A new survey from the Guttmacher Institute reveals that poor women are obtaining abortions in greater numbers than women from other income brackets. From 2000 to 2008, “the proportion of abortion patients who were poor increased 59%,” as women found it more difficult to access affordable birth control during an economic recession:

The survey occurred during an economic recession, which may account for some of the substantial increase in poverty among abortion patients between 2000 and 2008…. More indirectly, recent studies have found that because of financial constraints, women want to delay childbearing or limit the number of children they have, but these same constraints have made it harder for them to access contraceptives and to use them consistently. In these situations, poor women may have found it more difficult than better-off women to obtain and use contraceptives and prevent unintended pregnancies. Additionally, when confronted with an unintended pregnancy during the recession, poor women who might have felt equipped to support a child (or another child) in financially stable times may have decided that they simply were not equipped to do so now.

Significantly, 57% of the women who had abortions paid out of pocket for the procedure, regardless of their insurance status. As Guttmacher observes, “We suspect that several factors contributed to the lack of reliance on private insurance among women who had it. First, some may have had health care plans that exclude abortion services…Others may have been unaware that their plan covered abortion. Some women may have been reluctant to have the abortion on their insurance records out of concern that an employer, regular health care provider or family member whom they did not want to know about the abortion would have access to this information.”

The results are fairly consistent with earlier surveys, which found that continued stigmatization of abortion — treating it as if it is something wholly different something different than “normal” health care — forces women to pay out of pocket and disproportionately disadvantages poor women, who undergo the procedure at higher rates. Ironically, the passage of health care reform — which will certainly help women obtain access to better health care — could indirectly undermine access to abortion coverage and increase the financial stress of poorer women. The Nelson amendment “reignited the abortion wars in the states” and “opened the door for them to legislate away private insurance coverage of abortion.” The next Guttmacher survey may very well find more women paying out of pocket for abortion coverage than ever before.

In November, the Preventive Task Force issued recommendations advising primary care physicians against recommending mammograms to women under 40 years of age. While the guidelines were the result of comprehensive scientific review of the benefits of mammogram testing for women under 40 and have no bearing on coverage decisions, Republicans presented the Task Force as a poster child of health care rationing and even introduced and approved an amendment that essentially disregarded the task force’s recommendation. Many Democrats also voted for the measure.

But now, a new study published in the Journal of National Cancer Institute confirms that politicians should not interfere with science. Researchers tracked the records of “more than 117,000 women who had their first mammogram before 40, and the results support today’s guidelines for average-risk women.” The study found that “in a theoretical population of 10 000 women aged 35–39 years, 1266 women who are screened will receive further workup, with 16 cancers detected and 1250 women receiving a false-positive result.” From the study:

In our population, a substantial percentage of young women [under 40] received screening mammography, but few breast cancers were found, regardless of their specific age, race, or individual characteristics. Yet, these women experience high recall rates with high rates of additional imaging. The sensitivity, specificity, and screening positive predictive value of screening mammography were poor, and cancer detection rates were very low in these young women, who are not yet in an age group for which national organizations recommend regular screening mammography. Harms need to be considered, including radiation exposure because such exposure is more harmful in young women the anxiety associated with false-positive findings on the initial examination, and costs associated with additional imaging.

Undoubtedly for some younger women, an early mammogram is a life saver, but for the majority, it’s an unnecessary test that raises stress levels and contributes to skyrocketing health care costs. Government guidelines can reflect this reality without constraining the doctor. She or he can use the recommendations as just one piece of data among many that could help guide physicians in treating individual patients.

After all, the system can’t accommodate a situation in which doctors order CAT scans for simple headaches or complicated surgeries for problems that can be solved with a regimen of medication, and politicians shouldn’t pretend it can (while also complaining about rising health care costs).

The new health care law includes a free rider provision that assess employers with 50 or more employees “that do not offer coverage and have at least one full-time employee who receives a premium tax credit, a fee of $2,000 per full-time employee (excluding the first 30 employees from the assessment). Employers that do offer coverage but have “at least one full-time employee receiving a premium tax credit” will have to pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee.

Under the law, businesses that don’t offer coverage and pay wages that can qualify an employee to receive tax credits will incur additional costs, and fast food establishments are already complaining about the “increased tab.” Franchisees estimate the new federal health care bill “could cost them as much as $55,000 per restaurant annually,” Chicago Business reports:

That’s a significant hit for franchisees, whose restaurants generate about $2.4 million in revenue and $300,000 in pre-tax profit, on average. And it could hamper the Oak Brook company’s campaign to persuade franchisees to remodel thousands of locations in the next five years. With their profits reduced, the restaurant owners are likely to raise prices and resist McDonald’s push to offer promotions and discounts to boost sales. [...]

Mark Kalinowski, an analyst in New York at Janney Capital Markets, last month surveyed 16 franchisees about the health care bill and found the average expected cost was $55,000 per restaurant and the median response was $50,000. He estimates the new law would “wipe out” about 15% to 20% of profits.”

Part of this is likely overblown. Since the free rider/individual mandate requirement does not go into effect until 2014, nobody knows what the real impact of reform will be and some restaurants may find it cheaper to offer coverage to their employees in the exchanges or associations than pay the penalty. Secondly, having healthier workers serving and cooking fast food seems like a win-win for everyone involved, as does the possible increase in fast-food operating costs.

Fast food restaurants could conceivably respond to the higher costs by producing cheaper, even lower quality foods, or they could, as the article suggests, increase prices and stop renovating the space to attract younger children. If the latter is the case, then health reform could act as a “tax” that discourages consumption of the kind of food that increases chronic health care costs. That, seems to me, will be a sign that reform is working.

In the last month of the health care debate, the administration vilified insurers for denying coverage to sick people, dropping individuals when they became sick and increasing premiums by some 39% during an economic rescission. As the President crossed the country in a final push to build support for the effort, he argued that the current system “works better for the insurance companies than it does for the American people” and promised to sign a reform bill that would give the power back to the American people. “Every year, insurance companies deny more people coverage because they’ve got preexisting conditions. Every year, they drop more people’s coverage when they get sick right when they need it most. Every year, they raise premiums higher and higher and higher,” Obama said during a March 8th rally in Pennsylvania. “We need to give families and businesses more control over their own health insurance. And that’s why we need to pass health care reform — not next year, not five years from now, not 10 years from now, but now.”

Now that health reform has passed, the administration has adopted a much more conciliatory tone towards the industry. Yesterday, Obama invited 13 members of the Business Council to dinner to discuss “the legislation pending in the Senate to overhaul U.S. financial regulations, as well as administration efforts to spur economic growth.” Among the guests were the CEOs of two large insurance companies, WellPoint and Aetna:

· Ronald Williams, Chairman & CEO, Aetna
· Patricia Woertz, Chairman, President & CEO, Archer Daniels Midland Company
· Riley Bechtel, Chairman & CEO, Bechtel Group, Inc.
· Peter Grauer, Chairman, President & CEO, Bloomberg, Inc.
· Jim Owens, Chairman & CEO, Caterpillar
· Ellen Kullman, Chairman & CEO, DuPont
· Rex Tillerson, Chairman & CEO, ExxonMobil
· Jamie Dimon, Chairman, President & CEO, JPMorgan Chase & Co.
· Charles Moorman, Chairman & CEO, Norfolk Southern Corporation
· Steve Odland, Chairman & CEO, Office Depot
· James Goodnight, Chairman, President & CEO, SAS Institute Inc.
· Andrew Liveris, Chairman & CEO, The Dow Chemical Company
· Angela Braly, Chairman, President & CEO, WellPoint, Inc.

While some may view Obama’s new approach as a cynical ploy, the new friendlier tone makes more sense in the post reform-world. The administration will have to rely on insurers to implement reform and partner with the industry to encourage Americans to sign up for coverage. Regulators will work closely with AHIP and all of the health care stakeholders to issue the appropriate rules and regulations and will make use of the group’s technical expertise.

As Jon Kingsdale, the director of the Commonwealth Connector Authority, observed in yesterday’s Boston Globe, “Brow-beating various industries may be good partisan politics, but the Health Connector has worked diligently at creating solid, long-term working relationships.” Those same partnerships will be essential if the health implementation effort is to succeed.