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Trump Scaling Back the ACA could mean gutting of Obamacare

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It’s hard to determine exactly what Trump’s executive order waiving enforcement of large swaths of the Affordable Care Act means for Americans. Since Trump signed an executive order to minimize the “financial burdens” of Obamacare, there has been relatively little headway into what exactly happens next. It’s not possible to simply dismantle the ACA through an executive order due to the number of laws and regulations wrapped up in it. Essentially, more actions will need to be taken before significant change takes place.

However, that doesn’t mean Obamacare is safe. The ACA is under attack by Republicans in congress, who are currently attempting to draft a replacement plan, though the new President has repeatedly insisted they move faster and put something in place sooner rather than later. In the meantime, it’s unclear what, exactly, a Republican plan would look like, despite several proposals being currently considered.

The main danger Trump’s executive action signals is  to the provisions penalizing individuals for lack of care. Without this penalty in place, experts seem to believe that insurance companies will simply pull out of many markets, leaving large “dead zones” without coverage.

However, there has already been some pushback against a quick repeal or replacement, even from some Republicans. Many Americans rely on the healthcare offered by the ACA, and would be left without coverage if Obamacare gets repealed or replaced by a substandard system. GOP governors, in particular, are part of a growing voice urging congress to reconsider a full repeal of the ACA, especially the expanded Medicaid provisions that have proven very popular and successful with their constituents.

In the end, we have yet to see a comprehensive Republican-approved plan fully materialize. While Trump’s executive actions could signal the beginning of the end for the Affordable Care Act, we will have to wait and see what is offered up in its place – if anything.

What Preventive Health Screening is Free under your Plan?

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Did you know that the Affordable Care Act, better known as Obamacare, has required insurers and healthcare plans to cover a wide variety of preventive health screening tests? And most of the time, these procedures are now free for you!

Catching diseases early, before they become deadly (or better yet, preventing them entirely) is often the safest and most cost-effective way to fight sickness and stay healthy in life. That’s why all plans that are compliant with the Affordable Care Act (so basically any plans that started after 2010 in addition to Medicaid and Medicare) are required to include free screening options for their customers.

So what does that mean for you?

The short answer is: most commonly prescribed screening tests are available for free to you, with anything else likely subject to the cost-sharing part of your insurance policy. For a longer answer, you’ll want to browse through the list below of specific tests that are covered for all ACA-compliant plans, taken directly from the healthcare.gov website:

For All Adults:

  • Alcohol misuse screening and counseling
  • Aspirin use to prevent cardiovascular disease for men and women of certain ages
  • Blood pressure screening
  • Cholesterol screening
  • Colorectal cancer screening for adults over 50
  • Depression screening
  • Diabetes (Type 2) screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
  • Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 – 1965
  • HIV screening for everyone ages 15 to 65, and other ages at increased risk
  • Immunization vaccines for adults — doses, recommended ages, and recommended populations vary:
  • Diphtheria
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus (HPV)
  • Influenza (flu shot)
  • Measles
  • Meningococcal
  • Mumps
  • Pertussis
  • Pneumococcal
  • Rubella
  • Tetanus
  • Varicella (Chickenpox)
  • Lung cancer screening for adults 55 – 80 at high risk for lung cancer
  • Obesity screening and counseling
  • Sexually transmitted infection (STI) prevention counseling for adults at higher risk
  • Syphilis screening for adults at higher risk
  • Tobacco Use screening for all adults and cessation interventions for tobacco users

For pregnant women or women who may become pregnant:

  • Routine Anemia Screening
  • Breastfeeding support and counseling and access to breastfeeding supplies
  • Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
  • Folic acid supplements for women who may become pregnant
  • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  • Gonorrhea screening for women at higher risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  • Syphilis screening
  • Expanded tobacco intervention and counseling for pregnant tobacco users
  • Urinary tract or other infection screening

For All Women:

  • Breast cancer genetic test counseling (BRCA) for women at higher risk
  • Breast cancer mammography screenings every 1 to 2 years for women over 40
  • Breast cancer chemoprevention counseling for women at higher risk
  • Cervical cancer screening for sexually active women
  • Chlamydia infection screening for younger women and women at higher risk
  • Domestic and interpersonal violence screening and counseling
  • Gonorrhea screening for all women at higher risk
  • HIV screening and counseling for sexually active women
  • Human Papillomavirus (HPV) DNA test every 3 years for women with normal cytology results who are 30 or older
  • Osteoporosis screening for women over age 60 depending on risk factors
  • Rh incompatibility screening follow-up testing for women at higher risk
  • Sexually transmitted infections counseling for sexually active women
  • Syphilis screening for women at increased risk
  • Tobacco use screening and interventions
  • Well-woman visits to get recommended services for women under 65

For Children:

  • Alcohol and drug use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Blood pressure screening for children ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Cervical dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under age 3
  • Dyslipidemia screening for children at higher risk of lipid disorders ages: 1 to 4 years, 5 to 10 years,11 to 14 years, 15 to 17 years
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns
  • Height, weight and body mass index (BMI) measurements for children ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Hematocrit or hemoglobin screening for all children
  • Hemoglobinopathies or sickle cell screening for newborns
  • Hepatitis B screening for adolescents at high risk, including adolescents from countries with 2% or more Hepatitis B prevalence, and U.S.-born adolescents not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence: 11 – 17 years.
  • HIV screening for adolescents at higher risk
  • Hypothyroidism screening for newborns
  • Immunization vaccines for children from birth to age 18 — doses, recommended ages, and recommended populations vary:
    • Diphtheria, Tetanus, Pertussis (Whooping Cough)
    • Haemophilus influenzae type b
    • Hepatitis A
    • Hepatitis B
    • Human Papillomavirus (PVU)
    • Inactivated Poliovirus
    • Influenza (flu shot)
    • Measles
    • Meningococcal
    • Pneumococcal
    • Rotavirus
    • Varicella (Chickenpox)
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Lead screening for children at risk of exposure
  • Medical history for all children throughout development ages: 0 to 11 months, 1 to 4 years , 5 to 10 years , 11 to 14 years , 15 to 17 years
  • Obesity screening and counseling
  • Oral health risk assessment for young children ages: 0 to 11 months, 1 to 4 years, 5 to 10 years
  • Phenylketonuria (PKU) screening for newborns
  • Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
  • Tuberculin testing for children at higher risk of tuberculosis ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Vision screening for all children

For more detailed information on these covered tests, check out the Healthcare.gov website!

Supreme Court Ruling Suggests Data can Prevent Gun Deaths

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With the recent 6-2 ruling upholding the federal law banning people with misdemeanor domestic violence convictions from owning guns, the Supreme Court has sent a clear message regarding gun violence: when we have good data about how to prevent gun deaths, the federal government has a constitutional right to act.

For decades we’ve known there was a strong link between domestic violence and gun homicides, and in 1996 an amendment was passed barring people convicted of domestic violence misdemeanors from owning handguns. Research shows that abused women are five times more likely to be killed by a domestic violence partner if that person owns a firearm, and that two-thirds of women who had been domestically abused in homes with a firearm had been threatened at some point with that firearm. It’s also been shown that laws that prevent domestic abusers from owning guns are associated with reduced rates of domestic gun homicides.

The recent Supreme Court ruling gives hope to groups that are pushing for better funding for research into gun violence statistics – especially in light of recent events such as the Orlando nightclub shooting, with opposing factions arguing about whether or not restricting gun ownership rights to certain individuals could prevent mass shooting. It sends a clear message that, given strong data on how to save lives, the government has the authority to pass laws that restrict gun ownership for select groups of high-risk citizens.

The problem, of course, is that we still only have limited data on who commits gun crimes and why. The CDC is still hampered by restrictions on research funding, and doctors are still restricted from collecting data on gun ownership and risk. But at least for now we have assurance from the courts that what limited information we do have can be used for the greater good.

Gun Violence Screening E-book Live!

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Gun ScreeningThis marks the launch of our 3rd e-book in the Adult Guide: Health Screening and Prevention line: Gun Screening in the Doctor’s Office! This pamphlet focuses on medical screening for gun violence. It’s designed to help you understand your rights, why doctors may be asking you about gun ownership and domestic violence issues, and how that information can be used.

When we released the original Health Screening and Prevention guide, we expected the gun violence screening section to be one of the most controversial parts of the book. Our nation has suffered from a wave of violent shootings in recent years, and the Affordable Care Act (Obamacare) has introduced new controversy into the debate over doctors’ roles in helping screen for and prevent gun violence and dangerous incidences of mental health disorders.

This book is streamlined to focus on the reasons for screening while also providing information on the laws and regulations surrounding the practice. Medical screening for potential gun violence in on the rise, and while it is not mandated by the government many doctors consider it their professional duty to speak with their patients about potential risk factors and possible solutions.

We’ll be releasing these “mini-e-books” for each of the major chapters covered in the big e-book, and we’ll continue to update you here each time a new release goes live. Until then, we hope you find this guidebook to be useful!

If you have any questions, please feel free to e-mail us at drsalimjaffer@gmail.com, or leave a comment below!

Why We Don’t Fund Gun Violence Research

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CDC Headquarters in Atlanta

Whether or not guns themselves are a problem in our society may be a matter opinion, but one thing that we should all agree on is that we should have good data on how and why gun violence is committed (as well as the who, what, where, and when).  Both private citizens and law enforcement deserve to know when they might be at risk and what they can do to protect themselves, while doctors would better understand how to identify high-risk patients with mental health issues that might predispose them to violence. This should make sense regardless of political affiliation or how you feel about gun ownership.

And yet we have very little data. In fact, we perform almost no research at all on gun violence in our country. And the reason is entirely political – provisions in the annual appropriations bill (which directs federal funds toward research) prevents any money from being spent on gun control… and for decades, the NRA has been successful at branding “gun violence prevention research” as a sub-category of “gun control”.

It was 1996 when we passed legislation intended to strip the CDC of the ability to fund gun control research. The law was taken a step further, however, and the CDC essentially stopped performing any gun violence research at all. Since then, this ruling has also been applied to the National Institute of Health (NIC). As a result, for the past 20 years the United States has collected virtually no data on gun violence that could be used to curb or head off future incidences before they happen. And the result is that we have only limited private studies to look at when trying to figure out what to do about gun violence outbreaks, leaving our law officers and doctors mostly powerless. Even the senator who wrote the bill expresses deep regret at the results of his actions, stating that the law has been over-interpreted and resulted in unnecessary loss of life.

On top of all this, the NRA has fought in recent years to restrict doctors from asking their patients questions related to gun violence prevention. While they have been unsuccessful in preventing doctors from doing their jobs, they still have managed to force language into the Affordable Care Act and other provisions preventing the collection of data. They have managed to keep medical professionals from treating gun violence deaths as a “preventable disease”, despite similar causes of death being treated as such.

While there have been efforts to reverse these restrictive laws and open up the field of research for the public good, so far these attempts have amounted to nothing. The NRA and legislative allies have decided that public knowledge is a threat to the 2nd amendment, despite the fact that most Americans support gun ownership. The most recent attempt to end the ban on gun violence research is likely to go nowhere, at least until public opinion changes on the matter enough to pressure congress into taking action.

For now, we’re firing in the dark.