High-Risk Pool Guidance Viewed As Anti-Abortion Victory; Other Reform Issues Draw Attention

Anti-abortion activists have "scored a victory" after a decision last week by the Obama administration to not allow the new high-risk pools in America to cover most abortions, The Associated Press reports. Groups like the Catholic bishops had issued concerns when "at least one state — New Mexico — initially decided to allow coverage of elective abortion in a newly launched, federally funded program to provide coverage for high-risk uninsured people turned away by private carriers. Abortion foes also raised questions about Pennsylvania's plan, but state officials said the criticism was baseless. Trying to head off more problems, the Health and Human Services Department announced last week the program will not cover abortions except in cases of rape, incest or when the mother's life is in danger — exceptions traditionally allowed under federal law." That's different than in insurance exchanges that begin in 2014, which will allow consumers to have abortion coverage using their own, segregated funds than those from the government. Abortion rights activists say the restrictions in the high-risk pools go too far (Alonso-Zaldivar, 7/19).

The Hill: The decision by the Obama administration has sparked backlash from the American Civil Liberties Union. "In a message to supporters, Washington Legislative Office Director Laura Murphy asks that they pressure the White House to overturn its newly announced restrictions. 'The White House has decided to voluntarily impose the ban for all women in the newly-created high risk insurance pools,' Murphy writes. 'What is disappointing is that there is nothing in the law that requires the Obama administration to impose this broad and highly restrictive abortion ban. It doesn't allow states to choose to cover abortion and it doesn't even give women the option to buy abortion coverage using their own money'" (Pecquet, 7/17).

In the meantime, insurers are trying to position themselves to win as health reform is implemented. "While he awaits regulators' draft of important new health-care rules this summer, Cigna Corp. Chief Executive David Cordani is looking for ways to benefit," The Wall Street Journal reports. "Cigna mainly administers insurance policies for big businesses — an area little affected by the health-care overhaul. But Mr. Cordani hopes to sell more policies to individuals if the new health-care rules create an attractive-enough market. Insurance regulators are drafting rules that will effectively determine how lucrative that market will be by dictating how much leeway insurers have to calculate their 'medical-loss ratio,' or how much of premiums insurers use for medical care rather than administration" (Johnson, 7/19).

The Scranton (Pa.) Times-Tribune: Others are considering what health reform means for those with chronic disease, especially when these conditions lead to increased hospitalization and costs. "A report released in June by the Pennsylvania Health Care Cost Containment Council found that more than 60 percent of Pennsylvanians suffer from a chronic condition. The report also found that chronic conditions account for 80 percent of all health care costs and hospitalizations in the state, and that the state's hospitalization rates for diabetes, asthma, chronic obstructive pulmonary disease and heart failure were all worse than the national rates in 2007. … In addition to extending health insurance to millions of uninsured Americans, the health care reform bill also places emphasis on follow-up and coordinated care by encouraging providers to work together to treat patients suffering from chronic conditions like diabetes and heart disease" (Nissley, 7/19).

MedPage Today/ABC News: Additionally, rules recently issued reveal how some preventive health screenings will have to be covered cost-free by insurers starting this fall in an effort to make America healthier and to care for those at risk for chronic conditions. "The interim final regulations, which take effect on Sept. 23, require private health plans to cover all preventive services given an 'A' or 'B' recommendation by the U.S. Preventive Services Task Force, as well as preventive services recommended by the Advisory Committee on Immunization Practices. The covered services include screening for abdominal aortic aneurysm, aspirin to prevent cardiovascular disease, alcoholism and smoking cessation counseling, immunizations, screening mammograms and colonoscopies, and screening for other chronic conditions including hypertension, hypercholesterolemia, hepatitis, diabetes, HIV, osteoporosis, and iron deficiency. They also include screening for obesity as well as weight-loss counseling" (Frieden, 7/18).

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