healthcare

One of the most important cases the Supreme Court reviewed this year was United States v. Texas, which ruled on challenges to two Obama administration initiatives – Deferred Action for Parents of Americans and Lawful Permanent Residents and an expanded Deferred Action for Childhood Arrivals program – that would have affected up to five million people. In November 2014, President Obama announced Executive Actions that included additional temporary protections for immigrants who arrived as children (also referred to as “DREAMERS”) and a new program for parents of U.S. citizens or lawful permanent residents. The programs would allow them to remain in the country and apply for work permits if they have been here for at least five years and have not committed felonies or repeated misdemeanors. These actions have been on hold since early 2015, when a district court issued a preliminary injunction in response to a challenge brought by Republican authorities in Texas and ultimately joined by 25 other states. The actual focus of the case was quite mundane: Texas argued that it would suffer significant financial damages if required to subsidize the cost of driver’s licenses to those qualifying for the s new programs. However, the larger context was an unwillingness to allow the President to enact policy change following years of blocked and failed efforts at immigration reform at other governmental levels.In November 2014, Obama announced Executive Actions that included temporary protections for immigrants who arrived as children and a new program for parents of U.S. citizens and lawful permanent residents to apply for work permits. These actions have been on hold since early 2015.

The Supreme Court was unable to reach a decision in June. The case resulted in a 4-4 tie, an unusual but not unexpected result given the current makeup of the court following the death of Justice Antonin Scalia and reflecting the politically divisive nature of the case. This means that the decisions of the lower courts remain in place and the two initiatives are blocked, for now. more...

Catholic hospitals are a large and growing part of the U.S. health care system. Considerable public funding flows to these institutions, but they deny many reproductive health services and some kinds of end of life care to their patients. Catholic rules limit care in far-reaching ways, well beyond what many patients and health care providers understand or expect. These realities raise important issues about the future of religious restrictions in U.S. health care.

Restricted Care in a Growing Sector

Between 2001 and 2011, the number of Catholic hospitals increased by 16%, while public and secular not-for-profit hospitals decreased. One in six patients in the United States is cared for in a Catholic hospital, and in 2015, seven of the country’s 12 largest nonprofit hospital systems were Catholic. Although Catholic hospitals provide the same amount of charity care as non-Catholic hospitals, in terms of the percent of total revenues, they provide less care to Medicaid recipients than other kinds of hospitals.

Like other hospitals, Catholic institutions receive considerable public funding, yet they limit patient care to fit the Ethical and Religious Directives for Catholic Health Care Services written by the U.S. Conference of Catholic Bishops. As a condition of employment or medical privileges, doctors, nurses, and other clinical personnel are required to follow these directives when caring for patients in Catholic facilities.Legal rights mean little without practical access to reproductive health services. more...

Health care providers who perform abortions routinely use ultrasound scans to confirm their patients’ pregnancies, check for multiple gestations, and determine the stage of the pregnancies. But it is far from standard – and not at all medically necessary – for women about to have abortions to view their ultrasounds. Ultrasound viewing by patients has no clinical purpose: it does not affect the woman’s condition or the decisions health providers make. Nevertheless, ultrasound viewing has become central to the hotly contested politics of abortion.

Believing that viewing ultrasounds will change minds, opponents of abortion – spearheaded by the advocacy group Americans United for Life – have pushed for state laws to require such viewing. So far, eighteen states require that women be offered the opportunity to view their pre-abortion ultrasound images, and five states actually go so far as to legally require women to view their ultrasound images before obtaining an abortion (although the women are permitted to avert their eyes). In two of the five states that have passed such mandatory viewing laws, courts have permanently enjoined the laws, keeping them from going into effect.Ultrasound viewing by patients has no clinical purpose: it does not affect the woman’s condition or the decisions health providers make.

As the debates continue to rage, both sides assume that what matters for an abortion patient is the content of the ultrasound image. Abortion opponents believe the image will demonstrate to the woman that she is carrying a baby – a revelation they think will make her want to continue her pregnancy. Ironically, supporters of abortion rights also argue that seeing the image of the fetus will make a difference. They say this experience will be emotionally distressing and make abortions more difficult. Paradoxically, such arguments from rights advocates reinforce assumptions that fetuses are persons and perpetuate stigma about abortion procedures. more...

Latinos living in the United States comprise the largest number of immigrants of any racial or ethnic group – and for this reason, many Americans presume that immigration is the issue that matters most to Latino citizens and residents. But is that true? Do Latinos themselves view immigration as their top concern, and if not what other issues are high on their political agenda? My research tackles this question, which is important for understanding the potential political influence of the largest and fastest growing minority group in the United States. more...

The state of Texas leads the nation in the percentage of residents lacking health insurance. In 2012, nearly a quarter of the state’s population went without health coverage, some 6.4 million people. Texas alone is home to 13% of all uninsured Americans, with poor and low-income people the most affected. More than ninety percent of well-off Texans have health insurance. But the ranks of the uninsured include more than two out of five impoverished Texans—as well as more than a quarter of individuals earning modest incomes in 2014 between $11,670 and $46,680 (or between $19,970 and $79,880 for a family of three). more...

As the new Affordable Care marketplaces get under way in each state, how many Americans without health insurance will learn about their new options – including the generous subsidies available to help people with low or moderate incomes afford premiums for health insurance plans? Public confusion has been widespread, but outreach experiences suggest that providing accurate information – especially face-to-face – makes people more positive toward the health reform law and increases their willingness to sign up.

In the words of outreach specialist Libby Cummings of the Community Health Center in Portland, Maine, “When we have a chance to explain it to people, it’s been very positive. People are excited about it and want to have health insurance. People see it as an opportunity to get coverage that was never open to them before.” more...

Most Americans would be surprised to learn that the nation’s largest health care provider is not a private hospital network or an insurance company—it is the government-run Veterans Health Administration, popularly known as “the VA.” Every year more than 8.3 million veterans receive free or low-cost health care at hundreds of VA medical centers and outpatient clinics, parts of the most extensive integrated health care system in the country. The number of patients served has nearly doubled over the past fifteen years. Although VA patients are, on average, sicker and poorer than the average American, the system successfully delivers high-quality health care, even as it reins in costs. more...

The outcomes of the elections held on November 6, 2012 will have a big impact on students and other young Americans. The presidential candidates and their parties have taken sharply different stands on college costs, job opportunities, health care, social issues, voting rights, and investments in the nation’s future – all issues of special relevance to young people.

Paying for College – and Debt after Graduation

Since 1985, the price of a college degree has risen at more than twice the rate of inflation. Americans now owe more for student loans than for credit card debt. In response, President Obama increased Pell grants, simplified student aid applications, made it easier for ex-students to repay loans, and ended unnecessary subsidies to banks. The Obama administration has also moved to help students get accurate information on the costs and benefits of various colleges and universities. more...

Health reform has many popular parts—rules against insurance company abuses; subsidies and tax credits to make health coverage affordable for millions; improvements in Medicare. But controversy persists about the “individual mandate” rule—which says that everyone must either have health insurance coverage or pay a fine.

Attacks have intensified since the Supreme Court decision to uphold the Affordable Care Act, because the mandate fine was declared a valid exercise of the taxing power assigned by the Constitution to the federal government. Opponents of health reform denounce the mandate as “tyranny” and say that it amounts to a big “middle class tax increase.”

more...