Our guest bloggers are Kellan Baker, LGBT health care analyst at the Center for American Progress.

A decade ago, the Department of Health and Human Services released a comprehensive plan to guide its role in addressing the health care needs of lesbian, gay, bisexual, and transgender Americans. Of the plan’s five major goals, stocking the storehouse of knowledge about health disparities related to sexual orientation and gender identity was a central priority.

A steering committee with members from almost every agency within the Department developed the plan. It came on the heels of a groundbreaking 1999 report from the Institute of Medicine on lesbian health that exposed huge gaps in knowledge not only about the health of lesbians but also about women and sexual minorities in general. At the time the steering committee was developing its recommendations, Healthy People 2010 (the nation’s blueprint for a healthier America for the decade between 2000 and 2010) had just come out with its first-ever objectives related to the health of lesbian, gay, and bisexual people, and LGBT health advocates were compiling the Healthy People 2010 LGBT Companion Document.

The Department began developing the plan in the waning months of the Clinton presidency, but it was not released until April 2001. By then George W. Bush’s Administration had assumed power, and LGBT health was not only taken off the priority list, it was shoved firmly back in the closet. The next eight years delivered little more than rollbacks of reproductive health programs and the rise of abstinence-only funding linked to programs imposing views of sexuality and gender that entirely erase the lives of LGBT youth. Those years did see dramatic increases in funding for HIV and AIDS as part of the President’s Emergency Plan for HIV/AIDS Relief (PEPFAR), but almost nothing went to help track or stop the epidemic among gay and bisexual men and other men who have sex with men, as well as among transgender women.
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The Government Accountability Office’s (GAO) report on children’s access to physicians is far less dire than press accounts suggest. While children on Medicaid do have more difficulty finding specialists, most physicians are enrolled in Medicaid and CHIP and are “serving children covered by these programs”:

GAO estimates that more than three-quarters of primary and specialty care physicians are enrolled as Medicaid and CHIP providers and serving children in those programs. A larger share of primary care physicians (83 percent) are participating in the programs—enrolled as a provider and serving Medicaid and CHIP children—than specialty physicians (71 percent)…. Nationwide, physicians participating in Medicaid and CHIP are generally more willing to accept privately insured children as new patients than Medicaid and CHIP children.

Ninety-one percent of physicians accepted at least some new patients , but 66 percent of primary-care physicians had trouble finding specialty physicians:

The issue has become a political football, with conservatives using the access problems to push for legislation that would transform Medicaid into a block grant program — and in many ways making it even harder for children to find adequate medical care.

Out of the many troubling health care repeal amendments in the Korean trade agreement, Sen. Orrin Hatch’s (R-UT) proposal to repeal the maintenance of effort provision for the Medicaid program — which requires states to maintain their enrollment numbers or risk losing federal funding — is possibly the most egregious. It encompasses the Republican approach of “saving” the program by forcing more people off of it — no matter the consequences to the beneficiaries.

As Sen. Jay Rockefeller (D-WV) pointed out in a recent letter to Hatch, according to the Congressional Budget Office, the provision would result in substantial coverage erosion for children in the CHIP program:

– By 2013, 400,000 people will lose their Medicaid and CHIP coverage. Two thirds of those dropped from coverage will be children.

– Half of all states will end their CHIP programs by 2016. One quarter of states are expected to end their program even earlier, in 2015, while remaining CHIP programs are expected to scale back coverage.

– By 2016, the number of those expected to lose CHIP coverage will climb to 1.7 million people, with 700,000 left uninsured.

Interestingly, as a long-time proponent of extending health care coverage to children and a co-sponsor of the original CHIP bill in 1997, the Hatch of yesteryear would have opposed these cuts. Here he is in 2006, praising the program on its 10-year anniversary: “When we drafted this legislation in 1997, our goal was to cover the several million children who had no insurance coverage. We have gone a long way in meeting that goal, but we are clearly not there yet. Coverage of these uninsured children should still be our top priority.”

Greg Sargent notices that despite the GOP’s best efforts to malign the Independent Payment Advisory Board (IPAB) as a health care-rationing, grandma-killing, Big Government takeover, a new Kaiser Family Foundation poll finds that Americans have more trust in “an Independent panel of full-time experts appointed by the president and confirmed by the Senate” proposing ways to reduce Medicare spending than Congress or a federal agency:

The problem, as the public knows, is that politicians spend too much time soliciting contributions from medical providers to ever pursue an even handed approach to reducing their reimbursement rates. And one need to look no further than the GOP’s latest round of health care additions to the Korean trade agreement to see why elected officials are just no good at controlling health care costs.

Sen. Mike Crapo (R-ID), who has received $131,900 from hospitals/nursing homes and $152,050 from Health care professionals in 2010 (both represent his top 10 contributors), has proposed amendments to make “adequate” payment updates to ambulatory surgery centers and prevent CMS from cutting physician payments when developing rates for Medicare Advantage. Similarly, Sen. Pat Roberts (R-KS) took in $140,100 from the industry before offering an amendment to exempt Critical Access Hospitals from consideration by IPAB for payment reduction through 2018.

This isn’t to say that there was some specific quid pro quo attached to the dollars, but I imagine that it’s a lot easier to make cuts on the benefits side of the program when you spend a lot of time with providers and they in turn contribute to your campaigns.