Wednesday, February 27, 2013

Louisa-Care: Making Health Insurance More Affordable for Small Businesses

Louisa McQueeney is general manager and chief financial officer of Palm Beach Groves, a small, family-owned Florida gift and food shipping company. She believes it�s important for a small business to provide health insurance for its employees: �It creates a long-term relationship with your employees,� she says.

The health care law, Louisa says, is helping Palm Beach Groves continue to provide health coverage its employees by funding a health care tax credit for targeted small businesses. For Palm Beach Groves, that tax credit amounted to a $7,400 savings that could be used to offset health insurance costs. �

�It�s the first time in 12 years that I�ve actually seen a reduction in [health coverage] cost for the business,� Louisa says. �The decrease in our cost is directly tied to the tax credit. If it wasn�t for the Affordable Care Act, we would not be talking about a tax credit.�

Tuesday, February 26, 2013

Stronger Benefits for Seniors, Billions in Savings This Year

Two years ago, President Obama signed the Affordable Care Act and provided important relief to seniors, including a 50% discount on brand-name prescription drugs for those in the coverage gap known as the �donut hole.�

Prior to the passage of the new health care law, people on Medicare also faced paying for preventive benefits like cancer screenings and cholesterol checks out of their own pockets. �Now, these benefits are offered free of charge to beneficiaries.

These new benefits are already making a difference in communities across the nation. �Before 2011, David Lutz, a community pharmacist from Hummelstown, PA, described customers, �splitting pills, taking doses every other day, missing doses, stretching their medications,� noting that not taking their medications as prescribed was not good for their health. �

But, according to David, this has begun to change since the passage of the Affordable Care Act. �People cannot take their medications if they can�t afford them. This [Affordable Care Act] will make them affordable and they�ll take their medications on time, the way they�re supposed to, which will improve their health,� Lutz says. �There�s no question about it.�

In 2010, for example, those who hit the donut hole received a $250 rebate � with almost 4 million seniors and people with disabilities receiving a collective $1 billion. ��In 2011, Medicare beneficiaries received more than $2.1 billion in savings � averaging $604 per person last year � from the 50% discount on brand-name drugs in the donut hole.

And today, we have more good news. Even more seniors and people with disabilities on Medicare have benefited from these important measures:

In 2010 and 2011, over 5.1 million people on Medicare saved over $3.2 billion on prescription drugs in the donut hole. �In the first four months of 2012 alone, more than 416,000 people have saved $301.5 million � an average of $724 a person so far this year.In the first four months of 2012, 12.1 million beneficiaries on traditional Medicare received at least one free preventive service. �This includes over 856,000 who have taken advantage of the Annual Wellness Visit � a new benefit that allows patients to meet with their doctors once a year to develop and update a personalized prevention plan. �In 2011, over 26 million beneficiaries in traditional Medicare � received one or more preventive benefit free of charge.

These new benefits will increase over time. �In the coming years, the automatic discount on drugs in the donut hole will expand, and by 2020 the donut hole will be closed completely. And Medicare is growing stronger in other ways as well. Doctors and hospitals are beginning to receive new incentives to provide better care to patients �improving patient safety and lowering costs. �The new law also invests more resources in fighting Medicare fraud, to protect the trust fund, and keep Medicare secure for longer.

Thanks to the Affordable Care Act, seniors and people with disabilities are enjoying a Medicare program that is stronger and working better for David�s community and others all across the country.

Sunday, February 24, 2013

Choosing Ryan Defines Health Care For GOP Ticket

August 12, 2012

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Rep. Paul Ryan, R-Wis., speaks Saturday in Norfolk, Va., after being named Mitt Romney's vice presidential running mate.

Win McNamee/Getty Images

Rep. Paul Ryan, R-Wis., speaks Saturday in Norfolk, Va., after being named Mitt Romney's vice presidential running mate.

Win McNamee/Getty Images

One thing Republican Mitt Romney's choice of Rep. Paul Ryan as his running mate will certainly do is elevate issues like Medicare and Medicaid to the top of the election agenda.

As the nation gets closer to Election Day, Ryan's addition to the GOP ticket will present the public with a dramatic choice about the role the government should play in health care.

One thing the Wisconsin congressman never does is apologize for thinking big.

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"We also think we have a moral obligation to try and fix this country's big problems before they get out of our control," Ryan said in February on ABC's This Week.

Ryan is referring, among other things, to the budget plan he wrote and helped muscle through the House � twice. His plan would cut taxes, create private accounts for Social Security and, perhaps most notably, make major changes to the Medicare and Medicaid health programs.

The Medicare changes in particular are dramatic. Starting a decade from now, seniors would get a set amount of money rather than automatic coverage. They could use that to choose from a range of health plans.

"Doing it this way harnesses the power of choice and competition," Ryan said at a news conference last December. "Our goal here is to have the senior citizen, the beneficiary, be the nucleus of this program."

The amount of money the senior gets, however, wouldn't necessarily go up as fast as medical costs. Ryan and those who support his idea say that choice and competition would maintain the benefits. Others, including President Obama, aren't so sure.

"It says instead of guaranteed health care, you will get a voucher," Obama said in a speech last spring in which he blasted Ryan's budget plan. "If that voucher isn't worth enough to buy the insurance that's available in the open marketplace, well tough luck, you're on your own."

On Medicaid, Ryan's proposal would give states far more flexibility to decide how and who to cover, but also less money to do it with. In an appearance on PBS Newshour, Ryan said that what they're trying to do is couple Medicaid reforms with reforms in other programs such as food stamps, housing assistance, education and job training.

"We are trying to couple these things by sending them back to the states in block grants so the states can combine these dollars and reform the tattered social safety net," he said.

Analysts, however, say the cuts would be so large � about a one-third reduction over 10 years � states would have no choice other than to cut benefits or drop people from the rolls. Obama has said that this could put some elderly and poor people at risk.

At least one thing that's clear about Ryan's vision for health care compared to Obama's is that they're different. No one will mistake one for the other, says Aaron Carroll, a pediatrician and professor at the Indiana University School of Medicine who blogs on health economics. He says this campaign should give voters a clear choice.

"I think what Ryan puts forward is a vision of much less government involvement in things like Medicare and Medicaid, especially from the federal level," Carroll says.

What's less clear, however, Carroll says, is whether the nation really is ready to have what Ryan likes to refer to as an "adult conversation" about how to control entitlement spending.

"We probably can, but not in politics," he says. "Because in politics, of course, people want to win, and you win by scaring people into thinking [about] what the other side will do."

In 2010, Republicans tried to scare seniors about Obama's health law and Medicare. This time around, it will be the Democrats who will try to turn the tables.

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Why Some Hospices Turn Away Patients Without Caregivers At Home

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Amid An AIDS Epidemic, South Africa Battles Another Foe: Tuberculosis

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Saturday, February 23, 2013

Diabetes: Combating a Silent and Costly Killer

By 2050, as many as 1 in 3 adults in the United States could have diabetes if current trends continue, according to the Centers for Disease Control and Prevention (CDC). �Diabetes was the seventh leading cause of death in 2009, and people with diagnosed diabetes have medical costs that are more than twice as high as for people without the disease. The Affordable Care Act, the health care law passed in 2010, includes a number of provisions that directly address gaps in diabetes prevention, screening, care, and treatment.

Last week, CDC released its Diabetes Report Card 2012, which provides a snapshot of the impact of diabetes on our nation. Required by the Affordable Care Act, the Report Card profiles national and state data on diabetes and pre-diabetes, preventive care practices, risk factors, quality of care, and diabetes outcomes. ��It also documents the steps the Department of Health and Human Services (HHS) is taking to make a difference in the lives of millions of Americans living with diabetes and pre-diabetes today and to improve the lives of millions of Americans in the future through prevention.�

HHS is committed to fighting the diabetes epidemic across all of its relevant agencies and programs through a broad range of research, education, and programs that strengthen prevention, detection, and treatment of diabetes.� Thanks to the health care law, potentially life-saving preventive services are now offered in many health plans with no cost-sharing. These include:

Type 2 Diabetes Screenings for people with high blood pressure,Diet Counseling for people with known risk factors for cardiovascular and diet-related chronic disease, andBlood Pressure Screenings.

In addition, the Affordable Care Act expanded� CDC�s National Diabetes Prevention Program, a public-private partnership of community organizations, private insurers, employers, health care organizations, and government agencies working together to combat diabetes.�� The law also provides opportunities to improve treatment for people living with diabetes by supporting the creation of Medicaid health homes for enrollees with chronic conditions, and expands opportunities to address diabetes risk factors through community-based programs such as Community Transformation Grants.

We hope this Report Card will encourage individuals, communities, businesses, and other organizations to work with HHS to address the rising rates of diabetes and its consequences.� And we hope that more and more Americans will take advantage of the benefits of the Affordable Care Act, including the many free preventive services, so we can stop the current diabetes trends and be a healthier nation.

Read the full Diabetes Report Card 2012 (PDF - 1.36 MB).

McDermott Lands Top Dem Spot on Healthcare Panel

Rep. Jim McDermott (D-Wash.) snagged the top spot on a key healthcare subcommittee, House Democrats announced Tuesday.

McDermott is now the top Democrat on the Ways and Means Subcommittee on Health. The top spot opened up after former Rep. Pete Stark (D-Calif.) lost his reelection bid in November, and McDermott’s selection was widely expected.

McDermott, who is a doctor, was a strong supporter of President Obama’s healthcare law. He supports a single-payer healthcare system and has introduced a bill to let states pursue single-payer on their own, in the absence of a more sweeping federal overhaul.

He has sharply criticized Republicans’ plan to partially privatize the Medicare program � changes that would have to go through the health subcommittee if the GOP ever tries to put the plan on paper.

Why Tea Party Gov. Rick Scott Flip-Flopped on Obamacare

Florida Gov. Rick Scott was elected in 2010 almost entirely thanks to his activism opposing the Affordable Care Act, better known as Obamacare. Scott spent $20 million of his own considerable fortune attacking the law, and the Republican backed the state’s lawsuit challenging its constitutionality all the way to the Supreme Court. Scott had declared last summer that Florida would implement the law basically over his dead body, including the optional part that would provide federal funding to expand Medicaid to people making up to 138 percent of the poverty line.

So it was a bit of a surprise Wednesday when he announced suddenly that he had changed his mind: Florida should embrace the Medicaid expansion. We’d like to think that this article might have had something to do with his decision; Scott himself claims that mother’s death inspired his change of heart. But it’s more likely that the decision was a direct result of the US Department of Health and Human Services agreeing to grant Florida a waiver that would allow it to move more Medicaid recipients into private managed-care plans�many of which are part of huge corporate insurance companies waiting to cash in on the latest installment of Obamacare. (The Medicaid expansion is expected to send $66 billion in federal funds to Florida in the next decade.)

Scott has been saying for months that if HHS approved Florida’s waiver request, he might be more willing to take the Medicaid expansion. He was in DC in January meeting with HHS Secretary Kathleen Sebelius over the issue. But HHS’s decision to grant the waiver was somewhat surprising, given that the state was asking to expand a very troubled pilot project going back to the Bush era. The pilot project, which also required a waiver from HHS, allowed the state to put Medicaid recipients in five counties into private, HMO-type health plans rather than the traditional government health plan for the poor and disabled. Scott has championed the pilot as an innovative way of keeping government spending in check. Health care advocates, though, saw the program as a major disaster.

A study by the Georgetown University Health Policy Institute backed up their claims, finding that the biggest problem with the “reform” was that insurance companies got into the program thinking they’d make a lot of money, only to discover that they actually had to care for people who were expensively sick. Nine plans dropped out of the pilot project in a year, leaving many patients without access to any primary health care. There were horror stories, too: the woman denied a kidney transplant, the man with a lifelong seizure disorder who suddenly found he couldn’t get the Botox injections that calmed his seizures. If the patients weren’t getting dropped by the managed-care plans, they were fleeing them for whatever other options they could find. There’s no evidence that the private plans saved the state any money.

“We’ve been raising hell for a couple of years saying this is a problem,” says Laura Goodhue, executive director of Florida CHAIN, a consumer advocacy group that works for the uninsured in Florida. “When you’re caring for an expensive population with multiple conditions, lots of mental-health issues, the only way to make a profit is to delay and deny services, and that�s what we saw in Florida.”

Some of the companies chosen to lead the Medicaid “reform” pilot project weren’t exactly stellar performers before they got there. Wellcare, one of the HMOs in the project (and a major donor to Florida’s GOP), paid out $80 million in 2009 to settle charges federal criminal charges that it had lied about how much it actually spent on health care for poor kids and other vulnerable clients. Last year it paid out another $137.5 million to settle False Claim Act lawsuits alleging schemes to wring extra money out of Medicaid programs, including those in Florida, as well as cherry-picking customers and other abuses.

Despite experiences like these, the Florida Legislature in 2011 voted to expand the pilot project, and big insurers have been jumping to get into this market, (The insurance giant WellPoint, for instance, recently bought Amerigroup, a large Medicaid managed care company, to get in on new business thanks to Obamacare.) But to fully implement its new privatization law, Florida needed the federal government, which pays for about half the program, to waive certain requirements designed to protect patients.

Consumer advocates had fought the law and have been lobbying the Obama administration against granting Florida a waiver. And they had some success. Recently, HHS refused to allow Florida to let HMOs charge Medicaid enrollees $10 co-pays for doctor visits or $100 for emergency room visits for non-emergency care, as the state law allows.

And while Scott has heralded this week’s news about the latest waiver approval as a victory, what HHS actually agreed to is less than the governor and the HMO companies lobbying for the changes were probably hoping for. Among other things, HHS said that the state still has a long way to go to protect consumers enrolled in private plans, and that the approval of the waiver was “conditional,” premised on Florida developing “robust” community input and data-driven goals and strategies.

Goodhue says the new waiver has many more consumer protections built into it than the one granted under the Bush administration, and that hopefully it will prevent some of the problems that occurred under the state’s pilot program. She still doesn’t think that managed care is the way to go to improve Medicaid. But in the end, she�s pleased that it’s not as bad as it could be, and if it means that a million Floridians will get new coverage, that’s something advocates can get behind.

Tuesday, February 19, 2013

Cancer Rehab Begins To Bridge A Gap To Reach Patients

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Barring Insurance Discrimination Based on Pre-Existing Health Conditions

Too often, I�ve heard from people worried that they couldn�t leave a job because they had diabetes or breast cancer and they wouldn�t be able to get health insurance on their own because of their pre-existing condition.

Thanks to the health care law, those fears will soon be a thing of the past. As part of the Affordable Care Act, HHS today proposed a rule that would prohibit some of the worst insurance industry practices that have kept affordable health coverage out of reach for millions of Americans.

Under this new rule, starting in 2014, families and individuals would see new protections from egregious insurance company practices, including higher premiums or the denial of health coverage because of a pre-existing condition.

No longer would women like Myrna Rodriguez Previte, a breast cancer survivor, have to struggle to find health coverage because insurance companies refused to cover her because she had cancer previously.

No longer would young adults like Abby Schanfield, who has a rare genetic parasitic disease that has required multiple surgeries, and Steven Giallourakis, a two-time cancer survivor with chronic health conditions, have to worry about being refused coverage or charged more because of their medical history.

The proposed rule that HHS is issuing today would guarantee that being sick will not keep you, your family, or your employees from getting affordable health coverage.

This rule builds off earlier successes of the Affordable Care Act, which prohibited health plans from denying children health coverage because they had a pre-existing condition.

To learn more about how this proposed rule would create a better health insurance market for consumers, please see this page.

The Obama Administration today also issued the following:

A proposed rule outlining policies and standards for coverage of �essential health benefits,� while giving states flexibility to implement the Affordable Care Act. Essential health benefits are a core set of critical benefits that would give consumers a consistent way to compare health plans in the individual and small group markets. For more information regarding this rule, visit this page.A proposed rule implementing and expanding employment-based wellness programs to promote health and help control health care spending, while also ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status. For more information regarding this rule, visit this page.

Monday, February 18, 2013

Olympic Hopeful Works To Improve Bone Marrow Registries

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Saturday, February 16, 2013

Should The U.S. Import More Doctors?

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Wednesday, February 13, 2013

McDermott Lands Top Dem Spot on Healthcare Panel

Rep. Jim McDermott (D-Wash.) snagged the top spot on a key healthcare subcommittee, House Democrats announced Tuesday.

McDermott is now the top Democrat on the Ways and Means Subcommittee on Health. The top spot opened up after former Rep. Pete Stark (D-Calif.) lost his reelection bid in November, and McDermott’s selection was widely expected.

McDermott, who is a doctor, was a strong supporter of President Obama’s healthcare law. He supports a single-payer healthcare system and has introduced a bill to let states pursue single-payer on their own, in the absence of a more sweeping federal overhaul.

He has sharply criticized Republicans’ plan to partially privatize the Medicare program � changes that would have to go through the health subcommittee if the GOP ever tries to put the plan on paper.

Tuesday, February 12, 2013

Eyes On Election, Governors Hedge On Health Care

July 15, 2012

Listen to the Story 4 min 2 sec Playlist Download Transcript  

As governors from around the country meet this weekend in Williamsburg, Va., health care is near the top of their agenda. Specifically, what to do about the federal health law, now that the Supreme Court has given states new options.

Republican governors in particular said they were genuinely surprised by the Supreme Court ruling. The justices declared the health law in general constitutional, but gave states the option of whether or not to dramatically expand their Medicaid programs. They'll now get to choose whether to put most people who earn more than about $15,000 a year on the program or not.

"I think a lot of us, certainly on the Republican side, believed it would be found unconstitutional. So I think it's just added more confusion to the issue rather than settling the issue," said Utah Gov. Gary Herbert, "and probably more impetus on the November election to really find out and sort out what the implications are going to be going forward."

Indeed, the meeting's host, Virginia Gov. Bob McDonnell, said he wasn't planning to say yet whether his state would expand its Medicaid program, even with the federal government picking up the vast majority of the costs.

"Honestly, I don't think it's responsible fully for my state to make a decision now because there's still more information we need," he said.

Many Democratic governors see things differently, however, including Delaware's Jack Markell, the incoming chairman of the National Governors Association.

"This is not political. This is a financial analysis of what does it mean to cover, in our case, an additional 30,000 people," he said, "and my view � and we're clarifying that we're understanding it all properly � ... is that this is absolutely a good deal for Delaware taxpayers."

Unlike Republicans, who say the Supreme Court decision confused matters, Democrats like Maryland's Martin O'Malley also insisted that it should have ended the debate.

"I think most governors understand that the Supreme Court's decision was a final and clear ruling," he said.

Other Democrats were less charitable. Vermont's Peter Shumlin said some of his Republican colleagues aren't being honest by calling for the repeal of the health law on the one hand, while declining to say whether they'll accept the federal Medicaid funding that flows from it on the other.

"Have a spine. The American people are sick and tired of spineless politicians. [Either] say, 'I believe the Affordable Care Act is the wrong thing, so I will not take the loot,' or say, 'I believe the Affordable Care Act will help my state cover uninsured Americans, grow jobs, economic opportunities, and I'm taking the loot,' " Shumlin said. "But to say, 'I'm gonna criticize the plan, but I won't tell you whether I'm taking the loot or not until after the election,' that's what breeds cynicism among the American people."

O'Malley of Maryland thinks most of those Republican governors will eventually come around and take the money for economic � if not political � reasons.

"Once the posturing of the election is past, I think that a lot of these governors are going to have a hard time going home to their doctors, nurses, hospitals and explaining to them why they are passing up an opportunity to transform these dollars into better economic uses for job creation in their states," he said.

But for many Republican governors, like Nebraska's Dave Heineman, it's about something bigger than parochial interests.

"They all say it's free federal money. No, it's not. That's our tax dollars," he says. "It's costing every one of us."

Behind the scenes at the meeting, however, governors did seem to agree on one thing. There are still lots of questions they want the federal government to answer about how they will all work together as the health law's implementation proceeds.

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Monday, February 11, 2013

Seniors Fight Back Against Medicare Fraud

President Obama is making unprecedented strides in cracking down on health care fraud � already over $10.7 billion has been recovered since he took office.� And thanks to the Affordable Care Act, we have even more tools to stop fraud � including more law enforcement boots on the ground and more time in prison for criminals.� We�re also using state-of-the-art technology to spot fraud, similar to what�� your credit card company �uses . �As a result, prosecution of health care fraud cases is up 75% since 2008.

But for all of our new technology and investigative muscle, the most valuable resource we have in the fight against Medicare are the millions of seniors who serve as �our eyes and ears.� Seniors who notice services they never �received on their Medicare statements� often provide the �first tip that fraud is happening, so we�ve redesigned Medicare statements to make them easier to read and understand.� And our Senior Medicare Patrol (SMP) programs are educating seniors, family members, and caregivers around the country about the importance of reviewing their Medicare notices to identify errors and report potentially fraudulent activity.

That�s why the Obama Administration is investing more in the Senior Medicare Patrol. Today, the HHS Administration for Community Living announced more than $7 million in new funding to support Senior Medicare Patrol projects around the country.� This investment means more seniors will learn how to stand up for Medicare and will have even more support when they suspect that something isn�t quite right.

Seniors are paying attention and they are fighting back against the fraudsters who are trying to steal from Medicare. ��

I heard from a Medicare beneficiary in Texas who was asked to sign a work order for his diabetes supplies.� He said that normally he would have just signed and thrown the paper away.� But he had recently heard a presentation from the SMP at his adult day center, so he looked more closely and noticed that he was being charged $7,000 for one month�s supply.� So he asked his home nurse to help him call the National Hispanic SMP and together they figured out that the supplier was going to charge Medicare for 100 boxes of diabetes test strips and 100 boxes of lancets, even though he�d received only one of each.� The SMP helped resolve the case and made sure that Medicare only paid for the supplies he actually needed and received.�

Jerry Gilman, a 68 -year-old Vietnam veteran from California, has a medical condition that often makes him dizzy and in danger of falling.� His daughter, Deborah, and his doctor arranged for him to have a motorized chair to help him get around.� But the chair that arrived was not the chair that Mr. Gilman ordered.� It was smaller, flimsier, and made by an entirely different manufacturer.� Deborah called the supplier, but their hands were tied � Medicare had already processed the payment for the chair.� So Deborah turned to the SMP for help.� After weeks of investigating, they uncovered that someone had intercepted Mr. Gilman�s order and replaced it with the less sturdy chair.� The SMP was able to work with Medicare to correct the problem, get Mr. Gilman the correct chair, and make sure that Medicare wasn�t charged twice.

Chuck Johnson in Montana received a telemarketing call offering him diabetic testing supplies that he didn�t want or need.� But even though he was clear with the caller that he did not want anything, charges for those supplies showed up on his Medicare statement anyway.� Mr. Johnson got in touch with the SMP to see if they could help fix the problem.� Not only did his call mean that Medicare recovered money in his case, it also opened up a broader investigation into the organization that called him and could result in additional savings and prevented fraud.�

These three stories are eye opening, but they are not unique.� More than 1.5 million seniors have called SMP programs in cities around the country to ask questions and report potential fraud.� Together they�ve saved Medicare and the federal government in excess of $100 million. �

To all of you reading your Medicare statements carefully and tipping us off to fraud, I say thank you.� And I know your fellow American taxpayers say thank you, too. To learn more about the SMP program and to join us in our fight against Medicare fraud, go to www.stopmedicarefraud.gov.

Friday, February 8, 2013

'We Have No Choice': A Story Of The Texas Sonogram Law

January 22, 2013

Listen to the Story 29 min 0 sec Playlist Download Transcript   Enlarge image i iStockPhoto iStockPhoto

Tuesday marks the 40th anniversary of Roe v. Wade, the Supreme Court decision legalizing abortion. But in some states, access to facilities that perform abortions remains limited.

In part, that stems from another Supreme Court ruling from 20 years ago that let states impose regulations that don't cause an "undue burden" on a woman's abortion rights.

Texas, for instance, requires that a woman seeking an abortion receive a sonogram from the doctor who will be performing the procedure at least 24 hours before the abortion. During the sonogram, the doctor is required to display sonogram images and make the heartbeat audible to the patient.

The law went into effect on Feb. 6, 2012; Carolyn Jones had an abortion two weeks later. It thrust her into the complicated world of abortion politics and led her to write an article in the Texas Observer titled "We Have No Choice: One Woman's Ordeal with Texas' New Sonogram Law."

Read Carolyn Jones' Articles We Have No Choice: One Woman's Ordeal With Texas' New Sonogram Law Pregnant? Scared? Can They Help? Texas Women's Health Advocates To Bypass State In Bid For Federal Funds

Following that article's publication, Jones wrote a series for the Observer examining the impact of cuts to family planning services in Texas. Jones reported that since the state Legislature voted in 2011 to cut Texas' family planning program by two-thirds, 146 clinics lost state funds, and more than 60 of those clinics closed.

Jones talks about these cuts with Fresh Air's Terry Gross, and tells the story of her own encounter with the sonogram law.

Pregnant with her second child, Jones went for a routine sonogram and was told by her doctor that he was worried about the shape of her baby's head. A second sonogram that day at a specialist's office revealed a problem that was preventing her son's brain, spine and legs from developing correctly. The specialist warned that if the child made it to term, he would suffer greatly and need a lifetime of care. Jones and her husband decided she would have an abortion.

More On Roe V. Wade Shots - Health News 'Roe V. Wade' Turns 40, But Abortion Debate Is Even Older Around the Nation Involved For Life: Pregnancy Centers In Texas

Although she'd had two sonograms that day, the new Texas law required that she get another, administered by her abortion doctor, and listen to a state-mandated description of the fetus she was about to abort. (Four days after that sonogram, the state issued technical guidelines for its new mandatory sonogram law, indicating that if a fetus has an irreversible medical condition, as Jones' did, the pregnant woman does not have to hear a description of the sonogram.)

In her article, Jones asks: "What good is a law that adds only pain and difficulty to perhaps the most painful and difficult decision a woman can make?"

Jones tells Gross: "The politicians wanted women to have the sonograms so that they can see the life of the child that they are about to end, so it's an entirely ideological justification for why a woman would have to have a sonogram."

A full transcript of this interview is posted below.

Copyright © 2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. Today is the 40th anniversary of Roe v. Wade, the Supreme Court decision that legalized abortion. But since then, many states have passed laws that restrict women's access to abortion. According to the Guttmacher Institute, more state-level abortion restrictions were enacted in 2011 than in any prior year. And last year brought the second-highest number of restrictions ever.

We're going to look at what's happening in Texas, with a journalist who wrote about her abortion under the new Texas sonogram law. Later, we'll hear from the executive director of two Christian-run pregnancy centers, in Dallas, that encourage teens and women with unplanned pregnancies to keep the baby or put it up for adoption.

My first guest, Carolyn Jones, learned halfway through her pregnancy with her second child that the baby she was carrying had a severe developmental problem. She and her husband wanted a baby very much. But they decided to get an abortion, a decision she describes as heartbreaking.

She had her abortion in Austin, last February; just two weeks after Texas implemented its mandatory sonogram law. For reasons she'll explain, this law made the abortion even more heartbreaking. Her personal experience led her to write a series of articles for the Texas Observer, about how the state legislature has restricted access to abortion and has cut off state funding to Planned Parenthood clinics.

Carolyn Jones, welcome to FRESH AIR. Let's talk about some of the things you learned about changes in the Texas abortion law, from your own abortion experience. You wanted this child very much. You were hoping to have a brother for your little girl. And you had the abortion in January of last year. You had had a sonogram halfway through the pregnancy. What did the sonogram reveal?

CAROLYN JONES: What we'd expected the sonogram to reveal was the gender of the baby, the sex of the baby, which it did; but it also revealed that our baby had a major neurological flaw. And his brain, spine and legs had not developed correctly. And the doctor wasn't even sure whether he would make it to term - that the flaw was so serious - but that if he did make it to term, he would lead a life of great suffering. He would be in and out of hospitals, and it would be a life of pain and suffering for him.

GROSS: This was a hard choice for you to make. Can you talk a little bit about how you and your husband chose to proceed with an abortion instead of having the baby?

JONES: Mm-hmm. For me and my husband, we already have one child - a daughter; she's almost 3. And we love her so intensely. And I know that anyone else who, as a parent - will understand that intense parental impulse to protect your child from anything; absolutely any pain, you want to protect them from it. And when we heard that our second, very much-wanted child, if we brought him into the world, his life would be one of constant pain and suffering - to us, it was an instinctive response to think for this very brief moment, we have a choice about whether to introduce him to a life of pain or not.

And so to us, it was actually - it was a terrible choice; it was a heart-wrenching one. But it was also a simple one because as his parents, we chose what we believed was best for him, to prevent him from knowing a life of pain. And that was, in fact, quite a quick choice we were able to make as well, within minutes of my doctor giving us the terrible news. It was also almost an instinctive response about the choice that we would make. And this month, it's almost a year to the day that we made that decision. It was still the right decision for us because it was an instinctive one about protecting our child from pain.

GROSS: Once you made that choice, there were several steps you had to go through before the state permitted you to have the abortion that you chose to have. One of those steps had to do with a mandatory sonogram. You had already had a sonogram, the one that revealed the defect in the baby's nervous system. Why did you have to have another?

JONES: I actually, I'd had two sonograms that day. The first one was the one that revealed the anomaly. The second one was, we went straight to a specialist to confirm it. Those were both medically necessary sonograms, to understand exactly what the problem was. The third sonogram was one that was mandated by the state of Texas. It was a new law that had come into effect just two weeks prior to that day. And the law was intended to - let's see, the way the politicians described it, was to promote informed consent. The politicians want women who are having abortions to have the sonograms so that they can see the life of the child that they're about to end. So it's an entirely ideological justification for why a woman would have to have a sonogram. It's got nothing to do with - there are no medical reasons that the state required me to have it.

GROSS: Now, as it turns out - before we go any further, I want to mention that, you know, the law had just gone into effect, and a lot of health care providers weren't sure what they were mandated to do. As it turns out, under the law, you wouldn't have had to undergo this mandatory sonogram because the baby you were carrying had irreversible developmental problems.

JONES: That's right.

GROSS: But your doctor didn't know that yet because it was so unclear, and I don't think...

JONES: That's right, yeah.

GROSS: Yeah. So you had the mandatory sonogram that women - with few exceptions - have to get in Texas now. So what are the requirements surrounding the mandatory sonogram? And as we just explained, you ended up having this sonogram because your doctors didn't realize yet that you were exempted.

JONES: The requirements are that a woman must have the sonogram 24 hours before the abortion procedure can go ahead. The doctor who performs the abortion must also perform the sonogram - which, as you can imagine, creates all sorts of logistical nightmares for clinicians who are traveling from clinic to clinic. They're now having to add in this extra day, to provide the sonograms as well.

On top of providing the sonogram that every woman - with a few exceptions - must undergo before having an abortion, every woman must then wait for 24 hours. And, I mean, even though I was technically exempt from having had the sonogram, I wasn't exempt from the 24-hour waiting period.

Sorry, just to go back to the sonogram itself, the doctor would then have to describe the physical characteristics of the fetus. And the doctor - he or she - would also play the fetal heartbeat as well, for you to hear. The doctor would then have to read through a formal script, written by the state, about the abortion procedure as well as the risks of abortions. And two of the risks that are mentioned in this list are an increased chance of getting breast cancer, as a result of having an abortion; and an increased chance of having negative psychological outcomes - both of which, I should point out, have been discredited by mainstream medical science. Nonetheless, these two discredited facts, as well as - sort of unnecessarily graphic description of the abortion procedure itself, are part of the government script that a clinician must read to a patient before the abortion can go ahead.

Other parts of the requirements, as well, is that before the woman can go ahead with the abortion, she must also listen to a government script that tells her that the father of the child is liable to pay child support, whether he wants the abortion or not; and that the state may or may not pay for your maternity care. So these are all things that have to be included in the script that the woman hears, regardless of whether she wants to have this abortion or not.

GROSS: Let me just back up a bit. So the doctor performing the abortion, that has to be the same doctor who's doing the sonogram ...

JONES: Yes.

GROSS: ...and describing what he or she sees, to the woman who's having an abortion. So does that mean - like, in your case, the sonogram reveals terrible developmental problems in the fetus. Would the doctor be required to tell you that? Or is the doctor just supposed to say, I see arms; I see beginnings of legs; I see a little head - do you know what I'm saying?

JONES: I do, and I do think there is - you know, there are sort of formal characteristics that the doctor is required to describe. I have to admit that I imagine that the doctor, if he or she saw, you know, anomalies, they would describe them. But I have to admit, with the doctor, when he began to read this description to me - describe it to me, I found it so traumatizing that I heard the beginning; where he said that he could see four healthy chambers of the heart. And it's true - is that my very unwell child did have a healthy heart; not much else that was healthy, but the heart was. And to hear that was so traumatizing, that I did try and turn away, and try not to listen. So I really can't say what is part of the formal (technical difficulties), but I do imagine that they would have described what they saw, and perhaps my doctor did. I can't say.

GROSS: It sounds like the nurse wanted to help you not listen...

JONES: Mm-hmm. That's right.

GROSS: ...because she saw how traumatized you were, and she turned up the volume of the radio as the doctor was describing the fetus while reading the sonogram. Did that make you feel any better - like, at least somebody was trying to protect you from this mandatory sonogram?

JONES: In a very strange way, it did because in the room, at the time, was me, my husband, the doctor and the nurse. And there was not one of us in that room who wanted to go through that process of having to go through the sonogram. And, you know - and the doctor said to me, before it all started - and I was, you know, I was in a very emotionally fragile state. He did say to me, I'm so sorry I have to do this but if I don't, I will lose my license.

And that actually really helped; to imagine that all four of us were in it together, in a way. They showed such compassion for me in that no one agreed with it. And that did, in a strange way, help. And also, with the nurse turning the radio on - you know, I think it was, you know, maybe a D.J. or perhaps a commercial for used cars or something, clattering in the background. It was, you know, a slightly surreal experience. But again, the whole experience was so unpleasant that I appreciated any efforts they could make to stay within the law but still, you know, behave compassionately towards me and my husband.

GROSS: And one more sonogram question. You know, we've heard so much about transvaginal ultrasounds being mandated; you know, attempts to mandate that in some states. In Texas, it's not transvaginal; it's just an on-the-belly sonogram, right?

JONES: Actually, it is transvaginal. For anyone in the early stages of pregnancy, the only way that you can actually get a good look at the fetus is to use a transvaginal probe. For me, because I was at 20 weeks of pregnancy, I had the old - what would be called the jelly on the belly; which is, you know, the wand that you pass over your stomach. But for any woman in early stages of pregnancy - and in fact, you know, thousands of women in the last year have had to have a government-mandated transvaginal probe, for no medical reason.

GROSS: The goal of the mandated sonogram is to get the woman who is planning on having an abortion, to reconsider. What impact did the sonogram, and the recitation of the information that the government mandates the doctor to tell you - which is intended to discourage the woman from having an abortion - what impact did that actually have on you, and on your frame of mind, when you proceeded with the abortion?

JONES: It had no impact on my decision to go ahead with the abortion; none whatsoever. It was a private choice I'd made, and I was going to stick with that private choice no matter the people who tried to interfere with me. In terms of my broader frame of mind, it did make me feel very angry, and I still do. I still feel very angry that someone who has absolutely no say in, you know, my personal decisions, could still be there at that moment. The darkest day of my life was the day that we - I found out that information and had to make that decision. That someone could invade upon that - a politician, who has absolutely no jurisdiction over my private life - that they could invade upon that and so reduce my dignity, I do feel that that's an incredible injustice; and I still do, which is why I felt the need to write about it.

GROSS: We've talked a little about the abortion that you had because you were carrying a baby that had severe neurological impairments; and the doctor told you if the baby survived to the point of childbirth, that it would be basically condemned to a life of suffering. Let's broaden that discussion into what the Texas state legislature has been doing in the area of women's reproductive health care. In the 2011 session, the legislature cut the state's family planning program by two-thirds. What was the program, and who was most affected? What services were most affected?

JONES: The program - this would have been the state family planning budget; and before the 2011 legislature, it accounted for about $112 million. And that pot of money funded family planning and well-women services for about 220,000 of the poorest men and women in Texas. And not only did that provide birth control but also well-women exams and STD screenings, and breast cancer and cervical cancer screens. So it was really quite a comprehensive program.

During the 2011 legislature, that budget was slashed by two-thirds. It brought it down to about $40 million. Now, the reason that this money was slashed was because the conservative legislature wanted to starve Planned Parenthood of any state funding. And in a very unfortunate development, the legislature had somehow conflated abortion with family planning.

And these are not big chains, family planning chains across Texas. Many of them are actually small, mom-and-pop providers out in the rural areas, working with very small communities. You know, what we discovered at the Texas Observer was that within about six to eight months of these cuts happening, more than 60 family planning clinics across Texas were forced to close.

GROSS: Now, you write that many clinics that didn't close rely on funding from another endangered source in Texas, the Women's Health Program. What is that program?

JONES: That's right. The Women's Health Program, before the 1st of January of this year, was a federally funded program aimed at - again - the poorest men and women in Texas. I think it covered about 115,000 men and women. And it provided them with contraception and well-women care, and breast and cancer screening. As I said, it was federally funded; which means that for every $1 that Texas spent on this service, the federal government spent another 9. So as you can imagine, this was a good program for us to have in Texas.

Now, Planned Parenthood was the dominant provider of women's health program services in Texas. Forty-five percent of the clients in this program were seen by Planned Parenthood providers. And because this is Texas - and the conservative legislature have a vendetta against Planned Parenthood - in the 2011 legislature, they decided they needed to do whatever they could, to get Planned Parenthood out of Texas. So another way that they chose to do that was to exercise another law that meant that - it was called the affiliate rule - which claimed that Planned Parenthood would not be able to access federal funds because they were affiliated with abortion providers.

So Texas tried to exercise this affiliate rule. The federal government said it was not legal to remove one of the providers from the program. And it was then litigated in court; back and forth, between Planned Parenthood and the state of Texas, about whether they can or cannot be within this program. On the 31st of December, the federal government said that they would not be able to provide federal funding towards a fund that had evicted one of the providers.

And so the state of Texas said they would happily walk away from that 9-to-1 federal match because they really did not want to have to have Planned Parenthood in the program itself. So on the 31st of December, we lost the federal funding for that program. On the 1st of January this year, it became an entirely Texas-funded program. So it's now called the Texas Women's Health Program.

GROSS: Is there an estimate of how much money Texas is walking away from?

JONES: Yes, I think in - over a two-year period, it will probably cost Texas $70 million that they wouldn't have had to have spent if they'd stayed within the Medicaid program.

GROSS: We've talked about cuts to women's reproductive health care. We've talked about counseling against having abortion. What effect do you think all of this is having on the quality of women's health care and access to women's health care in Texas?

JONES: Well, we already know that at least 60 clinics across Texas have closed. We also know that even those clinics that still receive state funding, it was much less than what they were receiving before. So where they were providing family planning services for free, now they must share the costs with the patients. And that's very tough for these women, these low-income women who are in dire economic straits as it is. The other impact that we're seeing is that the family planning clinics that are still able to stay open, they aren't able to offer some of the more expensive yet more effective contraceptive options. So that's reducing women's choices as well.

Something else we're seeing, too, is that the Texas Health and Human Services Commission - the state agency that's responsible for all of this - they've already started their projected budget for 2014 and 2015. And they have projected 24,000 extra births as a result of these cuts to the family planning budget. And they have said that their budget will need, probably, about $273 million in order to cover the costs of all of these extra births. Now, this has more than doubled the size of the family planning budget that was slashed so dramatically in 2011.

We won't yet see exactly how many births there are, for a while. We won't see the impact of women whose cancer screenings - who weren't picked up in time. Those will come later. But, I mean, if the state agency itself is already projecting for so many extra births and so many greater costs, I think we can be sure that the collateral damage from those decisions made in 2011, will be far-reaching - and very damaging for women and men in low-income state, across Texas.

GROSS: I don't know if you can answer this, but are the extra births because women are deciding against abortion, or because they don't have access to contraception?

JONES: I would guess that there are both. I mean, we won't know this until we've got the figures. But I would imagine that there will be extra births from lack of access to contraception, and more women being funneled towards crisis pregnancy centers whilst those family planning clinics they might have gone to before have closed.

GROSS: The state of Texas is funding a program called Alternatives to Abortion, and this is a state program that funds crisis pregnancy centers.

JONES: Mm-hmm.

GROSS: What are these centers?

JONES: Crisis pregnancy centers are - their sole raison d'etre is to convince women with unplanned pregnancies to keep the child rather than have an abortion. And they're often Christian organizations, and they promote either parenting or adoption. And they really do their very best to persuade women that abortions are not the right decision for them.

GROSS: So what do you know about the information that is provided, and if there is information that is withheld for women at these centers?

JONES: Yes. The information that they will provide is, in fact, the same information that was provided to me when I went to the abortion clinic. It comes from a pamphlet written by the state, called "A Woman's Right to Know," which describes exactly - which describes the abortion procedure in very graphic detail. They speak about suctioned body parts and crushed skulls. It's really a very graphic, and very upsetting description.

And they also - the pamphlet will also speak about the link between having an abortion and getting breast cancer; the link between abortion and thoughts of suicide or depression; all of which, as I said before, have been discounted by the medical community. So this is the information that crisis pregnancy centers - or certainly, the ones that are receiving funding from the state - will give to women who come in there; women that they call - in their terms, abortion-minded women.

The information that they will give to them about parenting or adoption is overwhelmingly positive information. And, for example, the one crisis pregnancy center I was looking at in Abilene, Texas, the information they'll say is: Now that you are pregnant, you are already a mommy. And if you choose adoption, it's the most unselfish choice you can make for your child. So they lay out the choices that these women have. But as you can see, you know, they weight them all very differently.

GROSS: Since Texas has cut funding to family planning centers and to clinics that provide abortions, where is the money for the Texas Alternatives to Abortion program coming from?

JONES: The money came, interestingly, from the family planning budget. So during the - the one that was slashed so heavily in the last legislative session. Each session that goes by - the Alternatives to Abortion program has been running since 2005; it gets more and more money siphoned towards it. So that money is coming out of a program that is designed to prevent unwanted pregnancies, and is now going towards a program that's designed to promote childbirth and prevent abortion. It's sort of missing out the middle bit - which is, you know, the trying to help women prevent the pregnancies that would lead them to have an abortion, or lead them to end up in a crisis pregnancy center.

GROSS: In discussing alternatives to abortion, does the state allow the crisis pregnancy centers to discuss birth control with women who, after they deliver the baby, they can - if they so choose - not get pregnant again in the near future, until they're ready?

JONES: The terms of the contract are pretty sparse. So no, the state does not require the crisis pregnancy centers to discuss family planning with their clients. And in fact, that many of the crisis pregnancy centers - but they choose to discuss it anyway, and many of the crisis pregnancy centers promote abstinence as the only form of birth control. And this has much to do with the sort of religious affiliation of many of these crisis pregnancy centers; where they believe that chastity is actually the only effective form of birth control. And in fact, there are a few crisis pregnancy centers who believe that abstinence is also the only form of birth control for women who are married.

So that's quite an extreme position to take. And anyone who is at a crisis pregnancy center is, by definition, sexually active. So for these centers to promote abstinence as the only way to prevent future pregnancies is very irresponsible, from a public health perspective; and very troubling that the state does not require these centers - that are receiving state funding - to actually give them scientifically valid information about preventing future pregnancies. And not only is this concerning for women in that they're not receiving the information they need about preventing future unwanted pregnancies, but it's also, they're not giving them information about preventing things like sexually transmitted infections.

Again, these centers, crisis pregnancy centers will talk about the dangers of sexually transmitted disease; but again, they'll say that the only way that they can prevent getting a sexually transmitted infection is to abstain from having sex. But in fact, for teens and women in their 20s and 30s, that's not a realistic choice for many people. And again, it's - you know, very worrying, from a public health perspective, that these centers are promoting this information and in fact, they are receiving state funding to do so whilst at the same time, the evidence-based centers that were providing women with medically accurate information about their health, are being de-funded.

GROSS: But Texas doesn't mandate that these crisis pregnancy centers have an abstinence-only approach.

JONES: No, not according to the contract that these centers have with the state. It's not mandated. But it's also - there's nothing included in there, that says that they should give them accurate advice, either.

GROSS: You grew up in Zimbabwe, and I have no idea what Zimbabwe's abortion policies are. But is there anything that's particularly surprised you about the abortion debate in America, compared to who - what you were exposed to in Zimbabwe?

JONES: Mm-hmm. You know, I can't really speak to the abortion policies in Zimbabwe. But I can certainly just say, it surprised me just how restricted women's access is, in the U.S. I - honestly, before my personal experience, I was extremely naive about what kind of rights we have in the U.S. I mean, my understanding - and it was, as I said, very naive understanding - was since Roe versus Wade 40 years ago, women in the U.S. had the right to have an abortion. And to me, it was as simple as that, really.

And it wasn't until I had my own, personal experience that I started looking into this and thinking actually, though women have a legal right to an abortion, that those rights are being chipped away at - all of these different states. And in fact, what surprised me the most is that the legal right to abortion was enshrined, in 1973, for all women in the U.S. But then the Hyde Amendment - then actually removed that right for low-income women. The Hyde Amendment prohibited federal funds from paying for women's abortions unless - in the cases of, I think, rape or incest, or perhaps fetal anomaly as well; there were fewer - exceptions but essentially, it took away women's economic access to having an abortion. And that that has had a huge impact on women in the U.S.

So we may have a legal choice to have an abortion in the U.S. but actually, our choices are very much constrained by the kind of social and economic access that we have in society. And I'm horrified by how hollowed out that legal choice actually is.

GROSS: Well, Carolyn Jones, I want to thank you very much for talking with us.

JONES: Thank you for having me, Terry.

GROSS: Carolyn Jones has written about her abortion, the Texas mandatory sonogram law, and state cutbacks to family planning centers, for the Texas Observer. You'll find links to some of her articles on our website, freshair.npr.org.

Coming up: Carolyn Cline, the CEO of a Christian group that runs centers that discourage women with unplanned pregnancies from having abortions; and offers counseling and assistance to help with their pregnancies.

This is FRESH AIR.

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Starting today, consumers can review SBCs for many individual market plans which are posted on the Plan Finder�, here on HealthCare.gov (Click on �Find Insurance Options�). �In addition, health plans and health insurance issuers must give you the SBC at certain times during the plan or policy year, including when you purchase coverage and when coverage renews.� Also, consumers can always get an SBC from a plan or issuer by requesting it.

The health insurance marketplace can be confusing for consumers.� The SBC will help explain benefits and costs in plain language and in a uniform and recognizable format so consumers can see how a particular plan works in terms they understand.� In addition, the SBC will not contain any �fine print� or insurance jargon. Instead, you�ll get the basic facts. And when we make the insurance marketplace more transparent and competitive, we empower consumers and help drive costs down.

Remember�Before you enroll, take control. The SBC can help you find a health insurance option that is best for you.

You can learn more information on today�s announcement here.

For a sample SBC, please visit this page (PDF 530KB).

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