michelle ko md phd

social determinants + healthcare = disparities

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Announcing Undergraduate Public Health Scholars!

Are you:
Still trying to figure out what to do this summer? Interested in health research that doesn’t happen in a lab? Ever wondered what, exactly, is public health?

Logo courtesy of the Association of Schools and Programs in Public Health (ASPPH)!

Apply to the Undergraduate Public Health Scholars Program, a mentored research experience in the UCD Department of Public Health Sciences for THIS summer. Click here for information on the program and how to apply. Hurry, application deadline is May 1!


Lives That Don’t Matter, Part 2. The AHCA’s Greatest Hits


The last post was just a quick calling out of The AHCA for what it is: a recipe for increasing disparities in access, quality and health outcomes for many disadvantaged communities.

I had intended to follow up with a more detailed accounting of how that would happen, but then they failed to vote.  And since then, it sounds like both the White House and members of Congress have been trying to craft alternatives that continue to appeal to no one.

Trying to explain each new “compromise” option has become a game of Whack-A-Mole.  In general, the latest offers involved loosening restrictions on Title 1, which insurance plans would not longer have to do one/many of the following:

  • Community rating= Can now take your health history into consideration and charge you for it
  • Bigger age band= charge older people more
  • Essential health benefits= no longer has to cover all of these : hospital, ED, office visits, mental health, substance abuse treatment, maternity care, pediatric care, prescription drugs, rehab services, labs, preventive services
  • Coverage for children under age 26
  • Offer coverage for people with pre-existing conditions
  • No ban on lifetime/annual limits=Can now stop covering services if  you hit a max spending cap,  like if you have a major illness such as cancer and it hits the limit, insurance can refuse to pay any more

What is the point of these proposals? They get at what conservatives have argued- that there is too much insurance regulation in the ACA.  They will also open up the insurance market to more plan options that can be cheaper, especially for younger people. They also open the door for creating more health plans with fewer benefits that cost more.

In other words, with more tweaks, the main conclusions are the same: worsening disparities for those older and sicker.

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