HPV Vaccination Recommendation for Boys

The CDC’s Advisory Committee on Immunization Practices (ACIP) released recommendations for boys and the HPV vaccine yesterday. In order to reduce risk of acquiring genital warts, in 2009 the ACIP advised that the vaccine may be administered to males aged 9 through 26, however they did not recommend the vaccine for routine use. The unanimous recommendation now states routine use of Gardasil for 9- 21-year-old males as worthwhile in preventing cancer.

Despite these expert recommendations, debate over the vaccine still exists, even for girls. Fear of short and long-term side effects and efficacy has framed the controversy over the drug, as well as mandate and cost concerns. In fact, the three recommended shots cost $100 each, making it the most expensive immunization currently in use; generic versions are not projected to enter the market until 2015 or later. However, The Affordable Care Act signed into law mandates that immunizations recommended by ACIP prior to September 2009 include no cost-sharing requirements.  Recommendations made after 2009 (including the HPV vaccine for boys) will be required to be covered without cost-sharing in the next plan year that occurs one year after the date of the proposal. The group facing the largest barriers in receiving the vaccine include women 21 years and older, due to the fact that the Medicaid Early and Periodic Screening and Diagnostic Treatment (EPSDT) Benefit is for males and females under age 21. Vaccines covered by Medicaid are decided on a state by state basis (in 2009, only 28 states covered the HPV immunization for women).

Other debates surrounding the vaccine include promoting sexual activity of adolescents, and claims of its safety. The media and incorrect claims made by public figures continue these controversies, despite research proving otherwise. Providing accurate information on the vaccine in addition to the ACIP’s recommendations will help prevent deaths and unwarranted conditions from occurring.  Currently, HPV is the most common sexually transmitted disease with 75% – 80% of females and males in the United States infected at some point in their lives.

The ACA and U.S. Neonatal Mortality Rate

In light of the recent ambiguous rulings toward the constitutionality of the Affordable Care Act in the U.S. Circuit Courts, this contributor decided to write about implications for Maternal and Child Health.

Neonatal mortality, defined as deaths <28 days of age per 1,000 live births, is the focus of a study published in August by the Public Library of Science (PLoS) Medicine magazine. Although globally neonatal mortality rate has decreased since 1990, the United States still lags in ranking. Of the 176 countries and 3,551 country-year data analyzed, the United States ranked 41^st in neonatal mortality rate. Furthermore, even though death rate has decreased over time, it has improved at a slower rate than 117 other countries[i].

Although limited country data may hinder parts of the study, Americans should still be concerned with the researchers’ findings. The United States spends the most on health per capita compared to other developed countries. In fact, it is also has the highest rate of growth in health expenditure per capita: from 1980 to 2008, GDP health care spending proportion increased 7%[ii].

If the United States spends the most money on health care and has some of the most advanced technologies in the world, I question why newborns dying at such high rates? These queries guide my and other public health professionals’ values in prevention, and how investing in health at all ages of the lifecycle can improve outcomes for children. Quality preconception and maternal care can increase the chances of infant survival[iii]. Private insurance and out-of-pocket patient costs as sources of health expenditure are highest in the U.S. compared to other developed countries[iv]. With a lower percentage of funding from social programs and taxation, mothers, and sub sequentially their children, who do not have insurance are less likely to attend regular check-up visits. Visits help prevent premature death of infants through quality maternity care.

The Affordable Care Act signed into law last year will help fill these gaps, expand coverage to un/under insured, and hopefully change the status of U.S. babies today. In 2014, the provision that all health plans will cover pregnancy costs will go into effect. Currently, only 13% of individual health insurance plans include maternity care[v]. These debates over the legislation prevent mothers and children from getting the care they need to live happy, healthy lives. Advocacy is necessary to keep these issues in the forefront of our nation’s priorities.

Attend this free webinar sponsored by HHS’s Office on Women’s Health on “The Importance of the Affordable Care Act for Women”

Thursday Sep 29^th, 2011 at 2pm EST/1pm CST: https://services.choruscall.com/links/owhquarterly.html.

The Archived Webinar will be posted when becomes available.

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[i] Zahle Oestergaard, M., Inoue, M., Yoshida, S., Retno Mahanani, W., Gore, F. M., Cousens, S., et al. (2011). Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. PLoS Medicine , 1-13.

[ii] Kaiser Family Foundation. (2011, April). Health Care Spending in the United States and Selected OECD Countries. Retrieved September 12, 2011, from Kaiser Family Foundation: http://www.kff.org/insurance/snapshot/OECD042111.cfm

[iii] Braveman, P., Oliva, G., Grisham Miller, M., Reiter, R., Egerter, S. (1989). Adverse Outcomes and Lack of Health Insurance among Newborns in an Eight-County Area of California, 1982 to 1986. New England Journal of Medicine, 321:508-513.

[iv] National Audit Office. (2003). International Health Comparisons: A compendium of published information on healthcare systems, the provision of healthcare and health achievement in 10 countries. London: National Audit Office.

[v] Collins, S. R., Rustgi, S. D., & Doty, M. M. (2010, July 30). How Women Will Benefit from the ACA. Retrieved September 13, 2011, from The Commonwealth Fund: http://www.commonwealthfund.org/Blog/Jul/How-Women-Will-Benefit-from-the-ACA.aspx

The “individual mandate” and health reform: small steps, big challenges

Here on campus, many of us have spent the past few weeks cramming. Cramming for an epidemiology final. Cramming one more get-together with friends on an impossibly full calendar. Maybe cramming one more piece of turkey onto a plate piled high with holiday food.  We missed a lot of things during these past few weeks — and I’ll try to cover some of the highlights for you in the new year — but let’s talk about one of the big ones:  the likely demise of the “individual mandate” in President Obama’s Affordable Care Act.

The individual mandate was meant to require everyone in the United States — at least, those who can afford it — to purchase a “minimally comprehensive” insurance policy. So if you don’t have insurance in place (through an employer, as many Americans do), and can afford it, you’ll pay a fine: $695 a year (per adult) or 2.5 percent of your income, whatever’s higher.  Back in March, Virginia judge Henry Hudson declared the law unconstitutional, one in a series of Republican-led demonstrations contesting what is frequently referred to as “Obamacare.”

The response to this challenge is mixed: some health care reformers (Howard Dean among them) believe the bill doesn’t need the individual mandate in order to succeed.  Others (health insurance industry advocates, for example) believe we do: that insurance providers will not be able to compete fairly and transparently without a large pool of insured Americans, both healthy and sick.

Health care providers in Massachusetts would likely argue the latter. Their state’s mandate, enacted by a Republican governor in 2006, increased the number of insured residents to 98.1%– the highest rate of insured in the United States, according to a new report from the state’s Department of  Health and Human Services. This, in the midst of a serious recession wherein many Americans have lost insurance coverage.

The good news: politics can change, and quickly.  Government-sponsored health plans have been pitched before, even by staunch Republicans.  Although the individual mandate may fail, an “opt-out” option may satisfy both parties — allowing individuals to opt out of the general insurance pool, and later return. Children whose parents opt-out, meanwhile, could remain covered under existing programs. For a great explanation of the opt-out option, click here: http://www.prospect.org/cs/articles?article=averting_a_health_care_backlash

NYT poll: nearly half of unemployed do not have health insurance

Nearly  half of the unemployed Americans surveyed in a recent New York Times/CBS News poll indicate that they do not have health insurance.

The survey, conducted in December via telephone interview, sampled 1,650 U.S. adults, 708 of whom are unemployed.  Of  those, more than half “have cut back on doctor visits or medical treatments,” 25% said they had “either lost their home or been threatened with foreclosure or eviction,” and 25% are collecting foodstamps.

These results are especially unsettling when we consider the pending health insurance legislation, which could positively impact the lives of millions of Americans. Although proposed Medicaid expansions may cover some of their needs,  the cost of additional coverage premiums will likely be too expensive for others to bear.

For more on health insurance affordability, see:

http://news.yahoo.com/s/ap/20100105/ap_on_go_co/us_health_care_overhaul

http://www.nytimes.com/2010/01/06/us/politics/06cong.html?partner=rss&emc=rss

As well as a new study from the Urban Institute on subsidies and affordability:

http://www.urbaninstitute.org/UploadedPDF/411992_health_reform.pdf