Trump Administration Supports Health Programs That Will Sabotage Treaty Rights

(THIS ARTICLE IS COURTESY OF ‘INDIAN COUNTRY TODAY’ NEWS AGENCY)

 

Trump Administration Supports Changing Indian Health Programs That Will Sabotage Treaty Rights

Trump administration maintains tribes are a race rather than sovereign governments and Indian Health should not be exempt from Medicaid’s ‘race-based’ work rules

The Trump administration is supporting a major policy shift on Indian health programs which could result in a loss of millions of dollars to the Indian Health Service while also sabotaging treaty rights.

A story in Politico Sunday raised the issue. It said, “the Trump administration contends the tribes are a race rather than separate governments, and exempting them from Medicaid work rules — which have been approved in three states and are being sought by at least 10 others — would be illegal preferential treatment. ‘HHS believes that such an exemption would raise constitutional and federal civil rights law concerns,’ according to a review by administration lawyers,” Politico said.

Seema Verma, administrator for the Centers for Medicare and Medicaid Services confirmed in January that the Health and Human Services contends that tribes are a race as opposed to a separate sovereign government, thus not exempt from Medicaid work rules.

Administrator Seema Verma

@SeemaCMS

This survey is very insightful. Doctors know that helping individuals rise out of poverty can be the best medicine! https://twitter.com/merritthawkins/status/981252838239154178 

The Trump administration has allowed Arkansas, Kentucky and Indiana to institute work-requirements in order to eligible for Medicaid. Other states are in the process of seeking similar requirements where Medicaid participants would have to work some 20 to 80 hours each month in order to continue receiving the health insurance.

A graphic on Medicaid expansion by state.

Screen capture via ‘Families USA’

A graphic on Medicaid expansion by state.

The new policy on Medicaid work requirements “does not honor the duty of the federal government to uphold the government-to-government relationship and recognize the political status enshrined in the Constitution, treaties, federal statutes, and other federal laws,” said Jacqueline Pata, executive director of the National Congress of American Indians. “Our political relationship is not based upon race.”

“The United States has a legal responsibility to provide health care to Native Americans,” Mary Smith, who was acting head of the Indian Health Service during the Obama administration and is a member of the Cherokee Nation, told Politico. “It’s the largest prepaid health system in the world — they’ve paid through land and massacres — and now you’re going to take away health care and add a work requirement?”

Medicaid has become a key funding stream for the Indian health system — especially in programs managed by tribes and non-profits. Medicaid is a state-federal partnership and public insurance. The Affordable Care Act expanded Medicaid eligibility, but the Supreme Court ruled that each state could decide whether or not to expand. Since the expansion of Medicaid some 237,000 American Indians and Alaska Natives in 19 states have become insured.

Officially Medicaid represents 13 percent of the Indian Health Service’s $6.1 billion budget (just under $800 million).

But even that number is misleading because it does not include money collected from third-party billing from tribal and non-profit organizations. In Alaska, for example, the entire Alaska Native health system is operated by tribes or tribal organizations and the state says 40 percent of its $1.8 billion Medicaid budget is spent on Alaska Native patients. That one state approaches the entire “budgeted” amount for Medicaid.

Other states report similar increases. In 2016, Kaiser Family Foundation found that in Arizona, half of one tribally-operated health system’s patient visits were covered by Medicaid. And, an urban Indian Health program reported that its uninsured rate at one clinic fell from 85 percent before the Affordable Care Act to under 10 percent due to Medicaid enrollment.

Those Medicaid (and all insurance) dollars are even more significant because by law they remain with local service units where the patient is treated (and the insurance is billed). In Alaska more than two-thirds of those dollars are spent on private sector doctors and hospitals through purchased care for Alaska Native patients. And, unlike IHS funds, Medicaid is an entitlement. So if a person is eligible, the money follows.

A recent report by Kaiser Health News looked at Census data and found that 52 percent of residents in New Mexico’s McKinley County have coverage through the Medicaid.  That’s the highest rate among U.S. counties with at least 65,000 people. “The heavy concentration of Medicaid in this high-altitude desert is a result of two factors: the high poverty rate and the Indian Health Service’s relentless work to enroll patients in the program,” Kaiser reported. Most of McKinley County is located on the Navajo and Zuni reservations.

Kaiser Health News said Medicaid has opened up new opportunities for Native patients to “get more timely care, especially surgery and mental health services. It has been vital in combating high rates of obesity, teen birth, suicide and diabetes, according to local health officials.”

However the growth of Medicaid is resulting in unequal care for patients in the Indian health system. The benefits in some states, including those that expanded Medicaid under the Affordable Care Act, are more generous. Other states not only refused to expand Medicaid and have been adding new restrictions such as requiring “able-bodied” adults to have their Medicaid eligibility contingent on work.

But the Indian health system — the federal Indian Health Service and tribally and nonprofit operated programs — are in a special case because there is a 100 percent federal match for most services. So states set the rules, but do not have to pay the bill. (Medicaid is often the second largest single item in a state budget behind public schools.)

Medicaid is the largest health insurance program in America, insuring one in five adults, and many with complex and long-term chronic care needs. The Trump administration and many state legislatures controlled by Republicans see Medicaid as a welfare program. While most Democrats view it simply as a public health insurance program.

Work rules are particularly challenging for Indian Country. Unlike other Medicaid programs, patients in the Indian health system will still be eligible to receive basic care. So stricter rules will mean fewer people will sign up for Medicaid and the Indian Health Service — already significantly underfunded — will have to pick up the extra costs from existing appropriations. That will result in less money, and fewer healthcare services, across the board.

A letter from the Tribal Technical Advisory Group for Medicare and Medicaid said American Indians and Alaska Natives “are among the nation’s most vulnerable populations, and rely heavily on the IHS for health care. However, the IHS is currently funded at around 60 percent of need, and average per capita spending for IHS patients is only $3,688.” The latest per person cost for health care nationally is $10,348 (totalling $3.3 trillion, nearly 20 percent of the entire economy).

Uninsured rate for nonelderly American Indians and Alaska Natives from 2013-2015.

Screen capture Kaiser Family Foundation

Uninsured rate for nonelderly American Indians and Alaska Natives from 2013-2015.

The tribal advisory group said it is “critically important” that there be a blanket exemption for IHS beneficiaries from the mandatory work requirements.

A report in September by the Kaiser Family Foundation showed that the majority of American Indians and Alaska Natives on Medicaid already work, yet continue to face high rates of poverty. It said over three-quarters of American Indians and Alaska Natives are in working families, but that’s a gap of about 8 percent compared to other Americans (83 percent).

Income and work status for nonelderly American Indians and Alaska Natives from 2015

Screen capture Kaiser Family Foundation

Income and work status for nonelderly American Indians and Alaska Natives from 2015

The Trump administration’s characterization of tribal health programs as “race-based” is particularly troubling to tribal leaders because it would reverse historical precedence.

A memo last month from the law firm of Hobbs, Straus, Dean & Walker said the Centers for Medicare and Medicaid Services “has ample legal authority to single out IHS beneficiaries for special treatment in administering the statutes under its jurisdiction if doing so is rationally related to its unique trust responsibility to Indians. Under familiar principles of Indian law, such actions are political in nature, and as a result do not constitute prohibited race based classifications. This principle has been recognized and repeatedly reaffirmed by the Supreme Court and every Circuit Court of Appeals that has considered it, and has been extended to the actions of Administrative Agencies like the Department of Health and Human Services even in the absence of a specific statute.”

(The National Congress of American Indians is the owner of Indian Country Today and manages its business operations. The Indian Country Today editorial team operates independently as a digital journalism enterprise.)

Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter 

Marijuana Is Not A Gateway Drug Up: It Is A Step Down Drug Though

Marijuana Is Not A Gateway Drug Up: It Is A Step Down Drug Though

The first time that I ever tried smoking Marijuana (Pot) was in the High School parking lot the year I turned 17, that was 1973. As I learned through the years the Pot I tried was Norther Illinois Homegrown and was basically worthless as far as getting a buzz (high) from it. Back then you could buy a five-finger bag for $15 but I thought it to be a waste of 15 hard-earned dollars. I am now 62 years old so I have been around Marijuana for 45 years now so yes, I do have some opinions that I would like to share with you about what I think and believe about this God-given plant. The next time I tried Pot I was 23 years old and living in Houston Texas. I have never really been a drinker of alcohol nor a user of hard drugs and I have never once stuck or been stuck with a needle with street drugs in it, I have never had such a desire to do so. The far right (wrong) media has been talking trash about Pot at least since about 1988 saying it is a ‘gateway drug” that gets people to go into doing “hard” drugs like Crack, Pills and Heroine. Folks, my life’s experiences have shown me that Pot being a “gateway drug” is a bunch of lies (BS).

 

Folks, I have known people who have smoked Pot their whole adult lives who have never gone onto harder drugs and that includes alcohol. I have known people in several professions who liked to smoke Pot in the evenings when they got home from work to help relax from the stress of their day and who would smoke it on the weekends for the relaxation of it. These people I speak of are my age and older who are now retired from their jobs. These people were/are inner twined into the fabric of our economy. They bought and paid off homes, cars, boats, and raised families. None of these people who I know ever did anything to get into trouble with the law, they weren’t/aren’t robbers, murderers or violent people. Many millions of people believe that this is a God-given plant that is given to the people for many health benefits and believe that no man, no government has any right to refuse it to the people.  President Obama as well as this idiot we have in the Oval Office now say that Marijuana should stay in the class one category of drugs because it has no medical value and this is what the DEA also spouts as truth. I know that these are educated people (at least Mr. Obama is) but if they believe this they would have to be both ignorant and stupid. The only reason that these people would say something so stupid is if big money is involved, and you know it is. So, is it stupidity, ignorance or just plain crooked. Personally I have to go with the big money, thus the crooked concept.

 

I am a service connected disabled Veteran from active duty Army service. I was only in for seven months because in the second month I was struck by lightning during a training exercise. The VA has in the past loaded me up with pain killers which do almost nothing for the nerve pain so I had them stop them about 4 years ago as I have no desire to walk around like a Zombie. The only thing that I have found that helps is if/when I can find some good quality Pot. The Pot does not cure the issues but then again, neither do the pills. The Pot works like a block on the nerve pain, the pain is still there but it does not let the pain signals go from (A to B) SO IT STOPS THE PAIN SIGNAL FROM GOING TO THE BRAIN. About two years ago the Senators and Congressmen who were on the committee over seeing the budget for the VA at the last-minute took the provision to okay medical Marijuana out of the VA funding bill. These disgusting people should all be fired this November!

 

In my life I have seen many cases where people who used to smoke Pot but had to quit because of laws about pre employment and random drug test at their employers, if I remember correctly this kicked into high gear in about 1988. If you are old enough to remember this is about when our Federal Government started their so call ‘war on drugs’. This ignorance, the way they have gone about things have cost many thousands of lives and hundreds of billions of dollars that could have gone into the economy instead. For many people when they had to quit smoking Pot because it stays traceable in your system for about 30 days they then started drinking or just drinking more than they ever had. Also for many people who still wanted a ‘high’ when they had to quit smoking Pot turned to things like Cocaine, Crack, Heroine, and Pills because these things only stay in a person’s system about three days. So in essence, the Government has increased drug usage with their ‘war on drugs’. Check the stats, in states where Marijuana is now legal drug overdoses have gone down, Pill usage has gone down because people would rather have the mellow high that Pot gives and a fact is, no one has ever died from an overdose of Marijuana. If states would all legalize real Marijuana this new product called K-2 would disappear. It seems like every week we are hearing of people having to go to the hospital because of the chemical effects of this synthetic version of Pot. Just yesterday it was on the news that 10 people in Austin Texas were sent to the hospital because of it.

 

There is only one thing that comes to mind for the reason that Marijuana is not legalized and that is there is very big money flowing into D.C. politicians to keep it illegal. Remember what I said about the VA? If Marijuana became legal and the VA was able to dispense it the drug companies would lose billions of dollars each year because there would be no need or reason to take their chemicals. This would also save the VA and the tax payers billions of dollars each year, this is money that could be going into the economy instead of CEO’s pockets. The U.S. ‘war on drugs’ has in fact created drug traffickers and cartels. This ignorance has created revenue for street gangs here in the States. How many lives have been taken by these gangs from South America and Mexico to Los Angeles to Chicago to New York to small towns all over the U.S.? Marijuana being illegal has helped fuel other much more dangerous drugs and gang warfare on our city streets! How many police have lost their lives in this war? I don’t know that answer but even one Officer losing their life over the bought and paid for politicians and their hypocrisy is just plain evil. There is also the reality that many policing agencies go after the people with small amounts of Pot for the purpose of stealing people’s personal property like their homes, cars, land and bank accounts. It is safer and more profitable to go after these people who are much more mellow type of folks. The exception would be when the police are trying to arrest some of the Pot dealers, some times some of these folks will have guns or big dogs to worry about. There is also the concept of the Prison Industry which cost the public billions of dollars to arrest, convict and house/jail Pot smokers each year. Some States cry about over crowded prisons and want to have more jails and prisons built. The remedy to this problem is simple, free the people you have in the prisons who are there for simple possession of Pot. This would free up many cells in which to put the violent offenders! Also there is the problem of our Court system being so backed up with people charged with simple possession that it takes ridiculous amounts of time to adjudicate the cases of the violent criminals that our local jails are over-flowing. One last thought, the U.S. has more people in Prisons than any nation on Earth, more than Iran, Russia, China or even North Korea. The remedy to all these ill’s is simple, make Marijuana legal, every thing about this issue is a win win for our Country and our people.

The V.A. Refuses To Pay Their Own Bills: Yet It Is Your Credit Rating That Gets Tanked

The V.A. Refuses To Pay Their Own Bills: Yet It Is Your Credit Rating That Gets Tanked

This post today is a first hand story, not a second, third or any other kind. I know this story is 100% true because it is my own story. There are quite a few issues that I could talk with you about concerning the VA but for the purpose of keeping this post to readable length I am only going to talk about my largest medical bill that is on my personal credit. I have a hospital bill among other medical bills from an event that happened on September 13th, 2011 in N.W. Atlanta Georgia. I had blacked-out face first into an exterior steel doors steel hinges, made me even uglier than I used to be. I got awaken by three of the workers there where I was at. I then drove myself to a clinic there locally where once I had gone inside I blacked out again there. It was only about a quarter of a mile from the clinic to the huge Medical Center Hospital so I was taken by ambulance (unconscious) to the ER. It was three days before I remember anything, I was there five days total and their bill was $60,000 and some change. On day three once I had gotten my consciousness back I remember a few things the Doctor told me about my condition when I came into the ER. I was told that besides not being awake that both of my kidneys had shut down and that my BP was in the 50/20 range and dropping. So, was this hospital bill something that the VA should have paid for? Under the agreement that the VA has with America’s Veterans, this definitely qualified as a life or death emergency wouldn’t it? O, by the way, the reason that my BP tanked the way it did? The Georgia Doctors said that the VA had me on four times too much blood-pressure medicine and that it had kicked me down, very obviously (my opinion) once again, the VA Doctors almost killed me, again.

 

To make this a shorter story the VA has time and again refused to pay the hospital the money owed them. I have been told that it is their opinion that I could have made it to the closest VA, really! Thus being I could have made it to the Atlanta VA Hospital many miles away, it is my bill, not theirs, really! (This is how local Doctors, Clinics, Ambulance services, and Hospitals are being treated all over Our Nation by the VA, REALLY). Besides the fact that these fine people who kept you alive not getting paid for their work preformed, now the bills show up on your credit report. Why doesn’t it show up on the VA’s credit report and leave the people’s credit report alone? If the bill by law belongs to the VA why can that bill be held against the credit and good standing of a person when it is plainly not the persons bill?

 

In this closing paragraph I would like to give you their best slap in the face, your credit. Last summer my wife and I bought a home for the first time in our lives (I did pay off a house for an x-wife but it was never in my name). This $60,000 hospital is on my credit, I have challenged it a couple of times to no avail. This debt made my credit rating dive to about 680 and this forced me to have to go through the VA Loan Program to qualify for a home loan. I am not going to say that the VA system is all bad or that all of their employees are bad, that is not true. I believe I would not be alive today if it weren’t for the VA yet at the same time they have almost killed me several times through their ignorance and apathy (from some). So, what can a little person do when Goliath’s big brother won’t even pay his obligated debts and decides to dump his garbage on you? The only answer I could think of was to throw in my two cents worth on this subject matter which is now finally in the national news through this little blog in which I get to speak with you in.  I hope you have a great week, stay safe, God’s blessings I pray to each of you.

 

 

Heroin: What The Hell Are We Doing To Yourselves Folks?

Heroin: What The Hell Are We Doing To Yourselves Folks?

 

For those of you who do not know me from this blog I will tell you up front that what I am going to say if from my life’s experiences now being over 60 years old. I have never stuck a needle in myself for the purpose of getting some kind of a high, or even to decrease my own pain. I have had medical people do their thing quite a few times where I felt like a wore out pin-cushion before I got out of their care, but I have never stuck myself. I really hope that I do not end up needing Insulin shots someday. But, I have had quite a few folks whom I quickly found out where poking needles in themselves when they would get home from work or on the weekends for the purpose of getting a high was part of their normal day. As I set and watched quite a few people poking themselves or having their friends do it for them and putting them in very painful places, I had to wonder how, how and why they are where they are at this point in their lives? We hear on the news quite often now how Heroin is a major epidemic in many places in America today. I did not know until about a year ago that heroin is actually a very cheep costing drug, I had always though it would be a very expensive drug until I found out it is made from Morphine.

 

For those of you who have decided to first put a needle in yourself, I’m not talking about the first time you let someone else do it to/for you, I’m asking about the first time you yourself stuck a needle in yourself for the purpose of getting high, was it that? Was it in an attempt to get out of some type of pain, mental or physical? If there are ten million people in America alone that put that first drug, that first needle, in our-self, by our-self, are there ten million different stories? Stories of loss, of pain, of stupidity? In the ‘wired world’ about everyone has to have heard a lot of really bad things about this drug getting a power over you that you can no longer control so why? Why did you do that to yourself? All of the people who I knew way back then are gone now, old memories, I don’t know of any that made it anywhere near fifty. I have seen a few cases where people gradually got off of the drugs they were shooting up by turning more and more to the use of marijuana to calm themselves and start to see the world clearer and got themselves off of their own personal demon. I have learned and seen that marijuana is really a ‘step down drug’ that does help some folks, this ‘medication’ being illegal is insane and inhumane. There is another absolute fact and that is where Marijuana is a legal drug, pain pill use goes way down. Heroin or Morphine pills or how about the God-given medicine instead of the hundreds of billions of dollars spent on these pills, and then there is this Demon called Heroin that is killing so many people. The ‘War On Drugs’ got this part backwards folks. Drugs like Heroin are a disease on the human race as are these millions of ‘Pill Heads’ that the system is helping fan the flames of.

Brooking’s Institute looks at the human side of medical cannabis policy

(THIS ARTICLE IS COURTESY OF THE BROOKINGS INSTITUTE)

 

FIXGOV

In a new documentary short, Brooking’s looks at the human side of medical cannabis policy

John Hudak and George Burroughs

Medical cannabis is an increasingly available, alternative medicine that tens of thousands of Americans are turning to in an effort to get relief from their symptoms. Jennifer Collins is one such patient. On Wednesday, Brookings released “The Life She Deserves,” a documentary short profiling Jennifer’s struggle with an epilepsy disorder and with the public policies that have stood between her and the medical intervention her doctors recommended. In Brookings’s first use of this medium, the film tells both a personal and a policy story, highlighting the human side of a public policy failure.

Jennifer’s Story

At a young age, Jennifer was diagnosed with Jeavons Syndrome, an epilepsy disorder characterized by frequent seizures that often present as a fluttering of the eyes. During these seizures, Jennifer loses awareness of her surroundings. Those smaller seizures—which can number in the hundreds per day—can also cluster into a more serious and dangerous grand mal seizure, of which Jennifer has suffered many.

With the diagnosis, Jennifer’s doctors began a standard pharmaceutical regimen that ultimately culminated in more than a dozen pills daily and maximum adult doses of powerful anti-seizure medications. Those medicines came with side effects that included mania and suicidal ideation. Ultimately, pharmaceuticals were unable to help with Jennifer’s seizures and the side effects became overwhelming. Desperate for a solution, Jennifer’s parents read online about children moving to Colorado to access non-intoxicating, cannabis-based medicines to treat conditions like hers.

“The Life She Deserves” profiles the difficult choices the Collins family faced and explores what many patients and families sacrifice in order to get medical relief. Whether it is for a child with epilepsy, a young woman battling breast cancer, an Iraq War veteran with PTSD, or an elderly woman with chronic arthritis, accessing medical cannabis often requires weighing steep costs against the benefits.

Jennifer is a unique individual who has bravely fought both a chronic condition and a dysfunctional public policy system from a young age. Her story tells us as much about a strong young woman from Virginia facing a significant, ongoing health challenge as it does about a system of laws in which federal policy contradicts both itself and numerous state laws. Her story is one that is relatable to patients and the family members, friends, and colleagues of patients who see what Jennifer and her family have seen: cannabis-based medicines can provide relief in some patients. However, Jennifer’s story is not a unique one.

“The Life She Deserves” shows the overwhelming challenges that government can pose when it comes between doctors and patients, researchers and science. The film also highlights what has become a new normal in this country: the medical cannabis industry. Cannabis growers and sellers are not a group of sinister drug peddlers, operating in the shadows. The film highlights how a husband-wife duo responsibly cultivate cannabis in a heavily regulated system. And the seller is a rabbi who, inspired by his father-in-law’s decades-long battle with MS, opened a family business where he dispenses cannabis to a wide variety of patients—just a stone’s throw from the same institutions of government that label him a narco-trafficker.

Remarkably, in 2018, the idea of medical cannabis has become normal and mainstream. But as we explore in “The Life She Deserves,” the health challenges that draw people to it are devastating and the failure to implement effective policies forces them to make major sacrifices in order to access treatment they need.

A new format for Brookings analysis

It was clear that Brookings needed to explore a new medium beyond the white paper in order to peel back the stigma that continually cloaks medical cannabis. By producing a documentary, we were able to sit across the kitchen table from Beth and Pat Collins, at their home as they shared their difficult journey. We learned what the viewers of this film quickly learn: they’re just two parents who want to give their daughter a normal life. Because of this medium’s ability to create intimacy, the viewer gets see how government policy and the human experience collide to tell a compelling story. And Brookings is in a unique position for storytelling. The institution delivers in-depth analysis that can be presented with the human experience, positive or negative. What Brookings needed was a vehicle for such work. The documentary is precisely that vehicle.

In addition to home videos of Jen’s childhood and footage of Beth Collins testifying at the state legislature, maybe the most poignant moments in the film are of silence. In “The Life She Deserves” Jen reflects on the long road she’s traveled and where she is headed. When she pauses to collect her thoughts, in that silence we can see the severity of what she has been through—an emotion that words could not capture. At that moment we get a rigorously honest look at the pain she has experienced and the strength and courage it took to survive and talk about it. This is the power of storytelling and this is the power of the documentary. We live in a time when many in our country—on both sides of the aisle—see many areas of public policy as broken. Like Jen, millions of Americans feel the effects of those policy failures every day. The opportunity for effective policy storytelling has never been greater, and at Brookings we’re looking forward to telling many more.

Medical Cannabis: A Broken Policy

Authors

To those familiar with the world of medical cannabis, it is no secret that public policy in this area is broken. We have written extensively at Brookings about the numerous policy problems including banking, taxes, interstate access, and others. “The Life She Deserves” focuses on some of the most glaring issues facing patients themselves—an often-overlooked area. And the main issue that impacts patients, even more than access, is how little is known about how to maximize the benefits of cannabis to treat different conditions effectively. The U.S. government has made expanding that knowledge extraordinarily difficult.

Beyond the U.S. government declaring that the cannabis is illegal, federal policy also adds layers of bureaucracy that make research into the medical value of cannabis much harder. In fact, researching cannabis is more bureaucratically challenging than researching any other substance designated Schedule I—the nation’s highest level of drug control.

There is no excuse for a government that makes research more difficult to conduct. Those efforts are anti-science and ensure that politics influences the pursuit of scientific answers. Compounding the problem is that as more states pass reforms that label cannabis as medicine, there is increased demand for answers about the substance’s medical value. There is an ever-present and growing need to ask more questions about cannabis, not fewer. As more patients use this substance in an effort to relieve symptoms, the federal government should be committed to helping understand this area of science.

After all, what could the federal government fear from more research? In fact, no one in the nation—regardless of views on cannabis—should oppose expanded research. As we have written before, if you are an avowed opponent of cannabis and believe it is dangerous, it has no medical value, is highly addicting, and is a gateway drug, you should encourage more research that will demonstrate those findings. Those findings would be a wakeup call to many patients and, more importantly, to policy makers at the state level. For those who support medical cannabis and believe it is a miracle drug that can cure everything from a cough to cancer, you, too, should demand more research to demonstrate not simply medical value, but the precise ways in which cannabis interacts with bodily systems to provide relief and cures. Finally, if you don’t really care about cannabis, the current policy should bother you. Federal government intervention in science should terrify you.

When government impedes researchers from asking the questions they believe are important and conducting research in ways that their expertise and medical literature suggest are critical, the substance should not matter. The principle matters. In a time of an unpopular president, an embarrassingly unpopular Congress, and trust in government at near-historic lows, who should you trust to steer the ship of science: a physician and medical researcher from Michigan or a guy who happens to represent Kalamazoo in Congress?

As Patrick and Beth Collins note in “The Life She Deserves,” one of the biggest challenges facing medical cannabis patients is a lack of understanding about exactly which cannabis-based products assist with which conditions. There is also a deficit of information about dosing, interactions, side effects, and a host of other characteristics that patients are used to knowing about medicines that they take. Part of the blame rests with states moving forward to bring to market cannabis-based medicines without their enduring the normal regulatory processes we expect in the United States. However, much of the blame rests with a federal government that has allowed a racially-motivated, institutionally perpetuated policy overwhelm a commonsense approach that would remove unnecessary bureaucracy from blocking research.

Many patients will tell you that there is no question that cannabis helps them (although there are a number of patients who will also say that it does little for them). The biggest question that remains, however, is whether the federal government will stop politicizing research and help facilitate answers to the questions that patients are demanding.

The human cost of leaving patients and families to fend for themselves is clear, in Jen’s case as we see in “The Life She Deserves,” and in countless other households.

How Medical Marijuana Reduces Opioid Use; Saves Lives, Money

(THIS ARTICLE IS COURTESY OF THE ‘INSURANCE JOURNAL’)

(SIMPLY PUT: JEFF SESSIONS AND DONALD TRUMP ARE IDIOTS AND MORONS ON POWER TRIPS)

How Medical Marijuana Reduces Opioid Use; Saves Lives, Money

By  | April 3, 2018

Medical marijuana laws could be a boon to those battling the opioid epidemic, according to researchers who have identified a link between increased access to medical marijuana and a reduction in opioid prescriptions.

The studies suggest medical marijuana laws (MMLs) have helped save and could continue to save thousands of lives and billions of dollars now being lost to opioid addiction.

There is a downside: The promise of MMLs in reducing opioid use shows up thus far in urban areas, but not in rural America.

The marijuana laws have an effect similar to when any replacement for a drug is introduced, say researchers. In this case, marijuana appears to be a substitute for opioids as a pain medication in many cases.

This week the JAMA’s Journal of Internal Medicine published two studies that conclude that medical marijuana (or medical cannabis) laws have the potential to reduce opioid prescriptions. One study looked at Medicare Part D patient data and the other at Medicaid enrollee data.

The Medicare study (Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population by Ashley C. Bradford, BA; W. David Bradford, PhD; Amanda Abraham, PhD; and Grace Bagwell Adams, PhD, at the University of Georgia) found that opioid prescriptions fell in states that permit medical marijuana. Prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened.

A second JAMA Journal study (Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees, by Hefei Wen, PhD, and Jason M. Hockenberry, PhD, Department of Health Management & Policy, University of Kentucky College of Public Health) found that “medical and adult-use marijuana laws have the potential to reduce opioid prescribing for Medicaid enrollees, a segment of population with disproportionately high risk for chronic pain, opioid use disorder, and opioid overdose.” Using Medicaid prescription data for 2011 to 2016, the researchers found lower opioid prescribing rates where there were medical marijuana laws (5.88 percent lower) and adult-use marijuana laws (6.38 percent lower).

One of the MML researchers, Dr. W. David Bradford, discussed his past and recent research into medical marijuana and opioid prescriptions as well as other research at the Workers’ Compensation Research Institute (WCRI) annual symposium last week in Boston.

Among Bradford’s observations: the effect of MMLs on lowering opioid prescribing, while encouraging, is not fairly distributed.

“All of this is happening in urban areas. We can find no benefit, in this or any of our studies in rural America. As is often the case, people in rural sections of the country are getting a little left out from innovations,” Bradford said.

Bradford is the George D. Busbee Chair in Public Policy at the University of Georgia and former director and founder of the Center for Health Economic Policy Studies at the Medical University of South Carolina. He has been a visiting faculty member at Yale Medical School, and a tenured faculty member in the Department of Economics at the University of New Hampshire. Dr. Bradford has over 70 publications.

Bradford and his fellow researchers, including his daughter who is also a professor, looked at whether medical marijuana is being used as a substitute for other pain medications including opioids, as well as the effect this usage has on spending and on opioid mortality.

“We wanted to compare changes in pain medication use for people in states that don’t have medical cannabis and how those changes compare to the changes for people in states with medical cannabis laws,” he said of their first foray into the field.

They considered whether the state allows home cultivation or requires dispensaries. With dispensary-based distribution, it’s a lot easier to have “surety of the supply, a lot easier to get very finely defined hybrids that have the particular mix of cannabinoids,” according to Bradford.

They reviewed Medicare Part D enrollee data from 2010 to 2014 and then later updated this to include 2015 data. The number of states with an MML grew from 15 in 2010 to 24 over these years. They compared physician prescriptions in states with and without an MML for nine drug groupings: anxiety, depression, glaucoma, nausea, pain, psychosis, seizures, sleep disorders and spasticity.

In their analysis, they found that the use of prescription pain drugs fell significantly after a medical marijuana law went into effect. There were 1,230 fewer annual doses for all pain medications for these conditions per physician under all medical marijuana laws. They found 2,338 fewer daily doses per year for dispensary-based laws and 1,193 fewer daily doses per year for home-cultivation-only laws.

In their recent follow-up research, they focused specifically on opioid prescriptions. They found about a nine percent reduction in opioid prescriptions under any MML – but a higher 14 percent reduction in states with dispensaries. There was about a seven percent reduction in home cultivation states.

As Bradford puts it, when MMLs are implemented, use of prescription drugs falls “just as would happen if any effective new drug were approved by the FDA [Federal Drug Administration].”

Bradford and his colleagues did similar research using Medicaid data and came to the same conclusion that MMLs reduce use of prescriptions and opioids.

However, one troubling finding is that nearly all of the effect is happening in counties with more than 50,000 residents. “There was no benefit for rural counties,” he said.

They also calculated the financial impact. The combined 2014 savings to Medicare and Medicaid were $1.04 billion for states that had MMLs. Bradford said this could have been savings of $3.4 billion if all states had an MML.

“So these are nontrivial savings to Medicaid and Medicare – about one and a half percent of prescription spending is possibly diverted away from the programs,” he said, noting that the enrollees are the ones paying for the marijuana, not the payers.

Opioid-Related Deaths

They also have conducted research that is under review on the effect of MMLs on opioid-related deaths, using data on all non-heroin opiate related deaths for all 3,144 counties in the U.S. from 2000 to 2015. For all prescription opioid related deaths, they found: statistically significant reductions in mortality associated with any MML for all years from 2010 to 2015 in all counties together and no statistically significant effects in rural counties. For only non-synthetic opioid related deaths (i.e., no fentanyl) they found statistically significant reductions in mortality associated with any MML and with dispensary-based laws for all years from 2010 to 2015 in all counties together.

“We’re looking at somewhere in the neighborhood of a 20 to 30 percent reduction in mortality over what it would be,” Bradford said.

Bradford referred to a 2014 study by researchers at Albert Einstein Medical School in New York that also found a connection between MML states and a reduction in opioid deaths. This study (Study on the relationship between medical cannabis laws and opioid analgesic overdose deaths) reviewed 1999-2010 data from 23 states with MMLs. The authors compared opioid overdose death rates in states with medical cannabis programs to overdose deaths rates in states with no cannabis laws. They found about a 25 percent reduction, which translated to an estimated 1,729 fewer deaths than expected. The authors excluded opioid deaths from suicide and included overdose deaths related to heroin, since heroin and prescription opioid use are interrelated for some individuals.

“It looks like access to cannabis, when you design the policies appropriately, can save both lives and money,” Bradford told the WCRI audience.

“But again, in rural counties, there is zero estimated effect. We’re not finding any benefit in terms of mortality for the rural counties,” he reiterated.

Federal Marijuana Policy

Currently cannabis is listed in the Controlled Substances Act under Schedule 1, which means that it is a drug along with LSD, peyote heroin and others that have been “deemed to have no medically recognized uses and a high potential for abuse and therefore completely illegal.” It’s the most restrictive category. Physicians cannot prescribe cannabis, people cannot possess it, no one can sell it under federal law.

The view that marijuana has no medically recognized uses was challenged in January of 2017, when the National Academy of Scientific Engineering and Medicine published what Bradford considers a landmark study. The NAS reviewed more than 10,000 peer-reviewed clinical publications to determine whether there is sufficient evidence to draw conclusions regarding the medical application of cannabis.

“What they concluded is that there is indeed conclusive evidence that there are benefits to cannabis for chronic pain in adults, for nausea associated with chemotherapy and for spasticity and seizures. There is moderate evidence for many other conditions,” Bradford said.

The 2017 NAS report is “quite good evidence that cannabis is useful and, of course, what this implies is that a fine reading of the Controlled Substances Act would reschedule cannabis away from Schedule 1 and then to probably a 3 or a 4. That would be a level that physicians could prescribe it and could get involved.”

The Trump Administration has taken a harder line against legalized marijuana than did the Obama Administration, thereby complicating how medical marijuana laws and usage may play out. Currently 29 states and D.C., representing two-thirds of the U.S. population, have some form of medical cannabis law that runs counter to federal policy.

Public opinion on the subject has largely been supportive of legalizing marijuana for medical use. A January Quinnipiac Poll found that 91 percent of Americans support allowing people with their doctor’s assistance to get access to cannabis. The same poll found voters oppose 70 to 23 percent enforcing federal marijuana laws in states that have legalized medical or recreational marijuana.

Workers’ Comp Reimbursement

The workers’ compensation industry has generally been focused on the impact of medical marijuana on employees and safety in the workplace. As Bradford noted, patients, not insurers, are typically the ones now paying for their medical marijuana, even where it is a replacement for an opioid prescription.

There have been several court decisions approving reimbursement by health insurers or self-insured employers but for the most part states have remained silent on the matter of if and when reimbursement by an insurer or workers’ compensation carrier is allowed or required.

However, even in this uncertain legal environment, medical marijuana is gaining traction as an accepted treatment paid for by workers’ compensation, at least anecdotally, according to experts in a recent Claims Journal interview.

Brian Allen, vice president of government affairs for Mitchell, and Mark Pew, senior vice president of PRIUM, a division of Genex Services, said there is some reimbursement for medical marijuana being done on a voluntary basis when it is deemed a reasonable and necessary treatment. “The decision is really based on whether that patient is achieving benefit from it,” Pew said.

Pew said that carriers paying for medical marijuana treatment are not necessarily making it public.

When such cases reach courts, Allen thinks judges will be reluctant to get in the middle of a doctor-patient relationship. “I think the courts are going to defer to the doctors every time,” said Allen.

Pew agrees. “I think any court is probably going to lean towards the anecdotal story of the individual patient and if it’s helping with their pain and it’s reasonable and necessary based on the advice of doctors in that state,” he told Claims Journal. “I would assume that most states are going to come to that same conclusion.”

While marijuana is still illegal at the federal level, the Trump Administration has indicated that marijuana enforcement will be at the discretion of local assistant U.S. attorneys. Allen believes it’s unlikely they will pursue a medical marijuana case, unless there is some “egregious abuse.”

Both agree that for marijuana to become a more widely accepted alternative to opioids, researchers will have to shed light on the drug’s side effects. “They talk about the pluses. We really don’t hear a lot about the minuses, and we know there are some out there,” Allen said.

Pew believes more research needs to be done into the many chemicals within marijuana. “Just saying we’re going to reclassify marijuana or make it legal — it’s much more complicated,” Pew said.

Related:

Marijuana legalization could help offset opioid epidemic, studies find

(THIS ARTICLE IS COURTESY OF CNN)

 

Marijuana legalization could help offset opioid epidemic, studies find

  • Researchers compared prescription patterns in states with and without medical cannabis laws
  • States with medical marijuana had 2.21 million fewer daily doses of opioids prescribed per year
  • Opioid prescriptions under Medicaid dropped by 5.88% in states with medical cannabis laws

(CNN)Experts have proposed using medical marijuana to help Americans struggling with opioid addiction. Now, two studies suggest that there is merit to that strategy.

The studies, published Monday in the journal JAMA Internal Medicine, compared opioid prescription patterns in states that have enacted medical cannabis laws with those that have not. One of the studies looked at opioid prescriptions covered by Medicare Part D between 2010 and 2015, while the other looked at opioid prescriptions covered by Medicaid between 2011 and 2016.
The researchers found that states that allow the use of cannabis for medical purposes had 2.21 million fewer daily doses of opioids prescribed per year under Medicare Part D, compared with those states without medical cannabis laws. Opioid prescriptions under Medicaid also dropped by 5.88% in states with medical cannabis laws compared with states without such laws, according to the studies.
“This study adds one more brick in the wall in the argument that cannabis clearly has medical applications,” said David Bradford, professor of public administration and policy at the University of Georgia and a lead author of the Medicare study.
“And for pain patients in particular, our work adds to the argument that cannabis can be effective.”
Medicare Part D, the optional prescription drug benefit plan for those enrolled in Medicare, covers more than 42 million Americans, including those 65 or older. Medicaid provides health coverage to more than 73 million low-income individuals in the US, according to the program’s website.
“Medicare and Medicaid publishes this data, and we’re free to use it, and anyone who’s interested can download the data,” Bradford said. “But that means that we don’t know what’s going on with the privately insured and the uninsured population, and for that, I’m afraid the data sets are proprietary and expensive.”

‘This crisis is very real’

The new research comes as the United States remains entangled in the worst opioid epidemic the world has ever seen. Opioid overdose has risen dramatically over the past 15 years and has been implicated in over 500,000 deaths since 2000 — more than the number of Americans killed in World War II.
“As somebody who treats patients with opioid use disorders, this crisis is very real. These patients die every day, and it’s quite shocking in many ways,” said Dr. Kevin Hill, an addiction psychiatrist at Beth Israel Deaconess Medical Center and an assistant professor of psychiatry at Harvard Medical School, who was not involved in the new studies.
“We have had overuse of certain prescription opioids over the years, and it’s certainly contributed to the opioid crisis that we’re feeling,” he added. “I don’t think that’s the only reason, but certainly, it was too easy at many points to get prescriptions for opioids.”
Today, more than 90 Americans a day die from opioid overdose, resulting in more than 42,000 deaths per year, according to the US Centers for Disease Control and Prevention. Opioid overdose recently overtook vehicular accidents and shooting deaths as the most common cause of accidental death in the United States, the CDC says.
Like opioids, marijuana has been shown to be effective in treating chronic pain as well as other conditions such as seizures, multiple sclerosis and certain mental disorders, according to the National Institute on Drug Abuse. Research suggests that the cannabinoid and opioid receptor systems rely on common signaling pathways in the brain, including the dopamine reward system that is central to drug tolerance, dependence and addiction.
“All drugs of abuse operate using some shared pathways. For example, cannabinoid receptors and opioid receptors coincidentally happen to be located very close by in many places in the brain,” Hill said. “So it stands to reason that a medication that affects one system might affect the other.”
But unlike opioids, marijuana has little addiction potential, and virtually no deaths from marijuana overdose have been reported in the United States, according to Bradford.
“No one has ever died of cannabis, so it has many safety advantages over opiates,” Bradford said. “And to the extent that we’re trying to manage the opiate crisis, cannabis is a potential tool.”

Comparing states with and without medical marijuana laws

In order to evaluate whether medical marijuana could function as an effective and safe alternative to opioids, the two teams of researchers looked at whether opioid prescriptions were lower in states that had active medical cannabis laws and whether those states that enacted these laws during the study period saw reductions in opioid prescriptions.
Both teams, in fact, did find that opioid prescriptions were significantly lower in states that had enacted medical cannabis laws. The team that looked at Medicaid patients also found that the four states that switched from medical use only to recreational use — Alaska, Colorado, Oregon and Washington — saw further reductions in opioid prescriptions, according to Hefei Wen, assistant professor of health management and policy at the University of Kentucky and a lead author on the Medicaid study.
“We saw a 9% or 10% reduction (in opioid prescriptions) in Colorado and Oregon,” Wen said. “And in Alaska and Washington, the magnitude was a little bit smaller but still significant.”
The first state in the United States to legalize marijuana for medicinal use was California, in 1996. Since then, 29 states and the District of Columbia have approved some form of legalized cannabis. All of these states include chronic pain — either directly or indirectly — in the list of approved medical conditions for marijuana use, according to Bradford.
The details of the medical cannabis laws were found to have a significant impact on opioid prescription patterns, the researchers found. States that permitted recreational use, for example, saw an additional 6.38% reduction in opioid prescriptions under Medicaid compared with those states that permitted marijuana only for medical use, according to Wen.
The method of procurement also had a significant impact on opioid prescription patterns. States that permitted medical dispensaries — regulated shops that people can visit to purchase cannabis products — had 3.742 million fewer opioid prescriptions filled per year under Medicare Part D, while those that allowed only home cultivation had 1.792 million fewer opioid prescriptions per year.
“We found that there was about a 14.5% reduction in any opiate use when dispensaries were turned on — and that was statistically significant — and about a 7% reduction in any opiate use when home cultivation only was turned on,” Bradford said. “So dispensaries are much more powerful in terms of shifting people away from the use of opiates.”
The impact of these laws also differed based on the class of opioid prescribed. Specifically, states with medical cannabis laws saw 20.7% fewer morphine prescriptions and 17.4% fewer hydrocodone prescriptions compared with states that did not have these laws, according to Bradford.
Fentanyl prescriptions under Medicare Part D also dropped by 8.5% in states that had enacted medical cannabis laws, though the difference was not statistically significant, Bradford said. Fentanyl is a synthetic opioid, like heroin, that can be prescribed legally by physicians. It is 50 to 100 times more potent than morphine, and even a small amount can be fatal, according to the National Institute on Drug Abuse.
“I know that many people, including the attorney general, Jeff Sessions, are skeptical of cannabis,” Bradford said. “But, you know, the attorney general needs to be terrified of fentanyl.”

‘A call to action’

This is not the first time researchers have found a link between marijuana legalization and decreased opioid use. A 2014 study showed that states with medical cannabis laws had 24.8% fewer opioid overdose deaths between 1999 and 2010. A study in 2017 also found that the legalization of recreational marijuana in Colorado in 2012 reversed the state’s upward trend in opioid-related deaths.
“There is a growing body of scientific literature suggesting that legal access to marijuana can reduce the use of opioids as well as opioid-related overdose deaths,” said Melissa Moore, New York deputy state director for the Drug Policy Alliance. “In states with medical marijuana laws, we have already seen decreased admissions for opioid-related treatment and dramatically reduced rates of opioid overdoses.”
Some skeptics, though, argue that marijuana legalization could actually worsen the opioid epidemic. Another 2017 study, for example, showed a positive association between illicit cannabis use and opioid use disorders in the United States. But there may be an important difference between illicit cannabis use and legalized cannabis use, according to Hill.
“As we have all of these states implementing these policies, it’s imperative that we do more research,” Hill said. “We need to study the effects of these policies, and we really haven’t done it to the degree that we should.”
The two recent studies looked only at patients enrolled in Medicaid and Medicare Part D, meaning the results may not be generalizable to the entire US population.
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But both Hill and Moore agree that as more states debate the merits of legalizing marijuana in the coming months and years, more research will be needed to create consistency between cannabis science and cannabis policy.
“There is a great deal of movement in the Northeast, with New Hampshire and New Jersey being well-positioned to legalize adult use,” Moore said. “I believe there are also ballot measures to legalize marijuana in Arizona, Florida, Missouri, Nebraska and South Dakota as well that voters will decide on in Fall 2018.”
Hill called the new research “a call to action” and added, “we should be studying these policies. But unfortunately, the policies have far outpaced the science at this point.”

Kentucky Becomes First State to Adopt New Medicaid Work Requirement

(THIS ARTICLE IS COURTESY OF TIME NEWS)

 

Kentucky Gov. Matt Bevin announces federal approval of Kentucky's Medicaid waiver in Frankfort, Ky on Jan. 12, 2018
Kentucky Gov. Matt Bevin announces federal approval of Kentucky’s Medicaid waiver in Frankfort, Ky on Jan. 12, 2018
Alex Slitz—Lexington Herald-Leader/AP

By ALANA ABRAMSON

10:50 AM EST

The state of Kentucky has become the first to adopt the Trump administration’s new policy of imposing work requirements as a precondition of receiving Medicaid benefits.

Consequently, residents of Kentucky who are on Medicaid and considered healthy enough to work, must now comply with certain requirements to receive the health care provided by the government program.

The Trump administration announced on January 11 that states could impose work requirements on Medicaid recipients. One day later, the Center for Medicare and Medicaid Services approved a waiver for Kentucky adopting that new policy for the next five years. Under the program, which officially starts in July, Medicaid beneficiaries between the ages of 19 and 64 who do not meet exemption requirements must complete at least 80 hours per month of “community engagement,” which includes work, school, job skills training, or community service. If they do not complete the requirements, Medicaid eligibility will be suspended. The program exempts several categories of recipients, including pregnant women, those diagnosed as “medically frail,” primary caregivers, and former foster care youth.

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“It will be transformational,” Kentucky Governor Matt Bevin said in an announcement Friday. “Transformational in all the right ways, in good ways, in powerful ways.”

More than 2 million people are on Medicaid in Kentucky, according to the Kaiser Family Foundation, which is nearly one quarter of the state’s population. Kentucky was among the 33 states to adopt the Medicaid expansion program that is a cornerstone of the Affordable Care Act enacted under the Obama administration, but Bevin has been seeking to implement these changes since he was elected in 2015.

Bevin also defended the program from criticism that it was essentially punishing lower income people, and insisted that the program will only impact those who are physically able to work. The recipients of the program who are unable to comply with the new regulations, he said, will remain unaffected.

“This idea that somehow we are punishing people, that this will be a detriment to people I think is a huge huge misunderstanding of what people need,” he said, noting that he himself came from a low-income family. “There is dignity associated with owning the value of something you receive.”

 

SPONSORED FINANCIAL CONTENT

Stop Charging Rape Victims for Post-Assault Medical Care

(THIS ARTICLE IS COURTESY OF ‘CARE2’)

 

Stop Charging Rape Victims for Post-Assault Medical Care

34,075 SUPPORTERS
35,000 GOAL

According to current law, you can be billed for medical treatment you received after a rape. Let’s take a moment to let that sink in. Right now, the government allows hospitals to charge rape victims and their private insurers for additional costs after a rape. Thus one’s emotional trauma can often come with a high financial burden.

Currently, the Violence Against Women Act (VAWA), requires states to pay for rape kits. But there are often extra costs that are passed on to the victim. Pain medication, antibiotics, HIV prevention drugs, emergency contraceptives and other treatments aren’t guaranteed by the VAWA and they are not cheap. In fact, in 2013, women victims of rape paid out nearly 1.26 million dollars to cover extra medical costs. That’s nearly $1000 per person.

In no other instance are victims of violent crimes responsible for footing the bill for injuries the incurred. Rape victims shouldn’t be charged either.

The VAWA is up for reauthorization next year and it is time that Congress put an end to this practice by updating VAWA’s language to ensure all rape-related medical expenses are covered by the state.

Please sign this petition to voice your support for an updated VAWA that covers all rape-related medical expenses are covered by the states.

Dear Congress:

The Violence Against Women Act provides victims of sexual assault, rape and violence with the rights they deserve after such a harrowing experience. Yet, I recently learned that rape victims can actually be billed for the medical treatment they require after an assault. This is not the case for other violent crime victims and it shouldn’t be the case with rape victims. Please rectify this by updating the VAWA to ensure the state covers all rape-related medical expenses a victim may incur.

[Your comments here]

Sincerely,

[your name]

Texas House Passes Bill To Make Women Buy ‘Rape Insurance’

(THIS ARTICLE IS COURTESY OF ‘NEWS.GROUPSPEAK’)

 

The most populous Republican state in the country, the good ole’ state of Texas, has passed a bill in the House of Representatives that will essentially force women to buy rape insurance if they seek to have an abortion.

Critics of the bill are calling it especially cruel and a detriment to women’s health in general. If put into law, the bill will take effect as soon as Dec. 1 and force women to buy supplemental plans if they wish to have abortions, even if induced by rape.

Considering the Senate has already passed a very similar measure, and Governor Greg Abbott has already come out publicly showing his support, it’s only a matter of time before the bill gets signed.

“Women and parents will be faced with the horrific decision of having to purchase ‘rape insurance’ to cover them if they are victimized,” Democratic Representative Chris Turner said in a statement. “This is not only ridiculous, but it is cruel.”

“No woman plans to be raped. No parent plans for their child to be a victim of incest.” The idea that a woman would be forced to consider purchasing for herself – or a parent would be forced to purchase for their child – essentially a rape insurance policy should be abhorrent.”

The bill’s sponsor, Republican John Smithee, says it’s not that simple, though.

“It’s a question of economic freedom and freedom in general. This isn’t about who can get an abortion. It is about who is forced to pay for an abortion.”

By that, he means, he doesn’t want opponents of abortion being forced to subsidize it.

But, looking at it a different way, it will force women to completely absorb the costs of abortion. Every male in Texas with an insurance plan won’t have to pay into the pool of funds helping to support its costs. That will cost women more, which is another way for Texas Republicans to make women’s health care more expensive.

Also – if women don’t buy the supplemental insurance, which many lawmakers are betting that they won’t – it will make getting an abortion that much more unlikely.

“This bill takes us backwards,” said Rep. Ina Minjarez, D-San Antonio. “This bill is about denying Texas women their right to a safe abortion.”

Currently, 10 other states ban private insurance plans from covering abortions. Texas is about to be added to that list.