Tag: ACA

Quick Hormonal Birth Control Science Explainer

Yesterday, I saw a guy suggest that women who lose insurance coverage can go buy one of seven birth control brands offered by Walmart for $9—and that sounds like a broadly-applicable solution, but only if you don’t understand hormonal birth control. Most birth control pills have two hormones in them: one which convinces your body it’s producing a hormone it isn’t producing, and one which binds with a hormone in your bloodstream to mask it and convince your body it isn’t there. There are more than a dozen variations of each of these components, and hundreds of ways they could be combined.

How a given hormonal combination reacts with the body of an individual woman varies widely. The same pill will raise one woman’s sex drive and kill another’s. It’ll clear up one person’s acne and give another one acne. It’ll cause one to gain weight and one to lose it. It might be mood stabilizing, or cause severe depression. There are hormonal sliders the pill is moving, and you have no way to know in advance what this woman’s presets are, let alone how responsive her sliders will be to a set of chemicals she hasn’t tested personally.

Think of birth control pills as if they’re chili. There’s a whole bunch of different things called chili, and even if you know you want chili, a particular batch might have no ingredients in common with another batch. It might include elements you’re allergic to, or might be too spicy, or it might have none of the characteristics you want when you say “chili”. Beans v no beans, white v red, chicken v beef v vegetarian – the world of chili is vast.

Unlike with chili, you need a prescription for hormonal birth control, because although you’re probably safe if you’re on the same pill you’ve been taking for a while, you don’t really know how your body is going to react to a new one and it could react by forming blood clots that try to kill you. Testing a bunch of different kinds is strongly discouraged, and also impossible because your pharmicist wouldn’t give you a different kind of pill than the one prescribed to you. On top of that, the first month after you switch or start a pill variant is the most dangerous – is the time you’re most likely to have a life-threatening adverse reaction. When you think about switching types, you weigh that risk against the side effects you’re already experiencing.

(Why not opt out if it’s so dangerous, you might say. The answer is that pregnancy is even more dangerous. Sincerely, that is the reason the FDA thinks the risks are acceptable for female hormonal birth control but not male hormonal birth control.)

To make this less abstract, here are three forms of hormonal birth control I have used and how my specific body reacted to them:

Microgestin (norethisterone acetate and ethanyl estradiol) is great for me. I feel totally normal for the most part, with better skin and a slightly increased sex drive which is enough to be fun but not inconvenient.

Microgynon (levonorgestrel and ethanyl estradiol) is what I was prescribed when I moved to England, where Microgestin was not available. It makes me way more teary than my normal self. Not for the most part depressed, but more likely to burst into tears over something small. During two of the seven days of the month when I took spacer pills (the ones with no hormone that allow you to experience withdrawal bleeding, aka fake period) I felt delicate and bereft and wanted to be held by my partner – felt like I was mourning a very early miscarriage. This is a strange experience to get from a pill you take to ensure an egg will never be released and fertilized, and it felt simultaneously real and fake, the way “hangry” feels falser than angry.

Qlaira (dienogest and estradiol valerate) is what I was prescribed in Italy. The first month, I had terrible headaches. Those cleared up, but for the entire two years I was on this, I was emotionally flat and had no sex drive, and experienced constant dryness in parts of my body that shouldn’t have been dry. I didn’t get my libido back until more than a month after I stopped taking it.

None of this is a guide to what other women could expect. We can’t compare notes and say “I liked this one; you should try it” or “you have almond-shaped eyes, so clearly the best pill for you is lavender-colored.” However, you can see why maybe it could be a significant daily burden not to be able to take your preferred pill formulation. Of the three pills I listed above, Migrogynon is the only one with generic $9 Walmart equivalents. Otherwise, they offer progesterones I haven’t tried: norgestimate, norethisterone (not the same chemical as norethisterone acetate), and desogestrel.

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Another Healthcare Repeal Attempt

Senate GOP paves way for ObamaCare repeal bill” (Jordain Carney, The Hill)

Watch out for this. But also, don’t misinterpret it. Normally, you wouldn’t expect McConnell to bring a bill to the floor of the Senate unless he thought it could pass. However, with this healthcare-killing bill, because congressional Republicans used the budget reconciliation process to try to sneak it through without needing any Democrat votes, they’re in a jam: they can’t use that same procedural trick on any other bill while it’s still up in the air.

The Republican leadership wants to ram through a tax cut package for billionaires. They can’t do that with this healthcare turd clogging the pipe. McConnell is probably trying to flush it. (Maybe you’ve heard some of them grousing about how they “should have done tax cuts first” and wondered why they couldn’t pursue several legislative agendas simultaneously, like normal people. It’s because they have to use this cheat/exploit since their ideas are unpopular, and it’s strictly one-at-a-time. I’ll leave it to you to write a “camel through the needle’s eye” homily on the subject.)

So basically, worst case but unlikely scenario: this repeal passes. Best case but still bad scenario: it fails which lets them roll up their sleeves and start manfully widening the wealth gap so their pitiful wealthy selves don’t have to give up any comforts to feed the detestible poor. (Those housing-insecure kids should really get jobs. Non-voting losers.)

Collins-Cassidy Healthcare Bill

Republican senators Susan Collins (Maine) and Bill Cassidy (Louisiana) have been working on an alternate health care bill which does not cut $800 million from Medicaid, and does not prioritize tax cuts over coverage. Their stated goal is to keep Trump’s campaign promises of lower premiums, better care, and coverage for everyone, which is what the American people voted for. As they craft their bill, Collins and Cassidy are holding meetings with Democrats instead of just grousing about Democrats.

I don’t know that it will be a better bill than Obamacare. (You know I want to scrap employer-based healthcare entirely.) However, it’s credible. It’s the kind of approach you take if you are genuinely trying to fix something and help American citizens.

It’s not surprising that Collins and Cassidy would know a thing or two about this subject: Collins used to be the insurance commissioner of Maine, and Cassidy is a physician who founded several nonprofits to get free or low-cost care to low-income Baton Rouge families.

The fact that neither of these people were asked to be part of the main Senate working group on healthcare is shameful. They should be the leaders. It tells me that other bill isn’t about healthcare. Remember this later on, when Mitch McConnell et al are trying to get everyone to kiss the ring. They’ll say it’s a collection of the smartest Republican ideas. Isn’t.


Maria says: Your last paragraph hit the nail on the head. The GOP can’t accomplish the budget they want without gouging the ACA. So you’re right. The current bill isn’t about health care. So it remains to be seen if Collins and Cassidy will even get a GOP an executive audience for their bill. But at least it will be on the record.

Health Insurers Are Making Lots of Money Already

FYI, if you’ve worried about the poor insurers who gosh can’t make money with all this existing regulation requiring them to cover sick people:

UnitedHealth claims that Obamacare has reduced its 2016 earnings by $850 million. While they might have $850 million less than they wanted, UntedHealth’s profits are still soaring.

In fact, UnitedHealth announced record-breaking profits in 2015, followed by an even better year this year. In July 2016, UnitedHealth celebrated revenues that quarter totalling $46.5 billion, an increase of $10 billion since the same time last year. And company filings show that UnitedHealth’s CEO Stephen J. Hemsley made over $20 million in 2015. To be fair, that is a pay cut. The previous year, in 2014, Hemsley took home $66 million in compensation.

Health insurance industry rakes in billions while blaming Obamacare for losses” (Amy Martyn, Consumer Affairs)

Meanwhile:

A Salon analysis of regulatory filings found that the top five health insurers — UnitedHealth, Anthem, Aetna, Humana and Cigna — have doled out nearly $30 billion in stock buybacks and dividends from 2013 to 2015. (The Supreme Court ruled in favor of the Affordable Care Act in 2012.) Meanwhile, the increase in customers that these health insurers received under ACA has helped raise the stock prices of the top five insurers — some 80 percent for Anthem and 165 percent for Aetna since the high court ruled on June 28, 2012 that Obamacare was constitutional.

Making a killing under Obamacare: The ACA gets blamed for rising premiums, while insurance companies are reaping massive profits” (Angelo Young, Salon)

Healthcare Reform as an ugh group project

News keeps trickling out about Mike-Pence-led meetings to resurrect the heathcare bill by offering different contradictory things to different constituencies to see if any of it sticks. (It hasn’t.)

I feel a sense of deja vu, but it’s not deja vu about the recent Paul Ryan healthcare bill. It’s more like every group project ever — where nobody really has a project in mind, but you have to turn in something because otherwise you’ll fail the semester.

Is anybody else getting that – the sense that the White House wants “a bill” so they can “pass it” by some kind of deadline, but that’s about the extent of it?

Infant Mortality Rates in the U.S.

I’m sure this fall in infant mortality rates has nothing to do with expanding Medicaid, or making insurers cover contraceptives. Correlation doesn’t prove anything.

Infant Mortality Rates Fall 15 Percent in U.S.” (Maggie Fox, NBC News)

Meanwhile, big thank you to all the doctors, nurses, and epidemiologists who made big important changes to how we approach SIDS prevention. Y’all did good.

Health Insurance Doesn’t Equal Health Access

A sliver of cross-partisan agreement on healthcare: It’s not fair to have to pay for something you can’t access.

It has been observed by many people that red states, and in particular red rural counties, have had the largest increases in insurance coverage through Obamacare. So why would they be against it? Why would they be adamantly convinced they had to pay their money to help somebody ELSE?

In some cases, it’s probably straight partisanship, or a globalized sense of persecution, or just not knowing the score. But in other cases, they’re right, for a simple reason: Health insurance is meaningless if you can’t use it to access medical care.

That’s one of the reasons we created Obamacare in the first place – to get rid of insurance that doesn’t actually insure you, that drops you the second you make a claim. However, bad insurance wasn’t exclusively the problem, because the existence of insurance doesn’t magically create doctors where you need them.

If you are not in or near a sufficiently large population center, medical care is hard to come by. Doctors just aren’t there. Don’t want to be. Don’t want to move out to the middle of nowhere to make less money; don’t want to have to start their own one-room practice rather than join a medical community they can consult with, and refer to, and commission tests from.

If you want to see this expressed in a jokey fictionalized way, watch Northern Exposure. The struggle is real. My best friend lives in New Mexico, and has expensive “good” work-based insurance, and had to wait something like two years to get registered with a primary doctor even though she was willing to drive anywhere within 120 miles of her house. There aren’t doctors out there. Patient rolls are full. Even now, she has to assume she’ll spend $100 a month on urgent care, even though all she usually needs is for a nurse to shine a flashlight in a kid’s ear and, say “yep, ear infection” and prescribe a course of antibiotics – because there’s no chance she’s going to get a timely appointment with a pediatrician.

This isn’t a market failure; it’s the way markets work. Doctors don’t want to move to that area. You move to a small town because you have roots in the small town, and basically for no other reason. Meanwhile, the kinds of people from small towns that have big medical school dreams often have big other kinds of dreams that don’t involve the small town.

Freeing up the insurance market further, by allowing people to buy insurance across state lines, is not going to fix that, because it’s not an insurance problem. It’s the kind of thing that is best handled by creating a National Health System, which requires doctors to put in time out there, pays them some kind of bonus for that tour of duty, and sets aside large grants to create community health centers in geographically isolated areas. Obamacare didn’t do that. Republican Obamacare 2.0 doesn’t do that either. I’m not super optimistic that U.S. legislators are ready for that particular grand bargain, considering we weren’t even able to get rural broadband access going.

But absent such access: Yes, it is unfair to force people to buy insurance they cannot apply to their own medical care, whether because copays make those visits unaffordable or because there are not doctors to take the insurance. That is an absolutely fair critique. That is a way of making people with fewer resources subsidize people with more resources. And since the individual mandate is one of the three legs of Obamacare and the whole stool falls over without it, we’re kind of stuck.

Just a reminder that the fight, long term, isn’t really over Obamacare, or shouldn’t be. It’s a fight to get affordable healthcare to everyone. A lightly-regulated free market system doesn’t do that: my evidence is that it hasn’t. But Obamacare hasn’t either. It makes sense that some people are mad they have to spend money they can’t really spare on something they can’t really use. On that much, we can agree.