Our Health Policy Matters

Should the Affordable Care Act be repealed so that over a million people making more than $123,000 per year can avoid paying $3,000 in taxes beginning in 2016?  And should they be allowed to pass on the cost of their health care to everyone else? This week, a local newspaper quoted a lifelong Florida Democrat as saying she might vote for Mitt Romney because she believed ACA offered “a costly giveaway to freeloaders.” The irony is that the law actually does just the opposite – and Mitt Romney knows this better than most.  It requires nearly all health care “freeloaders” either to get insurance or pay a tax penalty. Eighty percent of those affected will get insurance.  But the Congressional Budget Office reported last week that it expects 6 million people to owe the tax penalty beginning in 2014.  The $8 billion the penalty will eventually raise will help defray the cost of uncompensated care. Six million people make up less than 2% of our total population.  Should

Why did the health care debate in this year’s election campaign pivot so quickly from the Affordable Care Act to Medicare? It may well be because of this:  While people still feel strongly about ACA, they don’t really see it as relevant to them.  But Paul Ryan made Medicare relevant to everyone when he proposed changing the program for the under-55 population. Some new data from the U.S. Census Bureau may explain why most people don’t see ACA as relevant to them. We learned this month that the number and percentage of people without health insurance changed modestly in the year after ACA passed.  The number of uninsured people went from 50 million to 48.6 million.  The percentage of uninsured decreased from 16.3 percent to 15.7 percent. These changes were small, as were some others.  The percentage of people with employer-based insurance decreased slightly, from 45.7% in 2010 to 45.1% in 2011, and the percentage of people who purchase private insurance directly rem

I am writing this column just a few hours after the birth of my second grandchild, Haley Marie.  Haley Marie looks like her father.  She is long and thin, and she is going to be very pretty when she is older. Our first grandchild, Noah, was born four months ago.  He’s in the 5 th percentile in weight, and my wife and I joked that it would be hard for Haley to beat that when she came along. She did.  She weighed in at two pounds and eleven ounces, which means that, according to the Annie E. Casey Foundation Kids Count project, she is one of the 1.5% of all U.S.  babies who are born each year at “very low birth weight,” or less than 1500 grams (3 pounds, 4 ounces).  So Haley Marie will spend her first days in a hospital neonatal intensive care unit.  Haley is fortunate.  She was beyond thirty-two weeks of gestation.  Her Apgar scores were stellar.  She is strong and has good lungs.  I can also offer direct testimony that she is alert and responsive to light.  I lear

We have made some big mental health policy mistakes in my lifetime.  And my son Tim is among the millions of our sons and daughters who have paid for them. This is because he happens to be among the 6% of sons and daughters with serious mental illness. We fail to see mental illnesses as often preventable and always treatable diseases.  And although half of us will be diagnosed with one during our lifetime and mental illnesses cost as much to treat as cancers, we more readily send people with mental illness to jails and prisons than we do to hospitals and health centers.  Meanwhile, we underfund mental health care, special education, and social services systems. I explain what this has meant for my son in an essay just published by Health Affairs , the nation’s leading health policy journal.  How I Helped Create a Flawed Mental Health System That’s Failed Millions – And My Son covers over twenty years of Tim’s life in Connecticut, Texas, and California – a life now