Women may seem to be the driving force of health reform, given all the attention recently paid to gender disparities in insurance premiums. In fact, the massive health reform bill unveiled by the House of Representatives yesterday contains several sections that pertain just to women in terms of abortion coverage, pregnancy services, and prohibitions against excluding those with pre-existing conditions, specifically mentioning women who've been victims of domestic violence. While the bill does provide maternity coverage as part of a basic benefits package that insurers must provide in their coverage, it specifically says that public funding can't be used for abortions—which would include coverage under the public option—except where it's already allowed, such as in cases of rape or incest or where a mother's life is at risk.
But men aren't being ignored; they're getting their issues addressed, albeit in a quieter way. I met separately this week with two healthcare activists trying to push their issues onto the legislative agenda: Planned Parenthood President Cecile Richards, who is lobbying hard for increased reproductive health services and backed by 4 million grass-roots activists; and former Redskins quarterback Joe Theismann, who is trying to increase the prevalence of screening for a major killer of men and is relying mainly on a great smile and a hero's legacy. (The Redskins were Super Bowl champs in Theismann's time.)
Theismann aims to increase awareness of abdominal aortic aneurysm, a blood-filled bulge in the giant artery in the abdomen that occurs in 4 to 8 percent of older men, killing 9,000 a year. His father, a former smoker with heart disease (putting him at increased risk), had an aneurysm diagnosed and treated several years ago. A simple ultrasound screening test detected it before it ruptured, Theismann tells me, and that probably saved his life, since only 10 to 25 percent of patients survive a rupture. Theismann himself had the screening several months ago—the test was clear—and now would like all male Medicare patients to have a screening test as well. The trouble is, Medicare covers it only during the first year of enrollment, usually at age 65. Men who put it off have to pay for it themselves, so many wind up skipping it, something Theismann would like to change with congressional legislation.
The U.S. Preventive Services Task Force recommends a one-time ultrasound screening in men ages 65 to 75 who have smoked at some time in their lives and doesn't take a position one way or another on whether screening benefits older men who have never smoked, since they're less likely to have an aneurysm. (It does, though, recommend against screening in older women since they're not at major risk.) A 2008 review study of one-time screening in older men—both smokers and nonsmokers—found that deaths from aneurysm-related causes were reduced by 21 percent (to 68 percent) with screening.
Theismann—who is being paid by Medtronic (which makes stent grafts to repair the aneurysms) for his work to promote screening—says he'd like to see men's health issues getting as much attention as women's. Indeed, women have been more successful at lobbying for their health needs. Richards ticked off an impressive list of Planned Parenthood's health reform lobbying efforts: 150 op-eds published in newspapers, 50,000 letters and E-mails sent to members of Congress, meetings this week—accompanied by 100 donors and affiliate heads—with the White House and Congress. She says she's pleased to see the attention being paid so far to women's health issues in health reform and adds that keeping abortion access at the status quo is an acceptable compromise—though she's keeping her eye on Michigan Democratic Rep. Bart Stupak and other members of Congress who are pushing to add amendments that ban federally funded insurance companies from offering abortion coverage, even if they set aside private funds for the coverage.
"What we're really worried about now," Richards tells me, "is a nursing shortage if health reform passes. We're having this problem at our family planning clinics in Massachusetts." These clinics have seen a sharp rise in patients since the state implemented health reform on its own. "We can't seem to keep up with the demand," Richards says. (Other medical institutions in Massachusetts are coping with shortages of doctors as well as nurses and other staff as access to insurance has expanded.)
Sure enough, the healthcare bill introduced yesterday in the House details coverage for nurses, specifically discussing optional coverage for at-home nursing services for pregnant and postnatal women and for free-standing birth centers, which are usually staffed by certified nurse-midwives.(The bill also contains a new initiative to prevent teen pregnancy, another item on Planned Parenthood's agenda.) But also tucked away in the 1,990-page document are two paragraphs calling for barriers to be lifted when it comes to Medicare beneficiaries accessing screening for abdominal aortic aneurysm. I'm guessing Theismann will be pleased about that.