Evidently, pulling yourself up by your own bootstraps isn’t enough to overcome a system that’s stacked against you.

A new study by researchers at the University of Georgia finds that young teenagers from poor communities who are good students, in good mental health, and well-adjusted socially end up with high levels of stress hormones, high blood pressure, and a higher body mass index by age 19. In turn, that compromises their immune systems and puts them at greater risk for developing conditions such as obesity, cancer, hypertension, stroke, and cardiovascular disease at a young age.

“Exposure to stress over time gets under the skin of children and adolescents, which makes them more vulnerable to disease later in life,” said lead researcher Gene Brody.

Poverty and social exclusion are already major risk factors for a host of medical problems, including mental health disorders, diabetes, obesity, and heart disease. But the new research suggests that the stress of escaping poverty’s shackles causes long-term damage to young Americans’ health.

“The children who are doing good at school, playing well with friends, have high self-esteem and don’t have behavior problems are often thought of as beating the odds or being resilient in the face of adversity. We hypothesized maybe at one level they are resilient, but looking at their biology and asking what is the cost, we find a physiologic toll to attaining behavior resilience,” said Brody.

Brody recommends that young Americans address this issue by getting preventative health screenings, noting that “it is very important for them to be monitored and have yearly checkups” to find out if they are at risk for a chronic disease.

Unfortunately, poor and isolated populations tend not to have access to quality health care. Poor communities have significantly lower numbers of hospitals that service them, and the financial burden of medical care prices many of the poor out of the system entirely.

One way that state officials can ease these disparities is by expanding Medicaid under Obamacare. The health law also mandates that preventative services be provided for free, and expands funding for community health centers in an effort to bridge the coverage gap between the rich and the poor.

But many Republican governors have been reticent to take part in the Medicaid expansion, meaning secluded and poor populations in their states won’t have the resources to manage chronic illnesses — even if they receive free screenings through a local clinic. Texas legislators voted to deny health coverage for 1.5 million low-income residents this past week, even though some low-income Texan families are so desperate for medical care that they’ve resorted to crossing the border into Mexico for services and sharing their insulin.

Read more

A coalition of reproductive rights groups joined DC Mayor Vince Gray (D) and DC Delegate Elanor Holmes Norton (D) at a press conference on Tuesday to push for budget autonomy for the nation’s capital city. Until the District of Columbia has the power to control its own budget, they say that DC’s women will continue to be burdened with abortion restrictions imposed by Republicans who don’t actually represent them in Congress.

Since DC’s budget currently has to be approved by Congress, other legislators can either block the city’s initiatives or force through unrelated riders. Those fights often center on women’s health issues. Last year, an appropriations provision blocked DC from covering low-income women’s abortion care with its Medicaid dollars.

At Tuesday’s press conference, women’s health advocates — including representatives from Planned Parenthood, NARAL Pro-Choice America, the Center for Reproductive Rights, the National Abortion Federation, the Reproductive Health Technologies Project, and the Religious Coalition for Reproductive Choice — pointed out that denying DC the ability to offer Medicaid coverage for abortion ultimately hurts the city’s most vulnerable women. The poverty rate in the nation’s capital is the third worst in the nation, behind Mississippi and Louisiana.

“This policy creates obstacles to care for low-income women, many of whom are women of color, who already face significant barriers to receiving high-quality care,” Susannah Baruch, the interim president of the Reproductive Health Technologies Project, explained in a statement. “However we feel about abortion, we shouldn’t deny a woman in DC the health coverage she needs just because she’s poor.”

“Politicians don’t belong in a woman’s personal medical decisions just as they don’t belong in DC spending decisions,” Dawn Laguens, Planned Parenthood’s executive vice president, pointed out. The rest of the country agrees with her. According to a 2012 poll, 78 percent of Americans don’t think Congress should be able to impose social policy riders on DC’s budget that interfere with the city’s local affairs.

Nevertheless, congressmembers haven’t taken kindly to the idea of home-rule in DC. Last month, a Florida Republican dismissed DC’s push for budget autonomy as an act of teenage rebellion. “Well, when my kids were young teenagers, they always wanted budget autonomy too,” Rep. Rep. John Mica (R-FL) said.

DC voters passed a budget autonomy referendum in a special election last month. As long as congressmembers like Mica don’t step in to intervene, it will become law on July 10th.

1.5 million low-income Texans may go without health care coverage after lawmakers in the state voted against expanding Medicaid using $100 billion in federal funds offered under President Obama’s health care law. The decision comes almost a year after the Supreme Court ruled that the federal government cannot require states to enroll more Medicaid beneficiaries.

The proposal, sent to Gov. Rick Perry (R) on Sunday, says state health officials “may only provide medical assistance to a person who would have been otherwise eligible for medical assistance or for whom federal matching funds were available under the eligibility criteria for medical assistance in effect on December 31, 2013.”

Under the Affordable Care Act, the federal government fully funds Medicaid expansion until 2016 and gradually reduces its contribution to 90 percent in 2020 and subsequent years. Texas — which has the highest percentage of uninsured residents — would never pay more than 7 percent of the cost of providing coverage to Texans, but Texas Republicans argued that “even $1 in the name of ‘Obamacare’ was a dollar too much.”

“Texas will not be held hostage by the Obama administration’s attempt to force us into this fool’s errand of adding more than a million Texans to a broken system,” Perry said. The decision means a loss of approximately $7 billion for Texas hospitals, which comes on top of the $700 million a year reduction in Medicaid payments from state budget shortfalls and cuts under sequestration.

Low-income Texans will also continue to struggle to afford coverage, since the law does not offer federal tax credits to purchase private health insurance coverage for most people below the poverty line. People living in the 26 states that have refused to expand Medicaid and have incomes “from the poverty level up to four times that amount ($11,490 to $45,960 a year for an individual) can get federal tax credits.”

Tom Banning, chief executive officer of the Texas Academy of Family Physicians, told NPR that failing to expand Medicaid will only shift costs throughout the health care system.

“These people don’t choose to get sick. When they do, they’re going to access our health care system at the most inefficient and expensive point, which is the emergency room,” Banning says. “And it’s going to cost the taxpayers, and it’s going to cost employers a lot of money to care for them. And we’re going to be forgoing billions of dollars that the feds have set aside for the state to pay for and provide this care.”

As a result of the state’s decision, Texas will continue paying for the taxes that pay for Medicaid expansion but wil be sending those dollars (and benefits) to other states.

As Congress debates comprehensive immigration reform, members of both parties have insisted on barring undocumented immigrants who achieve provisional legal status from receiving Medicaid coverage or Obamacare subsidies (a provision that was already part of the health law). But preventing these immigrants from gaining basic health benefits is actually a fiscally irresponsible model that will only raise health care spending and contribute to a sicker U.S. population.

The common argument against providing health care to undocumented immigrants is that, since they’ve broken the law, they should be punished. A part of that punishment involves denying them health care services through public entitlement programs or federal subsidies that are dependent on Americans’ tax dollars. “We must value the contribution of immigrants to our country. In doing so, we must protect our borders, we must protect our workers, and we must protect the taxpayer,” said House Minority Leader Nancy Pelosi (D-CA) on Thursday.

But the taxpayer already foots the bill for undocumented immigrants’ care — just in an incredibly inefficient and half-baked way. Under the auspices of the Reagan-era Emergency Medical Treatment and Active Labor Act (EMTALA), hospital emergency rooms can’t turn away patients based on their citizenship or insurance status. That doesn’t mean that their care magically becomes free — undocumented men and women who use the emergency room are still slapped with a hefty hospital bill.

However, if they are unable to pay that bill — which is fairly likely considering that they probably don’t have any insurance — then a combination of the federal government, state governments, hospitals, and other American consumers of U.S. health care are forced to absorb the cost. In turn, that raises prices for medical services, since hospitals want to recoup some of their losses. Some studies have estimated the price of subsidizing undocumented immigrants’ health care at about $10.7 billion per year.

The federal government has long been aware of this problem. In fact, soon after EMTALA’s passage, lawmakers authorized a special Medicaid fund that mostly goes towards subsidizing emergency treatments for undocumented immigrants. The program costs about $2 billion per year, and most of that money is used on delivering babies for pregnant, undocumented women who go to the emergency room.

Read more

Gov. Jan Brewer (R-AZ) has a message for her party: expand Medicaid — or else.

The combative GOP governor is sticking by a threat she made to veto all legislation until lawmakers resolve the 2014 state budget and pass Obamacare’s Medicaid expansion. On Thursday, Brewer proved that wasn’t just talk, vetoing five bills sent to her desk in quick succession.

“I warned that I would not sign additional measures into law until we see resolution of the two most pressing issues facing us: adoption of a fiscal 2014 state budget and plan for Medicaid,” wrote Brewer in her veto message. “It is disappointing I must demonstrate the moratorium was not an idle threat.”

Arizona officials only have five weeks before reaching the constitutional deadline for passing a budget. Last Thursday, six Republican state senators joined a unified Democratic caucus to pass a Medicaid expansion bill — but efforts have been gummed up in the state House since then.

Brewer isn’t letting the issue slide. She has been touring the Grand Canyon State to shore up support for the expansion and put pressure on reticent lawmakers in her own party.

Some Republicans opposed to the expansion have warned of dire political consequences for lawmakers who buck the traditional conservative opposition to Medicaid. In a letter to Republican legislators, the chairman of the Maricopa County Republican Committee wrote of the state senators who voted for expansion, “Their egregious actions will have serious consequences. Their political careers are all but over and their days numbered.” He referred to Brewer as a “rogue governor” in the same statement.

But Brewer appears to be sticking by her convictions. At the beginning of the year, she became the third Republican governor to embrace expansion, asserting that it would provide health coverage to 50,000 low-income Arizonans. While promoting the expansion in March, Brewer attested to the dire consequences of failing to expand Medicaid. “The human cost of this tragedy can’t be calculated,” said Brewer, flanked by public health officials, doctors, and advocates for the poor. “Remember, there is no Plan B.”

The Kaiser Family Foundation (KFF) estimates that expanding Medicaid would cut Arizona’s uninsurance rate by nearly a third.

The debate over Medicaid expansion has devolved into a GOP platform for grandstanding about the health reform law and the Obama administration. But an NPR article from Tuesday shines a light on what, exactly, most Republican governors’ refusal to expand Medicaid will mean for real Americans by examining poor communities in a state headed by one of Obamacare’s most ardent critics: Gov. Rick Perry (R-TX).

The piece centers on particularly destitute populations in southern Texas, where some uninsured residents are so poor, sick, and unable to cope with their medical bills that they resort to desperate measures such as crossing the border into Mexico for medications and even sharing their insulin shots:

[M]any of those who live here [in Brownsville] — including poor Latino immigrants, both legal and undocumented — suffer from diabetes and lack of insurance. Some of those uninsured diabetics, including American citizens and others living here legally, used to go across the border to Matamoros, Mexico for insulin. But now with the fear of brutal drug violence and tougher border restrictions, families share their insulin shots rather than risking the crossings.

A community health worker in Brownsville noted that “many of those who used to cross the border would qualify for Medicaid under the expansion offered by the health care law.”

This inequity is further exacerbated when dealing with a more serious or life-threatening chronic condition. One official at Brownsville’s local health clinic described how difficult it is to provide specialty care services to the poor and uninsured, emphasizing that Medicaid coverage would make it far easier to convince physicians to take on patients:

“Once you diagnose a cancer, then what?” said Dr. Henry Imperial, the clinic’s medical director. “How are you going to give me chemotherapy or surgery or radiation therapy? It goes out of our hands.”

Those complications can make for some intense arm-twisting among Brownsville’s medical ranks. Imperial said he often plies fellow doctors in town with beer to see his uninsured patients. “When they see me approaching them, they start running away,” he joked before turning somber. “It’s just tough. I could not do an appendectomy. I cannot operate on gall bladders. I need a surgeon.”

Most specialists, including surgeons, in Brownsville, accept Medicaid, said Imperial. “It does pay for services that otherwise the patient does not receive.”

GOP leaders like Perry and even some of the more serious conservative academic critics of Obamacare’s Medicaid expansion regularly cite the program’s low reimbursement rates as a reason for dismissing it. Perry has denounced expansion as doubling down on a “broken system,” since doctors won’t want anything to do with Medicaid to begin with.

Read more

Over 60 percent of the Americans living in the Deep South support Obamacare’s Medicaid expansion, according to the results from a new poll that surveyed a broad sample of people in Alabama, Georgia, Louisiana, Mississippi, and South Carolina.

The poll, conducted between March and April by the Joint Center for Political and Economic Studies, found that support for Medicaid expansion is somewhat divided along partisan lines. Nevertheless, a solid majority of residents in each of the five Deep South states favor expanding the public insurance program to extend coverage to additional uninsured Americans:

That public support stands in sharp contrast to the five states’ political leaders, who have resisted cooperating with health care reform at any cost. The GOP governors in each of those Southern states — Govs. Robert Bentley (R-AL), Nathan Deal (R-GA), Bobby Jindal (R-LA), Phil Bryant (R-MS), and Nikki Haley (R-SC) — have refused to expand their Medicaid programs.

“This survey clearly shows that governors and state legislators in the South who are resisting the Medicaid expansion are out-of-step with their constituents,” Brian D. Smedley, the director of the Joint Center’s Health Policy Institute, pointed out.

The broad public support for Medicaid expansion in this region makes sense. Low-income Americans in the South who don’t currently qualify for their state’s Medicaid program are being forced to simply skip out on medical care, and expanding Medicaid’s eligibility levels would ensure that they can access the health treatment they need. Deeply red Southern states also tend to have worse health outcomes compared to Democratic-controlled states on the coasts, and expanding Medicaid could help lessen some of those disparities.

But political resistance to Obamacare, even in the states that stand to benefit the most from it, remains strong. The governors in highly uninsured states are still refusing to consider cooperating with the Medicaid provision of the health reform law. And even when Republican governors reluctantly agree that Medicaid expansion is the right decision for their constituents, GOP-controlled legislatures in their states continue to block it.

As the political fight over Obamacare continues, Republican legislators in highly uninsured states have turned their back on Medicaid expansion — despite the fact that expanding the public insurance program could extend coverage to millions of their constituents. Of course, even if stringently anti-Obamacare politicians refuse to cooperate with health reform, the law will still take effect. But that doesn’t necessarily mean those red states won’t feel the impact of refusing to add more residents to their Medicaid rolls.

Health care outcomes already vary widely across states. Unfortunately, health policy does too. The states that are already among the nation’s healthiest are the ones taking steps to ensure their low-income residents will have the insurance coverage they need — while the unhealthier, more highly uninsured GOP-led states are refusing to do the same. As an analysis from the Los Angeles Times points out, the health care reform law can’t change the fact that the stubborn lawmakers resisting Medicaid expansion are likely going to deepen the health disparities that already exist across the country:

With nearly every GOP-leaning state on track to reject an expansion of the government health plan for the poor, the healthcare law’s goal of guaranteed insurance will become a reality next year mostly in traditionally liberal and moderate states. These states already have higher rates of health coverage.

Residents of these states — concentrated in the Northeast, upper Midwest and West Coast — also have better access to doctors and are less likely to die from preventable illnesses.

Colon cancer deaths in states opposing Medicaid expansion, for example, are an average of 16% higher than in pro-expansion states, according to a Los Angeles Times analysis of state health data.

Deaths from breast cancer are 8% higher on average in anti-expansion states. And adults under 65 are 40% more likely on average to have lost six or more teeth from decay, infection or gum disease.

An earlier analysis found that the governors for the most unsinsured cities in the United States have been resistant to expanding Medicaid. And even after some of those governors started to come around — most notably, Florida’s Rick Scott — the Republicans in the state legislature have continued to block the initiative. Opposition persists despite the fact that the poor Americans in the South, who are already being forced to delay their medical care because they can’t afford it, stand to gain the most from Medicaid expansion.

This isn’t the only example of health disparities becoming sharply divided by region. Abortion access, another area of health policy that’s largely been left up to states’ interpretation, also varies widely from California to Mississippi to North Dakota to New York. “It shouldn’t be that simply because you live in Mississippi that you don’t have the same health care that you can get if you lived in California,” one abortion doctor who travels to practice at Mississippi’s last remaining abortion clinic recently pointed out. Nonetheless, that’s the growing reality for the entire health care sector.

Over ten percent of all doctors and nurses on the government’s Medicare and Medicaid blacklist end up on it because they defaulted on government-backed student loans. Medical workers on the blacklist are barred from treating Medicare and Medicaid patients or receiving federal reimbursements for a predesignated time period.

According to a Modern Healthcare analysis of federal records, more than 5,400 of the 51,729 people on the government health entitlement blacklist were placed on it after failing to pay an HHS-backed medical student loan. Given a still-shaky economy, some in the health care sector expect that trend to continue:

[Government data] show that one of the most common reasons for getting barred is failure to repay HHS-backed student loans: 5,417 people are currently kicked out of Medicare for that.

The number of annual exclusions related to student loans has grown steadily in the past decade, peaking at 517 in 2011 before declining again. “That is tied to the economy, and I would expect that to continue to rise,” [said Lynn Gordon, a Chicago-area hospital group partner].

The increasing frequency of default-related blacklisting could prove problematic as the Obama Administration tries to entice more medical students to become primary care and family doctors. Primary care providers and nurse practitioners will be crucial to effective Obamacare implementation, since the health law is expected to drive up demand for medical services as millions of previously uninsured Americans gain coverage.

But the ballooning cost of a medical education could end up being a major barrier to the Administration’s recruitment efforts. According to the Association of American Medical Colleges’ (AAMC) 2012 report on medical school debt, “86 percent of medical school graduates had education debt, with a median amount of $162,000″ in 2011 — a number that has been rising steadily over the years:

AAMC estimates that a borrower with the median $162,000 debt “would have monthly payments ranging from $1,500 to $2,100 after residency.”

That disproportionately affects the very primary care doctors that are integral to health care reform and the U.S. medical system at large. In a 2012 report, consulting firm Merritt Hawkins & Associates found that family practitioners, pediatricians, and psychiatrists are the lowest-paid physician groups in the U.S. with a base pay of $189,000.

While that’s still a lavish salary compared to average U.S. compensation, it pales in comparison to specialist pay — and as the entitlement blacklist numbers underscore, that contributes to a system in which care providers are banned from treating certain patients for purely financial, rather than medical or criminal, reasons.

Read more

Faith leaders were an important group pushing red state leaders to accept Obamacare’s Medicaid expansion. And with open enrollment for Medicaid and the law’s insurance marketplaces inching closer, they’ll be crucial to making sure that Americans know how, where, and when to sign up.

To that end, Maryland officials are currently holding a summit with over 150 faith leaders in which they explain the nuances of the law — and urge religious leaders to distribute that information by educating their congregants and communities. Faith leaders are enthusiastic about the plan, since their day-to-day dealings with their communities gives them a unique perspective on Americans’ needs and struggles:

The Rev. Janet Craswell, of the Salem United Methodist Church in Brookeville, described the summit as very helpful. Although her church is in a small Maryland community, Craswell said she has been hearing from a wide variety of people who will be impacted by the overhaul, including families with unemployed and uninsured young adults, people with disabilities and small business owners who are confused and concerned about how the law will impact their businesses.

“We see people every day,” Craswell said. “I mean, we are dealing with people week to week, and we’re also dealing with people at the point of crisis where they’re in hospitals and in hospice and they’re having to deal with major life issues.”

In fact, coordinating Obamacare enrollment efforts with faith leaders could be great news for another population that has largely been ignored in all the hubbub and politics of the expansion: Americans who already qualify for the program, but have never enrolled. In a 2006 report, the Commonwealth Fund estimated that 62 percent of Medicaid or CHIP-eligible children were not enrolled in either program, and 66 percent of Medicaid-eligible low-income parents were not enrolled.

Much of that discrepancy has to do with underwhelming state outreach efforts stemming from a lack of adequate funding, as well as the reality that many Medicaid-eligible populations simply don’t know they have the resource available to them. “Even in states that have more of a commitment to bringing new populations in, they don’t have the budget to do outreach and take out ads,” said Melinda Dutton, a partner at a health consulting firm assisting states with Obamacare implementation, in an interview with American Medical News.

But with the renewed national push for Medicaid enrollment ramping up this year, some health advocates hope that these previously unenrolled Americans will get swept up in the effort and “come out of the woodwork.” That’s where faith leaders are crucial to the undertaking, since they have greater access to the rural or isolated communities that Medicaid may have overlooked.

For example, the homeless — or those on the cusp of entering transitional housing programs — often do not enroll in Medicaid due to barriers such as a lack of proper identification or a Social Security card. These populations also tend to distrust government institutions — but faith leaders and community organizations could help walk them through the process in a way that the government can’t, helping secure their medical stability. And with over 25 million Americans expected to gain coverage under Obamacare in the coming decade, state, federal, and public health officials will need all the help that they can get.