Our Health Policy Matters

It is never easy to absorb unpleasant information. And when I was a policymaker, if someone told me that my decisions were going to cost innocent people their lives, then I usually chalked it up either to hyper-sensationalism or hyperbole.  After all, would passing a small increase in a business tax really force an employer to imperil workers by cutting corners on safety?  Would gun registration really leave a homeowner defenseless in the case of a break-in? Would cutting back welfare a few dollars actually result in a choice between eating or heating in the winter? In most instances, it was hard to see the direct connection. But the more I learned about health issues, the more I understood that there really were some decisions that were a matter of life and death.  These were the issues that taught me humility.  These were the issues that taught me that I needed to set aside my political ideology and embrace both theology and hard data whenever...

It is never easy to absorb unpleasant information. And when I was a policymaker, if someone told me that my decisions were going to cost innocent people their lives, then I usually chalked it up either to hyper-sensationalism or hyperbole.  After all, would passing a small increase in a business tax really force an employer to imperil workers by cutting corners on safety?  Would gun registration really leave a homeowner defenseless in the case of a break-in? Would cutting back welfare a few dollars actually result in a choice between eating or heating in the winter? In most instances, it was hard to see the direct connection. But the more I learned about health issues, the more I understood that there really were some decisions that were a matter of life and death.  These were the issues that taught me humility.  These were the issues that taught me that I needed to set aside my political ideology and embrace both theology and hard data whenever...

Last week, I wrote about the states that have decided not to expand Medicaid this year.  The decision will cost them in money and lives.  But the 24 (and counting) states that have chosen to expand Medicaid will face challenges of their own.  As a new article in Health Affairs Blog reveals, expanding states will have plenty to do to assure that the benefits of expansion reach those most in need. The article, entitled Lessons of Early Medicaid Expansions Under the Affordable Care Act , reviews the experiences of five states and the District of Columbia in expanding Medicaid benefits to additional populations using authority granted to them under Obamacare.  The five states were Connecticut, California, Minnesota, New Jersey, and Washington. All of the states were able to capture federal dollars to support state or local low-income insurance programs.  But, according to the authors, there were seven lessons these states learned that could be warnin...

Last week, I wrote about the states that have decided not to expand Medicaid this year.  The decision will cost them in money and lives.  But the 24 (and counting) states that have chosen to expand Medicaid will face challenges of their own.  As a new article in Health Affairs Blog reveals, expanding states will have plenty to do to assure that the benefits of expansion reach those most in need. The article, entitled Lessons of Early Medicaid Expansions Under the Affordable Care Act , reviews the experiences of five states and the District of Columbia in expanding Medicaid benefits to additional populations using authority granted to them under Obamacare.  The five states were Connecticut, California, Minnesota, New Jersey, and Washington. All of the states were able to capture federal dollars to support state or local low-income insurance programs.  But, according to the authors, there were seven lessons these states learned that could be warnin...

In the aftermath of the decisions by state governors and legislators not to expand Medicaid, the grim numbers are beginning to roll in.  Failure to expand Medicaid will cost states more than 19,000 lives and over a billion dollars per year. And that, sadly, is only the beginning. Source: RAND Analysis, Health Affairs, June 2013 I wrote about this prospect earlier this year, when I concluded that as many as 36,000 lives could hang in the balance of the Medicaid expansion debate. Now we have some new numbers from a RAND Corporation analysis, published this month by Health Affairs , which quantified the impact of failing to expand Medicaid in fourteen states (as of April 2013) where governors opposed the expansion.  The fourteen states were Alabama, Georgia, Idaho, Iowa, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Texas, and Wisconsin. It found that in 2016 there would be 3.6 million fewer insured peo...

In the aftermath of the decisions by state governors and legislators not to expand Medicaid, the grim numbers are beginning to roll in.  Failure to expand Medicaid will cost states more than 19,000 lives and over a billion dollars per year. And that, sadly, is only the beginning. Source: RAND Analysis, Health Affairs, June 2013 I wrote about this prospect earlier this year, when I concluded that as many as 36,000 lives could hang in the balance of the Medicaid expansion debate. Now we have some new numbers from a RAND Corporation analysis, published this month by Health Affairs , which quantified the impact of failing to expand Medicaid in fourteen states (as of April 2013) where governors opposed the expansion.  The fourteen states were Alabama, Georgia, Idaho, Iowa, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Texas, and Wisconsin. It found that in 2016 there would be 3.6 million fewer insured peo...

It is way too early to break out the champagne over the latest Medicaid expansion initiatives bubbling up around the nation.  States that have been reluctant to expand traditional Medicaid are ablaze with proposals to offer “premium support” to expansion populations.  Premium support programs may differ in their details, but they have one thing in common.  Instead of offering regular Medicaid to an expansion population, the state pays the cost of their private insurance premiums. Kaiser Health News reported last week that the Department of Health and Human Services is encouraging states to explore this approach.  MSN featured some “let’s make a deal” offers on expansion by a number of GOP legislators.  And Health News Florida reported a wave of bipartisan enthusiasm for a Florida premium support proposal that was unveiled after support for traditional Medicaid expansion collapsed. For policymakers who don’t like Medicaid but want the fe...

It is way too early to break out the champagne over the latest Medicaid expansion initiatives bubbling up around the nation.  States that have been reluctant to expand traditional Medicaid are ablaze with proposals to offer “premium support” to expansion populations.  Premium support programs may differ in their details, but they have one thing in common.  Instead of offering regular Medicaid to an expansion population, the state pays the cost of their private insurance premiums. Kaiser Health News reported last week that the Department of Health and Human Services is encouraging states to explore this approach.  MSN featured some “let’s make a deal” offers on expansion by a number of GOP legislators.  And Health News Florida reported a wave of bipartisan enthusiasm for a Florida premium support proposal that was unveiled after support for traditional Medicaid expansion collapsed. For policymakers who don’t like Medicaid but want the fe...

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 Calif...

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 Calif...

If you are as grateful as I am that the nonstop coverage of debt ceilings and deficits is behind us for a while, and want to talk about something even Congress should be able to agree is worthwhile, then just repeat after me these two magic words. (No, not those two!) The words are "public" and "health."  There is a new article out entitled Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths .   Source:  Mays and Smith, Health Affairs, 7/11 The article has been published online by Health Affairs , and is in the August 2011 edition of the print journal.   It was written by Glen Mays and Sharla Smith. Spending on public health has long been one of our government’s great success stories.   It keeps our water clean, our air free of pollution, our food pure, our children immunized, and our homes and neighborhoods free of lead, rats, and violence.   It also promotes our health.   I wrote in ...

If you are as grateful as I am that the nonstop coverage of debt ceilings and deficits is behind us for a while, and want to talk about something even Congress should be able to agree is worthwhile, then just repeat after me these two magic words. (No, not those two!) The words are "public" and "health."  There is a new article out entitled Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths .   Source:  Mays and Smith, Health Affairs, 7/11 The article has been published online by Health Affairs , and is in the August 2011 edition of the print journal.   It was written by Glen Mays and Sharla Smith. Spending on public health has long been one of our government’s great success stories.   It keeps our water clean, our air free of pollution, our food pure, our children immunized, and our homes and neighborhoods free of lead, rats, and violence.   It also promotes our health.   I wrote in ...