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How LGBT Health Disparities Intersect With Other Health Disparity Groups

CAP is proudly taking part in the Health Equity Can’t Wait! blog carnival celebrating National Minority Health Month. Participating bloggers are health, consumer, civil rights, and provider advocates committed to promoting health equity. You can find all the posts for the carnival here.

In America today, an African-American baby is still twice as likely as a white baby to die before her first birthday. More than 30 percent of Latinos in the U.S. are uninsured, compared to 12 percent of non-Hispanic whites. Despite advances in HIV prevention and treatment, gay and bisexual men and transgender women of color are still disproportionately likely to become infected with HIV and to die from AIDS.

Clearly, race and ethnicity matter in health. So do gender, poverty, and ability. So too do sexual orientation, gender identity, and other characteristics linked to discrimination or exclusion.

And according to Senator Daniel Akaka, who introduced the Health Equity and Accountability Act yesterday in the Senate to build on the advances of the Affordable Care Act, “glaring health disparities based on racial and ethnic identity alone…are further exacerbated by factors such as socioeconomics, geography, and sexual orientation and [gender] identity.”

Areas of intersection between sexual orientation, gender identity, and other disparity factors include mental health concerns linked to minority stress, such as depression, anxiety, and suicide; higher rates of smoking and other substance use; and greater risk of contracting HIV and other sexually transmitted infections. Fear of mistreatment from health care providers who are not familiar with culturally competent care for different minority populations also prevents many people from accessing vital health services and compounds the seriousness of conditions such as heart disease, cancer, and diabetes.

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Study: Bullying Will Make You Age Faster

The issue of school bullying has garnered a lot of attention over the past few weeks, with a ratings controversy over the film “Bully” sparking renewed focus and support for victims. Bullying’s effects on mental health are well-known to anyone who faced it as a child, or still does. Now, however, researchers are claiming that its effects go far beyond that.

A new study released this week by Duke University researchers examined more than 200 children growing up in England and Wales. When looking at a type of DNA sequence called telomeres, the study found that exposure to violence during childhood, including bullying, correlated to a faster breakdown of that DNA in those children. That, in turn, can lead to faster aging, and more health problems later in life:

Telomeres are special DNA sequences found at the tips of our chromosomes; much like the plastic tips of shoelaces, they prevent our DNA from unraveling. Telomeres get shorter each time cells divide. That erosion places a limit on the length of time that a given cell can go on dividing. Emerging evidence suggests that telomeres are “master integrators,” connecting stress to biological age and associated diseases.

We showed, for the first time, that cumulative violence exposure is associated with accelerated telomere erosion, from age 5 to age 10 years, among children who experienced violence at a young age (e.g., domestic violence, frequent bullying or physical maltreatment by an adult). Children who were exposed to multiple forms of violence had the fastest telomere erosion rate.

As the researchers note, previous studies have linked increased stress to several health problems later in life. The reason for the link has been less clear, but the study authors hope that this will offer some insight into the mechanism behind it. At the very least, they write, this study “suggests new urgency for preventing harm to children.”

President Obama endorsed two anti-bullying bills earlier this month, but some in the Republican Party have chosen to take the opposite tack on the issue.

-Zachary Bernstein

Democrats Say Effort To Defund Prevention Is Part Of GOP’s ‘War On Women’

Moments before the House Republicans disregarded President Obama’s veto threat and passed a bill preserving lower interest rates on student loans by gutting the Affordable Care Act’s Prevention and Public Health Fund, the Democratic women of the 112th Congress blasted Republicans for undermining women’s health, arguing that the Fund would disproportionately benefit women. “It particularly benefits the reproductive health care, child bearing health care, preventive health care that benefits women,” Rep. Carolyn Maloney (D-NY) said and predicted that the action would further shrink the GOP’s support among female voters.

“We would prevent screenings for breast and cervical cancer,” Rep. Rosa DeLauro (D-CT) explained. “This fund helps to prevent coronary heart disease — and that is the leading killer of women in America. It mitigates osteoporosis, arthritis, mental illness — which disproportionately effect women in the United States.” Watch it:

The GOP measure — which passed in a vote of 215-195, with the support of 13 Democrats — finances the $5.9 billion cost of maintaining the 3.4 percent interest rate on Stafford loans for one year by repealing the Fund in its entirety and rescinding all unobligated balances, including money being spent this year. Health advocates believe that the Fund is essential for re-orienting the American health care system towards prevention of chronic conditions, which are “responsible for 7 of 10 deaths among Americans each year and account for 75 percent of the nation’s health spending.” Under the law, the Fund will “invest $12.5 billion over the next ten years (FY2013-FY2022) in effective programs proven to prevent disease and injury.”

“I call your attention to the fact that they don’t only take out what they need, they want to eliminate the Fund,” House Minority Leader Nancy Pelosi (D-CA) told reporters. “I view it as a statement of their values.” Democrats tied the action to the GOP’s proposals to restructure the Medicare program — which would force future seniors, particularly women to pay more for coverage — and their opposition to renewing an inclusive Violence Against Women Act.

Significantly, the Fund is also being used to increase “the size of the health care workforce” “to create new residency positions for primary care doctors and ramp up training capacity for physicians” and fund programs “to reduce obesity and tobacco use by targeting environmental factors — things like providing safe walking paths for exercise or access to smoking cessation programs.”

Note To The Supreme Court: Individuals Will Have Option Of Buying Catastrophic Coverage Under Health Law

When the Solicitor General defended the constitutionality of the mandate in the Affordable Care Act before the Supreme Court last month, Chief Justice John Roberts complained that the law’s minimum coverage provision would require Americans to purchase coverage they could do without or in some cases would never need. “You’re requiring people who are not — never going to need pediatric or maternity services to participate in that market,” Roberts said. Associate Justice Antonin Scalia agreed, noting, “It may well be that everybody needs health care sooner or later, but not everybody needs a heart transplant, not everybody needs a liver transplant.”

At the time, health care advocates pointed out that the law allows Americans to purchase a wide array of insurance products, including less comprehensive packages for those who wish to pay lower premiums for their coverage. Today, a new report from the Kaiser Family Foundation puts a finer point on this argument:

With much of the controversy over the ACA focusing on the individual market, it is noteworthy that the minimum coverage requirement is for insurance that is significantly less generous (and with a lower premium) than what most people have today. It is a level of coverage that most would consider catastrophic, providing protection in the event of an expensive illness while subjecting routine expenses (except for preventive care) to a relatively high deductible. While much of the opposition to the individual mandate is likely due to views about the appropriate role of government, a better understanding of how it works and what it requires could moderate some of the resistance to it. [...]

People will have the option of buying more generous coverage than the minimum required, required, and lower-income enrollees will be eligible for cost-sharing subsidies that decrease their out-of-pocket costs. But, some may still find themselves with insurance that requires substantial cost-sharing.

For instance, a bronze plan would have a deductible of $4,375 and an out-of-pocket cost sharing limit of $6,350 — rates are are “significant and would be considered catastrophic plans, particularly for people without significant personal savings,” the report notes. “These plans would also meet the requirements for tax-preferred Health Savings Accounts,” it adds.

These aren’t the comprehensive policies that progressive health policy wonks would have hoped for. But they will offer individuals and families an opportunity to buy insurance that will only cover the bare minimum and hopefully satisfy the justices in the process.

NEWS FLASH

White House Threatens Veto Of Student Loan Bill That Would Slash Preventative Care | The White House announced Friday morning that President Obama will veto a student loan bill that would maintain lower interest rates on Stafford loans by gutting the Affordable Care Act’s Prevention and Public Health Fund. The bill, H.R. 4628, would prevent interest rates on Stafford loans from rising from 3.4 percent to 6.8 percent on July 1. The Prevention Fund will “provide for hundreds of thousands of screenings for breast and cervical cancer,” the White House said in its statement and argued that while the administration “strongly supports serious, bipartisan efforts to prevent interest rates from doubling,” the bill “is a politically-motivated proposal and not the serious response that the problem facing America’s college students deserves.”

-Zachary Bernstein

Georgetown University President: We Will Continue Providing Birth Control To Our Employees

Since the Obama administration promulgated a new rule requiring employers and insurers to provide preventive health care services — including contraception coverage — some Catholic institutions have taken great offense to the regulation and accused the White House of waging a war against their religious objection to birth control. The rule exempts religious institutions and affiliated organizations from providing the benefit and offers employers a year-long grace period to implement the measure.

And while some Catholic colleges have responded to the controversy by stripping contraception from their plans, Georgetown University — the nation’s first Catholic institution of higher learning — has announced that it will not adopt any changes to its health insurance policies and will continue to provide birth control coverage to its employees. In a letter obtained by ThinkProgress dated April 26, 2012, President John J. DeGioia informs the Georgetown community that the University will offer contraception “for students who require them for health reasons unrelated to birth control,” and will institute “no change to the University’s approach to contraceptive coverage for employees”:

After thoughtful and careful consideration, we will continue our current practice for contraceptive coverage in our student health insurance for the coming year, as allowed for under the current rules issued by the United States Department of Health and Human Services.

There will also be no change to the University’s approach to contraceptive coverage for employees for 2013.

We will be monitoring further regulatory and judicial developments related to the Affordable Care Act. I hope this is helpful in clarifying a matter of concern to many of you.

In February, a Georgetown University spokesperson confirmed to ThinkProgress that employees “have access to health insurance plans offered and designed by national providers to a national pool. These plans include coverage for birth control.”

Twenty-eight states already require organizations that offer prescription insurance to cover contraception — including some of the nation’s largest Catholic institutions.

NEWS FLASH

122 Million Americans With Pre-Existing Conditions Spend $4,844 More Per Year For Health Care | Between 36 million and 122 million adults “reported medical conditions that could result in a health insurer restricting coverage,” a new report from the Government Accountability Office (GAO) finds, representing 20 to 66 percent of the adult population. Hypertension was the most commonly reported medical condition among adults “that could result in a health insurer denying coverage, requiring higher-than average premiums, or restricting coverage.” Insurers also denied coverage for:

Adults with pre-existing conditions spend $1,504 to $4,844 more per year annually on health care, and most — 88 to 89 percent — live in areas of the country “without insurance protections similar to the Affordable Care Act provisions, which will become effective in 2014.”

Morning CheckUp: April 27, 2012

Democrats slam ‘biased and partisan’ report: “House Democrats on Thursday accused Republicans of cherry-picking and distorting information to produce a “fundamentally misleading” report about President Obama’s healthcare law.” [The Hill]

Sebelius signals ‘doom’ if healthcare funds cut for student loan benefit: “Health and Human Services Secretary Kathleen Sebelius hit back Thursday at a GOP plan to extend a student loan benefit with money designated for the 2010 healthcare reform law, saying that cuts to preventive care will “doom” future generations. “We can educate our kids and invest in healthcare at the same time,” she said in committee. [The Hill]

Radical anti-abortion bill defeated: “A Mississippi Senate chairman on Thursday killed a bill that could have led to a homicide criminal prosecution for anyone performing an abortion once a fetal heartbeat is found.” [The Republic]

D.C. infant mortality rate at historic low: “The District’s infant mortality rate, long among the highest in the country, has fallen to a historic low because pregnant women are smoking less, fewer teenagers are having babies and women have better access to prenatal care, according to a Health Department report to be released Thursday.” [Washington Post]

Cancer survivors urged to eat better, exercise: “A cancer diagnosis often inspires people to exercise and eat healthier. Now the experts say there’s strong evidence that both habits may help prevent the disease from coming back. New guidelines issued Thursday by the American Cancer Society urge doctors to talk to their cancer patients about eating right, exercising and slimming down if they’re too heavy.” [AP]

Mental health report shows 11 million with serious illness: ‘Just under five percent of U.S. adults, or 11 million people, had a serious mental illness in 2009, US mental health officials report in the latest update. And 34,000 Americans committed suicide linked to mental illness.” [National Journal]

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