Women in combat zones can face difficulty getting some contraceptives

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Screen Shot 2015-08-11 at 12.43.44 PMBy Michelle Andrews
KHN

Next year, the military will officially lift restrictions on women in combat, the end of a process that may open up as many as 245,000 jobs that have been off limits to women.

But women who deploy overseas may continue to face obstacles in another area that can have a critical impact on their military experience: contraception.

It’s not a minor issue. Rates of unintended pregnancy among women in the military are 50 percent higher than those of women in the general population. And because of strict federal rules, their insurance does not generally cover abortion.

Rates of unintended pregnancy among women in the military are 50 percent higher than those of women in the general population.

Tricare, the health care plan for more than 9 million active and retired members of the military, covers most contraceptive methods approved by the Food and Drug Administration. Active-duty service members pay nothing out of pocket. Spouses and dependents of service members may face copayments in some instances.

But all methods aren’t necessarily available at every military hospital and clinic, and overseas, for example, women may have difficulty getting refills of their specific type of birth control pill.

Nancy Duff Campbell, co-president of the National Women’s Law Center, says, “It is unfortunate that here we have the military, that has one of the best health care systems in the country, and where we still have a gap is in contraception.”

Fifteen percent of active duty service members are women, and 97 percent of them are of childbearing age.

In a 2013 study, based on more than 28,000 responses to the 2008 Department of Defense health-related behaviors survey, researchers found that after adjusting for the larger concentration of young women in the military, the rate of unintended pregnancy among military women was 7.8 percent, compared with 5.2 percent among women in the general population.

“It’s critically important to address unintended pregnancy in the military, because it can be particularly damaging to women’s careers, and it’s hard to access abortion care,” says Dr. Daniel Grossman, a study co-author who is vice president for research at Ibis Reproductive Health, a research and advocacy group.

Abortion is available at a military facility or covered by military health care only if a woman’s life is in danger or if the pregnancy is a result of incest or rape. Women who want an abortion in other circumstances must use a non-military health care provider and pay for the procedure out of pocket, according to Department of Defense health officials.

Coverage for emergency contraception, meanwhile, has recently been expanded to all active duty service women and female beneficiaries without cost sharing.

It can be challenging to use contraceptives while deployed overseas for many reasons. There is the problem of trying to schedule a daily birth control pill when traveling across time zones, and desert conditions may make a contraceptive patch fall off. Although women are allowed a 180-day supply of contraceptives before deploying, obtaining refills of the same pill is sometimes difficult, some women reported in a 2012 study published in Contraception about access to contraception during deployment that was based on survey of 281 servicewomen.

Women also reported that they were told that contraceptives were unnecessary because having sex during deployment was forbidden or that they couldn’t receive an intrauterine device because they hadn’t yet given birth. Neither of those claims is true.

The majority of women surveyed also noted that they weren’t counseled about using contraception for either pregnancy prevention or menstrual suppression before deploying.

Pre-deployment counseling that specifically addresses women’s contraceptive needs could help counter confusion and ensure women have access to birth control methods that meet their needs. According to military health system officials, contraceptive and reproductive counseling is a covered benefit under Tricare and is an expected component of good clinical practice.

The House and Senate versions of the Pentagon’s spending bill for the fiscal year that begins in October contain measures that would affect contraception coverage in the military.

The Senate version of the bill would guarantee family planning education and counseling, while the House version would make available a broad range of FDA-approved contraceptives at military treatment facilities and ensure that women servicemembers have enough contraceptives to last for the duration of their deployment. A congressional conference committee is working to write a compromise between those two bills.

Defense Department officials said they had no comment on the pending legislation.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

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Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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To address doctor shortages, states focus on residencies

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By Rebecca Beitsch
Stateline

Last year, 369 students graduated from Iowa medical schools, but at least 131 of them had to finish their training elsewhere because Iowa had only 238 residency positions available.

The story was the same for at least 186 students who graduated from Missouri medical schools and 200 who studied at Tennessee schools.

States such as New York, California, Massachusetts and Pennsylvania were happy to take them—all four states took in more residents than students they trained.

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This is the world of medical resident matching. When states don’t have enough residency positions for the medical students they’ve trained, they become resident exporters. When states have more residency positions than they have students to fill them, they become importers.  Continue reading

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Gallup poll: Washington ranks 5th among states with drop in uninsured rate

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From the Office of the Insurance Commissioner

According to a Gallup poll released today, Washington is one of five states to exceed a 10 percent drop in the number of uninsured people.

Seven of the 10 states with the biggest reductions have two things in common: they expanded Medicaid (called Apple Health in Washington) and established a state-based health exchange (ours is called Washington Healthplanfinder).

Washington state has seen record-low rate requests from health insurers in the past two years. Insurers proposed an average 5.4 percent increase for 2016. These plans are now under review and the average rate increase is likely to be lower.

For 2015 plans, insurers proposed an average rate increase of 8 percent. Insurance Commissioner Mike Kreidler eventually approved an average 1.5 percent rate increase.

“I’m pleased to see the health insurers show an increased interest in the individual market and to see rates continue to come in relatively low,” Kreidler said when the 2016 rates were submitted in May of this year.

Open enrollment for 2016 health plans begins on Nov. 1.

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Use of services by ‘frequent flyers’ often brief, study finds

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Study Casts Doubt On Assumptions About Hospital ‘Frequent Fliers’

By Michelle Andrews
KHN

Physician and Nurse Pushing GurneySuper-utilizers are the frequent fliers of the health care system, whose serious illnesses send them to the hospital multiple times every year and cost the system hundreds of thousands of dollars annually.

Figuring out how best to address these patients’ needs and reduce their financial impact on the health care system is a subject of intense interest among policymakers.

Now a new study has found that, in contrast to the notion that “once a super-utilizer, always a super-utilizer,” many patients who use health care services intensely do so for a relatively brief period of time.

“. . . large numbers of emergency department visits and hospital admissions … might have been prevented by relatively inexpensive early interventions and primary care.”

Research and news reports often point out that super-utilizers are often uninsured or on Medicare and Medicaid and account for a large percentage of health care spending. Federal officials have suggested that their “large numbers of emergency department [ED] visits and hospital admissions … might have been prevented by relatively inexpensive early interventions and primary care.” Continue reading

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Half of US hospitals hit with a total of $420m in Medicare’s readmission penalties

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Sign for an emergency room.By Jordan Rau
KHN

Once again, the majority of the nation’s hospitals are being penalized by Medicare for having patients frequently return within a month of discharge — this time losing a combined $420 million, government records show.

In the fourth year of federal readmission penalties, 2,592 hospitals will receive lower payments for every Medicare patient that stays in the hospital — readmitted or not — starting in October.

Overall, Medicare’s punishments are slightly less severe than they were last year, both in the amount of the average fine and the number of hospitals penalized.

The Hospital Readmissions Reduction Program, created by the Affordable Care Act, was designed to make hospitals pay closer attention to what happens to their patients after they get discharged.

Since the fines began, national readmission rates have dropped, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month.

Some hospitals view the punishments as unfair because they can lose money even if they had fewer readmissions than they did in previous years. All but 209 of the hospitals penalized in this round were also punished last year, a Kaiser Health News analysis of the records found. Continue reading

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Event: Back to school and type 1 diabetes

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JDRF Logo
Teen/College Pre Events

Back to School and T1D

Friday, August 21, 2015 6:00-7:30pm

Join us at Seattle Children’s Hospital to discuss best practices to successfully manage type 1 diabetes through the next school year. This event includes a panel of knowledgeable professionals that will address your questions and concerns from a variety of perspectives.  Please RSVP by August 14.

Our panel includes:

  • Lindy MacMillan, JD — Attorney with the Washington Medical-Legal Partnership
  • Paul Mystkowski, MD–Endocrinologist, Clinical Faculty, University of Washington
  • Cathryn Plummer, MSN, ARNP, FNP-C–Former school nurse and T1D mom
Seattle Children’s Hospital, Main Campus–River Entrance
4800 Sand Point Way NE
Seattle, WA 98105
To register, please visit www.backtoschool-t1d.eventbrite.com or contact Karine Roettgers kroettgers@jdrf or 206.708.2240
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Telephone therapy helps older people in underserved rural areas, study finds

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red-telephoneBy Lisa Gillespie
KHN

Therapy provided over the phone lowered symptoms of anxiety and depression among older adults in rural areas with a lack of mental health services, a new study shows.

The option is important, one expert said, because seniors often have increased need for treatment as they cope with the effects of disease and the emotional tolls of aging and loss.

“Almost all older adults have one chronic medical condition, and most of these have been found to be significantly associated with anxiety disorder,” Eric Lenze, a psychiatrist and professor at the Washington University School of Medicine in St. Louis, said in an interview.

The study, by researchers at Wake Forest University and published Wednesday in JAMA Psychiatry, examined 141 people over the age of 60 living in rural counties in North Carolina who were experiencing excessive and uncontrollable worry that is brought on by a condition called generalized anxiety disorder.

The participants had up to 11 phone sessions between January 2011 and October, 2013. Half of them received cognitive behavioral therapy, which focused on the recognition of anxiety symptoms, relaxation techniques, problem solving and other coping techniques.

The other study participants got a less intensive phone therapy in which mental health professionals provided support for participants to discuss their feelings but offered no suggestions for coping.

The researchers found that severity of the patients’ worries declined in both groups, but the patients getting cognitive therapy had a significantly higher reduction of symptoms from generalized anxiety disorder and depressive symptoms. Continue reading

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Death with Dignity participation rises slightly in Washington

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More than half of participants receiving lethal dose of medication are women

From Washington State Department of Health

It’s been six years since Washington’s Death with Dignity Act went into effect and since that time, 725 adults with a terminal illness have chosen to end their lives with a physician-prescribed lethal dose of medication.

Death with Dignity participation rose less than 2 percent in 2014.

There were 176 terminally ill patients in 2014 who received a prescription to help them end their lives. The prescriptions were written by 109 different physicians and were filled by 57 different pharmacists. Of the 176 people who received these prescriptions, 170 are known to have died.

Death with Dignity participation rose less than 2 percent in 2014 compared to the previous year, although more than half of those who died last year were women — up from 48 percent in 2013.

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Those who died after receiving the lethal medications were between the ages of 21 to 101. As in previous years, many patients choosing to receive the medication listed the loss of independence as the reason for participating.

Of the 170 participants in 2014 who died: Continue reading

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