Repeal of Affordable Care Act is Politics Playing with the Wellbeing of Americans
My favorite part of all this focus on quality? Every hospital’s quality ratings are posted publicly. Not only is public shaming an amazing incentive for improvement, but it also means that hospitals are tracking this information and comparing it a public standard – something that didn’t exist before. Hospital A might have a huge rate of surgical infection and not even realize it because they didn’t know that other hospitals had lower rates. And now patients can look it up as well. If you’re about to get a knee replacement, you can look at the readmission rates of all your local hospitals and make an informed decision.
2) Birth Control Coverage
The ACA attempted to not only regulate the insurance market and improve access to healthcare insurance, but it also looked at the quality of healthcare insurance that folks were given. As part of ensuring that all insurance coverage provided basic preventative healthcare, the ACA listed discrete items that insurance companies were required to pay for.
The boon was inclusion of contraception coverage.
Women have long known that control over their reproduction (or lack thereof) is one of the greatest dictating factors in their lives. More recent analysis has shown that one of the largest single driving factors of the rapid gains that women made in workplace equity after the 1960s was the advent of the birth control pill.
The key phrase in contraception these days is LARC, or Long-Acting Reversible Contraception. LARCs are the most effective forms of birth control. Once inserted, they don’t require any further thought and efficacy is over 99%. Further, fertility returns to normal almost immediately after removal (which, by the way, is a simple office procedure). The problem is that though they are cost-effective in the long run, without insurance, the upfront cost is frequently prohibitive.
For example, the Mirena IUD is one of the LARCs that is currently available. It is effective for 7 years. Anecdotally, it’s also the most popular form of birth control amongst doctors, which I think says something. Without insurance coverage a Mirena IUD typically costs $500-800 for the device, plus an insertion fee that typically runs around $300.
Before the ACA, most of my patients could not afford that. Now not only are IUDs an option, but so are 3-year long implants, the patch, the shot, and the ring. Every person’s body is different and the best form of birth control for one patient is not necessarily the best for another. It’s critical to have options.
The loss of birth control coverage is one of my biggest fears for my patients. I say patients, not female patients. It’s true that in our patriarchal society women are frequently left to be in charge of birth control but let’s not forget that unplanned parenthood impacts men as well. I once took care of a man going through some occupational health testing. He confided that when he was in college he had once planned on going to medical school. When I asked him what changed, his answer was simple, “Procreated too early.”
And unplanned parenthood impacts children.