We Cannot Afford to Have the Clock Turned Back on Women’s Health

As we begin a new year, a lot is at stake for Americans’ health. Our nation’s leaders have promised substantial changes to the Affordable Care Act, from partial to full repeal, without the certainty of a replacement plan. While it can be easy to get caught up in the politics of health care, as ob-gyns our focus has always been on our patients and ensuring that they have access to safe, high-quality health care. That is why a critical part of our work here at ACOG is to advocate for the health of women, and as millions of people face the possibility of losing health insurance coverage in the coming months or years, ACOG’s work has never been more important.

Earlier this month, ACOG partnered with three leading medical organizations—the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians—to urge Congress to avoid repealing the ACA without an immediate replacement which would protect and retain the landmark women’s health provisions in the law.

The ACA is not perfect. In fact, ACOG didn’t endorse it originally because we felt it didn’t meet the needs of our physician members. However, while there’s lots to improve, the ACA does include really important protections for our patients’ health. Insurers must now cover maternity and preventive care and contraceptives. It stops insurers from charging women more than men for the same coverage, prevents insurers from denying coverage to women who were victims of domestic violence or who had a Cesarean delivery in the past. The ACA also guarantees women direct access to their ob-gyns without any limitations.

The coverage provided under the ACA allowed many women to schedule routine doctor’s appointments for the first time in their lives. We all know that when people have insurance, they’re more likely to use preventive care like mammogram and diabetes screenings that prevent more costly and life threatening health problems down the line.

Whatever one’s reservations may be about the law, as physicians we know how devastating it would be for a cancer patient to suddenly lose her coverage or for a pregnant woman to go without prenatal care and deliver a baby preterm because she could no longer afford health coverage. The fact is, low-income women are more likely to suffer from often preventable pregnancy complications and, unfortunately, that is the very population that stands to lose the most unless Congress protects these important benefits, including Medicaid expansion.

Today, 31 states and D.C. have expanded their Medicaid programs, offering coverage to 11 million newly eligible individuals. The most important part of the expansion to women is that those Medicaid programs cover low-income women even if they’re not pregnant. Regular Medicaid programs routinely only cover pregnant women through delivery and a few weeks after.

But speaking more broadly, all women stand to lose essential preventive care if the ACA is repealed. Access to breast cancer screenings decreases women’s likelihood of dying from the disease by up to 50 percent. Routine cervical screenings decrease the odds of late-stage cancer diagnosis by 60 percent. Finally, when women have access to more choices of affordable and effective contraception, including IUDs and implants, rates of unintended pregnancy, unplanned birth, and abortion drop dramatically.

In 2016 alone, 6.8 million girls and women gained health insurance coverage. If the law is repealed, those gains will likely be lost. We cannot turn back the clock on women’s health. The care we provide doesn’t stop in our exam or delivery rooms. It’s our responsibility to advocate on our patients’ behalf and protect their access to affordable, comprehensive health care. So let’s mobilize and use our collective community’s influence and expertise to ensure access to health care in this country.

To become involved in ACOG’s advocacy efforts, join us at the 35th Congressional Leadership Conference, The President’s Conference in Washington, D.C., in March.

Prevention of Preterm Birth Starts with a Healthy Mom

November 17 is World Prematurity Day. It gives us, as health professionals, an opportunity to direct our attention to a devastating health issue that impacts 15 million babies each year and rededicate ourselves to reducing that number. Several organizations, including ACOG, are supporting the cause through education, awareness, and advocacy events. However, there’s one event in particular that, coincidentally, started this week and stands to make the most significant impact in terms of lowering the preterm birth rate in this country and that’s open enrollment through the Health Insurance Marketplace.

Prevention of preterm birth starts with a healthy mom and that means access to prenatal care and preventive services. There are several risk factors for preterm birth, some of which include high blood pressure, low pre-pregnancy weight, alcohol and drug abuse, smoking, a prior preterm birth and a birth less than 12 months ago. Adequate health insurance coverage can make the difference between a pregnant woman carrying to term or delivering too early and the Affordable Care Act has helped make that coverage accessible to millions of women.

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Happy 50th Birthday, Medicaid & Medicare!

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It’s hard to believe that it’s been half of a century since President Lyndon B. Johnson signed Medicaid, along with Medicare, into law. Even though Medicare more commonly provides coverage for a smaller fraction of the patients in a typical ob-gyn practice, it still is an example of a national program that works very well, providing coverage for more than 50 million people. Over the past 50 years, Medicaid has grown to cover more than 71 million Americans — nearly one in ten women relies on Medicaid for health coverage which includes family planning, screening for breast and cervical cancer, and long-term services and support. In fact, Medicaid covered 45% of all U.S. births in 2010 and plays a critical role in ensuring access to pregnancy-related care. Without Medicaid, many women would struggle to access or be unable to afford the care we provide.

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Every Woman, Every Time…Cada Mujer, Cada Vez

What a difference a year makes. It was only a year ago that I said 2013 was “The Year of the Woman” and asked ob-gyns around the nation to lead efforts on behalf of women’s health. We saw a rocky start to the Affordable Care Act, yet as ob-gyns we have appreciated that so much of what we value for our patients is now considered a health benefit:  cervical and breast cancer screening, preconception health, maternity care.

The challenge in front of us is to provide care, lead change efforts in our hospitals and communities, and sustain our practices. At times it is daunting. This last year, we heard your concerns and worked on your behalf to improve our care delivery, to empower safety efforts, and to challenge those who fight reproductive health access, payment reforms and medical liability reform. We have worked hard to keep legislators out of our exam rooms!

A year ago I introduced a mantra that reinforces all that we hold dear: Every Woman, Every Time. For every woman, at every encounter in our health care delivery system, we need to help her achieve optimal health and wellness in the context of reproductive choices. This year has seen uncertainty and changes in health care delivery. I challenged all of us as ACOG Fellows to take the lead, because the changes in medicine will come at a cost that requires each and every one of us to foster change and collaboration.

No longer can we sit back and let change happen. Rather, we need to direct the changes, to lead the transformation that places women first. Only if we place the focus on quality, on service and on attaining health care access for all women will our practices—and our skills—flourish. By making women our focus, we will succeed. This past year, ACOG led a well-woman task force, to achieve consistency in well-woman care across all medical providers. We have opportunities to share with colleagues in internal medicine, pediatrics and family practice, and with our partners who are nurse midwives and nurse practitioners, in all aspects of well-woman care.

It has been an honor to represent the most wonderful specialty, both here and abroad. ACOG has a strong voice—in the halls of Congress, amongst our colleagues across the US, and amongst our sister organizations around the world. We are leaders.

ACOG relies on the work of all our Fellows. I thank each and every one of you for the gift of this year, to represent women, to represent Fellows, to represent ACOG

For Every Woman, Every Time.

Behind Many Olympic Champions Stands a Mom

I confess: I am an Olympics junkie. In 2012, I had the good fortune to spend two weeks in London for the Summer Olympics. Now, I’m getting ready to watch the Winter Games. I say I’m a junkie because I watch anything and everything leading up to the Olympics, and then I watch any event I can. Luge—wow! Snowboarding—so cool. And there’s curling, of course. And ice skating, downhill skiing, hockey, and speed skating. I love them all!

Now why would I mention this personal passion in my blog? Because of the moms. I enjoy the commercials that highlight the sacrifices of athletes—the arduous practice, the long journey, and living away from home are just a few of them. Then, the athletes acknowledge that it was their mothers who helped them succeed. Well, of course.

As we celebrate the Olympic Games, let’s remember that caring for all moms is our investment in the next generation. Optimum health does not happen by accident. Just as their child’s Olympic success depends on maintaining healthy lifestyle choices, including proper nutrition, avoiding tobacco and alcohol, and getting enough sleep, so, too, do moms need to make their own health a priority.

The Affordable Care Act ensures that moms—indeed all women—are covered for annual well-woman preventive health care with no co-pays or deductibles. Annual well-woman visits are important to help keep mothers healthy and strong so that they can raise healthy children. It’s all full circle!

So, let’s take a minute to applaud these mothers and remind all women that their children’s health begins with them. Here’s to the Olympics, to athletes, and to moms everywhere.

 

The ACA and OTC Medications – What Physicians Need to Know About Changes in Coverage

January 1 has come and gone, but many of us are unaware of some of the changes with the Affordable Care Act, particularly related to coverage of medications and supplements that became effective in 2014. For our patients who are enrolled in ACA-compliant plans, certain over-the-counter (OTC) medications are now covered at no cost when written as a prescription. Translation: Write prescriptions for these medications when medically necessary.

As an example, aspirin is now a covered medication under the ACA for women ages 55–79 when the benefit of reducing heart attacks outweighs the risk of gastrointestinal bleeding. The cost of OTC emergency contraception is also covered if a prescription is written for it. Vitamin D supplements are covered for women ages 65 and older to prevent fractures. And folic acid supplements are covered for women capable of becoming pregnant.

This change in insurance coverage comes at a time when research is looking closely at the benefits of supplements. Certainly all of us are confused at times when related research appears in the media and the benefits of vitamins and supplements are questioned. That’s why we as physicians need to make recommendations to our patients based on their individual needs. This ensures that reproductive-age women don’t forgo important and proven supplements—for instance, folic acid to reduce birth defects like spina bifida—based on a single study.

As physicians, we are in a position to not only recommend, but to reinforce the use of these medications and vitamin supplements for preventive health. It’s up to us health care providers to recommend and prescribe them.

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HIV Screening Should Be Routine

This past Sunday marked World AIDS Day. The truth is every day is a good day for us to encourage our patients to know their HIV status and to educate women on ways to reduce their risk of infection.

Some facts: According to the Centers for Disease Control and Prevention, women account for 20% of all new HIV infections each year. Most women with HIV (84%) are infected through heterosexual sex. The remaining women acquire HIV through intravenous drug use. Of the more than 1.1 million Americans living with HIV today, almost 24% of them are women. Unfortunately, women of color, particularly African-American women, continue to be disproportionately impacted by HIV and AIDS. Even though black women make up only 13% of the total US population, they account for 64% of all new infections each year.

A few years ago, many physicians probably screened patients for HIV only if they were high risk, were pregnant, or requested the test. Today, I believe that is changing. ACOG’s guidelines issued in 2008 recommend that ob-gyns routinely screen all our patients between the ages of 19 and 64 for HIV, regardless of their individual risk factors. Sexually active women younger than age 19 and women older than 64 who have had multiple partners in recent years should also be tested.

A lot of progress has been made in the fight against HIV/AIDS, but we haven’t won the war yet. Approximately one-quarter of Americans who have HIV don’t know it. The best defense our patients have is knowing their HIV status. Women who know that they are HIV-positive can take steps to reduce HIV-related illnesses, avoid unintended pregnancy, and protect their sexual partners from infection. Another benefit is that pregnant women who know their status can greatly reduce the risk of mother-to-child transmission of HIV (to less than 2%) by taking antiretroviral therapy.

My hope is that as more women gain health insurance coverage under the Affordable Care Act, more of them will get tested for HIV and receive appropriate health care. Getting more people tested and receiving treatment for HIV will go a long way in preventing new infections. As ob-gyns, we must increase our efforts to routinely screen all our patients for HIV, particularly in areas where HIV infection rates are highest.

Men’s Health Matters to Ob-Gyns

“Movember.” That’s the subject line of a recent email that landed in my inbox.

Movember?

My first reaction was that this was a misspelling. Then I thought, what the heck is that? It turns out that my male ob-gyn colleagues have decided to draw attention to men’s health by shaving their mustaches and beards at the start of the month. They’re having a contest to judge who grows the best mustache and beard by month’s end, all in the spirit of men’s health. Why? They want to ‘change the face’ of men’s health through awareness and education.

Launched in 2003 in Australia, Movember is now a global effort in which men grow a “Mo” (moustache) for 30 days during the month of November in an effort to raise awareness about men’s health.

What better way to raise awareness of men’s health than through ob-gyns? After all, we know that women tend to make health care decisions for the family, and often a woman is the one to bring (or drag!) her partner or parent in to the doctor for care. Perhaps if we share some men’s health statistics with our patients, the messages will reach more men. Movember has certainly created a buzz around my entire department, and often that “buzzzzzz” is the key to messaging.

Here are some key messages about men’s health to consider (from the us.movember.com website):

  • 24% of men are less likely to go to the doctor compared with women.
  • 1 in 6 men will be diagnosed with prostate cancer in his lifetime. In 2013, more than 238,000 new cases of the disease will be diagnosed and almost 30,000 men will die from it.
  • Testicular cancer is the most common cancer in males between the ages of 15 and 35. In 2013, 7,920 men will be diagnosed with testicular cancer and 370 will die from it.
  • 1 in 13 men will be diagnosed with lung cancer in his lifetime.
  • While not common, men can get breast cancer. About 2,240 new cases of breast cancer will be diagnosed among men and about 410 will die from it in 2013.
  • An estimated 13 million men, or 11.8% of all men over the age of 20, have diabetes.
  • More than 6 million men are diagnosed with depression each year. Almost four times as many males as females die by suicide each year.

As arguments continue around the Affordable Care Act, my message remains consistent: Prevention matters. We need to do everything we can to make healthy lifestyle choices for ourselves and our families. Regardless of whether it’s a male or a female, whether it’s prenatal care for a woman or aneurysm screening for a man—preventive health care is an investment in this AND future generations. Preventive health care is something we should all support.

New Contraception Counseling Aid Available for Ob-Gyns

As I said in my presidential address at the Annual Clinical Meeting in May, we need to address reproductive health and well-woman care at every single point of contact that women have in our health care system. If we are going to be successful in reducing the high rates of unplanned pregnancies in this country and all of the related maternal and infant health problems that go along with them, then we really only have one option: We must counsel and encourage all of our patients to use effective contraception.

The good news is that more women will have health insurance as the Affordable Care Act continues its roll-out. And under the ACA, more good news: Women now have access to all FDA-approved contraceptives without a co-pay. Coinciding with this, a new ACOG Committee Opinion in the November Obstetrics & Gynecology endorses the CDC’s US Selected Practice Recommendations for Contraceptive Use, 2013 (US SPR). The US SPR helps ob-gyns and other providers counsel our patients about how to use these contraceptives most effectively. This is a companion piece to the US Medical Eligibility Criteria for Contraceptive Use, 2010 (US MEC) that ACOG endorsed in a 2011 Committee Opinion. The US MEC provides guidance for determining which contraceptives are safe for women who have certain medical conditions.

The US SPR is arranged by contraceptive method and is easy to follow. It addresses a host of common as well as complicated issues related to contraceptive use that both doctors and patients may encounter. For instance, it provides guidance on which specific exams and tests we need to provide before prescribing a particular contraceptive method. It helps us advise our patients about exactly what do when they forget to take their daily birth control pill or are late in returning for their next injectable contraceptive. It also explains how to deal with side effects, such as breakthrough bleeding, and when and for how long to use backup contraception.

I think one of the many important points contained in the US SPR is that any contraceptive method can be started at any time during the menstrual cycle, as long as there is reasonable certainty that a woman is not pregnant.

I encourage you to read through and utilize both the US SPR and the US MEC. An eBook for the US SPR will be available soon. As I said at the ACM: Whether it’s a pill, patch, ring, injection, implant, insertable, or a ligation, we can address reproductive health for what it represents—an investment in our future.

Every Woman, Every Time. It’s up to us.

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ACOG and ACA: Investing in Women’s Health

As many of you know, I started my ACOG presidency announcing 2013 as “The Year of the Woman” because for the first time we, as a nation, are investing in women’s health care with the Affordable Care Act. It is an investment in our future when we provide all women with preconception care, prenatal care, and contraception.

I spent last week in Washington, DC, discussing the impact of environmental chemicals on our reproductive health with our elected officials. And what a week it was! I saw firsthand the dedication of the furloughed employees who were trying to help everyone. I heard the frustration of many DC residents as they faced reduced work hours and uncertainty about what the next day or week will bring.

Amidst all of this chaos, the ACA’s health insurance exchanges opened for business. Yes, there are going to be some difficulties along the road with implementing health care reform, but there will be fewer of them when we work together to make health care changes a success.

I was in the hair salon recently and found out that the women working there had no health coverage. I opened my iPad and showed them how to enroll in Covered California. In no time, they logged in, found affordable benefits, and were singing its praises. These are working women who had gone without coverage because they could not afford it and their small businesses did not provide health benefits. All of these women—some young, some single moms—all shared one uncertainty: What would they do if they became sick? They had not even considered getting preventive health care.

We need our government to open for business, we need to work on our health care delivery system, and we need to remind everyone that women are finally getting what we said is essential all along: Screening for cervical and breast cancer, screening for intimate partner violence and depression, contraception coverage, and prenatal care. Worrying about not being able to afford or even get health insurance because of a pre-existing condition can now be a thing of the past. Losing your health insurance coverage during the course of a difficult disease when you need it the most can also be a worry of the past. What a wonderful year!

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