Birth control access can be limited in places with Catholic health systems : Shots

Catholic health care systems can limit access to birth control.

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Catholic health care systems can limit access to birth control.

Rich Pedroncelli/AP

Last week, students returning to campus at Oberlin College in Ohio got a shock: A local news outlet reported that the campus’ student health services would severely limit who could get contraception prescriptions. They would only be given to treat health problems — not for the purpose of preventing pregnancy — and emergency contraception would only be available to victims of sexual assault.

It turned out the college had outsourced its student health services to a Catholic health agency – and like other Catholic health institutions, it follows religious directives that prohibit contraception to prevent pregnancy. They also prohibit gender-affirming care.

“I would characterize the student’s reaction as outrage,” says Remsen Welsh, a fourth-year Oberlin student and co-director of the student-run Sexual Information Center on campus. “A lot of people in my circles were sending [the news story] around like, what is happening?”

Although the college quickly came up with a new plan to offer reproductive health services to students on campus, the incident at Oberlin shows the wide reach of Catholic health care in the U.S., and how the rules these institutions follow can limit access to contraception.

Now that many states – including Ohio – have adopted restrictions or outright bans on abortion, that’s also raised the stakes for contraception access.

Religious restrictions affect many health care settings

Issued by the U.S. Council of Catholic Bishops, the Ethical and Religious Directives that guide Catholic health care systems “prohibit a broad swath of reproductive care,” including birth control pills, IUDs, tubal ligation and vasectomies, says Dr. Debra Stulberg, a professor of family medicine at the University of Chicago who has researched how these directives play out in health care.

Catholic hospitals have long been a mainstay of health care in America. And these days, the directives apply to a wide range of settings where people seek reproductive health care – including urgent care centers, doctors’ offices and outpatient surgery centers that have been bought by or merged with Catholic health systems.

They can also apply when Catholic health agencies are hired to manage health care services for other institutions, which is what happened at Oberlin.

Four of the 10 largest health care systems in the country are Catholic, according to a 2020 report. In some counties, they dominate the market. In 52 communities, the report found, a Catholic hospital is the only one around within a 45-minute drive.

“After all this consolidation, this is where it shakes out, where we’ve got about 40% of reproductive age women living in areas with high or dominant Catholic hospital market share,” says Marian Jarlenski, a health policy researcher at the University of Pittsburgh, who examined the data in 2020.

‘Not transparent at all’

Patients often aren’t aware that these restrictions might affect the care they get, says Lois Uttley,

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How Texas abortion law turned a pregnancy loss into a medical trauma : Shots

Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks.

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Elizabeth and James Weller at their home in Houston two months after losing their baby girl due to a premature rupture of membranes. Elizabeth could not receive the medical care she needed until several days later because of a Texas law that banned abortion after six weeks.

Julia Robinson for NPR

New, untested abortion bans have made doctors unsure about treating some pregnancy complications, which has led to life-threatening delays and trapped families in a limbo of grief and helplessness.

Elizabeth Weller never dreamed that her own hopes for a child would become ensnared in the web of Texas abortion law.

She and her husband began trying in late 2021. They had bought a house in Kingwood, a lakeside development in Houston. Elizabeth was in graduate school for political science, and James taught middle-school math.

The Wellers were pleasantly surprised when they got pregnant early in 2022.

In retrospect, Elizabeth says their initial joy felt a little naive: “If it was so easy for us to get pregnant, then to us it was almost like a sign that this pregnancy was going to be easy for us.”

Things did go fairly smooth at first. Seventeen weeks into the pregnancy, they learned they were expecting a girl. They also had an anatomy scan, which revealed no problems. Even if it had, the Wellers were determined to proceed.

“We skipped over the genetic testing offered in the first trimester,” Elizabeth says. “I was born with a physical disability. If she had any physical ailments, I would never abort her for that issue.”

Elizabeth thought of abortion rights in broad terms: “I have said throughout my life I believe that women should have the access to the right to an abortion. I personally would never get one.”

And at this particular point in her life, pregnant for the first time at age 26, it was still somewhat abstract: “I had not been put in a position to where I had to weigh the real nuances that went into this situation. I had not been put in the crossroads of this issue.”

But in early May, not long after the uneventful anatomy scan, the Wellers suddenly arrived at that crossroads. There they found themselves pinned down, clinically and emotionally, victims of a collision between standard obstetrical practice and the rigid new demands of Texas law.

It was May 10, 2022. Elizabeth was 18 weeks pregnant. She ate a healthy breakfast, went for a walk outside and came back home.

In the nursery upstairs, they had already stashed some baby clothes and new cans of paint. Down in the kitchen, images from recent scans and ultrasounds

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Finding health insurance prices for care is an ordeal : Shots

Insurers are complying with federal rules aimed at price transparency that took effect July 1, but consumer use of the data may have to wait until private firms synthesize it.

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Insurers are complying with federal rules aimed at price transparency that took effect July 1, but consumer use of the data may have to wait until private firms synthesize it.

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Data wonks with mighty computers are overjoyed. Ordinary consumers, not so much.

That’s the reaction two weeks into a data dump of enormous proportions. Health insurers are posting their negotiated rates for just about every type of medical service they cover across all providers.

But so much data is flowing in from insurers — tens of thousands of colossal digital files from a single insurer is not unusual — that it could still be weeks before data firms put it into usable forms for its intended targets: employers, researchers and even patients.

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“There is data out there; it’s just not accessible to mere mortals,” said Sabrina Corlette, a researcher at Georgetown University’s Center on Health Insurance Reforms.

Insurers are complying with federal rules aimed at price transparency that took effect July 1, she and others said. Realistically, though, consumer use of the data may have to wait until private firms synthesize it — or additional federal requirements start to kick in next year aimed at making it easier for consumers to use the price information to shop for scheduled medical care.

So why post prices? The theory is that making public this array of prices, which are likely to vary widely for the same care, will help moderate future costs through competition or improved price negotiations, although none of that is a guarantee.

Hospitals last year came under a similar directive, which stems from the Affordable Care Act, to post what they’ve agreed to accept from insurers — and the amounts they charge patients paying cash. Yet many dragged their feet, saying the rule is costly and time-consuming. Their trade association, the American Hospital Association, sued unsuccessfully to halt it. Many hospitals just never complied and federal government’s enforcement has proven lax.

While government regulators have sent more than 350 warning letters to hospitals, and have increased the potential civil penalty fines from $300 a day to up to $5,500, only two hospitals have been fined so far.

The requirement for insurers is broader than that faced by hospitals, although it does not include cash prices. It includes negotiated rates paid not only to hospitals, but also to surgery centers, imaging services, laboratories, and even doctors. Amounts billed and paid for “out-of-network” care are also included.

Penalty fines for not posting can be higher than those faced by hospitals — $100 a day per violation, per affected enrollee, which quickly adds up for medium- or large-size insurers or self-insured employers.

“We’re seeing high compliance rates because of the high penalties,” said Jeff Leibach, a partner with the

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How to avoid costly medical bills and get out of medical debt : Shots

How to get rid of medical debt — or avoid it in the first place

Patients and the consumer advocates say there are things people should do to try to avoid, or navigate, the medical debt trap. Financial assistance is available, but it all requires self-advocacy.

Lori Mangum was 32 when apple-sized tumors sprouted on her head. Now — six years and 10 surgeries later — the skin cancer is gone. But her pain lives on, in the form of medical debt.

Even with insurance, Mangum paid $36,000 out-of-pocket, charges that stemmed from the hospital, the surgeon, the anesthesiologist, the pharmacy, and follow-up care. And she still has about $7,000 more to pay.

While she was trying to manage her treatment and medical costs, Mangum remembers thinking, “I should be able to figure this out. I should be able to do this for myself.”

But medical billing and health insurance systems in the U.S. are complex, and many patients have difficulty navigating them.

“It’s incredibly humbling — and sometimes even to the point of humiliating — to feel like you have no idea what to do,” Mangum said.

If you’re worried about incurring debt during a health crisis or are struggling to deal with bills you already have, you’re not alone. Some 100 million people — including 41% of U.S. adults — have health care debt, according to a recent survey by KFF (Kaiser Family Foundation).

But you can inform and protect yourself. NPR and KHN spoke with patients, consumer advocates, and researchers to glean their hard-won insights on how to avoid or manage medical debt.

“It shouldn’t be on the patients who are experiencing the medical issues to navigate this complicated system,” said Nicolas Cordova, a health care lawyer with the New Mexico Center on Law and Poverty. But consumers who inform themselves have a better chance of avoiding debt traps.

That means knowing the ins and outs of various policies — whether it’s your insurance coverage, or a hospital’s financial assistance program, or a state’s consumer protection laws. Ask a lot of questions and persist. “Don’t take ‘no’ for an answer,” said Cordova, “because sometimes you might get a ‘yes’.”

Even people with health insurance can land in debt; indeed, one of the biggest problems, consumer advocates said, is that so many people are underinsured, which means they can get hit with huge out-of-pocket costs from coinsurance and high deductibles.

Here is some practical advice about facing down medical debt, at every stage of care and after.

Before You Get Care

Get familiar with your insurance coverage and out-of-pocket costs

Get the best insurance coverage you can afford — even when you’re healthy. Make sure you know what the copays, coinsurance, and deductibles will be. Don’t hesitate to call the insurer and ask someone to walk you through all the potential out-of-pocket costs. Keep in mind that you cannot make changes to your policy except during certain windows of time, such as open enrollment (typically in the fall or early winter) or after a major life event.

Sign up for public insurance if you qualify

If you’re uninsured but need health care, you might qualify for

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How much health insurers pay for care is about to go public : Shots

The new rules will help people get upfront cost estimates for about 500 so-called “shoppable” services, meaning medical care they can schedule ahead of time.

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The new rules will help people get upfront cost estimates for about 500 so-called “shoppable” services, meaning medical care they can schedule ahead of time.

DNY59/Getty Images

Consumers, employers and just about everyone else interested in health care prices will soon get an unprecedented look at what insurers pay for care, perhaps helping answer a question that has long dogged those who buy insurance: Are we getting the best deal we can?

Starting July 1, health insurers and self-insured employers must post on websites just about every price they’ve negotiated with providers for health care services, item by item. About the only exclusion is the prices paid for prescription drugs, except those administered in hospitals or doctors’ offices.

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The federally required data release could affect future prices or even how employers contract for health care. Many will see for the first time how well their insurers are doing compared with others.

The new rules are far broader than those that went into effect last year requiring hospitals to post their negotiated rates for the public to see. Now insurers must post the amounts paid for “every physician in network, every hospital, every surgery center, every nursing facility,” said Jeffrey Leibach, a partner at the consulting firm Guidehouse.

“When you start doing the math, you’re talking trillions of records,” he said. The fines the federal government could impose for noncompliance are also heftier than the penalties that hospitals face.

Federal officials learned from the hospital experience and gave insurers more direction on what was expected, said Leibach. Insurers or self-insured employers could be fined as much as $100 a day for each violation and each affected enrollee if they fail to provide the data.

“Get your calculator out: All of a sudden you are in the millions pretty fast,” Leibach said.

Determined consumers, especially those with high-deductible health plans, may try to dig in right away and use the data to try comparing what they will have to pay at different hospitals, clinics, or doctor offices for specific services.

But each database’s enormous size may mean that most people “will find it very hard to use the data in a nuanced way,” said Katherine Baicker, dean of the University of Chicago Harris School of Public Policy.

At least at first.

Entrepreneurs are expected to quickly translate the information into more user-friendly formats so it can be incorporated into new or existing services that estimate costs for patients. And starting Jan. 1, the rules require insurers to provide online tools that will help people get upfront cost estimates for about 500 so-called “shoppable” services, meaning medical care they can schedule ahead of time.

Once those things happen, “you’ll at least have the options in front of you,” said Chris Severn, CEO of Turquoise Health, an

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Supreme Court’s abortion decision puts doctors in legal limbo : Shots

Dr. Kara Beasley protests the overturning of Roe vs. Wade by the U.S. Supreme Court, in Denver, Colorado on June 24, 2022.

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Dr. Kara Beasley protests the overturning of Roe vs. Wade by the U.S. Supreme Court, in Denver, Colorado on June 24, 2022.

JASON CONNOLLY/AFP via Getty Images

Historically, doctors have played a big role in abortion’s legality. Back in the 1860s, physicians with the newly-formed American Medical Association worked to outlaw abortion in the U.S.

A century later, they were doing the opposite.

In the 1950s and 1960s, when states were liberalizing abortion laws, “the charge for that actually came from doctors who said, ‘This is insane, we can’t practice medicine, we can’t exercise our medical judgment if you’re telling us that this is off the table,’ ” explains Melissa Murray, law professor at New York University.

The Supreme Court ruled in doctors’ favor in Roe v. Wade in 1973. The majority opinion spoke of “the right of a woman in consultation with her physician to choose an abortion,” Murray says.

Yet doctors and patients are all but absent from the latest Supreme Court majority opinion on abortion in Dobbs v. Jackson Women’s Health Organization. In fact, in the opinion, Justice Samuel Alito uses the derogatory term “abortionist” instead of physician or doctor or obstetrician-gynecologist.

Legal experts say that signals a major shift in how the court views abortion, and creates a perilous new legal reality for physicians. In states where abortion is restricted, health care providers may be in the position of counseling patients who want an abortion, including those facing pregnancy complications, in a legal context that treats them as potential criminals.

“Alito’s framing is that abortion is and was a crime – that’s the language he uses,” says Mary Ziegler, a law professor at the University of California, Davis. There’s no dispute, she says, that “the result of a decision overruling Roe in the short term is going to be the criminalization of doctors.”

Roe v. Wade was doctor-centered

Doctors were at the heart of the court’s first landmark ruling on abortion, Roe v. Wade.

“The original Roe decision – it was very, very doctor-centered – extremely so,” says Ziegler, who has written extensively on the legal history of abortion. “At its inception, this was a right that was very much about health care and about the doctor-patient relationship.”

Roe and the abortion decisions that came after it like Planned Parenthood v. Casey, “had the framework that abortion is some sort of individual right, but it’s also health care,” explains Carmel Shachar, executive director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

The court essentially told states: “You can put restrictions on abortion services and on provider qualifications as you do for other types of health care, and as long as they are not so onerous that we

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