Our Health Policy Matters

Connecticut spends four times more per capita on state mental health services than Texas.  In Florida, 25 percent fewer people report having mental illnesses than in Washington. Across the nation, there are significant differences in the amounts states spend on mental health services.  Connecticut spends $189 per capita, while Texas spends only $39. But there are also significant differences in the reported prevalence of mental illnesses.  For example, fewer than 18 percent of Floridians report having a mental illness during the past year, but in Washington almost 24 percent do. But what happens when you put spending and prevalence together?  Some new rankings emerge that give you a measure of each state’s real commitment to protecting mental health – and treating mental illness – in their population.  This week, I have ranked all fifty states using both spending and prevalence data.       I have taken per capita m...

Connecticut spends four times more per capita on state mental health services than Texas.  In Florida, 25 percent fewer people report having mental illnesses than in Washington. Across the nation, there are significant differences in the amounts states spend on mental health services.  Connecticut spends $189 per capita, while Texas spends only $39. But there are also significant differences in the reported prevalence of mental illnesses.  For example, fewer than 18 percent of Floridians report having a mental illness during the past year, but in Washington almost 24 percent do. But what happens when you put spending and prevalence together?  Some new rankings emerge that give you a measure of each state’s real commitment to protecting mental health – and treating mental illness – in their population.  This week, I have ranked all fifty states using both spending and prevalence data.       I have taken per capita m...

All over the country, governors are finally beginning to propose new mental health services funding in the aftermath of last year’s mass shootings in Aurora and Sandy Hook. Notes: OH funding is from existing OHT appropriation. CT funding is bond money, some of which may be used by non-MHSA providers. There will be a long road back to policy sanity.  We have to dig ourselves out of the mess caused by $4.6 billion in state mental health cuts over the last few years.  But these governors give us hope that the funding-cut nightmare over which many of them have presided may be finally coming to an end.  In recent weeks, both Republicans and Democrats have announced new community behavioral health funding initiatives, typically ranging between $5 million and $20 million.   But support for community mental health services is not universal.  In states with the worst track records in funding mental health services, their governors continue to be sa...

All over the country, governors are finally beginning to propose new mental health services funding in the aftermath of last year’s mass shootings in Aurora and Sandy Hook. Notes: OH funding is from existing OHT appropriation. CT funding is bond money, some of which may be used by non-MHSA providers. There will be a long road back to policy sanity.  We have to dig ourselves out of the mess caused by $4.6 billion in state mental health cuts over the last few years.  But these governors give us hope that the funding-cut nightmare over which many of them have presided may be finally coming to an end.  In recent weeks, both Republicans and Democrats have announced new community behavioral health funding initiatives, typically ranging between $5 million and $20 million.   But support for community mental health services is not universal.  In states with the worst track records in funding mental health services, their governors continue to be sa...

There was a fascinating news report out of Arizona this past week that embracing the ACA Medicaid expansion will result in $8 billion in new federal dollars flowing into the state over four years – in return for an investment of $1.5 billion from the state. That looks pretty good on the surface, and the 435,000 people who will become insured as a result are a nice bonus. What many people don’t recall is that Arizona was the last state to enroll in the Medicaid program.  So a report such as this from a state whose embrace of Medicaid was a long time coming is especially noteworthy. After seeing numbers like that, I can’t help but wonder what might happen if the state decides not to expand Medicaid.  Its residents could lose a lot of money in return. This is what Florida is facing. We can calculate just how much money every resident of Florida will lose by reviewing what Florida Attorney General Pam Bondi wrote to the Supreme Court this past January: ...

There was a fascinating news report out of Arizona this past week that embracing the ACA Medicaid expansion will result in $8 billion in new federal dollars flowing into the state over four years – in return for an investment of $1.5 billion from the state. That looks pretty good on the surface, and the 435,000 people who will become insured as a result are a nice bonus. What many people don’t recall is that Arizona was the last state to enroll in the Medicaid program.  So a report such as this from a state whose embrace of Medicaid was a long time coming is especially noteworthy. After seeing numbers like that, I can’t help but wonder what might happen if the state decides not to expand Medicaid.  Its residents could lose a lot of money in return. This is what Florida is facing. We can calculate just how much money every resident of Florida will lose by reviewing what Florida Attorney General Pam Bondi wrote to the Supreme Court this past January: ...

Here is a cautionary tale about the risk of downplaying the importance of environmental health. A year ago, Fukushima City was a bustling city with a population of 290,000.  Its people were going about their business the day the earthquake and tsunami hit northern Japan, triggering the biggest environmental disaster most will ever experience. At first, the trains stopped running because of damage to the railways, and most of the city’s water stopped running because of ruptures in water mains. Over the next several days, a silent toxin began to spread along with word of the natural disaster.  The Fukushima nuclear power plants, 39 miles southeast of the city, began melting down, releasing radioactive particles into the air and water.  Although Fukushima remained outside the quarantined evacuation zone stretching twelve miles out from the nuclear facility, waves of radioactive cesium dust escaped the zone, flying on the winds toward the city.  As it...

Here is a cautionary tale about the risk of downplaying the importance of environmental health. A year ago, Fukushima City was a bustling city with a population of 290,000.  Its people were going about their business the day the earthquake and tsunami hit northern Japan, triggering the biggest environmental disaster most will ever experience. At first, the trains stopped running because of damage to the railways, and most of the city’s water stopped running because of ruptures in water mains. Over the next several days, a silent toxin began to spread along with word of the natural disaster.  The Fukushima nuclear power plants, 39 miles southeast of the city, began melting down, releasing radioactive particles into the air and water.  Although Fukushima remained outside the quarantined evacuation zone stretching twelve miles out from the nuclear facility, waves of radioactive cesium dust escaped the zone, flying on the winds toward the city.  As it...

In my last column, I described Florida’s new Medicaid managed care and previewed a few of its implications. In this column, I look closely at seven problems in the law.   First, Medicaid recipients will be asked to pay $10 per month to participate in the program, and $100 for each non-emergency use of a hospital emergency room.   This will increase Medicaid costs, not lower them.   Charging even $10 a month for Medicaid encourages people to avoid enrolling in the program until they get sick. What they don’t get is preventive care, so their care costs more.   Half of all emergency room visits are “non-emergency,” but the patient doesn’t know this until after he or she gets the diagnosis.   For example, chest pain is sometimes indigestion, but other times, a heart attack. You don’t want someone who might be having a health crisis to delay receiving care because they don’t have $100.   If they do and guess wrong, their care will only cost the state more. ...

In my last column, I described Florida’s new Medicaid managed care and previewed a few of its implications. In this column, I look closely at seven problems in the law.   First, Medicaid recipients will be asked to pay $10 per month to participate in the program, and $100 for each non-emergency use of a hospital emergency room.   This will increase Medicaid costs, not lower them.   Charging even $10 a month for Medicaid encourages people to avoid enrolling in the program until they get sick. What they don’t get is preventive care, so their care costs more.   Half of all emergency room visits are “non-emergency,” but the patient doesn’t know this until after he or she gets the diagnosis.   For example, chest pain is sometimes indigestion, but other times, a heart attack. You don’t want someone who might be having a health crisis to delay receiving care because they don’t have $100.   If they do and guess wrong, their care will only cost the state more. ...

Florida’s Medicaid reform law, which takes effect on July 1, mandates the enrollment of most of Florida’s 3 million Medicaid recipients into managed care programs.   It has been called transformational, but it probably won’t deliver on its promise. There is a lot to write about, so I’m devoting two columns to the subject – and publishing them both this week, instead of one this week and one next week.   This column focuses on the details of the new program.   It explains how first year cost savings are unrelated to managed care, why families of nursing home residents in particular should be worried, and how a new profit motive has been built into the Medicaid program.   My next column will focus on seven policy problems built into the new law.     While managed care got the headline, the first-year savings in the legislation come from a 5% provider rate cut, not from managed care.   Medicaid will still be a $20 billion+ program.   It will st...