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Posts Tagged ‘Affordable Care Act

What you need to know of Repeal of the Affordable Care Act (Obamacare)

Mindy Baranski shared this link. Yesterday at 1:55pm ·

For those celebrating the forthcoming repeal of the Affordable Care Act (Obamacare): Just a reminder that even if you are safely ensconced behind employer-provided insurance, the protections set forth in the ACA apply to you, too–

And if those protections are repealed along with the rest (or any part) of the program, you will also be affected.

That means you may be trapped in a job, because your pre-existing condition may mean you will not qualify for new insurance offered by another employer, and the cost of private insurance would be prohibitive.

If your employer shuts down, lays you off, or even changes insurers, well, you are out of luck.

(The Senate GOP voted this week that they would not require an eventual ACA replacement to protect against discrimination for pre-existing conditions, which was the standard before the ACA.)

It means that you (a young adult under the age of 26) or your adult children (over 18) may find yourselves without the protection of insurance, as the Senate GOP voted last night that an eventual ACA replacement will not be required to allow young people to remain on their parents’ insurance up to the age of 26.

It means that if you have a high-risk pregnancy, or life-threatening illness such as cancer, you may Not be able to afford all the care you need, because you may hit lifetime or annual caps.

If you have an infant born with any kind of severe medical condition, or premature, they may hit their lifetime insurance cap before they are old enough to walk.

The Senate GOP voted last night that an eventual ACA replacement program would not be required to prohibit lifetime insurance caps.

It means that if you are a struggling parent who is un- or underinsured, you will no longer be able to count on at least your kids getting the routine medical and dental care they need under the Children’s Health Insurance Plan (CHIP).

The Senate GOP voted that CHIP is not required to be protected by an eventual ACA replacement.

These provisions of the ACA affect everyone in this country, not just those without insurance through their employers.

If you are not okay with these changes, call your representatives and Senators and let them know what’s important to you.

Nothing has been set in stone yet, but our legislators have shown us a map of what they plan to do if constituents don’t make their voices heard loud and clear. (Telphone # 202-224-3121)

Students Losing Health Insurance: The Affordable Care Act?

On Friday, many University of Missouri graduate students found out via email they would no longer receive help from the university to pay for their health insurance.

The response on social media was strong and on Monday graduate students from across campus gathered to discuss their concerns and plan for their next step.

Graduate students received this news little more than 14 hours before graduate student health insurance coverage lapsed.

This decision affects graduate students from every department who work for MU as teaching assistants, research assistants and library assistants.

One of the graduate students affected is Jennifer McKinney Wilson, a fifth year PhD candidate in the sociology department. She spoke during the graduate student forum held today – which more than 400 students attended.

“When we found out on Friday that we lost our insurance, I was 22 days away from my delivery date,” McKinney Wilson said.

Now she says she is 19 days away, already in labor, and has had no health insurance since Friday.

“Being a graduate student has always been a little difficult and challenging,” Mckinney Wilson said. “I mean you have to make sacrifices to be here. Most of us took cuts in pay and things to come here. So up until today there were sacrifices, but they were doable. And now it doesn’t seem so doable.”

MU’s decision to stop giving grad students subsidies for their health insurance comes after an IRS rule that took effect July 1.

Under the Affordable Care Act, the IRS will fine employers who give their employees subsidies to help them buy their own insurance. The fines are $100 per day, per employee.

MU is offering the more than three thousand students affected a one-time fellowship to help offset the costs of health insurance.

The fellowship is up to $1200, just under half of what a health insurance subsidy from the University was worth.

Graduate students shared ideas of what to do next – including unionizing and walking out of classes they are scheduled to teach next week.

Andrew Bossone shared this link

“Under the Affordable Care Act, the IRS will fine employers who give their employees subsidies to help them buy their own insurance.

The fines are $100 per day, per employee.”

On Friday, many University of Missouri graduate students found out via email they would no longer receive help from the university to pay for their health
kbia.org|By Rebecca Smith

Internationally Comparing U.S. Health Care System  

Mirror, Mirror on the Wall, 2014 Update:

How the U.S. Health Care System Compares Internationally

Publications Fund Reports Mirror, Mirror on the Wal…

Executive Summary

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. under performs relative to other countries on most dimensions of performance.

Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror.

Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.

In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).

Expanding from the seven countries included in 2010, the 2014 edition includes data from 11 countries. It incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care.

It includes information from the most recent 3 Commonwealth Fund international surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2011–2013).

It also includes information on health care outcomes featured in The Commonwealth Fund’s most recent (2011) national health system scorecard, and from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD).

Overall health care ranking

Click to download Powerpoint chart.

The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage.

Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes.

The Affordable Care Act is increasing the number of Americans with coverage and improving access to care, though the data in this report are from years prior to the full implementation of the law. Thus, it is not surprising that the U.S. underperforms on measures of access and equity between populations with above- average and below-average incomes.

The U.S. also ranks behind most countries on many measures of health outcomes, quality, and efficiency.

U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles. Other countries have led in the adoption of modern health information systems, but U.S. physicians and hospitals are catching up as they respond to significant financial incentives to adopt and make meaningful use of health information technology systems.

Additional provisions in the Affordable Care Act will further encourage the efficient organization and delivery of health care, as well as investment in important preventive and population health measures.

For all countries, responses indicate room for improvement. Yet, the other 10 countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States.

These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving value for the nation’s substantial investment in health.

Major Findings

  • Quality: The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care.
  • Compared with the other 10 countries, the U.S. fares best on provision and receipt of preventive and patient-centered care. While there has been some improvement in recent years, lower scores on safe and coordinated care pull the overall U.S. quality score down. Continued adoption of health information technology should enhance the ability of U.S. physicians to identify, monitor, and coordinate care for their patients, particularly those with chronic conditions.
  • Access: Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost.
  • Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services.
  • There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.
  • Efficiency: On indicators of efficiency, the U.S. ranks last among the 11 countries, with the U.K. and Sweden ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical testing.
  • Sicker survey respondents in the U.K. and France are less likely to visit the emergency room for a condition that could have been treated by a regular doctor, had one been available.
  • Equity: The U.S. ranks a clear last on measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs.
  • On each of these indicators, one-third or more lower-income adults in the U.S. said they went without needed care because of costs in the past year.
  • Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives—mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60. The U.S. and U.K. had much higher death rates in 2007 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Australia and Sweden.
  • Overall, France, Sweden, and Switzerland rank highest on healthy lives.

Summary and Implications

The U.S. ranks last of 11 nations overall. Findings in this report confirm many of those in the earlier four editions of Mirror, Mirror, with the U.S. still ranking last on indicators of efficiency, equity, and outcomes.

The U.K. continues to demonstrate strong performance and ranked first overall, though lagging notably on health outcomes.

Switzerland, which was included for the first time in this edition, ranked second overall.

In the subcategories, the U.S. ranks higher on preventive care, and is strong on waiting times for specialist care, but weak on access to needed services and ability to obtain prompt attention from primary care physicians. Any attempt to assess the relative performance of countries has inherent limitations.

These rankings summarize evidence on measures of high performance based on national mortality data and the perceptions and experiences of patients and physicians. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data.

Patients’ and physicians’ assessments might be affected by their experiences and expectations, which could differ by country and culture.

Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home. Under the Affordable Care Act, low- to moderate-income families are now eligible for financial assistance in obtaining coverage.

Meanwhile, the U.S. has significantly accelerated the adoption of health information technology following the enactment of the American Recovery and Reinvestment Act, and is beginning to close the gap with other countries that have led on adoption of health information technology.

Significant incentives now encourage U.S. providers to utilize integrated medical records and information systems that are accessible to providers and patients. Those efforts will likely help clinicians deliver more effective and efficient care.

Many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, but the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions.

Based on these patient and physician reports, and with the enactment of health reform, the United States should be able to make significant strides in improving the delivery, coordination, and equity of the health care system in coming years.

us health care ranks last

Sign Up for Obamacare: Flagging Down the 200,000 uninsured health Taxi Drivers

Dan Ware has been driving a taxicab in Chicago for more than a decade, but he still doesn’t have what many jobs offer: health insurance.

“I’m without health coverage,” he says.

 posted this March 4, 2014

Flagging Down Taxi Drivers To Sign Up For Obamacare

And that’s not unusual, says Chicago Public Health Commissioner Bechara Choucair. “What we know in Chicago is that around 70% of taxi drivers are uninsured,” Choucair says.

That means about 8,000 cabbies could be eligible for coverage under the Affordable Care Act.

Nationwide, there are more than 200,000 taxicab drivers, and so in a few big cities — including Chicago — supporters of the Affordable Care Act are working to recruit them to sign up before this month’s open enrollment deadline.

Choucair says a couple of years ago, a study showed taxi drivers in Chicago had plenty of health problems, largely due to the long hours they spend behind the wheel.

“They don’t eat as healthy, they don’t exercise as much and those are definitely risk factors for diabetes, for heart disease, for strokes,” Choucair says.

Add to that chronic back issues that can come from sitting and health problems caused by traffic accidents.

Enrollment workers in Chicago are signing up taxicab drivers for Obamacare at the facility where cabbies obtain or renew their city chauffeur’s license.

“We’ve been enrolling an average of between 5 to 9 people on site,” says Salvador Cerna, an outreach manager for the state. He says others make appointments to get help enrolling, and there are plenty here who want assistance.

Ejaz Waheed has gone without health insurance for nearly a decade. “Back until 2005, I was with a regular job, so I had it. Then I became self-employed and I lost insurance,” he says.

Ghulam Memon began driving in 1994 and shares a similar story. “My wife has Medicare and Medicaid both because she’s 65-plus. I’m like 60 years, and I don’t have anything,” Memon says.

So he’s exploring his options, as is Orkhan Askarov, 24. Askarov was applying for his first taxicab license, and he says he’ll also apply for health insurance “and guarantee that if anything [happens] to me I’m going to be [in] good hands.”

The nonprofit Enroll America is running similar cabbie programs in Austin and in Philadelphia. The group’s president Anne Filipic says it’s trying different ways to reach out to the uninsured as the March 31 deadline nears.

“Our focus right now is an all-hands-on-deck effort to get the word out. We know that a lot of people still don’t have all the facts and don’t know, for example, that financial assistance is available, so we want to meet them where they are and get them the information that they need,” Filipic says.

In Philadelphia, where there are about 5,000 taxi drivers, many cabbies are getting their information at the headquarters of the Taxi Workers Alliance of Pennsylvania. President Ronald Blount says until now many simply couldn’t afford health insurance at all.

Most drivers in Philadelphia are earning less than $5 per hour. They are working 12 to 16 hours per day, 6 to 7 days per week,” Blount says.

He calls the Affordable Care Act a godsend and says about 700 taxi drivers have already signed up there. “Drivers were finding plans as cheap as $35 to $60 per month, and that’s something they can afford and these are really good health plans,” Blount says.

And that’s a boon for many cabbies who may take an easier route and seek out medical help early for any of the ailments that come from driving a taxi.

Another Myth: Health Care’s Free Market

This article has a clear, factual approach to why the US health system is expensive from price gouging by providers, denial of coverage by insurers, onerous patents by drug companies, high salaries of doctors, and the lack of single-payer system.

It also questions the fundamental rhetoric behind the ‘free market:’ “When opponents of the Affordable Care Act argue for patients negotiating health-care prices they make as much sense as proposing that passengers haggle over pay with an airline pilot.”

Has it ever occurred to you to negotiate with the pilot of the plane you just boarded about her pay?

Assuming the pilot was willing to take bids for her services, would you have any idea of how to evaluate the worth of that particular pilot compared to anyone else who might be at the controls?

How long would it delay the flight while you and other passengers haggled over that fee?

And what of the risks in having a pilot focused on whether she negotiated good deals with her passengers, rather than getting everyone safely to their destination?

 posted this January 03 2014 on Newsweek
The Myth of Health Care’s Free Market
1-3-13_NW0401_Hospital

                Ever wonder why an appendectomy costs $8,000 in one place and $29,000 elsewhere?                                              REUTERS/Jim Bourg

While haggling with pilots is absurd, the idea that individual Americans should negotiate the prices each pays for health care is getting a lot of serious discussion right now.

The reason is the Affordable Care Act, a.k.a. Obamacare, which critics are desperate to find some way to stop.

For weeks, politicians and writers in the opinion pages of The Wall Street Journal and other critical outlets have declared Obamacare a failure with plenty of victims.

Those are silly assertions because the law only took effect this week, on the first day of 2014.

These critics are all outrage with no detailed alternatives, except the mantra that competition will magically bring down health-care costs.

The libertarians at the Cato Institute argue “we need market competition more than ever. Not the mealymouthed substitutes bandied about by most health policy wonks. We need something that none of us has ever seen – real competition in a free health-care market.”

No. We need something easier, simpler, and already proven to cut costs.

1. For starters, markets can push prices up as well as down.

The electricity market rules, initially written by Enron (at the urging of former Vice President Dick Cheney, who was pals with the company’s late founder), can raise prices to 90 percent of what an unfettered monopolist could charge, as I showed in my book Free Lunch, citing research by Professor Sarosh Talukdar of Carnegie-Mellon University that no one has challenged.

2. There’s the knowledge component of markets.

When one side knows and the other side is ignorant, you get price-gouging. Under current policies, prices for medical services are generally confidential. You could call hospitals and your health insurer to ask the cost of a standard medical procedure, say cataract or gall-bladder surgery. I tried that, and was told at every turn that prices were proprietary information – none of my business, until I got a bill.

More than 4 decades ago the Supreme Court defined a fair market as the “price at which the property would change hands between a willing buyer and a willing seller, neither being under any compulsion to buy or to sell and both having reasonable knowledge of relevant facts.

How many of us have “reasonable knowledge” of medical procedures, costs, or even the difference between a neurologist and a nephrologist?

Is an accident victim writhing in pain, life’s blood flowing out of his body, free of compulsion?

And how many of us know the assortment of facts needed to price an MRI, an angiogram or just a dozen stitches?

Or, for that matter, whether any of those procedures is the best alternative, or even necessary?

We don’t have a free market for health-care services.

If we did, we would see a narrow range of prices for the same service. After all, a Ford F-150 pickup with the same options costs about the same in Washington, West Virginia, or Wyoming.

Not so hospital and medical costs, a fact brought home in the 2012 Pricing Report of the International Federation of Health Plans, a trade association for health insurance companies.

While the average U.S. hospital stay is just under $4,300 per day, one in four patients are charged $1,514 or less and one in 20 pay $12,537 or more.

The total cost for an appendectomy ranges from $8,156 for a fourth of these procedures to more than $29,426 for the most expensive 5 percent. The average cost is $13,851.

Economists learn before they get their undergraduate degrees that such huge variations are signs of inefficient markets or even “faux markets“.

Such wide price variations may even indicate collusion among some providers to jack up prices, which is generally illegal.

Even if we ignore these huge price variations, the trade industry report illustrates another problem: American health-care costs are completely out of line with the rest of the modern world.

In France the average daily cost of a hospital stay is $853; in the U.S., it’s $4,287.

An MRI costs on average $335 in Britain and $363 in France, but $1,121 in the U.S.

Routine and normal childbirth costs, on average: $2,641 in Britain and $3,541 in France but in the U.S. averages $9,775. Caesarean section delivery runs $4,435 in Britain, $6,441 in France; $15,041 in the U.S.

This pattern holds for all 21 procedures examined in the report.

Excessive health-care costs drain both the public purse and private purses, make manufacturing noncompetitive and force employers to divert attention from running their firms to dealing with health insurers.

Our universal single-payer health-care plan for older Americans, Medicare, has lower costs and lower overhead than the system serving those under age 65.

If everyone in the U.S. was on Medicare, the savings would move the federal budget from deficit to surplus.

Of the 34 modern economies, the U.S. has by far the costliest health care system.

For each dollar per capita that the other 33 economies spend on health care the U.S. spends $2.64, my analysis of Organization for Economic Cooperation and Development data shows.

Canada, Germany, and France each spend about 11.5 percent of their economy on health care, compared to 17.6 percent in the U.S.

We could have eliminated the income tax in 2010 had we adopted the Canadian, German, or French health-care systems.

Look at your pay stub and how much goes to federal income taxes, then think about the unnecessary economic pain American health care causes you.

LINEBREAK

One important distinction between other modern countries and the United States is that they all provide universal health care, while 48 million Americans had no health insurance in 2012 and another 30 million had coverage for only part of the year.

Millions have coverage riddled with loopholes and exceptions, not paying for such vital services as an ambulance, even when the patient is unconscious.

And all private health insurers try to avoid paying claims in various ways, from requiring onerous paperwork to denying a procedure was necessary.

On top of all this are restraints on trade in American medicine, like limiting the supply of doctors and nurses. The American Medical Association has acknowledged that it worked to hold down the number of physicians to push up income for doctors.

Under state licensing rules, many of even the best-trained foreign doctors cannot practice here.

And there are the drug and other medical patents. Economist Dean Baker notes that in America, “we grant patents to providers and then let them charge pretty much whatever they want, while other countries also grant patents, but then limit the prices charged.

When a patent expires, American law allows the drug company to pay would-be makers of generic versions to not produce the drug. That keeps prices, and profits, high. It ought to be illegal.

Congress expressly forbids Medicare from negotiating wholesale price discounts for the Medicare Part D program initiated by President George W. Bush, so Americans pay far more for drugs available in other countries, which negotiate huge discounts.

Finally, not everything should be judged by price competition.

The love and affection of our families, the loyalty of our diplomats, and the integrity of jetliner makers and of the airlines that hire pilots are not matters for market economics.

We could experiment with the kind of price competition that the Cato Institute proposes. It might even work, though I doubt it. But why?

We already know that universal coverage with a single payer is much cheaper than what America spends now. And we know that the quality of U.S. health care is far from the best – 37th in the world, according to the World Health Organization, which ranks France No. 1.

When opponents of the Affordable Care Act argue for patients negotiating health-care prices they make as much sense as proposing that passengers haggle over pay with an airline pilot.

How the US Shutdown will affect your pleasure quality time?

National Parks Will Close To The Public. 

They’ll Stay Open To Drilling If The Government Shuts Down

Jessica Goad, Guest Blogger and Matt Lee-Ashley published on Climate Progress this  September 26, 2013

Despite the fact that most Americans object to the tactic of shutting down the government over Obamacare, Congressional Republicans continue to insist that they will not pass a budget for the federal government unless the Affordable Care Act is defunded, meaning that the government could potentially shut down when its current funding authorization runs out this coming Monday, September 30th, 2013.

A review of the most recent contingency plans completed in December 2011 for federal agencies shows that under a government shutdown, federal land management agencies would be required to close national parks, wildlife refuges, and national forests to the general public, but keep them open to most oil, gas, and mining operations. (Are the oil industry hiring their own personnel or paying the government and State employees allocated to run these parks?)

The National Park Service’s contingency plan says:

Effective immediately upon a lapse in appropriations, the National Park Service will take all necessary steps to close and secure national park facilities and grounds in order to suspend all activities except for those that are essential to respond to emergencies involving the safety of human life or the protection of property…Where ever possible, park roads will be closed and access will be denied.

The closures, which may happen just 48 hours after tens of thousands of volunteers turn out this Saturday for National Public Lands Day, will not only throw a wrench in countless family plans, but will send chills through the country’s multibillion dollar tourism and recreation industry.

But because Congress allocates resources to federal agencies through a complex mix of funding sources, public lands and waters would likely remain open to most oil, gas, and mining operations.

This is even true for national parks. Drilling is currently happening in 12 national parks, including in Padre Island National Seashore in Texas and Big Cypress National Preserve in Florida.

The National Park Service’s contingency plan did not specify what impacts the shutdown would have on oil and gas operations within these areas but it does note that “access to personal and commercial inholdings and leased facilities is permitted.”

Additionally, while the Bureau of Land Management will not be able to process new oil and gas permits, oil and gas production at existing operations is expected to continue in other locations onshore according to the Bureau of Land Management’s contingency plan.

Yet only minimal agency personnel necessary for “protection of human life and property” will be on duty for inspections and enforcement and to oversee drilling activities such as “well shut-ins, re-completions, and down-hole/equipment changes in drilling/plugging operations.”

Current mining operations on public lands may continue as well, provided they do not need new authorizations or permits.

Offshore oil and gas drilling will also be largely unaffected by a shutdown.

The contingency plan for the Bureau of Ocean Energy Management, one of the two agencies that manages oil and gas offshore, states that:

In the event of a shutdown, BOEM would continue to perform major operations and planning. This would allow the Bureau to continue to plan for future exploration and development of energy resources on the Outer Continental Shelf… The operations and planning activities that continue would allow industry to function during a government shutdown.

Being “denied access” to national parks and public lands is not the only way that Americans will feel the effects of a government shutdown when it comes to energy and the environment.

As Climate Progress described this week, other federal agencies would be required to stop environmental permits for construction projects, cleanup of toxic waste sites, as well as many scientific research projects.

The Smithsonian Institution wrote in 2011 that “it would be necessary for us to close all museum buildings to the public.”

50 Years After the March on Washington, and Still Fighting for Jobs and Freedom

 Kenyon Farrow posted this August 22, 2013 on RH Reality Check:

On Saturday, August 24, tens of thousands of people will descend on the nation’s capital to commemorate the 50th anniversary of the 1963 March on Washington for Jobs and Freedom, the actual anniversary of which is August 28.

There have been some grumblings that the anniversary events will not duly encompass contemporary racial justice issues, and need to do more than re-live the famous images of the past.

I am often frustrated with the way racial justice issues for Black people can only be characterized as racist if they somehow reference past symbols of racial violence: legal “lynching,” the “new Jim Crow,” and Paula Dean’s antebellum-themed summer soiree.

The threats to cutting food stamps, the rollback on abortion access (which disproportionately affects poor women), the battles for low-wage workers and teachers, and the various fights over racial profiling in New York City, New Orleans, and Sanford, Florida, are all contemporary issues facing Black people in the United States, and each need their own mass mobilizations here and now.

The March on Washington, 1963.

The March on Washington, 1963. (Aude / WikiMedia Commons)

What’s past is prologue.

Many of the gains made as a result of the Civil Rights Movement are being rolled back, and some of the recent U.S. Supreme Court decisions are great examples of this, demonstrating just how much a constant presence the nation’s racist past remains.

In Shelby County v. Holder, the Court ruled section 4 of the Voting Rights Act of 1965 unconstitutional. Arguing in its decision that “things have changed in the South,” the Court nullified the formula initially created by the act to determine what jurisdictions needed federal “preclearance” before amending “any voting qualification or prerequisite to voting, or standard, practice, or procedure with respect to voting.”

Critical race legal scholar Kimberlé Crenshaw told Washington, D.C.’s Afro-American newspaper that the decision was akin to “building a dam to keep the lowlands from flooding and for 40 years the lowlands don’t flood and then deciding that you don’t need the dam anymore.”

But the Court didn’t stop at gutting voting rights. The Supreme Court also ruled in two cases making it more difficult for employees to sue on the grounds of racial discrimination. In Vance v. Ball State University, the Court ruling narrowed the definition of “supervisor” held by the Equal Employment Opportunity Commission.

Essentially, the Court decided that supervisors can only be held liable in a discrimination case if they have power over the hiring, firing, changing of work responsibilities, promoting, or demoting of an employee. (All these functions are not the role of the supervisor)

In a second case, University of Texas Southern Medical Center v. Vassar, the Court decided employees must prove that they’ve been denied a promotion or raise only because of discrimination—which gives employers more room to claim a host of other reasons why someone didn’t get a promotion or raise.

Much of the coverage of the Supreme Court decisions this summer focused on those regarding same-sex marriage.

Many people were thrilled that the Court declined to rule on the Proposition 8 case (which essentially made a lower appeals court decision in favor of same-sex marriage in California valid), and struck down the Defense of Marriage Act (DOMA), which made same-sex marriages recognized by the federal government in the states that currently allow such unions.

But this ruling is not without racial implications. As American University law professor Nancy Polikoff noted in a statement about the ruling, “The demographics of who marries now is highly skewed by race and class. There is every reason to assume those demographics will hold for lesbians and gay men as well. So we will have same-sex couples who don’t marry, just as we have different-sex couples who don’t marry.”

It is important to note, as Polikoff hinted, that African Americans as a U.S. racial group are the least likely to be married.

And even if Black gay and lesbians want to get married, the areas with the highest proportion of Black same-sex couples are in Southern states that have constitutional bans on such unions.

So even looking at the DOMA decision from a kind of “states’ rights” perspective, the situation is still one in which there is a liberalization of laws in states that have fewer Blacks.

And the places where Black people reside in great numbers (or are highly concentrated) have the most restrictive voting rules, drug enforcement, and access to social safety-net programs like food stamps and Medicaid, and the least labor protections.

In fact, if we go back one year to the Supreme Court decision on the Affordable Care Act, we see that a vast majority of the states that are not opting in to the expansion of Medicaid (and all the ancillary benefits for community health centers, hospitals, and health-care jobs that come with it) are in the South, with large uninsured Black populations.

A recent report by the Kaiser Family Foundation found that because of this, nearly 6 out of 10 African Americans who would have otherwise qualified for the Medicaid expansion in 2014 live in states where they will not receive it.

But despite these legal challenges, it seems clear to me that we are on the precipice of a moment of mass civil disobedience particularly involving Black people, the likes of which we have not seen in decades. From the Moral Monday protests in North Carolina, to the Dream Defenders in Florida taking on gun laws involved in the murder of Trayvon Martin and the prosecution of Marissa Alexander, to teachers and parents in Chicago and Philadelphia getting arrested to prevent school closures, to striking fast-food and Walmart workers, to all the work challenging racial profiling and police violence, from New York City to New Orleans, this may be a historic moment for the Civil Rights Movement of today that is largely being reported by mainstream media as isolated incidents and not a potential turning of the tide.

Though I grow tired of always pinning Black people to the past, I don’t think the Civil Rights Movement has the same level of emotional resonance for young people as it has for some others, and that can actually be a barrier to new forms of organizing, mobilizing, and resistance. But I do think, on August 24 at the National Mall, we have many struggles we’ll be carrying into the future.

Community health centers compare well with private practices, researcher finds

Government-funded community health centers, which serve low-income and uninsured patients, provide better care than do private practices, a researcher at the Stanford University School of Medicine has found.

The Affordable Care Act, which the U.S. Supreme Court upheld June 28, depends on community health centers to provide services to previously uninsured patients.

MANDY ERICKSON published in the Stanford School of Medicine on July 10, 21012:

Randall Stafford

Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, and colleagues at University of California-San Francisco looked at the actions physicians took when patients visited private practices versus the actions that were taken at community health centers, also referred to as Federally Qualified Health Centers and FQHC Look-Alikes, both of which receive government support.

Their study was published online July 10 in the American Journal of Preventive Medicine. Stafford is the senior author.

The results of the study are particularly encouraging given that the Affordable Care Act, which the U.S. Supreme Court upheld June 28, depends on community health centers to provide services to previously uninsured patients.

“If community health centers are going to be taking up some of the new demand, we can be confident that they’re giving relatively good care,” Stafford said.

Stafford and his colleagues analyzed records of 73,074 visits to private practices, FQHCs and FQHC Look-Alikes. Both FQHCs and Look-Alikes receive enhanced Medicare and Medicaid reimbursement; FQHCs also receive government grants.

The researchers acquired the records from the National Ambulatory Medical Care Survey, which the National Center for Health Statistics gathered between 2006 and 2008.

They evaluated the physicians’ adherence to professional and federal guidelines for 18 measures, which included treatments for specific diseases, screening for certain conditions, and diet and lifestyle counseling. “We looked at fairly common conditions that are seen in primary care,” said lead author L. Elizabeth Goldman, MD, of UCSF.

The researchers found that community health center physicians performed as well as their private practice colleagues in 13 of the 18 measures.

For the remaining five measures — use of ACE inhibitors for congestive heart failure, use of beta blockers, use of inhaled corticosteroids for adult asthmatics, blood pressure screening and avoidance of electrocardiograms in low-risk patients — the community physicians followed recommendations a higher percent of the time.

Given that patients at community health centers have more health and socioeconomic challenges and therefore take up more physician time, said Stafford, “The fact that community health centers look better is perhaps surprising.”

“On the other hand, having worked in community health centers, I can see how it makes sense,” he added. “These are centers where physicians are not as profit-driven and many have incentives more in line with providing quality care.”

Stafford added that the government has provided the centers with technology that helps manage patient care, which may explain their superior performance. And they are generally larger than private practices: “Having a number of colleagues helps you develop better practices. In a solo practice, you have rare opportunities to debate the best way to practice medicine.”

When the researchers adjusted the data so that the patients’ characteristics were statistically equal, the community health center physicians performed better on three additional measures: aspirin for congestive heart failure, statins for congestive heart failure, and avoidance of benzodiazepine, which has serious long-term side effects, for depression.

(The statistical adjustment did not alter the balance in the other previous measures, and if anything, the magnitude of the difference increased in favor of the community physicians.)

The study was funded by awards from the Agency for Healthcare Research and Quality and the National Heart, Lung and Blood Institute. In addition to Stafford and Goldman, other researchers from UCSF and Johns Hopkins Medical School contributed to the study.

Information about Stanford’s Department of Medicine, which also supported this work, is available at http://med.stanford.edu/medicine.

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