Healthcare Reform was a major topic of debate in 2009 and, while, the public faces a growing threat from diseases in general, there is an ongoing STD and unplanned pregnancy epidemic that continues to worsen.
Although reporting on these topics tends to be less frequent and less sensational than other health concerns, like Swine Flu, the consequences of ignoring these threats are just as serious.
“One main trend is that people are still getting infected,” said Nicole Adelman, Vice President of Education and Outreach at Planned Parenthood Mid and South Michigan. “The CDC came out with a statistic about a year ago that 1-in-4 teen girls has an STD. This is a lot!”
Also, according to Planned Parenthood’s website, “More than half of us get a sexually transmitted infection at some point in our lives.”
Fortunately low-income women age 19-44, who are Michigan residents and are not pregnant, may be eligible for Plan First!, a Medicaid program that provides reproductive health procedures and family planning to uninsured women.
Plan First! covers a variety of supplies and exams, including birth control, condoms, annual check ups, pap tests, treatment of sexually transmitted diseases, lab fees and prescriptions, according to the Michigan Department of Community Health (MDCH) website, www.michigan.gov/mdch.
“Many college students are teens. And lots of people who have STDs don't know they have them. They may have no current symptoms. People should be encouraged to be tested,” Adelman said.
Aside from STD prevention, communities also benefit from Plan First! because family planning saves tax-payers dollars. “Family planning programs certainly save tax-payers money by preventing unwanted pregnancies,” said Ashleigh Lipsey, a Waiver Analyst in the Actuarial Division of the MDCH.
“A Medicaid funded birth and health care for the child’s first year of life cost over $9,500,” Lipsey said. “While it’s difficult to quantify the exact savings from preventing unplanned pregnancies, as there is no way to predict how many women enrolled in Plan First! would have otherwise become pregnant, it’s easy to see the savings.”
Furthermore, there are additional advantages to family planning besides just saving money, Lipsey said. “Women who are able to plan the number and timing of their pregnancies enjoy improved health and have more educational and employment opportunities,” she said. “This enhances their social and economic status and improves the well-being of their families.”
Programs like Plan First! need support and enrollment in order to survive, Adelman said. “Plan First! was not affected directly by state budget cuts, but the
state needs applicants to sign up to make it work, and also to show it's needed,” Adelman said.
According to the to the MDCH website, nearly 200,000 women may be eligible for Plan First! Around 47,000 women are currently enrolled in the Plan First! Program, Lipsey said.
There are plenty of people who need the services that Plan First! provides, but it is difficult to get them enrolled, Adelman said. “More people need to learn about it, and there’s stigma associated with Medicaid, so sometimes people don’t want to sign up for it,” she said.
Opposition to family planning is usually based on religious beliefs, Adelman said. “Oddly, it seems those most strongly opposed to abortion are also opposed to birth control,” she said.
“Others, I would say, aren’t necessarily opposed to family planning, but don’t understand how important it is in prevention and how much money it saves,” Adelman continued. “If money has to be cut from budgets, they often don’t see the cost-saving, investing in family planning brings.”
Family planning saves money that would otherwise be spent on maternal and infant mortality, HIV and other environmental impacts, Adelman said. “It is estimated that every $1 spent on family planning saves approximately $6.50,” she said.
The Centers of Medicare and Medicaid Services (CMS), the federal agency that oversees state Medicaid programs, approved Plan First! in 2006, and the program is up for re-approval in 2010, Lipsey said. “The state is currently preparing documents to submit to the CMS seeking approval to continue operating the program,” she said.
The state must be able to prove that Plan First! is budget neutral, which means it cannot cost Medicaid more money to operate the program, than to not operate it, Lipsey said. “The cost savings of preventing unplanned pregnancies, which would be paid for by the Medicaid program, make this program budget neutral,” she said.
“Plan First! has been a very successful program and the State is confident the federal government will re-authorize it,” Lipsey said.
Although the State expects to renew Plan First!, the program struggles to enroll more people because there is not enough surplus to pay for advertising and other outreach tools. “Due to the scope of the budget cuts, the ripple effects can be seen in virtually every program,” Lipsey said. “Though Plan First! did not see funding cut directly, payments to Medicaid providers experienced deep cuts, which may limit access for individuals seeking services.”
One of the most difficult aspects of using Plan First! is finding a healthcare provider. “A Plan First! beneficiary may receive services from any provider who accepts Medicaid payment,” Lipsey said. Providers include physician practices, federally qualified health centers (FQHC) and local health departments.
There are three planned parenthood health centers in Washtenaw County, including one in Ypsilanti, which is open Monday through Friday, and has extended hours until 7 p.m. on Wednesdays. Patients can request an appointment on the Planned Parenthood website, or call 734-485-0144.
Planned Parenthood is a primary provider for women who have Plan First! coverage. “We do have a significant number of patients on Plan First!, but we would like to enroll more. It's a great program for free health care for women who really need it and can't afford it,” Adelman said.
Tracy, 24, is one of thousands of women in Michigan who qualifies for Plan First!. She has been covered by the insurance since 2006, but by then it was too late. Tracy had an abortion in 2005. “I would have been on birth control a lot sooner if I was able to get it for free. If I had been on birth control at that time, I could have saved myself the physical and emotional pain of having an abortion at age 19,” she said.
Like many people in Michigan, Tracy is struggling just to make ends meet, she said. “You know it’s just hard when you move into your first apartment and you have rent, utilities, food and gas to pay for, so $50 a month for birth control doesn’t really make the priority list, especially when you make minimum wage,” she said.
“They should be handing birth control out,” Tracy said. “I think a lot more girls would be willing to be on it if it was affordable.”
As the unemployment rate continues to grow in Michigan, more people will be affected by the loss of healthcare coverage. This could have a serious affect on college students who may lose their parents’ healthcare or cannot find employment that provides insurance. “There is definitely a correlation between the state of the economy and
the demand on our services,” Adelman said.
Also, many young women avoid having examinations because of the office visit and lab fees. HPV is a major threat to sexually active women. “Some forms of HPV can cause cervical cancer. That is pretty scary and even more so, is the fact there is no testing for men,” Tracy said. “So us ladies need to be responsible and take care of our bodies to protect ourselves and each other,” she said.
Tracy experienced a two-year period where she had to visit a doctor nearly every-other month because of common female infections. “I am very grateful to have had Plan First! during that time. There would have been no way I could have afforded my doctor visits, and these are issues you can’t just ignore,” Tracy said.
According to the MDCH website, “This program enables the Michigan Department of Community Health (MDCH) to provide family planning services to women who otherwise would not have medical coverage for these services.”
Plan First! is a Medicaid waiver that extends benefits to groups of people who would, otherwise, not be eligible for Medicaid, Lipsey said. Women who meet the age requirements for Plan First! would not be eligible for traditional Medicaid, she said.
“The Plan First! waiver extends family planning benefits -- services not related to family planning are not covered -- to women 19 – 44 years of age whose incomes are at or below 185% of the federal poverty level,” Lipsey said.
The federal government and state government jointly fund Medicaid, Lipsey said. The federal funding for Medicaid programs is based on a federal medical assistance percentage (FMAP), she said.
“The federal government places a great deal of importance on family planning services. The FMAP for all family planning services, through Medicaid or a Medicaid-funded waiver, is 90/10,” Lipsey said. “This means the federal government pays 90% of the total costs of all family planning-related services provided to Medicaid and Plan First! beneficiaries.”
Jessica, 25, is another Plan First! beneficiary who relies on the program to prevent unwanted pregnancy and to keep herself healthy. “I have to be responsible to be on birth control. If I was not on birth control I can only imagine how many more problems I would have,” Jessica said. “I was going to have to pay for it out of pocket but I ended up getting Plan First!.”
The program is easy to apply for, Jessica said. Women who are interested in the program can fill out an application at the MDCH website, or paper applications are available at Planned Parenthoods, across the state. “The program is doing it's best to make enrolling more simple -- online applications, simplified rules for Michigan born residents, etc,” Adelman said.
Jessica said she was grateful for Plan First! because she tried to pay for her own insurance in the past, but ran up debt when she could not afford to pay the deductibles. “That’s my only debt. I don’t have any credit card bills, I don’t have outstanding cell phone bills or anything like that. My only debt is primarily from medical bills,” Jessica said.
After a couple of surgeries and a series of exams, Jessica was forced to choose between debt or illness, she said. “They already tried to take me to court for the big one, that was like $2,500. That was for the first operation that didn’t even work, that insurance told me was going to be covered 80 percent.”
Jessica suffers from Interstitial Cystitis, a chronic and painful problem that affects the bladder, and she was also diagnosed with HPV within the past year. “Women are susceptible to so many things at any age, compared to men, and once you start being sexually active you have to get check-ups regularly,” Jessica said.
Jessica has had multiple surgeries, which contributed to her debt, and said she was worried about how to pay for future procedures. “I mean it can turn into cancer so it’s kind of a big deal,” she said.
Plan First! will cover the procedures to help prevent Jessica’s HPV from developing into cervical cancer. Plan First! relieves a lot of stress, and reproductive health is something women cannot afford to ignore, Jessica said.
