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Starting Wednesday, insurance companies will be required to cover eight preventive care services for women as part of the Affordable Care Act with no co-pays or deductibles. They include well-woman visits, HIV screenings and contraception. The new rules don’t kick in for everyone right away, but the change is a big one for many women. We learn about the services included and the expected effect.
- Cynthia Pearson Executive Director, National Women's Health Network
- Nancy Pallesen Executive Director, Arlington Free Clinic
MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Later in the broadcast, why droughts could mean blackouts, but first, an important provision of the Health Care law goes into effect tomorrow. It's called Affordable Access to Preventive Care.
MR. KOJO NNAMDIEight new services are now covered with no co-pays or deductibles, things like well-woman visits, HIV screenings and this is a big one for many, contraceptives. There's some fine print. It doesn't kick in for everyone right away and those without insurance are not affected, but it's a big change for women used to pulling out their wallet at every doctor's visit.
MR. KOJO NNAMDIJoining us to have this conversation is Nancy Pallesen. She is the executive director of the Arlington Free Clinic. Nancy Pallesen thank you for joining us.
MS. NANCY PALLESENIt's a pleasure. Thank you.
NNAMDIJoining us by phone in Washington is Cynthia Pearson, executive director of the National Women's Health Network. Cynthia Pearson, thank you for joining us.
MS. CYNTHIA PEARSONYou're welcome, glad to be here.
NNAMDIYou, too, can join this conversation at 800-433-8850. Do you currently pay out-of-pocket or have co-pays for any preventive care services that are now covered? 800-433-8850. Cynthia Pearson, what preventive services are now covered under this provision of the Affordable Care Act?
PEARSONAs you mentioned when you opened the show, Kojo, screening for HIV is covered, also screening for other kinds of sexually-transmitted infections. But it's not just things related to sexually-active women or women who are trying to prevent pregnancy, as you mentioned, with the coverage for contraception, there's also the screening and counseling about intimate partner violence, something that sometimes it's the first chance a woman does have to talk with anyone about it when she's in the exam room with a trusted doctor or nurse practitioner.
PEARSONAs you mentioned, well-woman exams, which are really important and also for pregnant women, screening for diabetes that develops during pregnancy, which sometimes has no symptoms, but can be harmful to the baby. And I think, oh, breastfeeding, that's the other one that's really exciting.
PEARSONMany women try their best to continue breastfeeding their babies for that full six months that's recommended, but so many of us have to go back to work before the babies are six months old and have to rent a very expensive pump to be able to pump milk, express milk and store it. That will be now covered with no co-pays, no deductible. So there are really some big gains here for women.
NNAMDICynthia, for people with private insurance, some, if not all, of the services included in this provision were already covered so what does it mean for them?
PEARSONCo-pays, co-pays and deductibles, so for young women who are using contraception, many of them are pulling out their wallets and they're having to pay an average of something like $14 a month, just on the co-pays for their contraception. And for some women, it's $40 a month.
PEARSONThese are women who are likely making minimum wage, you know, maybe $7 or $8 an hour depending what state they're working in and that's just a tough price to pay for someone who is on a very tight budget.
NNAMDINancy Pallesen, what does this new provision mean for your patients, people who don't have insurance?
PALLESENWell, that's right, Kojo, none of our patients have insurance. They're all uninsured and at our clinic, they receive comprehensive women's health care, other than prenatal care or care for contraception, because they go to Arlington County for that. We don't duplicate those services.
PALLESENSo for now, it will not impact our patients, but in 2014, we expect that many of our patients will go on Medicaid or have opportunities for insurance with exchanges and then they will benefit.
NNAMDIThe Medicaid expansion, will that eventually cover everyone who needs it in Virginia?
PALLESENAh, no, no, it won't and we're not even sure that it's going to cover Medicaid- eligible women in Virginia in 2014. It's a decision that the State of Virginia still needs to make, whether they go with Medicaid expansion or whether they choose not to do that. It would affect about 425,000 people in Medicaid so we certainly hope that Virginia does accept that Medicaid extension.
PALLESENBut there will still be many people in our communities and many women in our communities who do not have insurance for one reason or another and they may not be able to get or qualify for any of the new insurance programs or Medicaid. And those women will still not have access to any kinds of health care, other than through a social safety net clinic such as ours.
NNAMDIWe're discussing the Affordable Access to Preventive Care part of the Affordable Care Act, which takes effect tomorrow, August 1st. We're talking with Nancy Pallesen. She's the executive director of the Arlington Free Clinic and Cynthia Pearson, who is executive director of the National Women's Health Network.
NNAMDIIf you have questions or comments, you can call us at 800-433-8850. Do you currently pay out-of-pocket or have co-pays for any preventive care services that will now be covered? 800-433-8850. You can send email to email@example.com. Send us a tweet @kojoshow or go to our website, kojoshow.org, and join the conversation there.
NNAMDINancy, as the Health Care law goes into effect, presumably more people will have insurance. Do you expect to see fewer patients as a result?
PALLESENWe won't see fewer of the patients we currently have because some of our patients will qualify for Medicaid or one of the insurances. Other patients don't qualify. We'll keep those and -- but then there are many people in the community who are not covered in any way.
PALLESENWe have not been able to bring them into the program because we are space and money-limited. But over the last six months and the last year, we have had a significant increase in the number of people in the community coming to try to be a patient at our clinic. We hold a lottery once a month and we've had a significant increase, about a third every month.
PALLESENWe have around 150 people who come to be in the lottery and we usually take in 20 to 25 people so there is a great deal of need out there in the community and we will continue to provide care for those folks. And even knowing, Kojo, when the Health Care Act kicks in 2014, not everyone is going to be covered on January 1st. So it's going to take quite a bit of time for people to get into plans and to find physicians and nurse practitioners.
NNAMDIBefore we get to the phones, Cynthia, for those with insurance, as we mentioned, there is some fine print. This provision may not kick in for everyone tomorrow. Can you explain?
PEARSONYeah, let's talk about federal workers since there's so many here in this area. They go through open enrollment in the fall. They choose the plan for next year. When that plan kicks in, that's when this new coverage change will be felt for them.
PEARSONFor other people, many times it is January 1st when the new plan year starts. However, this is an area with a lot of universities and colleges and typically in those settings, at least the students and sometimes the staff and faculty are on a school-year plan. So it's whenever your plan starts new after August 1st.
NNAMDIAh, 800-433-8850 is our number, if you have comments or questions. What do you think of the new preventive care provisions that go into effect tomorrow? 800-433-8850. Here's Maria in Washington, D.C. Maria, you're on the air. Go ahead, please.
MARIAThank you, Kojo, this is Maria and I am the executive director of Mary's Center in the District of Columbia and Maryland and I just want to make a comment and also to ask and see especially for the national office, what are we doing for making sure that we are doing -- maximizing the education to both the providers and the general population so that they can actually take advantage of this new law and this new benefit?
PEARSONThat's a really great question because our experience, which is backed up by polls done by -- and surveys done by the Kaiser Family Foundation, is that the majority of people don't know what's in the health reform law unless it's touched someone in their own family already. So we're trying to privately raise funds through contributions to do an educational campaign called Countdown to Coverage, which you can look it up by dates and see what you get, you know, on a certain date or you can look it up by issues of interest to you for women of color, for mothers, for older women.
PEARSONBut we're, you know, a private non-profit. We don't have the reach that a large marketing company does or for that matter, the federal government so we're really happy that tomorrow the Secretary of Health and Human Services, the Surgeon General, quite a few top officials are getting out and doing a whole series of conversations.
PEARSONThey started with a press conference with the senators, the women senators who helped get this part of the law passed this morning and we're hopeful that the visibility that the federal government and the reach of the federal government will start to get the word out. And you're right, it has to reach the providers, the clinicians as well as the individuals.
NNAMDIMaria Gomez is president and CEO of Mary's Center. Maria, do you have any more -- any other questions or comments?
MARIAWell, the only other question I have and I guess a statement is, what are we doing also to make sure that the population who are not going to be covered and a certain population that we know that are not going to be covered -- and also there has been no conversation, of course, not today but in general, about, you know, the ability for us to continue to support women who are in situations where they actually need abortions.
PEARSONYeah, so two issues you've raised. One is how do we keep advocating for people who don't yet have that good job that offers them insurance or don't yet have that, you know, really well-paid, you know, free-lancing business that allows them to pay the cost of the insurance.
PEARSONWe have to keep working. We're advocates as well as educators and we are determined not to leave anyone out for any longer than possible. I mean, we did lose what we tried to get in the health reform in 2010. We lost covering everyone so we have to keep working and that's a job for all of us.
PEARSONThe other one about making abortion available when women need it is absolutely right on target because through human history, some women have always needed abortions at some time. And now we estimate that about one in three women will have had an abortion by the time she turns 45 so we are happy that most private plans continue to cover abortion.
PEARSONWe are frustrated that Congress is trying to interfere with the District of Columbia's right to use its own locally-raised tax money for abortion and we're trying to band together locally and nationally to do the hard, steady education that's going to need to be done to help people understand how important it is that when women find themselves in this situation that the service is available, safe and affordable.
NNAMDIUm, Maria Gomez, you were about to say?
MARIAI was just saying thank you to Octavia and you for bringing this issue and it's a very, very important issue and thank you for taking it on, so...
NNAMDIMaria Gomez is also a member of the WAMU community council as is Nancy Pallesen who joins us in our studio. If you'd like to join the conversation, call us at 800-433-8850. What do you think of the new preventive care provisions that go into effect tomorrow? Those provisions of the Affordable Care Act, do you currently pay out-of-pocket or have co-pays for any preventive care services that are now covered?
NNAMDI800-433-8850. Nancy, you mentioned earlier that you don't see necessarily everything falling into place immediately even after 2014 when the Health Care Act is fully in effect. Why is that?
PALLESENWell, Kojo, we're halfway through 2012, that's a year-and-a-half until January of '14 and there are no systems in place in our state yet to enroll qualified -- people who will qualify for the new insurance programs. There are no systems set up and that all takes time to do. And then we need to follow up on the education topic that was just discussed.
PALLESENWe need to educate the folks in Virginia who will be eligible for this new coverage. Many of them simply -- they don't know anything about it. They don't know that the ACA even exists. They don't know anything about the recent Supreme Court decision. So there's a great deal of education that needs to go on and many people will need assistance in getting signed up.
PALLESENAnd then, you know, they have to find a provider. And right now there are lots and lots of physicians, thousands and many thousands of physicians but many of our physicians right now in -- are specialists. So we need to think about how are we going to increase the number of primary care providers who will do much of this work going forward.
NNAMDICynthia, for those with insurance who will be affected by these new provisions, let's talk a little bit more about what's now covered. HIV screening, sexually transmitted diseases are another provision, correct?
PEARSONThat's right, and very important for women to one, you know, lower the likelihood that they will pass on an infection. As we heard last week with all the good coverage of the International HIV AIDS conference, that if we could get everyone screened and knowing their status immediately they will live more healthily and it will really drop the rate of passing the infection along to others. So that's a very important new, you know, way to reduce a barrier, to get that co-pay out of people's minds as a barrier.
NNAMDIFor a lot of people, contraception is a big one. What is now covered?
PEARSONAll FDA approved methods, which means from diaphragms, birth control pills, rings, shots, implants, IUDs. It's expensive and it's very important. And as we mentioned earlier, for some women, if they're young, working minimum wage, even an inexpensive generic monthly birth control pill can be a bite out of their pocket. And for women who are a little more settled, maybe have pretty good insurance that would cover it, the co-pay for some of those long-acting reversible methods like IUDs or implanted contraceptives can be hundreds of dollars, which is, you know, kind of mind boggling.
PEARSONSo this is a big, big advance to get that copayment gone. And now women will only have to pay for their insurance and have no extra fees.
NNAMDIHere is Laurie in Arlington, Va. Laurie, you're on the air. Go ahead, please.
LAURIEYes, Kojo. I was just calling. My only daughter is turning one and I rented a breast pump so that I could continue to breastfeed my daughter while I was teaching. And that pump cost me $60 a month. And so for a year, that's an incredible amount of money. I mean, obviously, I think my daughter's worth it, but I was so excited to hear that breast pump rental is going to be covered. I think that's just a huge step forward in validating the choices that women make.
PEARSONOne of the things we're so happy about that this has a benefit for women regardless of where they are in their reproductive years, whether it's putting off that first baby, spacing babies, being pregnant, or taking care of their new baby with breast milk. It's just got something for really everybody.
PALLESENCould I mention please, that this -- my grandmother was Margaret Sanger, the founder of Planned Parenthood. And her efforts and struggles took place 100 years ago. And in many communities in our country now, the same discussions and the same arguments are coming up. So I am just delighted that these steps are being taken in the Affordable Health Care Act to increase women's options to care because if they do have to pay for care, often they just simply do not go.
NNAMDIThank you very much for your call, Laurie. And I don't think you get back that $700 or so that you spent during the past year, but at least women in the future I guess won't have to pay it. On now to Madera in Prince George's County, Md. Madera, you're on the air. Go ahead, please.
MADERAHi, Kojo. How are you? I like your show always I'm listening when I'm in the car. This program is including P.G. County?
NNAMDIYes, it does include Prince George's County, does it not, Nancy?
MADERAOkay. I don't have insurance right now. I don't have a job since March. I don't have any (word?) so I am (unintelligible) how do I apply this?
PALLESENThere are different programs in different counties in different states around the country. Ours is -- the program I am with is strictly for Arlington County but Montgomery County and Prince Georges County and the District all have programs for low income people who are uninsured. So I would suggest that you contact your Department of Social Services and ask them to guide you to the place where you might be able to go.
NNAMDIAnd good luck, Madera. Thank you very much for your call. Cynthia Pearson, what about people working for religious organizations?
PEARSONThe religious organizations have a year -- sort of organization period, a year to sort of figure out how they can follow the law as all businesses are required to follow the law without doing something that they believe is outside the bounds of their particular religious teachings. So if you work for -- if you happen to work for an actual church or house of worship, you may not have the benefit of this law.
PEARSONBut if you work for a religiously affiliated company like Catholic Charities, Georgetown University, another kind of hospital, that business will have to follow this law. But they have a year -- an extra year to comply because the administration is trying to find a way that the employer could pay for everything but contraception and have the insurers pay for the contraceptive benefit. And that's taking a little while to work out.
NNAMDIAnd finally we got an email from Nivadida (sp?) who said, "I think it's important to note that women's preventive services will be at no charge only for groups that are not grandfathered. Many large employers opted to grandfather their plans. And for them, there will continue to be a cost share for these services unless the employer chooses to provide them free of charge." And that is correct.
PEARSONThat is correct, and our guess is that as the next two, three years go by the number of plans that are grandfathered will dwindle to almost nothing because of so much going on as the reform law rolls out. But your writer -- your audience member is correct that some employers can choose to grandfather and avoid this right now.
NNAMDICynthia Pearson is the executive director of the National Women's Health Network. Thank you for joining us.
NNAMDINancy Pallesen is the executive director of the Arlington Free Clinic. Nancy, thank you for joining us.
PALLESENThank you, Kojo.
NNAMDIWe're going to take a short break. When we come back, why droughts could mean blackouts. I'm Kojo Nnamdi.
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