Maternal & Child Health Blog

Reflections on a Lifetime of Public Health by Dr. Shirley Fleming

Over my 30 year career as a nurse, certified nurse-midwife, and public health professional, I have witnessed reductions in infant mortality spurred by policies that improved access to care and economic justice for the most vulnerable families. I was closely involved in advocating for changes in Medicaid, Kid Care, and social policies that would improve health outcomes and allow individuals the opportunity to thrive and fulfill their highest human potential.

However, I feel as though the progress that we fought so hard for is being ripped away and promoting access to care and the social determinants does not seem to be a priority for our legislators. Despite the immense prior success of Medicaid expansions, we are watching as eligibility and services are slashed. The public safety net is being devalued and diminished by legislators looking to close budget holes on the backs of hardworking families.

At the same time, federal health reform is on the horizon holding the promise of something better. The Affordable Care Act seeks to improve upon decades of advocacy efforts to increase access to care by making health care work for all of us. Good health is a key to basic human dignity.

My grandchildren suffer from severe allergies which means they are always at risk of a major health crisis and need consistent access to care. I am thankful that health reform has eliminated the possibility of them being discriminated against because of a so-called “pre-existing condition.”

I carry the narrative of justice as a public health person and a person of faith. Every person has the basic right to good health and opportunity to fulfill their purpose. Access to health care contributes to that and promoting care should be paramount for all public health professionals and people of good will. I hope that we as a people will have the courage and moral fortitude to move the arc of the universe toward justice in health care and the social determinants of health for all people.

Dr. Shirley Fleming is a grandmother, minister, and retired public health professional that believes the health care system should be driven by justice. Over her 30 year career, Ms. Fleming worked as a nurse, certified nurse-midwife, public health advocate, and the Chicago Department of Public Health First Deputy Commissioner.

Empowering the Next Generation Through Education

Being a youth peer educator has helped me a lot. It has educated me on sexual and reproductive health, sexually transmitted infections, and diseases. The information I've learned has helped me to educate my friends on all the responsibility that comes with sex. The topics I’ve learned have also made me think twice on the choices that I make. I have been reminded of all the responsibility that comes with having intercourse and have reconsidered relationships based on what I learned. As a youth myself, this program has overall been very helpful to me.

I think the information that I’ve learned needs to be taught at school-- it would be very helpful to youth of this generation. We need to know how to protect ourselves and keep ourselves healthy. Also young women need to know how to protect themselves from unplanned pregnancy and infections. From being a youth peer educator and talking with my friends, I know that this is the only way a lot of people will learn these things.

I have shared some of information that I learned about sexually transmitted infections with my friends. My friends were very surprised when I told them about herpes and the fact that you can’t get rid of it-- you can take medicine to keep it under control only. Teaching them something so important that they didn’t already know made me feel really good. I also told my friends that relationships can be very unhealthy and educated them on signs that they can watch for. This made them reconsider who they date and how they let people treat them.

My friends think the information that I share with them is very helpful and guides them when it comes to sex, relationships, and responsibility. I like knowing that I am making a difference in their lives because this is important information that every young person should have.

-Jasmine Cochran is a Youth Peer Educator working with the Campaign to Save Our Mothers and Babies in Englewood. 

 

Game Changer: The Affordable Care Act LGBT Individuals Win When the Rules Change

By Marissa Filippo

I recently attended Women Win with the Affordable Care Act, hosted by the Illinois Maternal and Child Health Coalition, and co-hosted by YNPN Chicago and the Illinois Choice Action Team.  The event was intended to educate people about the positive changes in health care they should expect when the law is fully implemented.  I identify as a lesbian and as such, encounter unique challenges in accessing health care, so I was particularly interested in hearing about improvements in the delivery of LGBT (lesbian, gay, bisexual, transgendered) health care.

In March of 2011, the Center for American Progress published “Changing the Game: What Health Care Reform Means for Gay, Lesbian, Bisexual and Transgender Americans.”  The report purports that gay, lesbian and bisexual adults are roughly twice as likely as the general population to be without health insurance coverage, and rates of uninsurance are even higher for transgender individuals (page 4). 

From my perspective as a concerned LGBT citizen, there are several major issues with the current system that the Affordable Care Act will address.  If you’re partnered and are lucky enough to access health insurance through an employer-recognized domestic partner relationship (which is not common), insurers and providers have no mechanism for recognizing/recording LGBT relationships on their forms.  And because recognition of same-sex partnerships is inconsistent across state and local governments, and non-existent at the federal level, (thanks to the Defense of Marriage Act) it’s extremely difficult to standardize the process. 

I find that I have to prove my domestic partnership status each time I see a new healthcare provider, which requires phone and/or written contact with my partner’s HR staff person, the provider, and the insurance companys--and that’s if you have insurance!   In addition, “transition exclusions” and “pre-existing condition” exceptions employed by insurance companies pose an impossible hurdle for transgender individuals, especially those who seek care during transition.  

Some of the beneficial changes LGBT individuals can expect as a result of the ACA are:

1) Data collection that includes sexual orientation and gender identity.  Hooray!  I’ll have a box to check!  LGBT individuals’ will be recorded, which can lay the groundwork for inclusive, non-discriminatory practices and improve our knowledge of LGBT health issues overall. 

2) The expansion of private insurance coverage through ACA will result in 16 million more Americans who will have affordable health insurance, including the LGBT population.  .

3) The ACA proposes a Patient’s Bill of Rights, which will end lifetime limits on coverage and will provide coverage to individuals with pre-existing conditions.  The bill of rights will also keep you on your parents’ insurance until age 26, and provide coverage for preventive care.  

The Affordable Care Act will shift the paradigm in our current health care system, to be sure.  The nonprofit sector will be at the forefront of the reform, helping millions of people in our communities gain access to health care under the ACA, women and LGBT populations especially.  The ACA is just the change we need to improve health care and quality of life.

Resources for more information about the ACA and LGBT & women’s health:

http://www.ilmaternal.org/

http://www.americanprogress.org/issues/2012/03/aca_top_10_lgbt.html

http://www.americanprogress.org/issues/2011/03/aca_lgbt.html

http://www.ilchoiceactionteam.org/

http://illinoishealthmatters.org/

http://www.chicagowomenshealthcenter.org/

http://www.healthcare.gov/law/index.html

http://www.dol.gov/ebsa/healthreform/

http://www.hrc.org/resources/entry/healthcare-equality-index-2011

http://www.windycitymediagroup.com/lgbt/AIDS-Groups-testify-for-Affordable-Care-Act/36975.html

Marissa currently serves as an Executive Assistant to the Chief Operating Officer at the Dental Assisting National Board (DANB), an organization which provides credentialing services to the dental community. Marissa has nearly ten years of experience working in nonprofits in Chicago and has been involved in programs related to public education, nonprofit management support and professional development training. Marissa maintains an interest in film and the arts and has taught Humanities at Harold Washington College, one of the City Colleges of Chicago. Marissa earned a B.A. in English from the University of Illinois and an M.A. in Interdisciplinary Humanities from Arizona State University.

Identity and Health – Breaking Down Barriers

As an African-American woman, I have spent much of my career researching, implementing programs, and experiencing firsthand the synergistic impacts of race and sex on health outcomes.    For my Master’s thesis, I studied physician bias in the treatment of heart disease in African-American women, and currently am focused on how stress due to racism may cause adverse birth outcomes for middle-class women of color. 

It has only been in the past two years that, like many researcher/practitioners, I realize that I am studying myself.  Now that I have a daughter, my goal is to contribute to this growing body of knowledge so that she is more likely than I was to have healthy children and grandchildren.

At the Illinois Maternal and Child Health Coalition (IMCHC), we seek to improve the health of women, children, and families over the lifespan through community engagement, partnerships, policy analysis, education, and advocacy.  Recently, our Board approved a new vision statement, which states that IMCHC “envisions an Illinois that works towards equity and social justice, fosters the development of healthy families, and provides fair access to quality health care - the basic rights of all human beings.”  We have approached our work with an asset-based/capacity building framework— which always starts with the foundation of strong, mutually beneficial relationships. 

Our Campaign to Save our Mothers and Babies project is based out of Englewood, a predominately African-American community with predictably high rates of infant mortality and poor health outcomes.  If we want to shift the paradigm so it’s not “predictable” that communities of color experience health disparities, we know that we must help young people break this cycle.  To that end, our staff there works with young women to share information about how to negotiate healthy relationships, discuss healthy reproductive behaviors, and most importantly, provide a forum for them to talk with one another and a trusted adult.  Over the past several years, we have heard stories that demonstrate how aware young people are of the power differential they feel with school officials, community members, and partners.  Many times, they feel their voices are not heard, or disregarded, and we have seen them make detrimental choices as a result.   Our goal is to create an environment in which they are able to strengthen their voices and maintain their power.  

During the past year, we have facilitated discussions with young women and legislators so that they can talk about conditions in their schools and community, such as the lack of school health centers and comprehensive sexual health education, that leave them at a disadvantage.  We conducted a photojournalism project where we worked with youth so that they could showcase how they visualized “health” (or lack thereof) in their community.   In an effort to transfer these skills and tools, we trained a group of nine youth peer educators to share their newly acquired knowledge with other teens via health fairs and community events.

At the culmination of National Minority Health Month, I continue to be aware of the many structural barriers our society has constructed that prevent women of color from achieving their fullest potential and implore all of us to work, in our own spheres of influence, to break them down, one by one.

- Janine Lewis

Governor Proposes Controversial Medicaid Cuts

Proposed cuts protect children while eliminating other important coverage

Yesterday, Governor Quinn unveiled his plan to reduce Medicaid spending in the FY13 budget by over $1.3 billion. The proposal has sparked much debate and has organizations, including the Illinois Maternal and Child Health Coalition both relieved and concerned about the health of Illinois’ vulnerable populations.

“Primarily,” said IMCHC Executive Director, Janine Lewis, “we are relieved that Governor Quinn did not make any cuts to children’s health coverage or services.  We also support some of the other proposed methods to reduce costs in Medicaid, because we think that there appears to be a real focus on patient outcomes.” 

The Governor’s proposed Medicaid cuts include 58 specific recommendations for eligibility reductions, the elimination of certain programs and non-federally mandated covered services, utilization controls, and provider reimbursement rate adjustments

Positive changes include eliminating or limiting payment for non-medically necessary elective c-sections prior to 39 weeks gestation; developing a statewide initiative to improve birth outcomes for high-risk pregnant women; and care coordination to help the most complex and high-need patients better utilize the health care system. 

Nevertheless, IMCHC joins with other partner organizations in their concern for decreased eligibility for other patient groups, especially for low-income, working parents in the FamilyCare program.  The FamilyCare program currently provides health insurance to parents and relative caregivers with household income of approximately $42,000/year for a family of four. The Governor’s proposal would reduce the income limit to just over $30,000/year for a family of four and would end coverage for over 26,000 individuals.

IMCHC is also concerned that adult dental services in Medicaid were recommended for elimination, which could lead many to seek care in hospital emergency rooms - the costliest place to seek care.

“While we are encouraged by the Governor’s continued commitment to vulnerable children, we urge him to take a closer look at the long-term health care and financial impacts of some of these recommended Medicaid cuts,” said Lewis.

The full list of cuts can be found here: http://www.illinois.gov/PressReleases/ShowPressRelease.cfm?SubjectID=2&RecNum=10183

 

Teen birth rates are falling, but comprehensive sex education would speed progress

The National Center for Health Statistics just released a promising and exciting data brief - Birth Rates for U.S. Teenagers Reach Historic Lows for All Age and Ethnic Groups  – that discusses the decline in teen childbearing and the possible causes for this decline.  The teen birth rate dropped 17 percent from 2007 through 2010 (a record low), and 44 percent from 1991. Further, rates fell across all teen age groups, racial and ethnic groups, and in nearly all states.

According to this brief, if the trends from 1991 had persisted, there would have been an estimated 3.4 million additional births to teenagers during that period.  And according to the National Campaign to Prevent Teen and Unplanned Pregnancy, teen childbearing in the United States costs taxpayers (federal, state, and local) at least $10.9 billion, annually.

Pretty stark and scary statistics, we know.

 Thanks, however, to committed individuals, organizations, health centers, health educators, and advocates, we have succeeded in halting this terrifying trend. 

Research has consistently demonstrated that effective sex education and STI prevention programs can really help young people avoid unintended pregnancy. When comprehensive sex-ed and access to care is provided, young people have delayed the initiation of sex; as well as reduced the frequency of sex and the number of new partners; and increased the use of condoms and contraception among sexually active participants.[1]

And yet, too many adolescents do not have access to health care, including reproductive health care services, leaving them at risk for pregnancy and diseases. Some Illinois students still don’t receive comprehensive sex education in school. That is why IMCHC is advocating for the passage of HB 3027, which will require that IF a school chooses to teach sex education THEN it must be comprehensive, medically accurate, and age appropriate.

The services provided at school health centers (SHCs) are also imperative to the health of our children and youth. 

SHCs help adolescents receive high quality health care right inside their school buildings, where students spend most of their time.   Along with providing immunizations, sports physicals, and mental and oral health care, SHCs provide those valuable reproductive health services.  Reproductive health services are part of a standard of care for health providers and major health institutions and are a vital component to treating the whole person.   The specific services provided vary by SHC, but in Illinois they are all required to provide or refer for these kinds of services.  

It’s frustrating to hear opposition to the school health model and to comprehensive sex-ed.  There is certainly a correlation between reproductive health care services and education and these data that show a decline in the teen birth rate.  Hopefully, now that we have statistics that demonstrate the value that this kind of care and education can have, those opposing voices will soften. 

 

---

[1] Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to    
  Prevent Teen Pregnancy, 2001.
  Kirby D et al. Impact of Sex and HIV Education Programs on Sexual Behaviors of Youth in Developing and Developed Countries.  
  [Youth Research Working Paper, No. 2] Research Triangle Park, NC: Family Health International, 2005.
  Alford S. Science and Success: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually
  Transmitted Infections. Washington, DC: Advocates for Youth, 2003.
  Alford S. Science and Success, Second Edition: Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted
  Infections. Washington, DC: Advocates for Youth, 2008.

 

Insurance Companies See the Benefit of Health Reform

The Patient Protection and Affordable Care Act (ACA) is a large, complex, and controversial law. With so many mixed messages about the intent and predicted impact of the reform efforts, it can be difficult to understand.

Upon closer examination of the ACA, the intent of this law is clearly to advocate for and protect consumers. For example, the ACA made it illegal for insurance companies to deny coverage based on pre-existing conditions (cancer, asthma, previous injuries, pregnancy, etc). Beginning in January 2014, insurance companies will no longer be able to charge women higher rates based on gender. ACA provides many additional benefits and protections to consumers.

So how do insurance companies feel about the impending changes?

As with any big change, there is some opposition. However, some companies are beginning to look beyond their initial discomfort to understand the advantages of the law. The ACA created a tax credit for small businesses to provide health insurance to their employees. Due to this tax credit, insurance companies saw a significant increase in the enrollment of small business employees (examples: UnitedHealth Group, Coventry Health Care, and Blue Cross Blue Shield of Kansas City). Increased enrollment is beneficial for individuals and for insurance companies.

UnitedHealth Group, America’s largest insurance company, has already started implementing pieces of the ACA, and additional reforms. UnitedHealth is unveiling and expanding new “value-based contracts,” which reward doctors for providing high quality, and efficient care. Additionally, UnitedHealth is expanding their business technology services to include a system that will connect doctors and nurses working with the same patient, which will better coordinate and streamline care. The ACA also calls for stricter electronic standards, which increases the security and ease of communicating information between heath care providers and insurance companies. This improved efficiency will save time and money.

The ACA protects consumers, and strides toward a more effective and efficient healthcare system. Although big changes often initially elicit resistance, large insurance companies are beginning to see the benefits of increased enrollment and are improving quality and efficiency as a result. 

 

Using Technology to Connect in New Ways in Illinois

According to the Pew Internet & American Life Project, 85% of all Americans 18 years and older own a cell phone; of these users, nearly a quarter (72%) of them “text”. A July 2011 report shows that nearly one-third of all adults are “smart phone” users.

Given that these statistics are only likely to increase as technology becomes more advanced and allows us to get information in even smaller and more portable devices, it’s important to consider how technology help in efforts to share important and relevant information, as well as connect individuals with services that fit their needs.

For the past two years, Text4baby, the first ever FREE mobile health service, has been using cell phones to share health tips with pregnant women and new moms. Moms sign up by texting BABY to 511411 (or BEBE to 511411 to receive messages in Spanish) to receive helpful messages that are timed to their due date or baby’s first birthday. These messages include reminders about check-ups, immunizations, oral health, and tips for good nutrition.

We here at the Illinois Maternal and Child Health Coalition serve as the statewide coordinator  and have been working with health departments, community clinics, doctors’ offices, as well as local businesses to promote text4baby. To date, we’ve helped enroll nearly 13,000 users into text4baby and have made FREE outreach materials available for order from our website. We’ve heard firsthand from text4baby users about how direct and simple the messages are and how helpful they can be, especially for first-time parents.

Of the many useful messages provided by text4baby, several of them provide users with information about how they can get no-cost or low-cost health insurance for their children by providing them with the toll-free hotline 1-877-KIDS-NOW (1-877-543-7669).

Parents who call the 1-877-KIDS-NOW number in Illinois will be connected with the All Kids program, which provides affordable health insurance to children who live in Illinois and meet income requirements. Parents can request an All Kids paper application to be sent to their address or they can fill out the online application.

Nearly 1.7 million children in Illinois benefit from the All Kids program, which covers doctor visits, prescription drugs, hospital and emergency services, dental and vision care, and more. Some parents may qualify for FamilyCare coverage for themselves and pregnant women may be able to get benefits from the Moms & Babies program.

Even if text4baby or the All Kids or other health insurance programs may not be something that you need, consider sharing these resources on your Facebook page or sending out a Tweet to your followers about the benefits of these programs. With your help, we can ensure that more women, children, and their families have the best opportunity to lead healthy and productive lives.

Kathy Chan, kchan@ilmaternal.org
Illinois Maternal and Child Health Coalition

Read more: http://www.momsrising.org/blog/using-technology-to-connect-in-new-ways-in-illinois/#ixzz1nsaiGRo3

 

 

New Rules Will Make it Easier for Consumers to Understand Health Plans

Last week, final rules were issued by the US Departments of Treasury, Labor, and Health and Human Services for the “Summary of Benefits and Coverage (SBC) and Uniform Glossary”.   The SBC is a first step in consumer protection, but it also presents opportunities for advocates to get involved.

The Affordable Care Act requires new standards for use by health plans that “accurately describes the benefits and coverage under the applicable plan or coverage” and also calls for the “development of standards for the definition of terms used in health insurance coverage.” The final rule provides additional guidance to health plans that were developed through consultation with national experts and consumer-tested focus groups.

While this may sound complicated and boring, this rule is actually a great step ahead for health care consumers, and in particular, women, who tend to be the primary health care decision makers in families. Confusing language and lengthy, complicated forms make it difficult for consumers to make educated decisions about their plan selection and can lead to poor choices and coverage that doesn’t meet the health care needs of a family or individual.

A total of 12 required content elements are outlined in the final rule, including:

• Uniform and standard definitions of medical and health coverage terms
• Description of the coverage, including any cost-sharing requirements
• Information about any exceptions, reductions, or limitations in their coverage

Plans will also be required to provide notices in a culturally and linguistically appropriate manner, but only when 10% of more of a county’s population is literate in the same non-English language. Currently, this only applies to 255 counties in the US, of which 78 are in Puerto Rico. HHS does plan to make available written translations of the SBC temple, sample language, and glossary in Spanish, Tagalog, Chinese, and Navajo. Advocates and community-based organizations should push plans to make information available in additional languages and continue to play a strong role in helping connect clients with information. 

The SBC will also offer coverage examples that will help consumers understand how a plan will cover costs in particular situations, for instance normal delivery of a baby or managing type 2 diabetes.

SBCs will be required starting on the first day of health plans years beginning on or after September 23, 2012. The SBC cannot be longer than four double-sided pages in length and must be printed in 12-point font or larger. Consumers will access the SBC online and hard copies will only be available by request. This is a potential barrier for consumers and advocates should see this as an opportunity to push for broader distribution.

Check out the SBC template and glossary on the Center for Consumer Information and Insurance Oversight’s website and let us know what you think. Will you take the time to read these new forms when they are issued by your health plan? Are there still terms or phrases that are confusing? What can IMCHC and other advocates do to help consumers better understand their options?

Feel free to post your comments and questions below or share them with Kathy Chan, Director of Policy and Advocacy with IMCHC.

Hey my name is Vashun Walker. I am here to tell you about the danger of smoking this harmful killer drug - Tobacco. Tobacco can be consumed in many different forms including smoking, chewing, snuffing or dipping. Tobacco contains nicotine which is a highly addictive drug. Smoking is killing our children and it is a big waste in our community. The tobacco problem seems to be getting worse as time goes on. Instead of putting money into this deadly drug, we need to put homeless people into houses and open more schools and other positive things. Operation Storefront helped show us just how much money is being wasted on advertizing. It’s sad and needs to change so we have been talking to our peers about tobacco and need to get the message out.