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Autism Increases in Prevalence, Faces Healthcare Barriers

In 2013, the Centers for Disease Control estimated one in fifty children had been diagnosed with some autism spectrum disorder (ASD.) ASD occurs in all cultures and ethnic, socioeconomic, and racial groups. It is also five times more likely to occur in boys.

ASDs are characterized by a restricted range of interest, repetitive behavior, delayed language, disordered language, and impaired social interaction. Additionally, sleeping disorders, such as insomnia, are much more prevalent among those with ASD. They are 80% more likely to have sleep disorders than those without ASD. Children with ASD are also three-and-a-half times more likely to have gastrointestinal disorders.

Causes of Autism

In the 1950s, it was believed that autism was caused by a mother being cold or distant to her child. Though there is not any research to support it, this belief still has some influence on parenting behavior in the 21st Century. Similarly, in the 1970s and 1980s, autism was linked to the rise in cable television, suggesting it was caused by too much TV. But, again, this is not supported by research.

The specific causes of autism are still a mystery. Research has identified factors that likely contribute to ASD development. One of these factors is believed to be genetics. Studies have shown that siblings of autistic children are fifteen to thirty times more likely than the general population to also have autism.

There are also prenatal and perinatal factors associated with autism. These include maternal and paternal ages over 30, use of certain prescription medications during pregnancy, gestational diabetes, bleeding after the first trimester, and meconium in the amniotic fluid.

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The Autism Spectrum

The term autism spectrum disorder is used to describe a broad range of pervasive developmental disorders. Each of the specific disorders described by ASD exhibit the characteristics mentioned above. Below I will list each of the pervasive developmental disorders and describe them in more detail:

  • Autism – neural development disorder exhibiting repetitive, restricted, or stereotyped behavior and impaired verbal and non-verbal communications and social interactions.
  • Asperger syndrome (AS) – people with AS have relatively preserved cognitive and linguistic development but exhibit all of the other symptoms listed above.
  • Pervasive developmental disorder not otherwise specified (PDD-NOS) – according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), PDD-NOS is the “severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific PDD.”
  • Childhood disintegrative disorder (CDD) – this is a low-functioning ASD characterized by late onset (after the age of three.)
  • Rett syndrome – Rett syndrome is set apart from the other ASDs in that it almost exclusively affects females. It is a disorder of the brain’s grey matter. Those with Rett syndrome have small hands and feet and slowed head growth.

How is ASD treated?

When they receive early interventions, children with autism have a much greater chance of improving their development and ability to learn important skills. The problem is that there are long waits for children to get into a doctor to get diagnosed with ASD. Another problem is symptoms may be hard to spot early on.

Every case of ASD is unique. Therefore, each child needs a treatment plan specifically designed for him. This will require working with a qualified health professional, such as an applied behavior analyst. The treatment provider will likely use a combination of dietary adjustments, medication plans, behavioral interventions, and the creation of regular schedules, since ASD sufferers like to have a predictable environment.

ASD is an increasingly prevalent disorder in the United States. It is important to accurately diagnose children who may have ASD early on in their lives to temper its effects.

(http://www.thestar.com/life/parent/2013/07/05/kids_with_autism_benefit_from_outdoor_classroom.html)

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ADHD: Most Common Behavioral Issue to Affect Children

Attention deficit hyperactivity disorder (ADHD) affects six to seven percent of all children according to the criteria set out by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). This is a disorder that will continue into adulthood for at least a third of the children diagnosed. It is a neurodevelopmental psychiatric disorder characterized by age-inappropriate problems with acting impulsively and hyperactivity or attention deficits.

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In the majority of cases, the cause of ADHD is unknown. Studies done with twins indicate that genetics are at least partially to blame. A lesser factor is likely environment. Mothers who drink alcohol or smoke during pregnancy can cause ADHD-like symptoms in their child. Premature birth, early adversity, and low birth weight also increase the risk of the child having ADHD.

Others suggest that society may have a role in the prevalence of ADHD. Some cases can be explained by high expectations of school children. A study found that younger children in a specific grade were more likely to be diagnosed than older. This is probably due to these children being considered developmentally behind.

How to Treat ADHD

ADHD is usually treated with counseling and medication. These may be used in conjunction or separately. Medication has been shown to improve the symptoms in 80% of those who have been diagnosed with ADHD. Those with ADHD are typically given stimulants. The two most common medications for ADHD are Ritalin and Adderall.

Ritalin, or methylphenidate as it is generically known, helps the ADHD patient concentration. Though it was prescribed heavily in the 1990s, it has recently fallen out of favor due to its abuse. Ritalin has similarities to cocaine and can lead to addiction. Adderall is a combination of amphetamines. It was introduced as a safer alternative to Ritalin. Yet, it is abused by some and can lead to dependence.

For more mild ADHD symptoms, behavioral therapies are recommended. These therapies include:

  • Cognitive behavioral therapy
  • Family therapy
  • Social skills training
  • Neurofeedback
  • Psychoeducational input
  • Interpersonal psychotherapy
  • School-based interventions
  • Parent management training

It is always best to check with a qualified health professional to determine which treatment is best for a child.

Is ADHD Over-Diagnosed?

With ADHD being the most common behavioral health issue among children, it naturally follows that there would be controversy regarding its over-diagnosis. Since the 1970s, parents, policymakers, teachers, clinicians, and the media have attacked how ADHD is diagnosed and treated. Healthcare providers generally consider ADHD a legitimate disorder, but the scientific community continues to debate aspects of treatment and diagnosis.

The opponents of the wide-ranging diagnosis of ADHD argue that it is just on the far range of normal behavior. Some say, “They’re children: they’re supposed to be hyperactive and inattentive!” Some anti-pharmaceutical activists argue ADHD diagnoses are marketed toward parents and healthcare providers. The pharmaceutical industry, they argue, does this to make more money selling medications.

There is no clear-cut answer to this debate. There are very knowledgeable and scientific arguments on each side of the diagnosis debate.

When Should a Child Be Tested for ADHD?

The symptoms associated with ADHD include:

  • Missing details
  • Distracting easily
  • Forgetting things
  • Difficulty focusing on one task
  • Fidgeting and squirming in one’s seat
  • Nonstop talking
  • Constant motion
  • Very impatient
  • Blurting out inappropriate comments

The above are just some of the symptoms. There are many others. But, as one can see, there is a very broad range of behaviors associated with ADHD diagnoses. Usually, a child should be tested for ADHD if the child’s school strongly encourages it for a specific child. They usually encourage testing when a child is being particularly disruptive or performing poorly academically. This is their way of saying to seek professional help before the child really starts to struggle in school.

Whether it is diagnosis or treatment, it is best to first consult with a qualified professional health provider, such as a pediatrician or a psychologist. Only they can determine if a child has ADHD.

(http://www.education.com/topic/adhd-child/)

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Understanding the Vaccination Debate

Vaccination is the introduction of an antigen, also known as a vaccine, into the body to stimulate the immune system to adapt immunity to a specific pathogen. It is the most reliable way to prevent the spread of infectious diseases. Vaccination has been credited with the eradication of smallpox. It has also severely restricted the spread of tetanus, polio, and measles.

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Vaccinations, a term used interchangeably with immunizations, were first introduced in 1796 to treat smallpox. At the time, smallpox killed 20 to 60 percent of all infected adults and 80 percent of infected children. Physicians found that by purposely injecting patients with other infections, they could inoculate them. Thanks to this, smallpox was finally eradicated in 1979.

Why Wouldn’t One Want to Vaccinate His Children?

Since vaccines were first introduced, there has been controversy over their use. People have opposed vaccinations for the following reasons:

  • Vaccines are ineffective.
  • Requiring vaccinations violates civil rights.
  • They may be dangerous.
  • Certain religions oppose medical interference.
  • Personal hygiene should be used instead.

In order for a vaccine to be made available to the public, it must pass rigorous testing. The results from the experiments on the vaccines must be replicated. If the vaccine is not shown to be effective, then it does not go on the market. It should be noted that vaccines are not always 100% effective for everyone. One can receive a vaccine and still contract the disease, though these instances are rare.

Many schools require parents provide proof that their children have been vaccinated. This is done to help avoid the spread of diseases. Some see this as the government telling them how to raise their children. But, as mentioned above, vaccines are only produced after rigorous testing and are aimed at eradicating diseases. These policies help the public at large by helping to eradicate diseases.

Certain Christian sects oppose vaccination because it is said to go against God’s will. For example, if it is God’s will that one should die from smallpox, then physicians should not interfere with vaccinations. This is a fairly uncommon argument.

Though personal hygiene is very important for stopping the spread of infectious viruses and diseases, it is not as effective as also being vaccinated. One should wash his hands and bathe regularly, but he should also get vaccinated.

The MMR-Autism Link

One of the most famous anti-vaccination studies to come out in recent times was a 1998 paper in the medical journal The Lancet. In the article, Andrew Wakefield provided data showing the measles, mumps, rubella (MMR) vaccine led to autism spectrum disorders in twelve children soon after they received the vaccine.

This spawned outrage and lawsuits from parents of children who had autism and received the MMR vaccine. An anti-vaccination movement also followed. In 2004, ten of the twelve co-authors of Wakefield’s study retracted the paper. The Sunday Times in 2009 reported that Wakefield fudged the data to show the MMR-autism link. And, in 2010, The Lancet formally retracted the 1998 study.

Despite the retractions, there are parents who continue to insist the MMR vaccine caused their child to be autistic. One of the most vocal adversaries of the vaccine is former Playboy model Jenny McCarthy. This continued anti-vaccination movement has led to a decrease in parents vaccinating their children. Still, there is no evidence that there is a link between the MMR vaccine and autism.

Conclusion

Based on the research on vaccinations, in general, they are relatively harmless and can be of great help to the public and the individual. Critics of vaccines base their opinions on unscientific arguments. The data shows that the benefits of vaccines far outweigh any risks.

With this in mind, it is important for parents to consult with their child’s pediatrician to make sure they are getting all of the recommended vaccines. Also, parents should make sure their child is not part of an “at risk” group that may need to avoid certain vaccines.

(http://www.chop.edu/service/vaccine-education-center/home.html)

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Video Advocacy Being Used to Promote Social and Health Causes

                In terms of promoting or advocating for a cause, there a variety of ways to go about this. Often times, people use popular tools such as the internet, TV commercials, flyers, and even public marches. These usually require a large budget and considerable resources in order to be successful. However, the people at the North Carolina Justice Center have a low cost and accessible solution for spreading awareness of a cause: video advocacy. This is an incredibly powerful, yet relatively easy tool to use. Video making allows for anyone with a camera and editing skills to create effective promotional material that can be used over and over again. In video advocacy, creativity meets with technology to form an effective means for promoting socially relevant causes that matter in our world. 

Required Equipment

In order to make videos, there are certain kinds of equipment that are required. The obvious and most essential piece is the camera. When searching for the right camera, one should make sure it has both a microphone input jack for external microphones and the ability to record high definition video. The latter is especially important as in today’s world of modern technology; people are expecting high quality video on a regular basis. To have standard definition may decrease a person’s inclination to watch.

The next piece of equipment is the microphone. This is important as it enhances the audio of your video, mainly the voices of a speaker featured in your video. Often times in an advocacy video, a speaker will be featured to shed light on a particular topic. Therefore, what he/she has to say is especially important and needs to be heard clearly. In conjunction with this, a microphone bracket mount is also needed. Having a microphone properly and securely mounted on a camera is vital as it ensures wherever your camera is pointed at, the audio will remain clear. An L-shaped bracket mount is recommended since it can carry a heavy load.

A tripod is another vital piece of equipment as it provides a stable platform for a camera to shoot footage without any shaking. Purchasing a high quality tripod will pay for itself in the long run as you will not have to constantly replace it. And finally, a camera bag should be purchased. This allows for a safe storage of all of your equipment, so that it may be used later.

Video Gathering Goals

Video advocacy requires specific goals to aim towards to. These usually come in the form of important issues facing this country. Many of these goals include:

  • Gathering stories from ordinary people into the mainstream media to illustrate a particular issue. This includes allowing these people to simply voice their opinions on policymakers, disasters, and laws.
  • Transforming ordinary people with good stories and interesting backgrounds into extraordinary advocates. A great example of this comes from how the NC Justice Center focused an advocacy video on health care reform. They choose to interview a small business owner and explore the effects on how the new health care impacted his business. From this, the video was able to capture the business owner’s input on what he thought should be done in Congress to fix the many problems associated with the reform.
  • Holding policymakers accountable for what their actions. An example of this can be found in how the chair of a powerful legislative committee announces a public hearing on an important issue. However, when more people are set to sign up, they may be turned away. With this in mind, a special advocacy video is made to bring awareness to this problem. This later gains widespread attention and forces the committee to allow for people to sign up.
  • Interviewing leaders of organizations. This serves to both gain the trust of these organizations and be a means in which organizations can have their voices heard in ways that would otherwise be hindered (mainstream media). For instance, a prominent figure such as a former head of Medicare and Medicaid may wish to discuss his opinions on the matter of health care reform. However, mainstream media outlets do not allow him lengthy interviews to fully express his views. With an advocacy video, this can give him the opportunity to do so.

(http://www.ncjustice.org/sites/default/files/HAC%20-%20Video%20training%20manual.pdf)

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Section 1115 Medicaid and CHIP Waivers Transparency Rule

                In recent years, there have been many definite changes in health care reform. Much of this has to do with President Obama’s federalization of health care, mainly the re authorization of the Children’s Health Insurance Program and the passing of the Affordable Care Act, which makes programs like Medicaid more readily available to Americans. The most prominent of these changes is the addition of Section 1115. Waivers such as this allow for states new ways to both pay and provide for health care services in CHIP and Medicaid. With this particular waiver, Section 1115, states can be allowed to apply to test new or existing approaches to finance and deliver Medicaid and CHIP. This would further expand the services of health insurance by having more transparency in policies and more consumer input. In combination, this will improve the future of health insurance for many Americans.

What does the Affordable Care Act do?

The Affordable Care Act, commonly known as “Obamacare”, is a piece of legislation passed in 2010 in order to expand health care. It seeks to rid of boundaries that would otherwise hinder eligibility of health insurance coverage to low-income and poverty stricken Americans. It does so in the following ways:

  • Removing limitation or exclusion for people who have any pre-existing health condition, including children and teenagers under the age of 19
  • Ensuring young adults under the age of 26 have coverage under their parents’ health care plan
  • Ridding of arbitrary cancellation of health insurance coverage
  • Ensuring the right to appeal any denial of payment
  • Banning lifetime limits on insurance coverage for all new health plans
  • Reviewing premium rate increases
  • Making sure the money the client puts in is used properly, such as spending it on health care instead of administrative costs
  • Covering preventive health care at no additional cost to the client
  • Protecting the client’s choice of medical doctors
  • Removing barriers set up by insurance companies for emergency services

(http://www.hhs.gov/healthcare/rights/index.html)

What is the Children’s Health Insurance Program?

CHIP or the Children’s Health Insurance Program exists to give aid and assistance to children in health coverage, due in much part from the ACA’s support. Originally, it was vetoed by President Bush in 2007 for threatening to federalize health care and take power away from the states. In 2009, President Obama reauthorized the program. CHIP attempts to provide many benefits to children, including:

  • Oral care such as dentists visits
  • Eye exams and glasses
  • The ability to choose doctors
  • Prescription drugs and vaccines
  • Mental health care
  • Hospital care and services
  • Lab tests
  • Special health needs treatment
  • Treatment of pre-existing conditions

(http://www.chipmedicaid.org/en/Benefits)

The Benefits of Section 1115

Section 1115 under the Social Security Act grants the Secretary of Health and Human Services the authority to approve experimental, pilot, or demonstration projects that aid health insurance programs like Medicaid and CHIP. The goal of this is to give the states additional flexibility to design and improve their health insurance programs. Section 1115 attempts to achieve this by:

  • Expanding eligibility of Medicaid and CHIP to individuals who are currently not eligible
  • Providing services not that is usually not covered by Medicaid
  • Using innovative service delivery systems that improve care, increase efficiency, and reduce costs

These demonstrations are set for a five-year period and can be renewed, usually for an additional three years. Section 1115 demonstrations must not be a budget burden on the federal government, meaning the costs of this project will not be more than the federal spending without the waiver.

Another great benefit from the Affordable Care Act is the fact it greatly increases consumer input. For instance, the ACA now requires for public comments and greater transparency of demonstration projects.  Established in April 27, 2012, a rule makes it mandatory to ensure public input into the development and approval of any new demonstrations. This also applies to extensions of existing demonstrations. All demonstrations, both applied and approved, are made publicly available at federal and state levels. This ensures that the public will have an opportunity to provide their input and opinions on a demonstration while it is under review at CMS. At the same time, this will also make sure the development of the demonstrations proceed in a timely manner (http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstrations.html).

 

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Young Adults and Ineffective Mini-Med Plans

                Health insurance in America today is now more important than ever. This is especially true for young adults, ages 19 to 29. While many are using the government sponsored Medicaid and CHIP programs, these young adults have been forced to use something known as mini-med plans. These plans have been largely criticized for its insufficient aid and often detrimental outcomes. The mini-meds offer very weak protection for young adults both in terms of benefits and coverage range. With all this in mind, it is estimated that by end of 2013, the mini-med plans will be phased out, due in much part of the Affordable Care Act.

Mini-Meds:  A Closer Look

A mini-med plan is often does more harm than good for the average consumer. Most mini-med plans have very limiting benefit caps, often placing the limit at only $5,000. The average young adult in need of serious health care will often pay bills up to thousands of dollars. One in every ten young adults has medical bills ranging from $5,000 to $50,000 a year.  Simply out, $5,000 does not cover the costs and will certainly not cover any long term costs for any future injuries or illnesses. Such high costs could even mean bankruptcy for some young adults working low paying jobs (http://ccf.georgetown.edu/ccf-resources/young_adults_perspective_on_the_problem_with_mini-meds/).

Another negative factor of mini-med plans is the sheer dishonesty involved with marketing the plans to consumers. Young adults are often unaware or uneducated in the realm of health insurance, making them easy prey to mini-med marketers who use complicated jargon. They are often deceived into believing the plans have an all inclusive coverage. Young adults, especially those in school, often think short term, which is exactly what mini-med plans are used for. They will be enticed by the mini-med’s low purchasing cost, but fail to realize how inefficient it really is. However, these plans are in fact too short term and will not cover the majority of their health care costs (http://www.foxbusiness.com/personal-finance/2012/09/11/mini-med-plans-worth-price-tag/).

So why are these ineffective health care plans still in use today? Besides those who are not prone to serious health injuries, many businesses offer their employees mini-med plans as health insurance. These businesses seek to offer the illusion they are providing benefits for their staff and workers, but in reality they are not. For instance, restaurants such as Ruby Tuesday, McDonalds, and Denny’s still offer mini-med health care plans. Ruby Tuesday requires its employees to pay $18.43 per week for a mini-med plan that only covers up to $1,250 for outpatient care and $3,000 for inpatient care per year. McDonalds makes its workers pay $56 a month that only covers up to $5,000 a year. Denny’s has a mini-med plan that covers up to a measly $300 per year for its employees (http://kff.org/health-reform/perspective/what-is-a-mini-med-plan/).

The Future of Mini-Med Plans

The future of mini-meds is coming to an end. This is due in large part to the Affordable Care Act which will phase out the short benefit caps that the mini-meds impose. After September 23, 2013, health insurance plans cannot have annual limits less than $750,000 with the banning of annual dollar limits of any kind by 2014. Mini-med plans exist today largely due to the government issued waivers that many businesses have signed in order to keep providing their employees with sub-par benefits with little cost. As of now, no new waivers will be allowed and any existing waivers will expire by 2014 (http://kff.org/health-reform/perspective/what-is-a-mini-med-plan/).

However, there may be a future yet for mini-med plans, albeit in a much more, cut down version. There seems to be no question that by the end of this year, mini-meds will be disposed of. But there are talks of having a so called “skinnier” coverage plan. An insurance company may be able to provide a dumbed down version of a full coverage plan that would be targeted towards low-income consumers. It would have no lifetime restrictions. As long as these plans meet the new health reform law’s qualifications, this could be a possibility. One of the nation’s most popular mini-med health care plan providers, Aetna, may convert to this new plan in the near future, most likely after 2013 (http://aishealth.com/archive/nhpw031113-02).

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CHIPRA Performance Bonus And Its Effect On Children

                As part of a reform on America’s health insurance policies, the Children’s Health Insurance Program was established to make health care more readily available to children in low-income families. In 2007, the Bush administration barred its progress as President George W. Bush vetoed its bill, claiming it would federalize health care and put more pressure on states. In 2009, President Barack Obama jump started the program by issuing the Children’s Health Insurance Program Reauthorization Act or CHIPRA. With the help of the Affordable Care Act, CHIPRA is allowed to assist children in need all across the nation. But the question lies, where would these children be without CHIPRA’s services? To answer that, we look no further than on its effectiveness in recent years.

The Components of the Children’s Health Insurance Program Reauthorization Act

As explained earlier, CHIP seeks to ultimately provide children with quality health insurance by making it easily accessible for them, despite their low-income backgrounds. When the Obama administration reinstated the program, new changes were made. The act provided states with increased funding, improved options, covering children under Medicaid as well as CHIP, and, most importantly, incentives for states to use CHIP. It remained clear how vital it was for the federal government to support states in this time of transition. This included developing practical strategies to identify, enroll, and retain health care coverage for uninsured children, mainly those who are eligible, but not enrolled.

CHIPRA seeks to not only assist states in this process but also increase the rate of children being insured in reliable health care plans by doing the following:

  • Providing the new Express Lane Eligibility option will allow states to enroll children into health insurance services such as Medicaid and CHIP based upon information from other programs and data bases
  • Increasing the funding to states meant for reaching out to communities in order to promote enrollments
  • Providing the new Performance Bonus  will eliminate some of the costs that states will have to pay, giving an incentive to cover children in health care plans through Medicaid or CHIP
  • Providing the option for states to verify U.S. citizenship by the use of data matches with the Social Security Administration in order to reduce health insurance coverage losses and delays, which would eliminate technical setbacks such as lengthy paperwork requirements
  • Automatically having  newborns whose mothers are covered through Medicaid and CHIP be eligible 

The Effectiveness of CHIPRA

The effectiveness of CHIPRA in terms of the number of children insured has increased dramatically over the years. This can easily be seen through simple comparisons. According to the U.S. Census Bureau, in 2008 alone, 7.3 million children were uninsured despite having the lowest uninsured rate of children that year. This was largely due to gaps in coverage and the fact that most were eligible, but were unable to be enrolled. These problems can be caused by administrative barriers as well as families simply not knowing if their children were eligible (http://www.medicaid.gov/medicaid-chip-program-information/by-topics/childrens-health-insurance-program-chip/chipra.html).

By 2011, enrollment numbers for children reached an added 1.1 million, a significant increase.  And by 2013, various improvements have been made. 47 states in the US provide coverage for children with family income at 200% of the Federal Poverty Level, also known as the FPL, or higher while 26 of them cover children with family income at 250% of the FPL or higher. In 17 states, children were covered with a family income at 300% of the FPL or higher. Often times, this increase in health care coverage can result in unwanted changes such as long waiting lines for medical appointments. In 2013, 13 states do not have a waiting period for CHIP programs and those that do have waiting periods, 19 of them have periods of 3 months or less (http://ccf.georgetown.edu/facts-statistics/medicaid-chip-programs/).

The Future of CHIPRA

The future of this program looks bright as the federal government is continuing its large scale funding. Outreach and enrollment grants from the Connecting Kids to Coverage program are being offered this year. The total comes to about $32 million and is available to states, local governments and community organizations.  With this much funding, the number of insured children is predicted to increase even further (http://www.insurekidsnow.gov/professionals/outreach/grantees/).

 

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What is the Blended Rate Proposal?

Obama’s administration in recent years has put into place major changes into Medicaid and Children’s Health Insurance Program. These changes come in the form of further federalization of health care, namely, proposing blended match rates. This new proposal is defined as an interest rate charged on a loan, which is in between a previous rate and the new rate. So these blended rates are usually charged at a rate that is higher than the old loan’s rate but lower than the rate on a new loan (http://www.investopedia.com/terms/b/blended-rate.asp). This all comes to play in balancing the budget. By having blended match rates, President Obama hopes to federal spending by moving costs over to the states. However, with any attempt at change, there are always sacrifices to be made. The question is, are the sacrifices worth the end result? Judging from recent events, many would disagree.

Current Health Insurance Policies

Many of the health care policies changes that have been in place since the beginning of Obama’s presidency are very much related to one another. The major ones include the likes of the Affordable Care Act and the Children’s Health Insurance Program. The purpose of both is to make health insurance more accessible to the majority of Americans living in low-income households or in poverty. In the case of the Affordable Care Act, it seeks to rid of any policies that may otherwise prohibit Americans from getting health insurance and adds several means in which they can obtain it. This includes:

  • Removing any pre-existing health condition that excludes or limits coverage for children and teenagers under the age of 19
  • Ensuring young adults under the age of 26 have coverage under their parents’ health care plan
  • Ending arbitrary cancellation of health insurance coverage
  • Guaranteeing the right to appeal any denial of payment
  • Banning lifetime limits on insurance coverage for all new health plans
  • Reviewing premium rate increases
  • Making sure the money the client puts in is used properly, such as spending it on health care instead of administrative costs
  • Covering for preventive health care at no additional cost to the client
  • Protecting of the client’s choice of medical doctors
  • Removing of barriers set up by insurance companies for emergency services

(http://www.hhs.gov/healthcare/rights/index.html)

For the Children’s Health Insurance Program, the main goal is to make health insurance easily available to children in need, such as those living in families with low income. This program would include benefits such as:

  • Oral care such as dentists visits
  • Eye exams and glasses
  • The ability to choose doctors
  • Prescription drugs and vaccines
  • Mental health care
  • Hospital care and services
  • Lab tests
  • Special health needs treatment
  • Treatment of pre-existing conditions

(http://www.chipmedicaid.org/en/Benefits)

The Affordable Car Act plays a major role in all of this in that it serves as a general foundation for many of Obama’s health care changes. The Children’s Health Insurance Program is heavily affected by ACA in that it provides an additional $40 million for both Medicaid and CHIP (http://www.medicaid.gov/medicaid-chip-program-information/by-topics/childrens-health-insurance-program-chip/childrens-health-insurance-program-chip.html).

This blended rate proposal would replace the current rate at which the federal government reimburses states for their costs in how they give health insurance to people. The rate would be set at a level that provides the state with less federal funding than under current law, which would save the federal government money. Under the health law, the federal government agreed to cover 100 percent of the cost of newly eligible beneficiaries from 2014 to 2016. Any costs afterwards, the government promised to cover at least 90 percent of them. The Supreme Court has ruled that states have the option to not expand Medicaid. However, opponents of this proposal claimed that this only serves to place pressure on states (http://insidehealthpolicy.com/Inside-Health-General/Public-Content/medicaid-source-rejects-gop-assertion-hhs-blended-rate-reversal-is-bad-for-states/menu-id-869.html).

Blended Rate Proposal’s Weaknesses

How exactly does the blended rate proposal play a role in health insurance? It starts off by changing how it is paid for. Many of the costs for Medicaid and CHIP are moved to the states. This is aimed at reducing federal expenditures. While this may help with reducing federal costs, the reality is that the proposal may be doing more harm than good.  By shifting costs to states, this will likely prompt states to cut payments to health care providers such as doctors and hospitals and scale back the health services that Medicaid covers for low-income children, families, and people with disabilities. Such payment cuts to health care providers will likely have doctors reject patients who do have Medicaid and CHIP, as they lack the incentive and cannot afford to treat them. Here are some noticeable weaknesses associated with the blended rate proposal:

  • This shifting of costs to states would only burden them, not actually constrain the cost overall. States would face their own budget problems, which then in turn cause them to reduce the quality of health care and scale back health insurance services such as Medicaid and CHIP. As mentioned before, this would come in the form of cutting payments to health care providers, giving doctors less incentive to continue their line of work since they will not be able to afford to do so. This will limit the amount of people who can be admitted and covered in health care plans.
  • Calculating each state’s new blended rate would become extremely difficult to do so in an accurate manner. In order to properly compute a blended match rate for each state, officials would have to make assumptions about each state’s future Medicaid and CHIP enrollment numbers and expenditures. This would include factors such as:

 

  1. The number of people in each state who would be eligible for Medicaid
  2. The number of people who will actually enroll in the program
  3. The health status these people are in
  4. How many people in each state who are now eligible for Medicaid, but are currently not enrolled will enroll after the new health reform expands its coverage

These are, again, based on assumptions which are inherently uncertain and not based on actual state experience.   These officials will not be making assessments based off any hard data, but ambiguous assumptions that could lead to disastrous, long term affects (http://www.cbpp.org/cms/?fa=view&id=3521).

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Investments in State-Based Advocacy Show Great Returns in Covering Uninsured Children

                Health insurance for children has become a major concern in the United States. In a time of economic depression, families throughout this country are struggling to provide adequate care for their children. That’s where the Children’s Health Insurance Program or CHIP comes into play. This program, which was created by the United States Department of Health and Human Services, seeks to provide matching funds in health insurance for families with children. The program’s history has encountered various obstacles. Starting in 1997, CHIP has offered these services in states all across the country that needed them. However, in 2007 President George W. Bush vetoed the program’s bill, claiming it would federalize health care and give the federal government too much power in regulating health insurance. With this limitation in place, the number of children that could be insured dropped. Then in 2009, President Barack Obama reauthorized the program by adding $32.8 billion and adding 4 million more children to be insured. Thus, CHIP’s efforts have been at work ever since. But how effective has the program been in recent years? The truth is, the program has made a modest impact at best. (http://en.wikipedia.org/wiki/State_Children%27s_Health_Insurance_Program)

Children’s Health Insurance Program’s Inner Workings

The Children’s Health Insurance Program’s main goal is, as the name implies, to insure children with health care plans. This would include benefits such as:

  • Oral care such as dentists visits
  • Eye exams and glasses
  • The ability to choose doctors
  • Prescription drugs and vaccines
  • Mental health care
  • Hospital care and services
  • Lab tests
  • Special health needs treatment
  • Treatment of pre-existing conditions

(http://www.chipmedicaid.org/en/Benefits)

Part of this program is related to the Affordable Care Act, in which the motion seeks to make health care more readily available to people living in low incomes. The ACA provided an additional $40 million for both Medicaid and CHIP (http://www.medicaid.gov/medicaid-chip-program-information/by-topics/childrens-health-insurance-program-chip/childrens-health-insurance-program-chip.html).

In terms of costs for CHIP, enrollment fees are based upon a family’s income. They can be $50 or less per family, per year while co-pay for doctor visits and prescriptions for lower income families can go for $3 to $5 with higher income families being $20 to $35 (http://www.chipmedicaid.org/en/Costs).

Children’s Health Insurance Program and Today’s Medical Care

The shocking reality is that the majority of children in America are still uninsured. As it turns out, the Children’s Health Insurance Program may have the opposite effect of what was intended. According to the Census Bureau, the overall poverty line remains high with 15 percent of Americans and 1 in 5 children still living in poverty. The cause of this is closely related to the lack of insurance. It is estimated as of 2012, that nearly 14 percent of children living in poverty lacked health insurance which remained this way despite decreased rates for people under the age of 65. This goes against the standards set up by Medicaid and CHIP, which should by all means, provide America’s low-income families with the ability to insure their children. Despite this, there are at least 2.23 million uninsured children living in the poverty line.

The reason being is that more and more parents who are uninsured are more likely to have children who are uninsured. When CHIP was upheld by the Supreme Court, many provisions that would expand Medicaid were cut down. This severely limited the ability insure adults. The Government Accountability Office found that 84 percent of children had the exact same insurance status as their parents. So if a parent used Medicaid, so will his children. However, if is uninsured, so will his children as well (http://parenting.blogs.nytimes.com/2012/09/26/when-parents-cant-enroll-in-medicaid-children-stay-uninsured/?ref=statechildrenshealthinsuranceprogramschip).

Even children with Medicaid and CHIP may be turned down by doctors. A study shows that children with Medicaid are either outright turned down or made to wait longer when consulting a doctor’s help, even for serious medical conditions. According to a study by The New England Journal of Medicine, 66 percent of those who had Medicaid-CHIP were denied appointments. In Illinois, children who had Medicaid and CHIP had less access to preventive health care than children insured by private health insurance (http://www.nytimes.com/2011/06/16/health/policy/16care.html).

Children’s Health Insurance Program’s Future

It’s not all bleak for the future of the Children’s Health Insurance Program. As of July 2013, the US government is said to give $32 million in grants to expand the program and get more low-income families insured. This is this help identify which children need the service the most and help them get the care they need. The United States Department of Health and Human Services claims the grant will range from $190,000 to $1 million and will focus on five main areas:

  • Ensuring that schools get more involved in efforts to enroll children and keep them in the insurance programs
  • Reducing health coverage disparities by promoting enrollment of children most likely to be uninsured, so that those with Medicaid and CHIP are not forced to wait or be denied treatments by doctors
  • Making the enrollment process for children in other public benefit programs such as nutritional programs much more fluid and easier
  • Improving the application process in order to provide high quality and reliable Medicaid and CHIP services in the communities that need them the most
  • Training and informing communities about the new application and enrollment processes. This will in turn help families understand this and help them get the help they need to insure their children

(http://www.medicinenet.com/script/main/art.asp?articlekey=170953)

Another example of this can be found in Colorado’s Telluride Foundation. The organization has recently been given two major federal grants to help insure kids. The grants include an awarded $380,459 from the U.S. Department of Health and Human Services to identify and enroll children eligible for Medicaid and the Children’s Health Insurance Program. The program will target children in San Miguel, Ouray, Montrose and Delta counties who are eligible for the health insurance but not currently enrolled. The main purpose of the grant is to reach out to schools and communities by focusing on enrollment and retention activities.  The Tri-County Health Network will hire and train outreach workers to connect with parents through local schools (http://www.telluridenews.com/articles/2013/07/15/news/doc51db41913cf8a395943012.txt).

 

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California and Health Insurance Exchanges Under ACA

Under the presidency of Barack Obama, this country has seen great changes, especially in the realm of health insurance. Perhaps the most famous of these changes is the Affordable Care Act, commonly known as “Obamacare”. The purpose of this act, as the name implies, is to increase the affordability, increase the rate of health insurance coverage, and reduce the overall costs of health care for Americans. Under this act, insurance companies are required to cover applicants with new minimum standards and offer the same rates regardless of pre-existing conditions or sex. The Congressional Budget Office has predicted that the ACA will lower both future deficits and Medicare spending. The main goal of this act is to improve healthcare by streamlining it and making it more accessible (http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act). The state of California, one of the strongest supporters of the act, is currently leading the charge.

Obamacare

What does ACA do?

As mentioned before, the main purpose of the Affordable Care Act is to making health insurance more readily available to Americans. It hopes to achieve this in various ways. In terms of coverage, the ACA does the following:

  • Removes any pre-existing health condition that excludes or limits coverage for children and teenagers under the age of 19
  • Ensures young adults under the age of 26 have coverage under their parents’ health care plan
  • Ends arbitrary cancellation of health insurance coverage
  • Guarantees the right to appeal any denial of payment

For costs, the ACA includes:

  • Banning lifetime limits on insurance coverage for all new health plans
  • Reviewing premium rate increases
  • Making sure the money the client puts in is used properly, such as spending it on health care instead of administrative costs

For the health care itself, the ACA introduces:

  • Coverage for preventive health care at no additional cost to the client
  • Protection of the client’s choice of medical doctors
  • Removal of barriers set up by insurance companies for emergency services

(http://www.hhs.gov/healthcare/rights/index.html)

 California Health Benefit Exchange under the ACA

California is the perhaps the one state in America the most affected by the Affordable Care Act. Under this legislation, California has enacted the California Health Benefit Exchange. This policy seeks to increase the number of Californians insured by health insurance, improve the quality of health care, reduce costs of health insurance, and lower health disparities. This is achieved by giving the people of California the freedom of choice so that they may choose the best health plan for their individual needs. The California Health Benefit Exchange follows these guidelines:

  • The Exchange will be more consumer-focused by having the policy’s actions recognize the diverse cultural, language, economic, educational and health status needs of Californians
  • This new Exchange will make health insurance much more affordable while still maintaining quality and access
  • The Exchange will be a help set the foundation for positive change in the health care system of California by using its market role to form new strategies for providing high-quality, affordable health care, promoting illness prevention, and reducing health disparities
  • The Exchange will make stronger relationships with the people of California by earning their trust through accountability of faults, responsiveness of actions, transparency of dealings, speed of aid, flexibility and reliability of policies, and cooperation with the people
  • The Exchange advocates partnerships with various health care providers, health plans, doctors, government agencies, consumers, and employers
  • The results of the Exchange will be measured by its strong contributions to the Californian public such as the levels of equality of health care, health care quality, health care coverage, and health care diversity

(http://www.healthexchange.ca.gov/Pages/HBEXVisionMissionValues.aspx)

The ACA’s impact on Insurance Exchange

The actual impact of the Affordable Care Act as of now varies. For physicians and those in the medical field, the effects are modest at best.  This is most likely due to the law’s relatively young age. However, the full impact of the act is said to go into effect by January 2014. It is projected that up to 4 million Californians are to actually get health insurance. This includes the health insurance exchange program and Medicaid expansion. California has poured in an estimated $43 million for the Health Benefit Exchange program, the most any state in the US has done for a sanctioned ACA program. The main reason behind such a large budget is the sheer diversity of people in the state, which holds a population that speaks over a hundred different languages.

(http://www.medpagetoday.com/Washington-Watch/Reform/40157)

The Future of Medicaid in California under the ACA

In terms of Medicaid expansion, this is where the real faults of the new act seem to lie. One of the main goals of the California Health Benefit Exchange program is to increase the availability of Medicaid. This would include everyone under the 133% level of federal poverty. This however, does not exactly guarantee good access to these services.  The reality is that this act becomes a sort of false promise for service. The patients often times are unable to get a medical doctor in a timely fashion because the physicians simply cannot afford to participate in the program as much as they would like to. While the ACA may be initially beneficial to patients in California, it may be detrimental in the long term. Healthcare professionals such as doctors are less willingly to enact such drastic changes to their current practices. This will in turn negatively impact patients as they will not get the healthcare they were promised, making the future for the California Health Benefit Exchange act seem grim.

(http://www.medpagetoday.com/Washington-Watch/Reform/40157)

The ACA’s effects on Hospitals in California

The hospitals in the state of California are expected to experience heavy cuts in costs. Many of these cuts come from the payments to physicians and hospitals in order to support the expansion of health care. As a direct result, drastic new hospital practices are taking place. Hospitals are now focusing on preventing their patients from even having to return to hospitals. In the last year and a half, there have been considerable efforts to reduce the use of emergency services by increasing the capacity of urgent care. The idea is to reduce the likelihood of complications or any need to go back to the hospital.

(http://www.medpagetoday.com/Washington-Watch/Reform/40157)

 

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Welcome to The CCF Blog

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