Checking Up On Health: September 28, 2016

On acne, Breast Cancer Month and Medicaid expansion.

Health News and Views
Compiled by Benita M. Dodd

Get ready to see pink ribbons everywhere in October.

Breast Cancer Month is October, and Breast Cancer Day is celebrated Saturday. Get ready for pink ribbons everywhere during this annual campaign to increase awareness of the disease. Millions have walked and millions of dollars have been raised in campaigns to fight breast cancer, going to research, education and support efforts.

Do you know how the pink ribbon came about? According to the Breast Cancer Action Network:

In the early 1990s, 68-year-old Charlotte Haley began making peach ribbons by hand in her home. Her daughter, sister, and grandmother had breast cancer. She distributed thousands of ribbons at supermarkets with cards that read: “The National Cancer Institute annual budget is $1.8 billion, only 5 percent goes for cancer prevention. Help us wake up our legislators and America by wearing this ribbon.”

As the word spread, executives from Estée Lauder and Self magazine asked Haley for permission to use her ribbon. Haley refused, and Self magazine was startled by Haley’s answer. “She wanted nothing to do with us. Said we were too commercial.” But Self really wanted to have her ribbon. The magazine consulted its lawyers and was advised to come up with another color. It chose pink, a color that focus groups say is “soothing, comforting, and healing” – everything breast cancer is not. Soon Charlotte Haley’s grassroots peach ribbon was history, and the pink ribbon became the worldwide symbol for breast cancer.

How aware are you of breast cancer? Take my nine-question True/False quiz. Answers below.

A) Breast cancer is the most diagnosed cancer among American women.[i]

B) Breast cancer is the leading cause of death among women.[ii]

C) More women die of breast cancer than any other cancer.[iii]

D) Breast cancer occurs only in women.[iv]

E) Screening mammograms save lives.[v]

F) Breast self-examination helps reduce breast cancer deaths.[vi]

G) Your chances of getting breast cancer increase with age.[vii]

H) Most breast cancers are hereditary, a genetic legacy from your parents.[viii]

I) The probability of an American woman dying of breast cancer is low.[ix]

Affordable Care Act

The Georgia Chamber of Commerce has outlined its proposal for expanding health care access to low-income Georgians. It’s been careful not to call it Medicaid expansion and, with details sparse, it’s too early to comment on the plan. Except to reiterate that for Georgia to expand Medicaid is a bad idea.

Why? States across the nation that have expanded Medicaid enrollment under ObamaCare are evidence that this is not only unaffordable, it’s unsustainable and uncontrollable.

The federal government is reimbursing 100 percent of the cost of newly eligible Medicaid enrollees under ObamaCare (dropping to 90 percent by 2020), creating a perverse incentive in the states to game the system and get as much money out of it as possible. The goal has become economic development instead of quality, affordable health coverage. (“Think of how many jobs this will create.”)

The result has been higher spending and higher enrollment than projected by the Congressional Budget Office. Enrollment is 25-50 percent above what was projected, and spending is 40-50 percent above expectations. The federal government is spending $232 billion above CBO’s projections for coverage from 2016-2024 – and that’s with fewer states expanding Medicaid than expected!

Further, “While interest groups within the states – particularly hospitals and insurers – benefit from the higher spending being charged to federal taxpayers, substantial evidence suggests much of this new spending is wasted or provides little value for its intended recipients,” writes Brian Blase of the Mercatus Center in Forbes.com.

Not surprisingly, waste, fraud and abuse in Medicaid are increasing: Blase notes:

The Wall Street Journal highlighted a new government report showing that improper Medicaid spending exploded between 2013 and 2016. Improper payments amounted to about $67 billion in 2016, a $41 billion increase from the estimated $26 billion in 2013. The large increase in improper Medicaid payments has occurred while the ACA Medicaid expansion took effect, suggesting that the expansion is the main cause of the stunning rise. (Interestingly, the Department of Health and Human Services has pulled the report from the Internet.)

Most interesting is that federal Medicaid expansion spending per enrollee is higher than for previously eligible adults under Medicaid. And why wouldn’t states favor new enrollees if they get a higher rate of funding for them?

Rumor has it that some in the Georgia Legislature are making Medicaid expansion a priority. It will take just a few Republicans to join forces with Democrats – who have long demanded Medicaid expansion – and put Georgia on the path of costly expansion experienced by other states, even as those states are brainstorming on how to rein in their programs.

Without a doubt, the state should facilitate access to quality health care for low-income individuals who need affordable coverage. The Georgia Public Policy Foundation has put forth a thoughtful, proposal for affordable coverage for low-income individuals – one that helps recover uncompensated care by health care providers, too. At the federal level, U.S. House Speaker Paul Ryan has outlined his “Better Way” plan for health care. There are so many ways to make health care more accessible – allowing direct primary care; expanding scope of practice for health professionals; ending Certificate-of-Need requirements to encourage competition and lower prices, and facilitating telemedicine among them.

There’s a lot to consider, much more than that “federal dollars” (taxpayer funds) are on the table for the taking. Federal dollars come with strings attached. It’s time to push back and demand flexibility so that Georgia can innovate locally and meet the needs of our fellow citizens when it comes to health care costs, quality and access.

Examples of direct primary care:

Partnering for Health Services (PHS), a hospital-based family practice clinic started by Altoona Regional Health System in Altoona, Pa. The clinic does not accept health insurance for its primary care services, but about 30 percent of PHS patients carry hospitalization-only coverage. PHS functions as a traditional full-service doctor’s office, open 4.5 days per week, providing all types of primary care services, diagnostic services, medications and referrals to specialists within its network. Patients are accepted into the clinic by proof of no primary care insurance, have household income up to 300 percent of the federal poverty level (FPL) and do not qualify for Medicaid. For unlimited visits to the clinic with no copays or deductibles, patients pay a monthly capitation fee based on income. Patients with household income up to 150 percent of FPL pay no fee; patients with income up to 300 percent of FPL pay $99 per month. Small business owners can also purchase an employee-based plan for $169 per month per employee. See more at http://www.empower3cfh.com

Paladina Health. North Carolina’s Union County government is seeing benefits for workers and taxpayers from adopting a direct primary care option for the county government health plan in April 2015. The county expects to save $1 million in health care claims under its contract with Paladina Health. “That’s $1 million saved on just 37 percent of Union County’s 1,983 covered lives who seek preventive care from a board-certified physician at Paladina’s near-site clinic,” wrote Katherine Restrepo in Carolina Journal. Read more about it in a recent Forbes magazine article. View the video presentation from the John Locke Foundation here.

Patience, pimples a virtue: Those who suffer from acne are likely to live longer, according to new research. British scientists say the skin of acne sufferers appears to age more slowly than those who have not had acne. They discovered that the white blood cells of people who have had acne have longer protective caps on the ends of the chromosomes, much like the plastic tips that stop shoelaces getting frayed.

ANSWERS TO QUIZ

[i] A) True. Just under 30 percent of cancers diagnosed in American women are breast cancers.

[ii] B) False. Heart disease edges out cancer as the leading cause of death among women (22.4 percent vs. 21.5 percent.) Death rates from breast cancer have been dropping since about 1989, believed to be the result of earlier diagnosis through screening and increased awareness, as well as better treatments.

[iii] C) False. Lung cancer (26 percent) kills more women than breast cancer (14.4 percent).

[iv] D) False Men can and do get breast cancer. Less than 1 percent of all breast cancers occur in men, however.

[v] E) True. Studies show they alert physicians to the presence of cancer. But they can have negative effects, too. For example: Of all breast cancers detected by screening mammograms, up to 54 percent are estimated to be results of overdiagnosis, resulting in treatment for insignificant cancers.

[vi] F) False. In fact, experts say, instruction and encouragement to perform breast self-exams lead to more breast biopsies and diagnosis of more benign breast lesions.

[vii] G) True. About one in every eight invasive breast cancers is found in women younger than 45, while about two in every three invasive breast cancers are found in women age 55 or older.

[viii] H) False. Just about one case in 10 of breast cancer results from genetic factors you inherit from your parents.

[ix] I) True. According to the American Cancer Society, the lifetime risk of dying from breast cancer ranges from 0.2 percent for women up to age 40 to 2 percent for a woman age 70 or older.