ACE

Category: Public Health

  • Pros and Cons of the Medicaid-funded Housing Debate

    Pros and Cons of the Medicaid-funded Housing Debate

    What is Medicaid and Section 1115? 

    Medicaid is a federal government-funded health insurance entitlement program that provides health coverage to primarily low-income and disadvantaged individuals. Each state runs its own Medicaid program, so eligibility and benefits may vary. 

    While Medicaid benefits traditionally include physician and other health services, Section 1115 of the Social Security Act allows the Department of Health and Human Services to approve experimental projects that would promote Medicaid’s objectives. The Biden-Harris Administration is using Section 1115 waivers to fund their newest initiative, the Housing and Services Partnership Accelerator, which provides funding to eight states (Arizona, California, Hawaii, Maryland, Massachusetts, Minnesota, North Carolina, Washington) and D.C. to promote partnerships across housing and health sectors. States will collaborate with community-based organizations and housing providers to locate and pay for services such as rental assistance, security deposits, and housing transition services. 

    The Accelerator is part of the administration’s efforts to address social determinants of health (SDOH), which are the factors where people live, work, and play that affect health outcomes. There is a well-established correlation between housing status and health outcomes—unsafe environments, stress, limited access to resources and transportation and other housing-related factors are examples of how housing status leads to worse health outcomes. People experiencing homelessness experience many health disparities including higher rates of chronic disease, premature deaths and mortality. 

    Housing and Healthcare: An Effective Partnership?

    Proponents cite that permanent supportive housing is effective in improving health outcomes, especially for individuals experiencing chronic homelessness, because it provides the basic resources and services needed to maintain health. Therefore, they argue the clear link between housing and health makes Medicaid an appropriate bridge between social services and healthcare. 

    However, those against using Medicaid funds worry that collaboration efforts may be ineffective. Government agencies, medical services, and nonprofits have rarely worked together in the past. In fact, some studies found that healthcare systems do not collaborate well with non-healthcare organizations because of the differences in their core missions, political power, and lack of expertise. Those in favor of funding housing through services that specialize in housing argue that prioritizing immediate health goals in housing policies is less effective than investing in long-term health outcomes. Due to the mismatches between priorities of health systems and social service organizations, they argue the task of addressing SDOH is mishandled and opportunities to invest in long-term health are overlooked. 

    Cost-Benefit Analysis

    Additionally, many advocates for Medicaid-funded housing believe that the initiative will save healthcare costs over time. They believe that funding housing services will decrease health disparities related to housing status, which in turn will decrease healthcare spending. 

    For example, people experiencing homelessness tend to depend on emergency departments and overnight stays for healthcare. Their dependence on hospitals carry high costs for the healthcare system—the top 5% of hospital users are overwhelmingly poor and housing insecure and are estimated to consume 50% of U.S. healthcare costs. Patients with documented housing instability also require mental and behavioral care at a rate ten times higher than people without housing instability and have longer lengths of stays, with an average of two additional days. Case studies in Oregon, Chicago, and New York have found that permanent supportive housing successfully reduced Medicaid costs, hospital days, and emergency department visits.

    However, mixed literature on the cost effectiveness of funding housing services is why many are against using Medicaid for funding. One randomized trial found that providing permanent supportive housing for chronically homeless individuals decreased psychiatric emergency department visits by 38%, but did not decrease medical emergency department visits or hospitalizations. In fact, one study explained that SDOH initiatives often struggle to generate returns on investment due to the complexity of our healthcare system. Those against using Medicaid funds for housing argue it would take away from already struggling programs related to basic health needs. 

    Housing Crisis Solutions

    Those in favor of Medicaid-funded housing also point out the importance of addressing both health disparities in unhoused populations and also the homeless crisis. Medicaid-funded housing may be the quickest way to help disadvantaged Americans because Medicaid is an entitlement program, meaning anyone eligible for its services is entitled to them. On the other hand, housing programs have budgets set by Congress and are underfunded. 75% of those eligible for federal housing assistance do not receive it, and the overwhelming demand has caused many housing agencies to stop taking applications. Because of the differences in funding structure, some argue that there is a moral obligation to provide care because it is not possible to completely overhaul the housing department and it is unethical to deny services on the basis of waiting to research returns on investment. For example, the director of the Center for Medicaid and CHIP Services noted that saving money is not the only issue at hand and that it is important to also evaluate health outcomes.

    However, some argue that this perspective ignores the root problems of the housing crisis and will only threaten the future of housing programs. For example, some housing experts are worried that the funding will also set back people in line for federal housing assistance or even threaten their eligibility for other homeless services. Additionally, a study assessing Maryland’s 1115 waiver program from 2022 explained that limited supply of affordable housing and participant backgrounds (such as rental history, credit scores, and stigmas against people experiencing homelessness) made it difficult to locate housing solutions. One of the hospital executives interviewed in the study said that without government action to increase housing, SDOH cannot really be addressed. 

    Takeaways From the Debate

    Advocates for Medicaid-funded housing services cite previous Section 1115 initiatives and their successes such as improved health outcomes, healthcare cost reductions, and housing crisis solutions.

    Those against the initiative cite problems with past health-housing initiatives, including ineffective partnerships, minimal return on investment, and inability to address root problems of SDOH and long-term health goals.

  • The Health Care Debate for Undocumented Immigrants: What You Need to Know

    The Health Care Debate for Undocumented Immigrants: What You Need to Know

    What types of health insurance do immigrants currently qualify for?

    Undocumented immigrants are generally ineligible for federal healthcare programs due to immigration status regulations and public charge rules. Additionally, even immigrants who are “lawfully present” face barriers to accessing federal healthcare programs such as Medicaid and the Children’s Health Insurance Program (CHIP), which are state-administered and federally funded to provide coverage to low-income individuals. They are also excluded from the Health Insurance Marketplace, a federal service that offers tax cuts and subsidies to make insurance more affordable.

    Undocumented immigrants in the U.S. are eligible for emergency medical care under the Emergency Medical Treatment and Labor Act (EMTALA), funded through Medicaid. Beyond emergency care, their options are limited to private insurance through employers or primary care at community health clinics. Many rely primarily on EMTALA-covered emergency services, with a high likelihood of not having access to regular medical care or a doctor’s visit in the past year.

    The combination of eligibility restrictions for federal programs, limited access to private insurance due to employment in low-benefit jobs, and barriers like fear and language differences makes undocumented immigrants more likely to be uninsured compared to lawfully present immigrants and U.S.-born citizens.

    Background on undocumented immigrants in the US

    In recent years, several states have started expanding health coverage to undocumented immigrants to improve healthcare access and reduce financial strain on hospitals treating uninsured patients. On the federal level, there was a move towards expansion with the introduction of the Health Equity and Access under Law (HEAL) for Immigrant Families Act in 2023, aimed at eliminating healthcare barriers for all immigrants, regardless of status. Despite these efforts, challenges persist. For example, Illinois had to scale back on enrollments due to budget underestimations, affecting about 6,000 people’s insurance coverage. Moreover, with unauthorized crossings at the US-Mexico border hitting a record 2.4 million in 2023, cities like New York City have been overwhelmed, committing $2.4 billion in 2024 to address the costs related to the large influx of migrants.

    The Cost of Providing Care

    Proponents of expanding healthcare coverage to undocumented immigrants argue that it would not result in excessive costs and could actually lead to savings in other areas. They point out that providing regular preventative primary care to undocumented immigrants would reduce the need for more costly emergency department (ED) visits, which often arise from lack of insurance. Cost analyses support this view, showing that regular primary care is less expensive than ED services that could have been avoided. Furthermore, the lack of preventative care can lead to advanced chronic diseases, which are significantly more costly, imposing an estimated economic burden of $4 trillion a year. It’s estimated that preventing unnecessary ED visits could save approximately $4.4 billion annually.

    Supporters of expanding health coverage to undocumented immigrants say that there is a widely held misconception that immigrants use more healthcare than those born in the U.S. and “drain” medical resources. One systematic review indicates that both private and public health insurance expenditures are lower per capita for immigrants, particularly undocumented ones. Additionally, immigrants tend to pay more in out-of-pocket expenses, contributing more to medical costs than they receive in services. 

    Opponents of expanding health coverage to undocumented immigrants argue that such programs are financially unsustainable, pointing to significant costs associated with existing state initiatives. For instance, California’s Medi-Cal program, which was the first to extend coverage to all undocumented immigrants, is projected to cost over $2 billion annually. This comes at a time when California faces a budget deficit of approximately $73 billion, according to estimates by the state’s legislative analyst. Critics believe that simply providing universal coverage is not cost-effective and suggest alternative solutions to improve healthcare access. They advocate for policies like lifting bans on the sale of short-term health plans, which are less expensive, and expanding private insurance options as more sustainable approaches to delivering affordable care.

    Illinois recently had to pause its health insurance program for undocumented immigrants due to higher-than-expected costs. Since its launch in 2020, the program expanded twice and was projected to cost $1.1 billion. However, in 2023, the state allocated only $550 million and capped enrollment at 16,500 participants. The governor’s spokesperson attributed the underestimation of costs to unreliable metrics from the U.S. Census, indicating challenges in accurately predicting financial needs for such programs.

    How does expanding healthcare access relate to the migrant crisis?

    Advocates for expanding health coverage to undocumented immigrants argue that it will improve the overall health of the nation. With an estimated 10.5 million undocumented immigrants in the U.S., proponents suggest that broader access to healthcare could significantly boost public health by increasing care availability and vaccination rates among this population. They point to outbreaks of vaccine-preventable diseases, such as measles, poliovirus, and Covid-19, which have been linked in part to vaccine hesitancy among immigrant groups and low immunization rates. A systematic review indicated that barriers like limited access to medical care and infrequent doctor visits contribute to vaccine hesitancy. Therefore, supporters of healthcare expansion believe that improving access to care for undocumented immigrants will help reduce the spread of preventable diseases.

    Opponents of expanding health benefits for undocumented immigrants argue that such policies could incentivize more immigration to the U.S. They cite studies suggesting that immigrants are drawn to areas with generous welfare benefits, including healthcare. Critics also highlight the strain on hospital resources due to increased immigration. For example, Colorado hospitals have seen a significant increase in migrant patients, with a 69% rise in new patients over a three-month period, totaling around 6,000 migrant visits. This surge has led to overcrowded emergency departments, impeding access for other patients and forcing some hospitals to turn patients away. Dr. Richard Zane, chair of the Department of Emergency Medicine for UCHealth, expressed concerns, stating, “We will not deny emergency care. But at some point, access is impeded for everyone.”

    Takeaways from the debate: Cost analysis and the effect of coverage expansion on the US population 

    The debate over expanding healthcare to undocumented immigrants is complex, entangled with concerns about costs, program sustainability, and the ongoing migrant crisis. Proponents of expansion argue that it could lead to modest costs by reducing unnecessary emergency department visits and would significantly benefit public health by increasing healthcare access for the large undocumented population in the U.S. However, opponents contend that evidence from state programs and healthcare systems points to substantial costs associated with such expansions. Additionally, they argue that the growing number of undocumented immigrants, exacerbated by the migrant crisis, will further strain city, state, and federal budgets.

  • The Medicaid Reentry Act Debate: The Pros and Cons of Healthcare Services for Returning Citizens

    The Medicaid Reentry Act Debate: The Pros and Cons of Healthcare Services for Returning Citizens

    What is the Medicaid Reentry Act?

    The Medicaid Reentry Act is a proposed amendment to Medicaid law, designed to enhance healthcare access for incarcerated individuals, especially during their transition back into society. This legislation addresses healthcare disparities and improves health outcomes for a population often facing socioeconomic vulnerability.  For example, despite approximately 58% of incarcerated adults meeting clinical criteria for drug dependence or abuse, less than 30% receive any drug-use treatment while incarcerated. The Act seeks to bridge this gap in healthcare provision.

    What does the Medicaid Reentry Act do?

    The Medicaid Reentry Act, introduced as a bipartisan effort by Senators Tammy Baldwin of Wisconsin and Mike Braun of Indiana, targets the reduction of drug overdoses and recidivism post-release from prison. Recidivism, the tendency for convicted individuals to re-offend, is a pressing issue in our justice system. This Act addresses it by providing healthcare services during the crucial reentry period post-incarceration, aiming to break the cycle of recidivism.

    The Act proposes reinstating Medicaid benefits for eligible individuals 30 days prior to their release to avoid coverage gaps. Immediate access to healthcare upon release can help manage chronic conditions and mental health issues, thereby reducing overall illness rates. Additionally, it facilitates access to substance use disorder treatments, lowering the risk of overdose deaths. The Act aims for improved health outcomes and cost-effective healthcare.

    Its discussion in the context of the COVID-19 pandemic, the drug overdose crisis, and structural racism highlights its potential positive impact on healthcare services for eligible incarcerated individuals. This is especially relevant given the high rates of chronic diseases, mental illness, and substance use disorders among the incarcerated population.

    Arguments for The Medicaid Reentry Act:

    The Medicaid Reentry Act is a significant piece of legislation aimed at improving the reintegration of individuals after incarceration by addressing healthcare transitions. It recognizes the crucial role of health coverage, care, and medication during reentry, focusing on effective state and local practices to connect returning individuals with healthcare services.

    One key aspect of the Act is granting states the flexibility to reinstate Medicaid benefits before release, ensuring a smooth transition and immediate healthcare support upon reentry. Supporters of the Act highlight its importance, noting that individuals reentering society are 129 times more likely than the general population to die from a drug overdose in the first two weeks post-release. The Act prioritizes streamlined access to addiction treatments, thereby reducing the risk of post-release overdose deaths—a critical concern given the higher prevalence of substance use disorders in correctional facilities. By providing thirty days of Medicaid coverage before release, the Act aims to improve access to quality healthcare, promoting successful reintegration for individuals in jails, prisons, and juvenile detention centers.

    Supporters of the act recognize that the majority of incarcerated individuals will eventually reintegrate into society, highlighting the importance of uninterrupted health coverage. This approach aims to improve health outcomes, leading to better employment opportunities, housing stability, and family support, potentially reducing recidivism and the financial burden of repeated incarcerations.

    The policy is aligned with data demonstrating that expanding eligibility for public assistance programs such as Medicaid can have positive impacts on incarcerated individuals’ health, economic well-being, and crime-related outcomes. Expanded Medicaid eligibility in certain healthcare policies can increase access to treatment for conditions that may enhance employment prospects and reduce the risk of reoffending.

    Arguments against the Medicaid Reentry Act:

    Opponents of the Medicaid Reentry Act argue that the legislation could contribute to the national debt, especially in the current inflationary environment and amid ongoing concerns about the impact of the latest coronavirus variant. They point to the Medicaid Inmate Exclusion Policy, which prohibits the use of federal Medicaid funds for healthcare services provided to inmates of a public institution, as a key factor in the financial strain on counties. This policy shifts the responsibility of covering medical costs for incarcerated individuals to local budgets. Opponents are concerned that passing the Medicaid Reentry Act under this regulation could exacerbate financial strain on local budgets.

    Critics raise concerns about Medicaid enrollment declines in states not expanding, especially in Republican-led areas. The absence of consistent standards for accrediting correctional medical services under Medicaid leads to care quality issues. The Act’s effectiveness in jails, where discharge timing is uncertain, may be limited. Medicaid’s dual role as healthcare and a federal grant system raises worries about unequal benefits favoring wealthier states. The removal of Medicaid continuous enrollment may impact the Act’s effectiveness. 

    Research on state-driven Medicaid changes shows mixed results on recidivism. Fast-tracked Medicaid enrollment for individuals leaving prisons with serious mental illness increased usage but didn’t lower recidivism rates after twelve or thirty-six months. This raises doubts about Medicaid expansion’s effectiveness in this regard.

    Conclusion

    The Medicaid Reentry Act aims to improve healthcare for individuals post-incarceration, potentially reducing recidivism. However, concerns exist about financial strain on local budgets, inconsistencies in correctional medical services, and the Act’s effectiveness in jails due to uncertain discharge timing. The debate underscores the complexity of healthcare policy in the context of incarceration and reentry, highlighting the need for careful consideration of both the benefits and potential drawbacks of such legislation.

  • Pros and Cons of the Access to Genetic Counselor Services Act

    Pros and Cons of the Access to Genetic Counselor Services Act

    Introduction

    Genetic counseling is a service where a patient’s personal and family medical history are reviewed to assess the risk for genetic disorders and other diseases. The service is typically provided by genetic counselors but can also be done by other medical professionals like a patient’s physician. Currently, Medicare does not reimburse genetic counselors, which limits their ability to get paid for their services.

    The Access to Genetic Counselor Services Act is a proposed bill in Congress that would enable Medicare to reimburse genetic counselors for 85% of the amount it currently reimburses a patient’s physician.

    Arguments in Favor

    The Access to Genetic Counselor Services Act aims to enhance access to genetic counseling services for millions of Americans on Medicare by recognizing genetic counselors as independent Medicare providers, allowing them to bill directly. This change would alleviate the burden on physicians, freeing up more time for them to see other patients and streamlining the process for patients, who would no longer need to coordinate visits with multiple providers. This could lead to shorter wait times and improved access to care. According to the National Society of Genetic Counselors (NSGC), better access to genetic counseling can lead to earlier detection and treatment of diseases such as cancer, ultimately improving health outcomes.

    Proponents of the Access to Genetic Counselor Services Act argue that it could save Medicare over $4 billion in the next decade. The potential savings are attributed to several factors: genetic counselors are poised to recommend the most appropriate tests for patients, thereby reducing unnecessary testing and expenses. Another significant source of savings is the reduction in wasteful spending. For example, one study highlighted by advocates reviewed a series of genetic tests and found that 22% were inappropriate, suggesting that genetic counselors can play a crucial role in enhancing the efficiency and effectiveness of healthcare spending.

    Arguments Against

    Opponents of the Access to Genetic Counselor Services Act express concerns primarily based on the scope of practice and potential for fraud. The American College of Medical Genetics and Genomics (ACMG) argues that independently ordering tests is considered a practice of medicine, a role for which genetic counselors are not fully qualified. Currently, genetic counselors work under physician supervision, a setup ACMG supports because it believes that collaborative care yields the best medical outcomes. ACMG suggests amending the bill to allow genetic counselors to still be reimbursed by Medicare but under the requirement that they work collaboratively with physicians, not independently.
    Another significant concern is the risk of fraud within the rapidly expanding genetic testing industry. In 2019, federal agencies uncovered $2.1 billion in genetic testing fraud involving doctors bribed to order unnecessary and expensive tests reimbursed by Medicare. By expanding the number of professionals authorized to order reimbursable tests, the Access to Genetic Counselor Services Act could potentially increase the risk of similar fraud schemes, exacerbating challenges in an already vulnerable area.

  • Understanding the Tobacco Advertising Debate

    Understanding the Tobacco Advertising Debate

    History and Background of Tobacco Advertising

    Tobacco companies have employed various advertising methods over the past 75 years. Advertising initially began in the 1940s when tobacco companies enlisted doctors and dentists to endorse their products with slogans like “Just What the Doctor Ordered” and “More Doctors Smoke Camels.” This evolved into celebrity endorsements in the 1950s and 1960s, child-friendly characters in the 1990s, and sports and events marketing in the 2000s.

    In 2019, the largest cigarette and smokeless tobacco companies spent $8.2 billion on advertising and promotional expenses in the United States alone. This translates to approximately $22.5 million per day. Concerningly, research indicates that the tobacco industry has targeted specific demographics, particularly youths and young adults, to influence them early and secure future consumers.

    To address this issue, various regulations have been implemented to restrict point-of-sale (POS) advertising, signs, and displays, as well as require specific package sizes and written warnings for tobacco products. Federal law prohibits tobacco advertising on television and imposes restrictions on magazine and billboard advertising but does not prohibit advertisements in stores. In response, tobacco marketing has surged on the internet, especially through social media, where regulations are still lacking.

    Arguments for Tobacco Advertising

    Freedom of speech

    Companies often invoke ‘freedom of speech’ protection, asserting their right to inform consumers about their products. Advocates argue that cigarette advertisements provide essential consumer information and assist consumers in making informed decisions.

    From this perspective, the concept of ‘freedom of speech’ in advertising highlights the significance of empowering consumers to make choices aligned with their preferences and values. By presenting comprehensive product information, cigarette advertisements contribute to a marketplace where individuals can exercise autonomy in decision-making. This includes the fundamental right to engage with diverse perspectives and make choices that reflect their values, even when faced with controversial or contentious advertising content.

    Legal

    Tobacco’s legal status inherently supports arguments for its legality in advertising. Supporters of this view emphasize that advertising plays a crucial role in informing consumers about the array of choices available in the market. They argue that responsible advertising practices educate adults about different tobacco products, enabling them to make informed decisions about their consumption habits.

    Proponents of tobacco advertising contend that, when conducted ethically and transparently, advertisements offer valuable information on product attributes, flavors, and potential health effects. This information empowers consumers to assess the risks and benefits associated with tobacco use. Additionally, advocates highlight advertising’s role in promoting healthy market competition and driving economic growth in the tobacco industry. They assert that allowing companies to advertise their products stimulates consumer demand, fostering business expansion and innovation.

    Competition among companies encourages continuous improvements in product quality and the development of new offerings that cater to consumer preferences. Furthermore, revenue generated from advertising investments contributes to job creation, research and development endeavors, and overall economic well-being. From this perspective, legalizing tobacco advertising aligns with free market principles, promoting competition, innovation, and economic prosperity while respecting businesses’ rights to promote their lawful products.

    Economic impact

    The tobacco industry has a significant positive economic impact, which is often overshadowed in discussions about public health concerns. One key contribution is job creation. Globally, tobacco cultivation, manufacturing, distribution, and retailing support millions of jobs, especially in regions where tobacco farming is a significant agricultural activity. This includes roles from farmers tending to tobacco crops to workers involved in processing, packaging, and selling tobacco products, providing livelihoods for many individuals and families.

    Furthermore, the tobacco industry generates substantial government revenue through taxes and duties imposed on tobacco products. These revenues finance crucial public services such as healthcare, education, infrastructure development, and social welfare programs. Additionally, the industry stimulates economic activity in various sectors like advertising, transportation, packaging, and retail, thereby boosting local and national economies.

    Arguments against Tobacco Advertising 

    Health impacts

    Tobacco use is a major contributor to preventable deaths globally, leading to various serious health conditions such as cancer, cardiovascular disease, respiratory illnesses, and numerous other health issues. Smoking is notably linked to an elevated risk of lung cancer, as well as cancers affecting the mouth, throat, esophagus, pancreas, bladder, kidney, and cervix, among others.

    Besides the direct health effects of smoking, exposure to secondhand smoke also poses risks. Non-smokers exposed to secondhand smoke face an increased likelihood of developing many of the same diseases as active smokers, including lung cancer, cardiovascular disease, and respiratory ailments.

    Beyond individual health impacts, tobacco use places a significant burden on healthcare systems and economies due to heightened healthcare costs, reduced productivity, and premature mortality. In essence, the repercussions of tobacco sales on health are profound and wide-ranging, emphasizing the critical need for comprehensive tobacco control measures to diminish tobacco use and its associated health repercussions.

    Reduce smoke rates

    Reducing exposure to tobacco advertising has the potential to decrease the initiation of smoking among young people and non-smokers. Research indicates that advertising plays a crucial role in influencing attitudes and behaviors related to smoking, particularly among vulnerable demographics.

    Moreover, a decline in tobacco advertising could lead to lower smoking rates among current smokers. Advertising tends to reinforce smoking habits and promote continued tobacco use. With reduced exposure to these ads, smokers may have fewer reminders of their habit, potentially increasing their motivation to quit or cut down on tobacco consumption.

    Harm the natural environment

    The cultivation of tobacco plants necessitates significant amounts of land, water, and pesticides, leading to deforestation, soil degradation, and water pollution. Land clearance for tobacco farming disrupts ecosystems, diminishes biodiversity, and the chemicals involved in cultivation and processing can contaminate soil and water sources, posing risks to wildlife and human health. Additionally, the production and transportation of tobacco products contribute to greenhouse gas emissions and air pollution. Cigarette butts, the most common form of litter globally, contain toxic chemicals and non-biodegradable materials that harm marine life and pollute oceans and waterways. Addressing the environmental impact of tobacco sales is crucial for promoting sustainability and protecting ecosystems for future generations.

    To mitigate this environmental harm, stricter regulations for tobacco products are advocated. This approach is seen as a means to decrease tobacco sales, thereby reducing demand and, subsequently, the supply of tobacco. One proposed strategy is to promote the Polluter Pay Principle, whereby producers are accountable for cleaning up the pollution they generate.

    Conclusion 

    Addressing the tobacco advertising debate requires a balanced approach that takes into account the interests of individuals, businesses, and society. Effective policies need collaboration among policymakers, public health advocates, and industry stakeholders to find a balance between consumer choice, public health, and environmental sustainability. Both sides agree that promoting informed decision-making, protecting vulnerable populations, and ensuring the well-being of individuals and ecosystems are crucial in tackling the complex challenges posed by tobacco advertising.

  • Understanding the Access to Infertility & Care Act Debate

    Understanding the Access to Infertility & Care Act Debate

    Background on Infertility & Fertility Preservation

    Infertility poses a significant public health challenge, affecting roughly one in six individuals worldwide, irrespective of income levels. In the United States, married women aged 15-49 face a notable prevalence, with approximately 19% experiencing difficulties conceiving. Furthermore, within this demographic, 26% of women who do conceive encounter challenges in achieving and maintaining a pregnancy. Typically, infertility rates are assessed based on the inability to conceive after a year or more of unprotected sexual activity.

    For individuals facing infertility, there exists a range of treatment options, although their high costs often render them inaccessible without insurance coverage. To tackle this issue, 21 states in the U.S. have implemented fertility insurance coverage laws. Among these, 14 states provide coverage for In Vitro Fertilization (IVF) treatments, one of the more common and effective fertility interventions. Additionally, 15 states have specific coverage laws for iatrogenic infertility, which refers to infertility caused by medical procedures or treatments.

    This legislative advancement underscores a growing acknowledgment of infertility as a significant health issue, prompting the need for more accessible and affordable treatment avenues. Nevertheless, the availability of insurance coverage for fertility treatments varies widely across states, underscoring ongoing disparities in healthcare access concerning reproductive health.

    Introduction to the Access to Infertility Treatment & Care Act

    The Access to Infertility Treatment & Care Act is designed to broaden insurance coverage for infertility treatments and fertility preservation procedures across the United States, targeting a diverse range of individuals, particularly those in low and middle-income groups, as well as veterans, Medicaid enrollees, federal employees, and military members.

    Key provisions of the bill include:

    1. Prohibitions for Health Insurance Providers: The bill forbids health insurance companies from offering incentives to policyholders to opt out of infertility procedures. It also prevents these providers from decreasing reimbursement rates for healthcare providers who perform infertility and fertility preservation procedures.
    2. Mandatory Coverage Requirements: The Act mandates that health insurance plans in the U.S. cover the costs of specific infertility treatments, such as In Vitro Fertilization (IVF). It ensures that individuals who need to undergo medical treatments that could impair fertility have access to fertility preservation methods.
    3. Extended Coverage: Coverage for infertility treatment and fertility preservation is extended to include veterans, individuals enrolled in Medicaid, federal employees, and members of the military.

    The Act is particularly focused on assisting groups that often face difficulties with infertility, including low and middle-income couples, single women, women over the age of 35, Medicaid holders, federal employees, veterans, and military personnel. By doing so, it aims to address disparities in access to fertility treatments and to support a broader range of individuals facing infertility challenges.

    Arguments in Support of the Access to Infertility Treatment & Care Act

    1. Financial Accessibility to Treatments

    Advocates of the Access to Infertility Treatment & Care Act highlight the significant financial relief it could provide to individuals who currently find the costs of infertility and fertility preservation care prohibitive. They point to a 2015 survey conducted by the Wall Street Journal, which revealed that 44% of women who underwent infertility treatments incurred debts exceeding $10,000.

    Congresswoman DeLauro emphasizes the harsh reality faced by many due to the lack of insurance coverage for such treatments. She notes that the high costs often force individuals to make difficult choices between basic necessities like food, clothing, and housing, and their desire to pursue parenthood. This financial barrier, she argues, effectively limits family growth to those of certain financial means.

    Supporters of the Act argue that by reducing the financial strain associated with infertility treatments and fertility preservation, the Act will not only make these medical services more accessible but will also alleviate the emotional stress often accompanying these procedures. The aim is to create a more equitable landscape where the dream of starting or growing a family is not restricted by economic barriers, thus addressing both the financial and psychological impacts of infertility.

    1. Infertility Treatments and Fertility Preservation Should Be Considered “Medically Necessary” Forms of Care

    Advocates of the Access to Infertility Treatment & Care Act are highlighting the evolving dynamics of family planning in modern society. A significant number of young people are now opting to start their families later in life due to educational and career commitments. This shift means that many women are attempting pregnancy in their mid-30s and 40s, an age range often associated with more complex pregnancies compared to younger women. Supporters of the Act argue that women should not be compelled to choose between their professional ambitions or educational pursuits and their fertility aspirations due to the financial burden of infertility treatments.

    Another key point raised by proponents of the Act is the promotion of “fertility equality” for the LGBTQ+ community. Currently, many insurance providers do not cover fertility treatments for same-sex couples, which advocates see as a significant inequality. The Access to Infertility Treatment and Care Act aims to address this issue by mandating that fertility treatment and preservation coverage be extended to all individuals, regardless of their gender or sexual orientation. This provision would mark a significant step towards ensuring that LGBTQ+ individuals and couples have equal access to fertility treatments and the opportunity to start families, just like their heterosexual counterparts.

    Arguments Against the Access to Infertility Treatment & Care Act

    1. Religious & Ethical Beliefs

    Opponents of the Access to Infertility Treatment & Care Act often have religious or ethical concerns regarding the medical processes used in infertility treatments. For example, Roman Catholics and Orthodox Christians, both of which make up about 20% of the world’s population, do not support assisted reproduction. In a globally recognized 1956 proclamation by Catholic figurehead Pope Pius XII, artificial insemination was deemed “illegal” and “immoral,” as it separates procreation from the act of having sex. Other opponents grapple with the ethical implications of deciding what to do with extra embryos harvested during treatments such as IVF. Deciding whether to donate the embryos to another family, thaw and dispose of them, or store them indefinitely is a challenging moral dilemma for some. Many believe that the Act will expose more people to ethically complex choices regarding their fertility journeys.

    1. Infertility Treatments as Optional Procedures & Adoption

    Infertility treatments and fertility preservation procedures are not remedies to extremely serious or life threatening health conditions. As a result, opponents to the Act state that the treatments should not be considered required procedures under health insurance guidelines. Furthermore, to encourage adoption, some critics argue that there should be more benefits for those who choose to adopt, in place of coverage for infertility treatments. A 2021 study found that over 113,000 children of the 391,000 in foster care are eligible for adoption. Opponents to the Act believe that coverage for infertility treatments could potentially dissuade people from adopting a child currently in need of a home.

    Conclusion

    The Access to Infertility Treatment and Care Act debate grapples with diverse religious, financial, ethical, and medical perspectives on the emotionally-charged topic of fertility. Without insurance coverage for infertility treatments and fertility preservation, some people are left without the opportunity to ever have biological children. Meanwhile, opponents believe that religious contentions surrounding infertility treatments, in conjunction with the intricacies of insurance financials, should prevent fertility preservation and infertility treatments from being covered. Ultimately, the legislation, despite its final outcome, will be heavily debated for time to come.

  • Understanding the FAIR Drug Pricing Act Debate

    Understanding the FAIR Drug Pricing Act Debate

    The Fair Accountability and Innovative Research Act was introduced in March 2021. The FAIR Drug Pricing Act imposes a requirement on pharmaceutical companies to notify the U.S. Department of Health and Human Services (HHS) and furnish a transparency and justification report at least 30 days before implementing any price increase on drugs priced at $100 or more. This notification is necessary if the price hike surpasses 10% within one year or 25% within a three-year period. Additionally, for drugs with a list price exceeding the median family income, which stood at $70,784 in 2021, manufacturers are obligated to submit a transparency and justification report as well.

    This act was brought on by public concern over drug affordability. According to a poll by KFF, six in ten adults are taking at least one prescription medicine, while a quarter of adults are taking 4 or more. This is a problem because those who need more medicine may be unable to access them due to the high cost. The FAIR Drug Pricing Act aims to curb drug prices by limiting unnecessary price hikes; however, some question the effectiveness of the act.

    Arguments in Favor of the FAIR Drug Pricing Act

    1. Easier to control prices: Drug pricing transparency allows citizens to learn about price hikes in advance, as well as the justification for price hikes. Policymakers believe this may give citizens the ability to organize and protest price increases, and raise the cost for pharmaceutical companies who may currently feel they can raise prices with impunity.
    2. Control healthcare expenditures: Drug spending in the U.S. increases every year, beyond inflation. In 2021, overall pharmaceutical expenditures in the U.S. grew 7.7% compared to 2020, for a total of $576.9 billion. Utilization (a 4.8% increase), price (a 1.9% increase) and new drugs (a 1.1% increase) drove this increase. Drug transparency can contribute to overall healthcare cost savings, as it allows policymakers to identify and address instances of excessive pricing or price increases.
    3. People will become more educated in terms of choosing drugs for health: This transparency encourages consumers by giving them insight into the reasoning behind price changes, helping them make more informed decisions about their medication options. For example, if a drug has a history of price hikes, a consumer might more heavily consider purchasing an alternative treatment or discussing other options with their healthcare provider.

    Arguments Against the FAIR Drug Pricing Act

    1. Hinder companies’ ability to invest in future drug development: When pharmaceutical companies’ research and development costs are made public, policymakers and patient advocates may use this information to pressure companies into lowering drug prices. While this may benefit patients in the short term, it could hinder companies’ ability to invest in future drug development. 

    The collective push for lower drug prices, while addressing the present needs of patients, introduces an intricate dilemma. The revenue streams that sustain pharmaceutical companies’ ambitious research and development projects might experience a pinch as pricing adjustments ripple through the industry. The risk of eroded profitability looms, potentially hampering the companies’ ability to reinvest a significant portion of their earnings into the high-risk, high-reward realm of future drug development.

    Additionally, when drug production information becomes available for everyone, competitors may strategize to develop a similar drug at a lower cost, eroding the profitability of the original. This type of intense competition may drive down companies’ incentives to develop new drugs. 

    1. Shortages in generic medications: A generic drug is a medication created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use. Generic drugs tend to cost less than their brand-name counterparts because generic drug applicants do not have to repeat animal and clinical (human) studies that were required of the brand-name medicines to demonstrate safety and effectiveness. However, if generic drug manufacturing costs are made public, repercussions of this include lowering the price of drugs and less revenue being generated in the medicine market, resulting in the reluctance of companies to enter the drug market, fearing that they cannot compete on price and still maintain profitability. In the long run, transparency would lead to shortages of essential generic medications.

    The reports are economical and scientific: Transparency might not be beneficial if citizens aren’t able to comprehend the intricacies of the justification report. Particularly in medicine, these reports often include complex chemical and intricate biological terminology. In tandem with scientific terms, transparency reports are also likely to include detailed economic models that aren’t in the norm for most American citizens. The challenge of decoding both the scientific and economic dimensions can result in significant hurdles for citizens looking to glean insights from these reports. As citizens strive to make informed decisions about their healthcare choices and understand the rationale behind drug pricing, the opacity of complex scientific and economic jargon can often lead to a lack of clarity and transparency, ironically defeating the purpose of the transparency initiative.

  • Understanding the ACA in Chronic Care Debate

    Understanding the ACA in Chronic Care Debate

    The Patient Protection and Affordable Care Act, also known as the Affordable Care Act or “ACA” for short, is a healthcare reform law that was unveiled in March 2010. The primary objective of the ACA is to increase access to health insurance for a larger number of U.S. citizens. Because of this, the ACA mandates that every U.S. citizen and legal resident must have health insurance. To achieve its goal, the government is planning to expand the Medicaid program, which is the primary program for healthcare coverage serving people of lower income, to expand coverage for all adults whose income falls below 138% of the federal poverty level.      

    Chronic diseases, which are ongoing health conditions that have lasted at least one year, are consistently affecting growing numbers of America, and are the leading causes of death in the United States. About 45% of Americans suffer from at least one chronic illness. Thus, chronic care is currently one of the biggest costs in healthcare, which claims 90% of the $4.1 trillion of the healthcare budget for people with chronic and mental conditions. People 50 years old and older with at least one chronic disease are projected to increase by 99.5% from 2020 to 2050, totaling at 142.66 million by 2050, which might affect health insurance and health funding as a whole. People with chronic diseases need long-term care, treatment, and resources, which means that the costs of healthcare are large to begin with. Because it is predicted that people with chronic conditions will rise in the following years, it is also predicted that the costs of healthcare will continue to rise as a response. These high costs could either make health funds raise their prices or place a greater financial burden on people with chronic diseases. This is where the ACA comes into play. The ACA’s goal of expanding health insurance access for all Americans raises the question of how it would impact individuals with chronic diseases.  

    Advocates champion the ACA for three reasons:

    1. Affordable healthcare is considered a right. One of the primary arguments put forth by ACA advocates is the belief that affordable healthcare is not merely a privilege but a fundamental right that should be accessible to all individuals. This ethical standpoint aligns with the principles of social justice, as it emphasizes the importance of ensuring healthcare access for everyone. By aiming to provide more access to health insurance and healthcare for all, the ACA plays an important role of promoting justice within health, which includes a fair distribution of healthcare resources to ensure that society flourishes as a whole. Consequently, this understanding implies that individuals with chronic diseases and illnesses should receive enhanced insurance benefits to adequately address their healthcare needs and facilitate proper care and treatment. 
    1. The ACA helps with preventative measures for individual conditions. It provides free preventative measures, contributing to better health outcomes and cost savings in the long run. For example, it offers a range of vaccines to both children and adults, a considerable number of screenings, including several types of cancer and chronic conditions, and behavioral screening. This ensures that individuals are able to receive immunizations and screenings which are crucial in preventing the spread of diseases and safeguarding public health. Furthermore, the ACA addresses the financial challenges associated with chronic disease management. Under the ACA, insurance plans are required to cover a wide range of prescription medication for chronic conditions, services related to chronic disease management (check-ups, consultations with healthcare providers, and therapy), and a reduction in hospitalization costs. By requiring insurance plans to cover health benefits, the ACA helps individuals with chronic conditions manage their conditions and prevent complications or exacerbations. 
    1. The ACA helped lower the costs of healthcare. The Patient’s Bill of Rights, which is an interim final regulation announced about six months after the Affordable Care Act, ensures that some financial barriers towards getting healthcare will be removed. A study found that 64% of the sample was satisfied with the impact of the Patient’s Bill of Rights. Supporters of the ACA believe that this Bill of Right has helped a lot of people (children, pregnant women, and people with disabilities) by protecting patients’ coverage for pre-existing conditions, protecting the choice for doctors, and ending lifetime limits on the care that a patient may receive. 

    Those opposing the ACA are against this for three reasons:

    1. Critics of the ACA believe that mandating nation-wide coverage might not be feasible from both an organization and financial standpoint. There are multiple challenges to universal healthcare, including a heavier burden on insurance companies for providing funds for the previously uninsured or the government to provide lower costs for healthcare and physical and technological changes in the healthcare system. With chronic diseases, a growth in the demand for healthcare is inevitable, which means that as more people get insured, healthcare workers will receive more burden in their line of work as the demand for healthcare continues to grow. Moreover, the cost of healthcare will continue to increase and that burden will fall onto taxpayers. Opponents of this plan believe that it might not be the most efficient in terms of manpower and financial burdens. 
    1. Trust among American citizens and the government is low, leading to skepticism and disbelief in the ACA’s effectiveness. Critics of the ACA believe that the government should have minimal involvement in healthcare. The opposition’s reasoning for this is the belief that the government is doing too little to address the issues of concern for several groups, including middle-income people, retirees, rural residents, and suburbanites. Middle-income people are especially burdened because the inflation of costs associated with health insurances are increasing faster than their income. Retirees are also burdened by the rapid inflation of healthcare costs. Due to not actively earning income, they are worried that the ACA might lead to cuts in their Medicare benefits or increased costs for supplemental coverage, adding to their financial insecurity. 
    1. People opposing the ACA argue that healthcare should be based on personal financial responsibility. The argument is that individuals who have not made sufficient efforts to finance their own healthcare should not receive the same level of support as those who have made greater financial contributions. People against the ACA think that some individuals may not be deserving of healthcare benefits if they have not demonstrated adequate effort or responsibility in managing their own healthcare expenses. However, oppositions do make exceptions for individuals with disabilities or pre-existing conditions. They recognize that certain people face circumstances beyond their control that may prevent them from independently financing their healthcare needs, which leads to the acknowledgment that these people need social support and safety nets to ensure that they have access to the necessary healthcare services.
  • Food Security and Local Food Production

    Food Security and Local Food Production

    Background

    Generally, local food production refers to systems in which food is produced, distributed, and consumed within the same area. However, there is debate within the local food movement about this definition. For example, some call for local food systems to expand distribution—to sell food outside of the boundaries of the local community—while others fear that this kind of expansion would dilute local food’s impact. The looseness of the term local food production is perhaps indicative of its relatively new growth in the American food system. 

    Historically, local food (at least in the way that it is generally defined today) was not a major factor in American food production. Even today, it makes up a very small portion of total U.S. agriculture. The U.S. Department of Agriculture (USDA) found that in 2012, local food sales produced $6.1 billion, or about 1.5% of total U.S. agricultural production. This is an increase from 2008, where the USDA estimated that these sales accounted for $4.8 billion. However, the U.S. food system remains focused on globally integrated food production, where the places in which food is grown and processed and the places where it is eaten can be thousands of miles apart. 

    There are efforts to use local food production to address issues of food insecurity, which remains a significant issue in the U.S. The USDA reported that 10.5% of households in the United States were affected by food insecurity in 2020. The use of local food production as a means of addressing food insecurity has been contextualized differently in different national contexts. In Cuba, for example, it has been utilized as a means of bolstering the nation’s domestic food supply, particularly during times of crisis. In the context of the U.S., the focus of local food production appears to lie less on increasing the quantity of the food supply than it does on shifting the way in which the food supply is produced in order to improve food access and food system resiliency.

       USDA Estimates of Local Food Sales 2008-2012, Congressional Research Service

    Food Accessibility

    Proponents of local food production argue that it can improve access to food. One of the main arguments is that local food production, by siting food within communities, can make healthy food more accessible to those communities. In neighborhoods where healthy food vendors are scarce, residents may need to travel outside of their neighborhood to reach healthy food; local food production is intended to bring healthy food closer to people. 

    Another main argument made by supporters of local food production is that it can encourage the formation of political practices, within communities, that enable people to have greater agency in their food system, and make decisions about food distribution more equitably. Access-based local food production efforts can be seen through governmental policies in the form of USDA funds that are designed to support farmers markets and urban gardens. On the nongovernmental side, there are efforts to create local food systems that link consumers, producers, processors, and distributors with institutions to support the community through local food production and food-based businesses. 

    There are also efforts to form local food retail sites such as farmers markets. The evidence surrounding each of these elements of accessibility is conflicting. There is some evidence that local food production can have some impact on the diets of communities. For instance, there is research suggesting that proximity to farmers markets improves diet and exercise. Additionally, there is research showing that, in general, convenient access to healthy food causes incidences of overweight and obesity to decrease, and diets to improve. As farmers markets are designed to bring food (especially produce) from local farmers directly to consumers in a community, it has been argued that farmers markets can fulfill this role of providing convenient food access. However, it has also been argued that there is not sufficient evidence to demonstrate that increasing access to local food improves either diets or food security. 

    A study of 24 farmers markets in Los Angeles found that the amount of fresh produce offered in farmers markets differs based on the racial and economic composition of the communities in which they operate, which raises issues about equity. In addition, local food is often as, or more expensive than, non-local food, which casts doubt on its potential to improve access through affordability. 

    At the same time, there is evidence showing that expanding local food production increases employment, among a number of other positive economic outcomes. For example, a study from Iowa State University found that re-localizing the production of staple food items (such as chicken or eggs) would add 50-75 jobs in Southeast Iowa. 

    Evidence of local food systems fostering more equitable food distribution and increased community agency is similarly conflicting. Research suggests that while local food production can increase equity and agency, it does not always do so, and some have argued that localized food systems may actually produce issues of inclusion. However, others argue that this criticism of local food systems makes generalizations that are too broad, and call for more research on different local food initiatives.

    Food Resiliency

    Advocates for expanding local food production allege that it can improve food security by strengthening the resiliency of the American food system. One of the main arguments is that expansion of local food production makes production sites more geographically dispersed, and introduces diversity in production and distribution, making the system less vulnerable to shocks. It is also argued that it shortens supply chains, thereby saving on energy costs and protecting the environment. 

    The USDA has invested some money into the resiliency aspect of local food production, including loans specifically intended to encourage private investment into local food processing. Additionally, in an endeavor that combines both the private and governmental sectors, there is a partnership between the Southeast regional supermarket chain Lowes Foods and the Center for Environmental Farming Systems that used U.S. government funding to engage in a partnership to increase the amount of local food available at Lowes Foods. 

    There is some debate about whether local food systems improve food system resiliency. While local food systems shorten supply chains, because they are generally meant to keep the distribution of food within a certain area, the claim that they reduce energy costs has been challenged. For example, some research suggests that the local deliveries made by trucks performing regional food distribution are relatively less efficient than the large-scale transportation used in the mainstream food system. Some have also argued that local food production may not be the most efficient use of agricultural resources, arguing that non-local producers make better use of them. 

    Additionally, an article from the American Enterprise Institute argues that, though local food production has its uses, a food system that makes use of international food trade is less vulnerable to disruption than a purely local one, because the shocks to global food systems that are the most important are weather-based issues affecting yields, and usually impact individual countries more severely than they do the world system as a whole. 

    There is evidence supporting the use of local food production as a means of strengthening food security, and actions are being taken within the federal government, as well as  outside of it, to expand it. However, an existing body of contradictory research suggests a potential need for further research on this topic, if local food production’s potential to impact food security is to be fully understood. 

  • Understanding the Access to STD Resources and Healthcare Debate

    Understanding the Access to STD Resources and Healthcare Debate

    What are Sexually Transmitted Diseases (STDs)?

    Also known as sexually transmitted infections (STIs), sexually transmitted diseases (STDs) are “infections that are passed from one person to another through sexual contact”. While there are more than 20 types, the eight most common in 2018 included chlamydia, genital herpes, HIV, HPV, syphilis, trichomoniasis, and hepatitis B. STDs can be symptomatic or asymptomatic, and STDs caused by bacteria or parasites are easier to treat because antibiotics are effective remedies. Viruses, on the other hand, cannot be treated and medications can only be used to mitigate the spread and severity of symptoms. Preventative measures include latex condoms (although condom usage remains low), regular screenings, and vaccines for HPV (the most common type of STD) and hepatitis B. 

    Rates of STD transmission remain high throughout the United States, and disproportionately affect gay and bisexual men as well as Black and Hispanic populations. In 2018, 20% of Americans were infected with an STD, totaling out to 68 million infections by the end of the year. Those within the 15-24 year-old age group comprised 46% of those cases. STD cases are increasing; as are the healthcare costs associated with treating STD patients. In direct costs alone, spending amounted to $16 billion in 2021. It is crucial to treat STDs early because untreated diseases such as chlamydia, gonorrhea, and syphilis can lead to ectopic pregnancies and fertility issues for women and a higher risk of contracting HIV. 

    Current Financial Coverage for STD Resources and Healthcare

    Medicaid is the largest financial contributor to reproductive healthcare coverage. Medicaid is also the largest public funder of HIV treatment and care. In 2014 and 2015, data from the National Ambulatory Medical Care survey indicated that compared to other payment sources, Medicaid disproportionately covers services for individuals that are most likely to need STD care, which is usually those who are younger, female, minorities, part of the LGBTQ+ community, people with disabilities, and those of lower socioeconomic status. In 2020, 37 states and the District of Columbia made STI screenings and counseling, preventative vaccinations, and PrEP eligible for coverage under Medicaid. 

    Medicare provides healthcare financing to those who are 65+ and/or have long-term disabilities. Part B covers “STI screenings for chlamydia, gonorrhea, syphilis, and/or hepatitis B once every 12 months for individuals at increased risk for an STI or at certain times during pregnancy for pregnant individuals”. It also covers one HIV screening per year, and Part D covers all approved antiretrovirals (with potential for cost sharing). Under the Affordable Care Act, private health insurance plans are mandated to cover recommended preventative services (HIV, other STI screenings, and prescriptive contraceptives for women) with no cost sharing. Uninsured individuals can receive care from health clinics and departments that are federally funded by agencies like HRSA, the CDC, and the Office of Population Affairs (OPA). 

    Title X

    Title X, created in 1970, is a program for low-income individuals to obtain affordable birth control and reproductive healthcare. Wellness exams, birth control, contraception education, and testing/treatment for STDs and HIV are all provided. Participating clinics like Planned Parenthood, federally qualified health centers (FHQs), and state and county health departments receive federal funding for services of this nature. In 2019, the Trump administration passed the Title X gag rule. This effectively banned physicians associated with the program from providing patients with information about abortion. Other services were also affected by this decision–Title X’s network patient capacity was reduced by half, Planned Parenthood could no longer serve 40% of the program’s four million patients, and six states lost Title X providers entirely. The original provisions of the Title X program were reinstated by the Biden administration in 2021. 

    Arguments in Favor of the Right to Contraception Act & Financial Coverage of Contraceptives

    The Right to Contraception Act was introduced in summer 2022 with the objective of protecting “a person’s ability to access contraceptives and to engage in contraception, and to protect a health care provider’s ability to provide contraceptives, contraception, and information related to contraception”. This bill also argues that access to contraception is a fundamental human right, that it is essential to one’s ability to participate equally in economic and social life (especially for marginalized populations), and that it is vital to sexual and reproductive health. Furthermore, it acknowledges that some states have attempted to associate contraceptives with the definition of abortion.

    The bill would grant individuals the statutory right to obtain and engage in contraception, for healthcare professionals to provide “contraceptives, contraception, and information related to contraception” (codifying the right to contraception nationwide), and for the Justice Department to take contraception restrictions to court. Following the overturning of Roe v. Wade, legislators have begun to explore codifying other policies, like access to contraception, which were not viewed as necessary before. 

    Arguments Against the Right to Contraception Act & Financial Coverage of Contraceptives

    Some in opposition argue that the legislation violates states’ rights to regulate their own healthcare policy and violates the Religious Freedom Restoration Act, which “establishes balancing test courts can use when deciding religious-liberty cases involving federal laws and regulations”. There is also concern because the bill does not list any age restrictions, making protections for minors more difficult. 

    There is also concern that the bill is a “Trojan horse for more abortions”. It would grant a federal right to use the abortion drug Mifepristone (which has both contraceptive and non-contraceptive uses). The legislation would also prohibit states and the federal government from cutting off taxpayer subsidies to Planned Parenthood, and abortion services are offered by Planned Parenthood subject to state regulation. 

    In September 2022, the state of Texas was taken to court by a group of residents and employees over the Affordable Care Act. They argued that mandating the coverage of preventative care violated their religious freedoms and that health plans covering screenings for STDs and HIV prevention drugs should not be required because it will “facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use”. Judge Reed O’Connor’s final ruling was that “compulsory coverage for [these] services violates [employers’] religious beliefs by making them complicit in facilitating homosexual behavior and [illegal] drug use”. Therefore, Texas insurers no longer have to cover PrEP (prevents transmission of the HIV virus), contraception, HPV vaccines, and screenings/behavioral counseling for illicit drugs and STDs. 

    What Happened to the Right to Contraception Act?

    The Right to Contraception Act ultimately passed the House of Representatives with a 228-195 vote. In July 2022, Senators Patty Murray and Edward Markey sought unanimous consent to get the Right to Contraception Act passed, but it was blocked by Senator Joni Ernst. As a result, the bill died because “Legislation not passed by the end of a Congress (in this case, from January 3rd, 2021 to January 3rd, 2023 in the 117th Congress) is cleared from the books”. Today, this question remains: should contraceptives continue to be publicly and privately funded, or should access be regulated on a state level?