Our Health Policy Matters

It has been a busy health policy year.  Here are my choices for the top health policy stories.  They all may not have made big headlines, but all will reverberate for some time.  The Slowing of Healthcare Inflation This was on my watch list coming into this year , and I’ll lead with it today because it was the best health policy news of the year.  When healthcare inflation came in low this year, it did all sorts of good things.  It helped balance state budgets, extended the life of the Medicare Trust Fund, and dropped the price tag of the Affordable Care Act.  Inflation is supposed to jump up this year as millions more become insured, but we can at least hope that a more modest trendline continues. Mental Health Parity And for some more good news… It took five years and incessant lobbying from heroes like Patrick Kennedy, but the final rule implementing the Mental Health Parity Act of 2008 was finally released this year , coinciding roughly with the 50 th anniversa

At least thirty-six states increased funding for mental health services during 2013, according to a recent report by the National Alliance on Mental Illness .  And last week, Vice President Biden announced that the federal government was adding $100 million in new funding for mental health services. So have we turned the corner on our nation’s mental health funding crisis, as many of the accompanying news headlines seemed to imply?  Or are these initiatives more a token gesture aimed at mollifying the mental health advocacy community in the aftermath of the Sandy Hook massacre, as others have suggested ?  I think that – with a couple of notable exceptions in Connecticut and Texas – the initiatives tend more toward tokenism than real change. Consider the national initiative.  On the face of it, $100 million sounds like a lot of money.  But it still represents only around 3 percent of the Substance Abuse and Mental Health Services Administration (SAMHSA) budget, the agenc

We hear so often that the Republicans have offered no alternatives to Obamacare that we think it must be true.  It isn’t.  They presented at least two alternatives to the Affordable Care Act in 2009.  And neither would be better than what we have today.  One would have had all the Obamacare implementation problems.  And the other would have insured no more than a thimbleful of people.  The first was called the Patients’ Choice Act, offered by Paul Ryan.  The other was called the Affordable Health Care Act for America, offered by John Boehner. Elements of the Ryan plan , which was introduced in the spring of 2009, will sound very familiar to you: “The federal government partners with states to create State Health Insurance Exchanges.” These exchanges became a core component of Obamacare, and would look exactly like the exchanges in place today. “The Exchange would require all participating insurers to offer coverage to any individual – regardless of age or

There are bad reviews and then there are bad reviews.  But it would be difficult to imagine some worse headlines than the ones Obamacare has received during the past month. My favorite for over-the-top headline?  How about this gem from the National Journal: “ Why Obamacare May Be Obama’s Katrina, Iraq .” That’s right.  An initiative to insure millions of Americans has been equated with the most frightening American natural and man-made disasters of the 21 st century.  In a world in which we have come to expect tight plotlines, heroic successes, and quick and satisfying endings, I imagine that a blockbuster like Obamacare was never going appeal to critics. The Obamacare story is being reported this month as if it were a classic disaster movie, with millions of people about to be left out in the cold to fend for themselves in a chaotic healthcare system as Obamacare exchanges crash and burn around them. But that’s not close to reality. This week’s announcement t

At long last, the Administration has released the final rule implementing the Mental Health Parity and Addiction Equity Act of 2008 . This will extend mental health insurance benefits on a par with medical/surgical benefits to at least 30 million more people.  And, more importantly, we have finally ushered in a 21 st Century response to a set of diseases for which we still often employ 19 th Century treatments – locking the door and throwing away the key. The Mental Health Parity Act (MHPA) was passed in 2008.  Its purpose was to end insurance discrimination against people with mental illness.   For larger group health plans, it outlawed annual and lifetime limits on mental health or substance use disorder benefits when there are no annual or lifetime limits on medical/surgical benefits. And it required that co-insurance and co-payments be substantially the same for both mental health and regular medical/surgical procedures. As it turned out, the MHPA needed t

I admit it.  I have Obamacare fatigue. I’m tired of endless stories about website glitches and the small numbers of people who rushed to buy health insurance three months before it would even go into effect.  But I am most fatigued by the newest invented controversy about the so-called “health-insurance-you-like” policies that have been outlawed because they do not meet even the bare minimum standards established by the law.  That’s right – the American people just love lousy health insurance! Source: NSDUH, 2013 So I thought I would write about something less controversial – drugs.  Because some new facts suggest that if we really want to change a useless federal policy, we will end – as quickly as we can – our failed War on Drugs. President Richard M. Nixon declared “War on Drugs” in June of 1971.   We have been fighting this war for forty-two years now, long enough to determine if it has made any difference in our lives.  It has.  The War on Drugs has loaded up

I have never been the biggest fan of the Affordable Care Act.  I believe that since the government is already paying over 70% of our nation’s health care bill and we’re paying another 12% out of pocket, this colossal effort to preserve the small share financed by privately-funded private insurance without bankrupting the nation may not have been worth the effort.  Medicare-for-all would have been a much better approach. But now that an emerging group of at-risk Democratic senators have joined the Republican chorus to delay the individual mandate , I want to offer an opposing view to theirs.  Obamacare has been compromised enough. Since it was enacted in 2010, Obamacare has undergone the following significant changes: The minimum medical loss ratio requirements were delayed in several states. The long-term care insurance program has been repealed. The prevention fund has been raided. The reductions in payments to providers have been put off. The mandatory Med

Exactly a half century ago, in October, 1963, President John F. Kennedy signed the Community Mental Health Centers Act into law.  It affected two very different classes of people - people with mental illness and people with developmental disabilities. In many ways, it was a civil rights act, promising to replace large, segregated institutions with integrated, community-based services. It made a huge difference for people with developmental disabilities.  But for people with mental illnesses, its promise is unfulfilled and the dream sometimes feels like it is dying. When President Kennedy signed the Mental Retardation Facilities and Community Mental Health Centers Construction Act on October 31st, he did so with optimism. The law specified that the new community mental health centers would offer four services – prevention, diagnosis, treatment, and rehabilitation or recovery – to people with mental illness.  And the result would be that all people, no matter what th

As Congress lurches today toward what at best will be another short-term “solution” to the debt ceiling and government shutdown debacle, there is a reason to believe that it will never effectively tackle entitlements.  What we need and what we want are two different things.  And this inept Congress – which in the eleventh hour of its most recent manufactured crisis is still posturing over Obamacare – has no idea how to balance the two.  Source: US House Website We need our entitlements – that’s why they exist.  But we also don’t want to pay for them. Take the Affordable Care Act – in the crosshairs of so many politicians – as an example.  Next to no one wants it all repealed.  Coverage for pre-existing conditions, a guarantee that insurance won’t be cancelled even after an illness hits, and tax credits to lower the cost of health insurance are all needed and immensely popular. But these things cost money.  When Congress passed the Affordable Care Act in 2010, it in

This is Mental Illness Awareness Week . But the sad tragedy of Miriam Carey is another reminder of how deeply unaware we are about mental illness in general and its relationship to violent behavior in particular. And how much we rely on myths to fill in the gaps in our knowledge. We all heard the news about Ms. Carey last week.  But we were not exactly informed by it.  Ms. Carey drove her car onto a White House driveway, hit some temporary fencing, backed up, and then pulled away . She was pursued toward the Capitol by law enforcement officers in what became a high-speed chase.  Ms. Carey was eventually cornered near Garfield Circle.  Six officers, with guns pulled, approached her car there.  She apparently panicked, scattering the officers as she drove away.  At least nine shots were fired at her as the chase began again.  She eventually got stuck on a median near a Capitol guard station, where she was shot to death by an officer. As I watched the unfolding news th

As we gaze this week at the wonderland we call Congress, it might amaze us that Congress actually shut down the federal government over the implementation of the Affordable Care Act. Rep. John Culberson of Texas grinned like a Cheshire Cat as he explained it this way in an outlandish interview on CNN, “we do not want the federal government socializing health care as they have in England and in France.” This is socialized medicine?  Really? He wasn’t content to leave it there, adding a new “sacred” right to the Constitution to explain further his position. “The right to be left alone as Americans is probably our most important right.” As the Mad Hatter would say, “Why, you might just as well say that ‘I see what I eat is the same as I eat what I see.’”  But Representative Culberson was on a roll.  Literally.  This was two days after he was reported to have shouted “let’s roll!” as House Republicans concluded a caucus in which they re-affirmed their intent to

It is hard to imagine a political strategy less likely to achieve its intended outcome while simultaneously harming the economy than shutting down the government to prevent the implementation of Obamacare. But that probably won’t stop Senator Ted Cruz from trying .  And unless cooler Congressional heads prevail this week, while he will do no real harm to Obamacare, he may well do harm to the economy. Obamacare is the law, shutdown or not.  And no matter what, on Tuesday you will still be able to go to any hospital in the country and get treated, your doctor’s office will still be open, and your insurance company will still expect you to pay your premium. But when the government is shut down, the stock market suffers.  And a few points on the downside in our stock market that are attributable to a single event may be more significant than you think. Let’s go back to 1995.  The Newt Gingrich-led House shut down the government twice – on November 14, 1995 for a w

The latest Obamacare navigator “compromise” may calm one small battle in Florida.  But it won’t end the war on Obamacare being waged by hypocritical public officials around the country. A couple of weeks ago, I wrote about the Congressional effort to undermine the Obamacare navigation program in its entirety.  A House Committee has ordered nonprofits winning navigation grants to produce reams of material, and promises to punish those that have failed to comply.  Source: US Census Bureau Navigators will assist people in applying for public or private insurance to pay for their health care.   Navigators are not a new concept, created by Obamacare.  They are as old as Marco Rubio, and Obamacare is not the first federal initiative ever to fund them.  In fact, I implemented the policy of the Nixon Administration as a VISTA paralegal 35 years ago, navigating underinsured elders to the Medicaid program. So we know that navigators can be trusted to do their jobs. But