Archive for the ‘health care’ Category
Ever wonder what to say when some ‘helpful’ person asks awkward questions like
“When are you going to get married?”
“Don’t you want kids?”
“Aren’t you worried about who will make medical decisions for you?”
AtMP members have come up with lots of fun, creative retorts, including
“When are you going to get divorced?”
“Why do you have kids?”
“Of course I’m not worried, I’ve written my advance directives! Have you?”
Here’s the truth about healthcare decision making: you can handle it. You already have an equal right to name a proxy – someone to speak for you if you can’t speak for yourself. You don’t have to be in a relationship or get married to have peace of mind about decision making in medical emergencies. And it’s free!
National Healthcare Decisions Day is April 16th. Are you ready? It’s as easy as 1,2,3!
Go for it!
USA TODAY reports that suicide “rates among GI’s who are single or divorced double when they go to war, [but] the rate among married soldiers does not increase…”
“One of the big things we’re interested in now is digging into this marriage thing and saying, ‘What is it you get, by being married? And how could we put it in a bottle so we can give it to everybody, whether or not they’re married?” says Ronald Kessler, a psychiatric epidemiologist at Harvard Medical School who is working on the project.
I’ve written to Dr. Kessler to suggest that many of the things married soldiers get need to be budgeted, not bottled. Pay rates, VA and survivor benefits, housing quality and other tangible features of military life have all been documented to be better for married service members.
I also suggested looking at it from the other direction: what do unmarried soldiers get that harms them, and how do we take that away. For example, do they get assigned harder jobs or longer hours or more crowded barracks? That would hardly be surprising, as we have heard many examples of such assignments in civilian life. Do unmarried soldiers get more teasing (i.e., harassment) about their relationship status, or less sympathy when their relationships end? That would also mirror workplace complaints that we frequently hear from civilians.
Job-based health benefits for unmarried people are under attack all over the country.* Most recently, the Michigan State Senate resolved to take away health benefits from the unmarried families of state employees, including the staff at public universities. This would be an especially painful setback because Michigan’s rules are more inclusive than many other states’: any adult household member can be covered, even if not in a romantic relationship with the employee.
If you know someone who lives in Michigan, please encourage them to speak up!
Last year, LGBT organizations committed to doing a better job of connecting LGBT rights to other social justice issues. They’ve done a really nice job lately of connecting domestic partner benefits to collective bargaining in Ohio. I always want to see more emphasis on the fact that healthcare and workplace issues like domestic partner benefits are not just “gay” concerns, but affect much larger numbers of unmarried people.
Ohio’s unionized government employees don’t get DP benefits. But unionized workers at public universities in Ohio do. Several of those contracts cover only same-sex partners, but Kent State’s, for example, does not discriminate on the basis of gender (although partners cannot be “related by blood to a degree that would bar marriage”). Kent State is in the Akron Metro Area, where the 2009 American Community Survey estimated that 95% of the area’s over 15,000 unmarried partner households are different-sex couples. (Unmarried partner households comprise 5% of area households altogether.)
When unions negotiate workplace rights and benefits like inclusive domestic partner coverage, the impact can be felt beyond just the few union members who are in a position to use them. Employers discover that the sky doesn’t fall, and extend similar benefits to everyone. For example, Ohio recently granted nonunion state employees the right to take bereavement or sick time for issues related to a live-in partner.
This is a great example of extending what I call “care time” – the right to take time off work to care for the health of loved ones (and oneself) without being fired or losing pay. Care time is a big area of marital status discrimination in healthcare and at the workplace. Expanding care time is an affordable and humane way to achieve more fairness for all unmarried people.
Professor Nancy Polikoff’s blog Beyond Straight and Gay Marriage is always worth reading (and you can always find it here, lower right side of your screen). This week she posted big news that I know you care about. You simply must check it out!
- 35,000 Michigan state employees to gain “plus one” health benefits
- Illinois civil union law signed today — more equality yet more injustice
- Penn Law Review hosts debate on arguing for marriage
Florida Governor Rick Scott says his “personal position” is that only “married couples” should adopt children. Meanwhile, the Congressional Research Service details federal tax benefits for people who adopt children.
An international expert says the state of Vermont could launch a single-payer health system. Meanwhile, Vermont’s 2006 health reforms seem to be covering more people (no data on marital status, however).
The national health care reform law that passed last year took some important steps towards getting marital status out of people’s way when they’re trying to access affordable health care. It should not be repealed.
One nice step is that young couples no longer have to put off marriage in order to stay on their parents’ health plans.
A much bigger step is increased coverage for single people with low incomes. Scheduled to start in 2014, people who earn less than $15,000 per year will be eligible for Medicaid in every state. That’s hugely important because Medicaid has primarily been available to low-income mothers and children, with eligibility varying state by state.
Obviously, health care reform affects all of us, for reasons that go far beyond our marital status, and there are many other places you can find information on how it affects seniors, women, businesses, etc. But even if you care only about equality for unmarried people and ending marital status discrimination, you should speak out against repealing health care reform.
(If you’re completely sure the repeal effort is just a publicity stunt that doesn’t matter, then please take a moment to join the call for single payer, the one reform that really takes marital status out of the health care equation.)
If you’re on our email list, you recently saw my hopeful predictions for 2011. Here’s a bit more detail about what they mean and why I think they could come true.
Political candidates in majority-unmarried districts will drop their old “families first” slogans and start campaigning “for every single one of us.” An important use of the decennial Census is to redraw Congressional district lines so that each district contains roughly 1/435th of the population (that’s a simplification, of course). After the 2000 Census, our friends at Unmarried America produced a wonderful list of unmarried majority cities. We already have two volunteers willing to help crunch the latest Census figures, and we already have great feedback about what unmarried voters want candidates to say. We’ve sketched out a plan to find and draw attention to Congressional districts where most adults are unmarried. If you’re good with data and/or publicity, we can use your help to get this off the ground!
Scientists will discover that marital status discrimination is bad for people’s health, urging companies to treat unmarried employees fairly as a way to reduce healthcare costs. A fantastic advisory committee is helping us develop a research framework that could demonstrate the impact of marital status discrimination on public health. Our objective is to build widespread, high-level recognition that correlations between marital status and health outcomes are caused by laws or regulations that use marital status to determine access to healthcare. Demonstrating causality will support AtMP’s position that marital status discrimination in healthcare is a social justice problem to be solved.
Congress will rewrite the welfare law, replacing the 1990′s “marriage-only” preamble with words like: “the most important factor in a child’s upbringing is whether the child is brought up in a loving, healthy, supportive environment.” Those very words are in the preamble of the House bill mentioned in my last post – it gained 39 co-sponsors and supportive feedback from the administration last year. AtMP started advocating these changes a decade ago and we’re committed to seeing it through to success.
Major foundations will give AtMP grants to hire a full-time researcher / organizer to advance these and other projects. For the first time, a well-known LGBT foundation has invited AtMP to request a grant, and an experienced grant writer has volunteered to help me write a most compelling proposal. Wish us luck!
In August, AtMP commented on the proposed federal hospital visitation rule. We urged that it explicitly ensure visitation access by health care proxies, access to incapacitated patients who have not designated visitors and/or completed advanced directives, and access without discrimination on the basis of marital/relationship status.
In late November, the Centers for Medicare and Medicaid Service (CMS) published the final rule, along with general responses to all the comments it received (nearly 7,600, of which “more than 6,300 were versions of a form letter”). We didn’t get everything we wanted, but overall we’re delighted that a strong and inclusive visitation rule is now in place for practically all hospitals.
For this result, you should thank your fellow AtMP members, who bravely shared their private heartbreaks for the sake of preventing yours. Much credit also goes to Jess, who slogged through the regulatory process, and to Heather, who drafted AtMP’s initial analysis. And credit also Nancy Polikoff, who set us on this course back in 2008 by correctly predicting that hospital right were the low-hanging fruit for a valuing-all-families approach to policy change.
First, here’s the final rule, which goes into effect on January 18th, 2011:
Patient visitation rights: A hospital must have written policies and procedures regarding the visitation rights of patients, including those setting forth any clinically necessary or reasonable restriction or limitation that the hospital may need to place on such rights and the reasons for the clinical restriction or limitation. A hospital must meet the following requirements: (1) Inform each patient (or support person, where appropriate) of his or her visitation rights, including any clinical restriction or limitation on such rights, when he or she is informed of his or her other rights under this section. (2) Inform each patient (or support person, where appropriate) of the right, subject to his or her consent, to receive the visitors whom he or she designates, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and his or her right to withdraw or deny such consent at any time. (3) Not restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability. (4) Ensure that all visitors enjoy full and equal visitation privileges consistent with patient preferences.
We are delighted that CMS directly addressed our concern that legally appointed health care agents be assured visitation:
One commenter suggested that health care proxies or powers of attorney that are legally recognized in one State also be recognized by hospitals in other States for the purpose of establishing visitation rights. Response: We agree that the patient’s representative and/or support person, as the individual responsible for exercising the patient’s rights on the patient’s behalf when the patient is incapacitated or otherwise unable to do so directly, should be granted direct access to the patient. This basic concept is embodied throughout the current hospital regulations, including through the requirement at § 482.13(a) and (b) that the patient or patient’s representative must be informed of the patient’s rights and how to exercise those rights. We also agree that using the information provided in an advance directive or other written document, whether it is or is not legally recognized by the State, may be useful for hospitals when trying to determine appropriate visitors when a patient is unable to communicate his or her own wishes and a legal representative as established consistent with State law or a support person is not available to exercise the patient’s visitation rights on his or her behalf.
We are also pleased with CMS’s approach to ensuring visitors for incapacitated patients.
[C]ommenters stated that, when a patient is incapacitated, the patient’s … support person should not be chosen solely based on an individual’s legal relationship with the patient. Commenters noted the lack of protection for ‘‘families of choice,’’ which do not necessarily fit a traditional definition of a family, one based on bloodlines, marriage, or adoption, make it difficult for visitors to gain access to sick loved ones. … Response: … In the absence of a verbal support person designation, hospitals would look to their established policies and procedures for establishing a support person for the purpose of exercising a patient’s visitation rights. … [T]here are numerous sources of information and documentation that may be appropriate to establish the appropriateness of an individual to exercise an incapacitated patient’s visitation rights on his or her behalf… [Furthermore] we believe that documentation to establish support person status for the purpose of exercising a patient’s visitation rights should be required only in the event that the patient is incapacitated and two or more individuals claim to be the patient’s support person. (emphasis added)
Obviously, we are disappointed that marital/relationship status was not added to the final rule. Here’s how CMS addressed that point:
Commenters stated that the protected categories in the proposed rule should be expanded to also include: marital status, family composition, age, primary language and immigration status. In addition, commenters suggested that the proposed rule make explicit that institutional or individual conscience cannot be used to deny a visitor access to the patient. Response: As revised, we believe that this rule makes clear that hospitals must establish and implement visitation policies that grant full and equal visitation access to all individuals designated by the patient or support person, consistent with patient preferences. Patients (or their support persons) may designate anyone as an approved visitor, and a hospital or CAH may not discriminate against any approved visitors (and may impose only reasonable, clinically necessary restrictions or limitations on visitation). We believe that this regulatory policy is responsive to the concerns of commenters while still adhering to the specific instructions of the President’s April 15, 2010 memorandum to the Secretary. Therefore, we are not expanding the list of explicitly protected classes at this time. (emphasis added)
This response proves how important it is to educate the President himself so that he sends good instructions to his agencies. It also offers a sobering lesson: identity-based advocacy yields narrow victories that can alienate rather than build the base.
***Lastly, it is easy to confuse visitation with medical decision-making rights. (In fact, CMS repeatedly noted that many commenters had addressed decision-making issues instead of or in addition to visitation issues.) Please remember that it is the states (not the federal government) that regulate who can make medical decisions for incapacitated patients who have not completed advance directives. In those situations, a hospital must follow the law of the state where it is located. You should complete advance directives naming your health care proxy, power of attorney or agent, today! Learn more, or go directly to your state’s free paperwork.
Amidst all the drama of the election, there’s been little coverage of this result of great importance to all unmarried people:
Massachusetts voters have, for the second straight election, overwhelmingly affirmed their support for single payer health reform by turning in majority ‘Yes’ votes in all fourteen districts where local single payer ballot questions appeared on November 2.
As you know if you’re on our email list, we always send out a reminder to vote. Unmarried people don’t vote as often as married people do – if we did, we’d shape every election. If you’re a Massachusetts resident, your reminder included a link to information about the single payer ballot question – it was great to hear that 20% of you were interested in learning more.
Single payer health reform is the best deal for all unmarried people. The current system of employer-based health insurance inevitably uses marital status or relationship status to keep employers’ costs down. Using narrow definitions of family to set eligibility for coverage discriminates against a wide variety of unmarried people and makes care-giving harder. Even after the big national health care reform effort last year, marriage remains the on / off switch for access to health care in America. Basic health care and costs should be equal for all individuals under a national single-payer system.
Part of this year’s election drama is the threat to roll back last year’s (inadequate) health reform. Enough already! It’s time for our national leaders to get serious about single payer. It’s time for us to make that happen! Sign our new petition and let’s get going for real change.