Health Care Reform

Mamas on Bedrest: National Paid Sick Leave is a Closer Reality!

March 20th, 2013

I am an ardent supporter paid sick leave for US workers. The United States is one of only 4 countries world wide that offers no sort of paid leave for maternity, medical illness/treatment or to care for an ill family member. While most of us will agree that the United States offers unparalleled employment opportunities, it is shocking and disturbing that the US does nothing to support its workers when they or those they love fall ill.

I suppose with so many workers to choose from, there is no incentive to be loyal to employees. The US unemployment rate is still over 7% and there are many people willing to work for wages well below what they are worth and take jobs well below their skill set in order to simply secure a job and meet the needs of their families. It’s a very precarious work environment.

But I am still baffled as to why employers are so averse to supporting their employees.  According to the Center for American Progress, when an employee who earns $50,000 per year leaves a company-regardless of whether they leave voluntarily or are asked to leave-the cost to replace that employee is approximately 20% of that person’s annual salary. In the US, approximately 75% of the workforce earns $50,000 or less annually.  Likewise, if the employee earns $75,000 per year and leaves, the employer again has to spend approximately 20% of that employee’s salary or roughly $15,000 to replace that employee. Now considering that 9 out of 10 employees in the United States earns less than $75,000 annually, this can have substantial ramifications if a company has a high turnover rate. The Center for American Progress notes that the cost to replace a worker who makes less than $30,000 annually is slightly less, approximately 16%, yet lower waged service workers are often those with the highest turnover as they seek to increase their annual earnings. And not surprising, the cost to replace an executive or professional employee can be as high as 213% of the employee’s annual salary! Wouldn’t it simply make sense for employers to offer their employees better benefit packages that included health benefits, paid time off and flexible working schedules?

This is a situation that I closely watch for Mamas on Bedrest & Beyond. Many, many mamas have contacted me and my colleagues distraught because of mounting debt and job loss due to being placed on prescribed bed rest. As a result, I do what I can to advocate for paid family leave including presenting cases to Senator Barbara Mikulski (D-MD) with my friend, colleague and the Executive Director of Better Bedrest Joanie Reisfeld, supporting the Paid Medical Leave Initiatives advocated for by the National Partnership for Women and Families, Working Mother Magazine and MomsRising and educating women and families about their leave options.  According to the National Partnership for Women and Families, To date:

The Portland City Council voted unanimously to approve an ordinance that will let tens of thousands of workers in Portland earn the paid sick days they need. The bill is awaiting signature from Mayor Hales, making the bill law, and making Portland the fourth city to provide paid sick days.

The Philadelphia City Council, once again, approved a similar measure that would guarantee Philadelphians the same right. Hopefully Philadelphia Mayor Nutter, who vetoed the paid sick days bill in 2011, will take a second look and sign this common sense proposal.

Laws are already in place and working well in San Francisco, Washington, D.C., Seattle and Connecticut. And there are dozens of efforts to advance similar proposals across the country, including in New York City, Massachusetts and Vermont.

Given the economic benefits to companies and the benefits to working families, paid medical leave just makes sense. We Mamas on Bedrest know this, economists know this, advocates know this and yet the fight continues. Hopefully corporate CEO’s and lawmakers will evaluate the data and see that paid medical leave just makes sense. As the Center for American Progress noted,

“This brief documents that the cost of employee turnover for businesses is high, regardless of the level of wages being paid to the departing or incoming employees. Companies typically pay about one-fifth of an employee’s salary to replace that employee. While it costs businesses more to replace their very-highest-paid employees, the costs for most employers remains significant and does become less significant for those with low earnings.

Workplace policies that improve employee retention can help companies reduce their turnover costs. Family-friendly policies such as paid family leave and workplace flexibility help retain valuable employees who need help balancing work and family. For example, research has found that access to any form of parental leave makes women more likely to return to work after giving birth. Moreover, by 2050 up to 20 percent of Americans will be older than age 65, and improved leave policies would allow workers to provide the care their elderly parents may need without having to sacrifice their livelihoods.”

Mamas on Bedrest: Did any of you undergo “preconception” counseling before becoming pregnant?

March 18th, 2013

Good Morning Mamas!!

Question: Did any of you undergo “preconception” counseling before becoming pregnant? 

I ask this question because a couple of days ago, I was trolling twitter and inserted myself into the #acogchat. The topic of discussion was preconception evaluations. When I entered the discussion, I’m thinking a good 20-30 minutes into the chat, the group was discussing how more women need to be aware of their health histories and essentially should have all their “medical ducks in a row” prior to becoming pregnant to avoid complications. Well you all know me. The statements were making my neck hairs stand on end because they seemed to be saying that when pregnancy complications arise, it’s because of something mamas haven’t addressed prior to getting pregnant, a sort of negligence. In my experience with Mamas on Bedrest that simply isn’t true. For many mamas, there is no rhyme or reason that they have the complications they have. And on that note, I jumped into the conversation.

Let me begin by saying that the moderators and participants of the chat were very gracious and receptive to me and my views. I didn’t exactly “tip toe” my way into the chat, I went in full throttle in defense of mamas! But as the chat progressed, we all reached a really good consensus about preconception health care and health care in general. With a candid discussion about the limitations of our current health care climate as well as cultural and societal opinions, we all left the chat with the following “agreement” regarding preconception evaluations/examinations/counseling:

A Preconception Exam/Evaluation is really preventive maintenance. As the chat progressed, we all realized that if health care providers ask, AT EACH AND EVERY VISIT, about a person’s medical history; if any new complications have arisen, if the patient has any new concerns, is there any change in family history…Then we are doing preconception counseling-the way that it should be done. A woman’s health (or anyone’s health) should always be optimized at any doctor/patient interaction. When we providers don’t ask these questions and update a patient’s record each and ever visit, we drop the ball not the patient.

Preconception Exams/Evaluations must be done for men as well as women! Conception takes 2 PEOPLE!! We focus so much on women (as the carriers) but we cannot forget the fact that the sperm quality will also affect whether or not conception takes place and has just as significant an impact on the health of the baby as the quality of the egg and mama’s health. Just as it’s important for mamas not to smoke or drink if they are trying to get pregnant, fathers who smoke, drink or have other health issues won’t impart healthy genes to their offspring and may also be impeding the conception process.

Preconception Exams/Evaluations must begin in pediatrics. This is one area in which there was some controversy. We all know that teen pregnancy is an issue in the United States. Yet, there is no consensus on when/how to teach sex education in schools. What we as a group came up with is that if we teach children to always take exemplary care of their bodies; stressing the importance of not smoking, not drinking alcohol in excess, avoiding recreational drugs, maintaining a healthy weight for height, getting regular exercise, avoiding risky sexual behavior, etc…We are teaching not only good health habits, but imparting good preconception habits.  By focusing on good health, we can reduce the stress many parents feel regarding “sex education” and not step on toes. For example, talking to a teenager about how condoms work and how they prevent the spread of disease is a different conversation than, “You should use condoms at every sexual encounter. ” We impart the medical information and allow parents to speak to the moral implications as they see fit. (And while we know that many parents won’t speak with their children about sex, it is still the parents’ right to impart their moral code on children, not ours-no matter how much we feel it is needed. We can suggest to parents that they discuss certain issues with their children, but in the end, as it was brought up by a parent on the chat, it’s the parent’s obligation, responsibility and right to educate their children (or not) about sex.)

Do discuss medical costs. I brought this to the attention of the group that many insurance companies don’t cover maternity care and require a separate rider on policies. So many woman have been caught by this. Who wouldn’t? It’s natural to assume that if you have insurance, it will cover you if you become pregnant. This just isn’t the case! So as clinicians, we must ask our patients at each and every visit if their insurance has changed, and to give them a simple “heads up” that many treatments and procedures aren’t covered and they should review their insurance policies annually (and most especially if they are planning to become pregnant).

Make Sure Pre-Existing Conditions are Well Controlled Prior to Conception. Again, this was a topic that got us wound up for a minute. But as we discussed it, we all realized, that if health care providers are truly monitoring their patients’ medical conditions, say diabetes, then the goal should always be tight control. At each office visit the importance of blood sugar control should be discussed and emphasized-whether the patient is trying to become pregnant or not. So again, it’s not a question of preparing the patient for pregnancy, it’s about making sure the patient is in optimum health always.


I really am glad that I “crashed the chat”. I had the opportunity to speak on behalf of Mamas on Bedrest and to contribute to a really great discussion on patient care. The one area we were not able to address is the notion that all of this can be done in 8-12 minutes. But I am confident that given the passion and dedication to this group of health care professionals, even that “obstacle” will soon be eliminated.

Mamas on Bedrest: What to Look For When Shopping For Health Care Insurance

March 13th, 2013

Hello Mamas,

I am newly single and find myself in the precarious position of needing health insurance. (Or will need it shortly!) To be honest, I had no idea where to begin! As a health care provider, I am keenly aware of the importance of adequate health care coverage. As I type this I have a family member who is without coverage and newly diagnosed with a rare form of cancer. Strange stuff pops up and it is imperative that you be prepared.

Health care coverage in the United States is a hotbed issue. With the passage of the Affordable Care Act in 2011, health care coverage is available to many more Americans, yet there are still many people who do not have adequate health care coverage. Additionally, far too many people play what I like to call “Health Care Roulette”. I see this primarily in younger, healthy people who feel that shelling out a couple of hundred dollars each month is a ludicrous expense, but also in families where they struggle to keep a roof over their heads. The young figure they  aren’t on medication, have no illnesses and they mistakenly believe that they are at very low risk. This is a sad, risky line of thought. Young folks are often the ones who jet away on ski vacations, take exotic adventure vacations, hike, bike and engage in other vigorous activities in which unexpected accidents can occur. A broken bone requiring surgical reduction and setting can run thousands of dollars. If you are uninsured, you are responsible for that medical bill. And let’s not forget ourselves, Mamas on Bedrest, in this category. How many of you really anticipated going on bed rest? Yet as many of you are well aware, without health insurance, a hospital bed rest stay or even a complicated labor and delivery can put a family thousands of dollars in debt or worse-bankruptcy. So with all of that in mind, I set about finding reasonable, affordable health care or myself.

I consider myself very lucky. I happened to mention my plight to my accountant and she had some ready resources for me. As I am self employed, I will be able to deduct all of my health care expenses off of my taxes, including the cost of  the policy. But even better than that, she referred me to a very reputable, knowledgeable insurance broker who has set me up with an incredible health care plan. She herself is single and self employed. We are only a couple of years apart in age, so she pretty much set me up with a plan that she would use for herself. I am quite happy with what she has offered me. Here are the highlights.

Co-Payments- I opted for a plan without co-payments. First and foremost, I rarely go to the doctor. I go annually for my gynecological exam and otherwise only go perhaps for a physical examination or an urgent illness/injury. By using providers within the network, I will be assured of a fixed cost for the visit (covered by the insurance). If I go “out of network” I will have a fixed payment for the office visit and will be responsible for any additional charges. But in general, I can apply what I pay to my deductible and later recoup some costs. Also, opting for no co-payment keeps my premium.

Deductibles-I got a pretty good deal here as well. As a single person in relatively good health (got dinged a bit for my age!) I have a reasonable deductible and it will integrate prescriptions into that deductible. My deductible is also my maximum out of pocket expense. Deductibles can be tricky and I highly advise getting some help here. My broker really gave me good information on this and I am quite pleased with her advice.

HSA Account – Being self employed and a Health and Wellness professional, having a health savings account is a must for me. Along providing me with a way to save up funds in the event of a catastrophe or even if I choose to do some alternative treatments, there are tax advantages or business owners. HSA’s are also available if you have a high deductible health insurance plan, so ask your insurance agent if you are eligible for an HSA. While this may not help you now, it would be a great way to pay for a midwife or birthing center or treatments (such as a birthing tub) in the future, which are often not covered by conventional insurance plans.

Supplemental Accident Coverage-This coverage provides added benefits in the event of an accident; you know the type-you break your leg while skiing in Switzerland? This additional coverage will enable you to be flown home and pay for some medical expenses and not be hit with a gastronomical bill. It won’t cover everything, but it will make a dent and provide much needed cash immediately.

Life, Dental, Vision Insurance-I also have the option of adding these coverages to my policy. Yes, they come at additional expenses, but their monthly payments are far less than paying for expenses out of pocket. Again, check with your insurance broker/agent for more details.

I realize that this topic may seem out of line with Mamas on Bedrest, but in actuality it is very pertinent. I can’t tell you the number of mamas who call me when they find out that Maternity care is not a covered benefit of their insurance policy and they need to purchase an additional rider. (Like that’s going to happen if they are already prescribed bed rest!). It’s really important that you look at your insurance policies from time to time, I recommend yearly at the enrollment period, and make sure that you have all the coverage that you and your family need. Many people view health care insurance as an expensive luxury. But if you get without adequate health insurance coverage, it can mean the difference between exemplary care with the best treatments possible and just getting by.