaning, semantics can have a destructive effect – both in terms of the attitudes it conjures as well as the actions motivated by these attitudes that may result in a less accepting culture. Furthermore, the choice we make to listen to or silence the pleas of those affected by these semantics not to be equated with a word of derision directly reflects — however subconscious — the value that we as a society place on these individuals.
When I politely express sensitivity of or distaste towards the r-word, I am often asked sympathetically if I have a family member or close friend who is intellectually or physically disabled. When I answer in the negative, they sometimes go on to think I’m just being too serious. It always confuses me, as if the only justifiable reason to advocate for others or express sensitivity about a cause is due to a personal relationship. As a trained Pediatrician and an Allergist, I regularly advocate for children and those with allergies though I don’t have any of either. My sensitivity results from a simple decision to be socially conscious with my words for the millions who may be hurt or affected by them.
I don’t mean to be a stick in the mud. Nonetheless, if serving as a voice for those who aren’t heard makes me one, I’m okay with that. I don’t personally get offended easily, but am often sensitive to speech that may offend vulnerable populations, and even more so if I am certain it hurts them. So it’s something that I actually don’t want to be desensitized to.
At the end of the day, “banning” a word really isn’t going to solve anything. Stigma and its counterpart, inclusion, are reflected in actions and the cycle of attaching a pejorative subtext will only repeat with any euphemism for those with disabilities unless the underlying negative connotations are removed. Moreover, censorship violates our freedom of speech, and that is the last thing any social justice advocate, such as myself, would support. However, if the Special Olympics campaign to “end the word” causes us to be reflective before we speak and fosters mutual partnership towards the common goal of becoming a more mindful and inclusive society, it will have more than done its job.
This article was also published using a different title by the Huffington Post.]]>
To begin with, there is nothing “diet” about diet soda. The impact they may have on your health includes the following:
One study which followed more than 2500 multiethnic people for nine or more years, found that people who drank diet soda every day increased their chances for strokes, heart attacks, and vascular events by 61%. The risk also increased for metabolic syndrome, which is a cluster of risk factors that occur together, including excessive fat around the waist, low levels of high density lipoprotein (HDL) and high blood pressure. Adults and children who drink either regular or diet soda increase their likelihood of developing metabolic syndrome by 50%. Those with metabolic syndrome have double the risk for heart issues and stroke, and an increased risk for developing diabetes. Those who drink at least one soft drink a day also have a 31% greater risk of becoming obese. An increased waist circumference, yields stronger predictions towards heart disease than weight gain alone. There is also a 25% increased risk of developing high blood triglycerides and high blood sugar, and a 32% higher risk of having low HDL (the “good” cholesterol) levels.
Those with increased risk factors for vascular disease can help by reducing their consumption of diet soda. These risk factors include high blood pressure, diabetes, high cholesterol, smoking, a family history of cardiovascular disease, and metabolic syndrome.
If that isn’t enough, the carbonation in soft drinks, which is present in both regular and diet versions, also robs the body of nutrients and minerals, especially calcium. These drinks also contain significant fluorides, which deplete the body of iodine and cause the thyroid gland to slow down metabolism.
The added artificial sweetener acts like monosodium glutamate (MSG) in the body, which is known to increase feelings of hunger. What happens is that the non-sugar sweeteners confuse your brain because the taste receptors in your mouth feel something sweet and trigger a cascade that includes preparing for insulin secretion to utilize the perceived glucose. While there are less calories present in diet soda, and therefore theoretically this should help with weigh reduction, since there is no glucose present, your brain ultimately notes this and you end up craving carbohydrates for the sugar rush. Some diet sodas actually contain even more caffeine so your body still feels this rush, despite the lack of sugar. Moreover, the initial perceived sweetness may actually cause the hypothalamus gland in your brain to direct the pancreas to secrete insulin. However, because there is no glucose, insulin resistance develops as the body is unable to properly use the produced insulin.
Caffeine, which is a stimulant, causes your adrenal glands to produce cortisol – the stress hormone. A rise in cortisol will stimulate significant energy production by releasing amino acids, glucose and fatty acids into the blood stream. The problem is that your body is in a state of stress and tries to work hard to compensate.
Over the years, aspartame has been linked to an array of conditions including multiple sclerosis, Gulf War Syndrome, epilepsy, chronic fatigue syndrome, Epstein Barr syndrome, Parkinson’s disease, Alzheimer’s disease, diabetes, mental retardation, lymphoma, and birth defects. Some of the symptoms associated with these conditions are: headaches, dizziness, irritability, anxiety attacks, vertigo, epileptic seizures, irrational rage, numbness, tingling, fatigue, blurred vision, blindness, hearing loss, loss of taste, slurred speech, mood alterations, depression, insomnia, cognitive or physical delay, memory loss, heart palpitations, muscle spasms, choking spasms, miscarriages, sexual dysfunction, rashes and/or joint pain. While the validity of all of these associations has not been by any means unanimously confirmed in studies, they are worth noting as theorized possibilities.
On the basis of this information, we as clinicians have a duty to advise patients and consumers of the above risks, particularly towards those who perceive diet soda as being “healthier” than regular soda. We should recommend replacing diet sodas with healthier alternatives and concentrating on an overall healthier diet and exercise routine.]]>
Therefore, as we begin to focus detection of mental illness on high-risk individuals in order to prevent heinous crimes like those in Aurora, Colorado, Oak Creek, Wisconsin, and Newtown, Connecticut, we cannot forget the importance of the mental health of the general population. Just as no one is safe from developing cancer these days, no one is safe from a mental health issue. Our world is a high stress place and with events like Newtown’s becoming more commonplace, it is becoming even more stressful.
Questions of safety and security in everyday life are not to be taken lightly. Many people, especially parents of last week’s tragedy, are beginning to question the safety of their children outside of the home. Malls, houses of worship, theaters, and schools — public venues once considered safe and enjoyable places — leave many of us feeling insecure, and in some cases, paranoid.
I will wholly admit that last Friday’s shooting shook me to my core. I immediately jumped online and started to research home schooling. My husband, away on business, called and begged me to keep our son indoors. My sister called us paranoid – and that’s when I paused to think: are we really becoming paranoid? Obviously I can’t just sit inside my house day in and day out. Then I started to think that my house could be unsafe. With all of these thoughts came overwhelming feelings of sadness, anger, frustration… and yes, paranoia — and I know I wasn’t the only one feeling this way.
So how do we address the mental health of the general population? I suggest a simple starter plan of 5 points:
First, mental health should become a standard part of primary care. The World Health Organization has repeatedly called this integration the most viable way to detect and treat mental illness. The Patient Protection and Affordable Care Act requires that insurance plans offer “behavioral health” coverage, including mental health and addiction and substance abuse help, as an “essential health benefit,” which is major progress (that may regress if the Supreme Court decides Obamacare is unconstitutional in March).
Second, mental health professionals should be seen and treated as extremely important members of the field and heavily supported. “Associative stigma,” which is the stigma that mental health professionals experience a result of treating a stigmatized group of people, results in emotional exhaustion and decreased job satisfaction which can have a negative impact on their patients’ treatment.
Third, mental health should become a central topic of discussion in faith-based circles and centers. Muslims, for example, should start destigmatizing mental health disorders by pushing for khutbahs, halaqas, and other public discussions on the topic and frequently referencing the Quran and Hadith that underscore the existence and importance of mental health. On the spiritual soundness of the heart, Prophet Muhammad, peace be upon him said, “There is in the body a piece of flesh – if it becomes good, the whole body becomes good and if it becomes bad, the whole body becomes bad. And indeed it is the heart.” (Bukhari)
Fourth, we need to become better listeners. People are so quick to hear someone’s issue and give advice. If only advice always worked, the world would be fine. Better than advice is the process of listening, letting someone feel truly heard, allowing someone to vent wholly and truthfully without judgment, and supporting ones emotional release. That is to say: don’t stop someone from crying. More and more studies are showing the evolutionary advantages of crying, how it may be human nature’s way of emotional healing.
Fifth, give yourself and your loved ones a break. Remember that you are human and you are susceptible to mental illness, and it is very common. A quarter of adults in the US suffer from one or more mental disorders. When you feel sad, hurt, depressed, take it seriously. Do not brush it off as “just a bad day,” or “I need to be stronger.” Being open to recognizing a problem is true strength.]]>
Systematized Diversity Training Does Not Exist
The American Muslim population is a fairly young one in many regards. Though Muslim immigration to the US dates as far back as the founding of the nation, the current expansion of the American Muslim population is fairly young. As such, American Muslims and American Muslim communities do not yet have a uniform identity. American Muslims are as diverse as the practice of the religion itself. This, perhaps, might serve as one major barrier to the current lack of systematized diversity training on American Muslims – particularly in the healthcare field.
Muslim organizations or professionals that provide diversity training tend to do so with a view to the increase in discrimination over the last 3-4 years that the American Muslim population has witnessed. Thus, these trainings will tend to focus heavily on the ideology of the religion and defending the religion – rather than present an objective cultural awareness of American Muslims. These trainings will also tend to rely heavily on historical anecdotal information rather than attempt to address or define the current cultural identity of an American Muslim.
If the healthcare field were to glean lessons learnt from other fields in the area of diversity training and developing effective diversity training, it would be to view American Muslims in an objective manner. This would include setting aside presumptions of a violent culture or stereotyping based on the behavior of individuals involved with the events of 9-11. Instead, the field must move towards the primary goal of diversity training – and this is to provide the best healthcare service possible to American Muslims, as integrated citizens of this nation.
What Should Diversity Training on American Muslims for Healthcare Professionals Not Include?
In addition to not focusing on the discrimination of American Muslims, as that is a political consideration, the diversity training should focus on more than the topics of gender, food, and end of life issues. The existing diversity training for healthcare professionals will typically include just these areas. Though useful, they only provide a superficial understanding of what distinguishes an American Muslim from an American of another religion.
Elements of a Successful Diversity Training on American Muslims for Healthcare Professionals
According to studies done by Gallup, the U.S. Institute of Peace, Pew Research Center and other organizations, American Muslims today have the following characteristics:
Given the breadth of the American Muslim population, there cannot be one diversity training on American Muslim communities for healthcare professionals. In format, it is essential to have a separate diversity training or separate segments within the same training to address each American Muslim cultural group – Middle Eastern, Latino, Asian, European, African, and African-American – to take into account key nuances from both culture and religion. These trainings will need to go into detail on the appropriate etiquette for each cultural ethnicity, gender, educational background, income bracket, and age.
Since the focus of these trainings for health professionals is essentially on the quality of caregiving between a provider and diverse Muslim patient populations, the content of the trainings will need to address barriers to receiving adequate healthcare that is rooted in cultural norms. This will need to go beyond a basic understanding of Islam or its practice but will need to thoroughly cover cultural beliefs that deter the pursuit of effective healthcare at the right times.
Given the amount of material and training that needs to be developed to address Muslim patient healthcare needs, this will likely fall to a diversity training organization or perhaps one of the top insurance conglomerates as they have at their disposal the resources needed to fully and adequately develop these trainings. This should include focus groups among the different cultural groups within the American Muslim community, as well as with American Muslim physicians who likely have developed best practice methods for addressing the healthcare needs of Muslim patients. Ideally, this type of training should be developed by American Muslim physicians but without an adequate centralized leadership within the American Muslim medical community to spearhead this effort, one would hope that at the very least American Muslim physicians are consulted and focus groups within the American Muslim community are held.
As it stands, the training described above does not exist neither with the format nor focus I recommend. This training is essential to the further integration of the American Muslim population. Adequate healthcare is the quintessential battleground for the American Muslim community to establish itself as a critical component of the fabric of this country. Thus, it can be argued that developing diversity trainings on American Muslims for healthcare professionals is more than just about adequate healthcare. It is a political move for American Muslims and one that would help the community further establish itself. American Muslim healthcare professionals should consider it obligatory to take the lead on this endeavor, as the community stands to greatly benefit from it; it will help with the new wave of discrimination against American Muslims in recent years and at the present moment.]]>
Healthcare spending in the U.S. stands at 17.9% of GDP. The rate of spending has increased over the decades, driven by rising prescription drug costs, a rise of chronic diseases and administrative costs that are higher than most western nations due to the fragmented payment and delivery system in the United States.
The ACA is designed to tackle healthcare costs on two levels:
1) By streamlining systems and containing costs at a national level and
2) By protecting households from escalating costs by expanding insurance coverage and ensuring insurance policies are comprehensive and fairly priced
A National Approach
The ACA tackles healthcare costs at a national level by regulating prescription costs, aggressively pursuing medical fraud and seeking avenues to cut administrative costs and payments while expanding insurance coverage. For example, discussion that the Obama administration will cut Medicare by $716 billion is only partially true, because those cuts are primarily aimed at reducing the reimbursement rates to hospitals and private insurers.
Protecting Households from Medical Debt
The most contested component of the Affordable Care Act is the individual mandate, a law that requires all residents of the United States to have health insurance, with some exemptions for financial hardship. The logic behind mandating insurance is that in a nation where the median income is $50,054, having no insurance or having incomplete insurance coverage (underinsurance) means that every illness is financially ruinous and as such, it is in the public interest to require everyone to have insurance. However, health insurance is not only expensive, but insurers can also choose to exclude certain groups, such as those with pre-existing conditions. In order to overcome these challenges, the ACA’s provisions include expanding Medicaid coverage to low income adults, creating state insurance exchanges where uninsured adults can find competitive health insurance rates, allowing young adults to stay on their parents insurance, mandating larger employers provide employees with coverage, barring insurance companies from excluding people who have pre-existing conditions and eliminating lifetime spending limits on insurance so that people with illnesses such as cancer are not forced to pay for their own treatment.
The state Health Insurance exchanges are an important element of the ACA’s plan to control insurance costs for individuals. Once the exchanges are implemented, individuals will be able to log into a statewide website where they will see the prices for several different insurance plans and will be able buy into a plan collectively with others in their state. This pooling and price transparency forces down prices and channels insurance plans through a state mechanism that will ensure important services such as mammograms, screenings for cervical cancer and prenatal care are covered at no cost.
The Cost of Uninsurance
The Romney/Ryan ticket has offered an alternative vision in controlling healthcare costs by proposing to not only repeal the ACA, but to also cut Medicaid by a third over 10 years, in addition to implementing fundamental changes to the structure of Medicare. This approach will not only be devastating to a sizable portion of the population, (Medicaid currently provides insurance coverage to 20% of the nation’s children), but it also does not address the economic impact of the uninsured and underinsured.
Critics of the ACA, such as Governor Romney, have stated that the uninsured can find healthcare by going to emergency rooms and safety net providers. A problem with this is that when uninsured individuals do seek care, it results in household medical debt and uncompensated care. The uncompensated care is then paid for in part by the federal government, such that taxpayers are faced with reimbursing emergency room care at rates far higher than if the patients had gone to primary care providers. Uncompensated care is also paid for by hospitals and safety net providers many of whom are facing financial hardship, such that they need to cut costs and/or increase their prices. Consequently, repealing the individual mandate and cutting Medicaid will decrease immediate government outlays towards insuring individuals, but it will increase the tax payer burden for uncompensated emergency room use and healthcare payments will be higher as people without insurance tend to delay care such that when they do seek care it is much more expensive to treat. It is important to note that uncompensated care is not a matter of individuals not wanting to take responsibility for their bills; households that do try to pay for their out of pocket healthcare costs are left in financial ruin. In 2007, 62.1% of bankruptcies were due to illness or the burden of medical bills. This debt burden is also experienced by millions of underinsured individuals, 60% of people that have medical debt had health insurance at the time that the debt occurred.
Another reason that insurance coverage is important to household budgets is that the majority of healthcare spending is due to chronic disease. Currently, 75% of the $2 trillion spent annually on healthcare goes towards chronic diseases such as heart disease, stroke, cancer and diabetes. Diseases such as diabetes can only be treated if the patient can afford multiple provider visits and monthly prescription costs, which for most households can only be achieved through comprehensive health insurance coverage. While many safety net providers do attempt to provide free or low cost treatment for chronic diseases, cuts to government health insurance will mean safety net providers will be overwhelmed with finding ways to serve an increasing number of patients who cannot afford to pay. The Obama administration has been progressive in working towards addressing chronic diseases. In addition to the ACA’s provisions to mandate coverage for preventative health services, the administration has launched programs such as the First Lady’s ‘Let’s Move’ initiative that seeks to address childhood obesity and create healthy communities. As obesity accounts for $147 billion in healthcare spending, the focus on developing healthy communities is critical to the nation’s health and wealth.
The November Decision and Other Challenges to the ACA
If the President is reelected, the ACA will increase the number of privately and publicly insured, protecting many households and institutions from medical debt. It is projected that the ACA will reduce the number of uninsured nonelderly adults by 27.8 million and cut the cost of uncompensated care by 61 percent. However, these figures will only be realized if the states decide to implement the ACA.
While healthcare advocates had desired a public option for universal coverage, even the limited expansion under the ACA has been contested by some states. While the majority of insurance expansion will be federally reimbursed, states will be responsible for administrative costs of reform and potentially the costs of securing and training additional healthcare personnel. Several states challenged the constitutionality of the ACA, resulting in a Supreme Court ruling that upheld the ACA but removed the penalty for compliance. The ruling allows states to decide whether they will implement the ACA, leaving a great deal of uncertainty on what healthcare reform will look like across the nation.
Even healthcare advocates supportive of reform have criticized the ACA on two fronts: coverage and access. The structure of the ACA relies heavily on expansion of private health insurance coverage which will undoubtedly be advantageous to insurance companies, but it is still uncertain if the public will see favorable insurance rates and coverage. Furthermore, having health insurance is not the same thing as having better access to healthcare. Governor Romney instituted healthcare reform in Massachusetts that has resulted in high insurance coverage rates, but not necessarily better access to healthcare as reforms have resulted in more people seeking care, leading to longer wait times.
Given these challenges, only time will tell how much the ACA will increase insurance coverage and whether the increase will translate into improvements in health outcomes and access to care. There are some promising signs even at this stage of reform with a study showing three states that have expanded Medicaid coverage have seen reduced mortality, improved access to care and improved self-reported health.
The ACA holds much promise, but the administration is facing an uphill battle towards nationwide implementation. A second term for the President will protect the ACA, but it is just one of many hurdles that the Obama administration faces in realizing the ACA’s goal of containing healthcare costs and making healthcare affordable and accessible.
Khadija Gurnah is a specialist on Medicaid Retention and Enrollment. She is the CEO and Founder of Zanoora Health Tech Solutions.]]>
Affordable Care Act (ACA)
If elected, Governer Romney has pledged to repeal the Affordable Care Act (ACA), dubbed by many as ‘ObamaCare.’ His opposition stems largely from the Republican view that the latest major healthcare overhaul represents government intrusion in a free-market economy:
“From its start, it (ObamaCare) was about power, the expansion of government control over one-sixth of our economy, and resulted in an attack on our Constitution, by requiring US citizens to purchase health insurance. It was the high-water mark of an outdated liberalism, the latest attempt to impose upon Americans a euro-style bureaucracy to manage all aspects of their lives.”
Reflecting his party’s ideas, Romney has championed instead for states to create their own solutions to healthcare and vie with one another, maintaining a free-market competition. As Massachusetts’ governor, however, the plan he helped craft in mid-2006 shared more of a resemblance to President Obama’s, making it the first state to in fact achieve near universal-coverage. His law required nearly all residents to have healthcare coverage or pay a tax penalty, and mandated employers to offer insurance to their workers. It also established a health insurance exchange where individuals could find affordable coverage that offered certain benefits by the state, as well as subsidies to those in need.
So what explains the discrepancy in positions between his time as Governor and Election 2012? Romney contends that although his plan might have worked well for Massachusetts, he does not believe the government should ever force such plans on the nation as a whole, echoing Republican sentiments. But one of the continuing ironies of his health care position is that it cost Massachusetts hundreds of millions of federal dollars to make its health law possible. Under a Romney administration, other states likely would not get a similar chance.
Medicare & Medicaid
The Romney/Ryan plan seeks to transform Medicare into a “premium support” program applying to those currently younger than 55 years of age. The primary goals of this “premium support” system are to reduce the growth in Medicare spending, and rely more on a competitive marketplace. It would give seniors a voucher (fixed-payment) to purchase either existing, government-run Medicare services, or private insurance coverage. Over time, the amount of the voucher would increase, but it would grow slower than the costs of health-care.
Under this approach, beneficiaries can choose among competing plans, but if they enroll in a more expensive plan, for whatever reason, they would pay the additional premiums themselves. This differs with the current Medicare system, in which beneficiaries pay the same Medicare premium regardless of where they live, whether they choose traditional Medicare or a private plan, or whether they live in a high-cost or low-cost area. Romney has not said how the amount of the fixed payment would be adjusted annually as health-care costs rise. He has however stated that the eligibility age of Medicare would increase from 65 to 67 years under his plan. Although this is estimated to save the federal government $5.7 billion per year, it would result in twice that cost to affected seniors and businesses that would otherwise cover them.
Romney has also proposed a major shift in Medicaid, the government entitlement program providing health insurance to the poor and disabled. Current funding for Medicaid is provided on both the federal and state levels, and anyone who meets either of the given requirements would qualify. Under Romney’s plan, however, states would receive set amounts, or “block grants,” from the federal government to be distributed as they see fit. Many federal restrictions on Medicaid would be lifted, allowing states to save money, if they wished, by covering fewer people or providing fewer benefits.
Conservatives, who have long supported Medicaid “block grants,” say the approach would not only save taxpayers money but also encourage states to innovate and tailor their programs to the specific needs of their populations. Romney has said he would hold Medicaid growth to the rate of inflation plus one percentage point, a spending reduction that he has said would save the country $100 billion a year.
Romney has expressed support for the spending targets in his running mate Representative Paul Ryan’s 2013 federal budget, which held Medicaid growth to that of overall inflation. According to the Congressional Budget Office, by 2022, Medicaid and Children’s Health Insurance Program spending would only be $322 billion, just $4 billion more than was spent in 2009. Yet, the reductions in federal spending for Medicaid would likely lead to increases in the number of Americans without health insurance and strain the safety net, even with added flexibility for states to administer their programs. Federal Medicaid money played a key role in financing Romney’s 2006 Massachusetts healthcare bill, which reduced the amount of uninsured in that state by half, according to the Kaiser Family Foundation, a non-partisan health policy research tank.
Paul Ryan’s proposed cuts to Medicare are only 60 percent as large as the cuts to Medicaid and other health-care programs. Moreover, his biggest change to Medicare wouldn’t kick in until 2023—the start date for his voucher-based premium support program. By comparison, Ryan’s cuts to Medicaid are more drastic, and they start sooner: Between 2013 and 2022, it would make nearly $1.4 trillion in cuts to Medicaid that “would almost inevitably result in dramatic reductions in coverage” as well as enrollment, according to the non-partisan Kaiser Family Foundation. The CBO believes that $750 billion in Medicaid cuts under Ryan’s plan would “require states to limit payments to providers, curtail eligibility for Medicaid, provide less extensive coverage to beneficiaries, or pay more out-of-pocket costs than under current law.”
Women’s Health Issues
Governor Romney has stated that he is “pro-life,” that the Roe v. Wade ruling should be overturned, and that abortion policy should be regulated by the states. Although he once backed abortion rights in Massachusetts, he now thinks the procedure should be illegal “except in the causes of rape, incest, or to save a mother’s life.” If he were to repeal the Affordable Care Act (ACA), he would eliminate both the contraceptive coverage and no-cost coverage of preventative services it offers to women in private–insurance and Medicare. He supports legislation that would broaden exemptions to providers and employers who claim religious conflict with certain health care services, namely abortion and contraception. He has criticized the Obama administration’s requirement that certain employers that object to birth control on religious grounds must cover it as part of their health insurance plans.
With respect to family planning, Governor Romney has said that he would eliminate the Title X program, which grants funds to low-income women for contraception as well as maternity care benefits. He also would not permit any federal funds to be given to organizations such as Planned Parenthood that provide abortions with private funds. And like other Republican presidential candidates before him, he supports reinstatement of the Mexico City policy, which would bar the government from providing money to international groups that use non-U.S. funding sources to deliver or promote abortions.
The next president will profoundly influence the future of our health care system. Not since the 1964 election of Lyndon Johnson, whose victory made possible the enactment of Medicare and Medicaid, has a presidential contest carried such significant, immediate, and certain consequences for providers, patients, and all others involved in our health care system. America’s health care system, as it stands, is unsustainable, with high costs, uneven quality of care, and millions being left uninsured. In an aging society, we have no trusted system for long-term care. Healthcare costs have risen faster than the economy, unsustainable for federal and state governments, employers, and the average citizen.
The greatest distinction between the healthcare plans of Romney and Obama lies in each candidate’s respective views on the role of government in financing access to health insurance coverage, as well as restraining growth in healthcare spending. With the economy under the pressure that it is, these financial issues are likely to take precedence in voters’ decisions, especially with respect to Medicare and Medicaid. President Barack Obama’s health care law will extend coverage to 30 million uninsured and keep the basic design of Medicare and Medicaid the same. It is not clear how well his approach will control costs for taxpayers, families and businesses. Mitt Romney would repeal Obama’s healthcare overhaul, the ACA; what parts he would replace have yet to be indicated. Romney would revamp Medicare, pushing future retirees toward private insurance plans, and he would turn Medicaid over to the states.
On women’s health, voters are once again given a stark choice between candidates. Romney has switched his stance from governor to Republican nominee, adopting a pro-life approach in contrast to the Democrat’s pro-choice platform. Romney’s ability as president to enact federal abortion restrictions would be limited unless Republicans gained firm control of Congress. But the next president could have great influence over abortion policy if vacancies arise on the Supreme Court. The prospects of reversal of Roe vs. Wade would increase if even two seats held by liberal justices were granted to Romney-nominated conservatives. The economy has also played its hand on this topic, as reflected in abortion taking precedence over preventative care services as a heated-issue.
The risk of expanding coverage is that health costs consume a growing share of the stressed economy. The risk of not expanding coverage is that millions continue to be uninsured or burdened with heavy costs as the population ages. In a period of economic instability, the Romney/Ryan healthcare plan cautions against the former, while Obama argues for the latter with proposed slashes to federal programs to protect the nation’s poor, disabled, and elderly. It is up to the voter to decide which path to take in 2012.
Shifa Mohiuddin is an MD-MPH candidate at George Washington University. She has participated in lobbying efforts with AMHP on Capital Hill.
Research indicates that US healthcare is a market driven system providing access to health care based on the ability to pay into the system. This ultimately means only people with employer insurance, State and Federal Insurance programs and consumers paying out of pocket for insurance, are able to access affordable healthcare. According to Shi and Singh, approximately 40.5 million (16.8%) of Americans were uninsured in 2000 and now this number has reached almost 50 million people. Among the 40.5 million uninsured are middle class families with no medical insurance from employers and recent immigrants.
When my parents moved to U.S., I had serious concerns about their access to health care, as in the United States there is limited initial medical support from the government for new immigrants. In fact, most immigrants are required to be legal residents for 5 years before they qualify for public health insurance such as Medicare and Medicaid. Furthermore, information regarding access to health care is not easily accessible and healthcare services are not well integrated for those people who do not have insurance plans.
Consequently, the first and the easiest option for recent immigrant is to seek care in community based health clinics which can provide basic services to all people regardless of immigration and insurance status. Another option is to be seen by a medical practitioner in a nearby county hospital where medications, radiography and other specialized examinations can be conducted at a nominal door fee. At times, the nominal fee can be waived under the charity care benefit with appropriate documentation. However, even with charity care status, some aspects of medical expenses are not covered, such as pharmacy bills and dental care. Additionally, in the county hospital system, the waiting time for a patient to see a specialist can sometimes be six to eight months.
Apart from community health centers and the county health care system, there are other nonprofit organizations working in major metropolitan cities to support and guide new immigrants to obtaining better health care services. These include Umma Clinic based in California and Illinois-based Compassionate Care Network. In addition, some philanthropists have also started free medical clinics where basic medical tests and examinations are performed free of cost. However, this still leaves a question of how individuals will manage the costs of major surgeries, as these procedures are not performed in free clinics. In addition, chronic diseases require constant out-of-pocket expenses that can quickly overwhelm most families.
There is no single magic pill which can address all of the issues related to our healthcare system with regards to recent immigrants. However, as we are shifting towards universal health care coverage with the full implementation of the Affordable Care Act by 2014, we can expect some drastic changes in the U.S. health care system that will hopefully improve access to care for recent immigrants.
Immigrants who are here legally and are employed by companies in the United States can still be among the ranks of the uninsured because employers are not mandated to provide health insurance to their employees. The Affordable Care Act (ACA) will in part address this problem through a special provision requiring larger employers to provide their employees with health insurance and giving tax benefits to smaller employers if they do provide employer based insurance. The ACA will provide increased opportunities for legal immigrants in the U.S. to have access to affordable health insurance via state administered insurance exchanges. This news is like moonlight in a dark night for recent immigrants.
It is evident from the above discussion that the U.S. health care market is a multi-layered system with modalities that are not well integrated. This lack of integration makes access to care particularly difficult for the uninsured and for new immigrants. The expansion of Medicaid to more U.S. residents will be an opportunity to improve lack of amalgamation of various medical services, potentially providing new immigrants with more services under one roof. Consequently, it will lead to fewer emergency visits by this population and in turn cost containment can be achieved. The Affordable Care Act and widening of Medicaid coverage by states, provides reason for optimism that new immigrants will be able to receive better and well incorporated services.