Our Health Policy Matters

Last week, I reviewed five of my top ten health policy stories of the year.   Here are the other five, all of which involved matters that will have a major impact on our day-to-day lives in the coming years. 5.   The Enactment of CLASS.   Private long term care insurance has been on the policy agenda since the 1980s.   Seniors realized that the cost of long term care could bankrupt them, so they began protecting their assets by transferring them to their children.   The state and federal governments were left to pay the tab, and went looking for help. Private long term care insurance products were developed as a solution.   However, not enough people bought them.   When they were young, people didn’t think they would need the insurance, but once they got into their 60s and 70s, the premiums were too high.   This year, the federal government took action.   Tucked into the pages of the health reform legislation is a new government-sponsored long term care insurance program starting in 20

2010 was the most significant year in health policy since the 1960s.   It dominated the policy agenda for the first few months of the year, and it stayed in the news throughout the election season.   As the year drew to a close, conflicting lower court decisions about the constitutionality of the individual mandate foreshadowed a continued policy debate into the foreseeable future.   What makes a health policy story big in a time of change?   It’s not just the attention it commands in the media.   It’s the impact it has on our lives.   This week and next, I’ll countdown ten.     Using the impact criterion, there were actually some that weren’t part of health reform!     Here are my choices for numbers ten through six. 10. The Election of Senator Scott Brown.   It is hard to remember that as we entered 2010, the Democrats seemed to be putting the finishing touches on a bill that could pick up 60 votes in the Senate.   Lincoln, Lieberman, and Nelson were among the ones to whom everyone w

In the 1990s, the Department of Health and Human Services looked at health spending versus the improvements in the health of our population in the 20 th century.   The results were startling. 97 percent of our spending was in health care, versus 3 percent in wellness and prevention – the activities of public health.   Despite the meager investment in public health, however, 50% of the improvement in our health status could be attributed to it. Managing our health and preventing disease means a longer life.   I admit that this lesson wasn’t lost on me.   I run or take long walks at least three times a week, eat five portions of fruits or vegetables a day and no red meat, enjoy a glass of wine with dinner, and do my best to manage my stress.   My weight today is just a little higher than it was when I was in high school forty years ago. Those are the things I can do by myself, but they’re not enough. Without statins my cholesterol numbers would be a nightmare.   So I also go for my annu

States battling to repeal new health reform mandates have settled on two issues that may well turn out to be political brick walls.   One issue is the requirement beginning in 2014 that individuals purchase insurance or pay an income tax surcharge, the so-called “individual mandate.”   The other is the federal expansion of the Medicaid program.   The battle is being joined in the courts, the Congress, and state legislatures. Most of the action so far has been in the courts.   Florida has filed a suit challenging both the individual mandate and Medicaid expansion.   CNN calls it the “highest profile” lawsuit of many, and 19 other states have joined it. Florida argues that the individual mandate is unconstitutional, contending that it’s unconstitutional for the federal government to require individuals to purchase health insurance by taxing them if they don’t.   As of last week, federal judges in both Michigan and Virginia have ruled against this position in other cases, but these decisi

There is an epidemic of mental illness in America.   It’s time policy leaders did something about it. They could start by acknowledging just how widespread this epidemic is.   According to the National Institute on Mental Health , it affects one-fourth of our population – over 57 million adults and over 15 million children.   Why are the numbers so staggering? No one knows for sure, but the bad economy, wars, and abuse are all probable factors. According to a Gallup Poll released last year, the bad economy led to an increase in emotional illness among all adults.   Especially hard hit were those between the ages of 30 and 55, the family breadwinners. CNN reported in 2007 that one-third of all veterans returning from Iraq or Afghanistan were treated for mental illnesses.   Their children were also affected.   According to a survey of health records released this past month and reported in the New York Times , children between the ages of 3 and 8 with parents in the military had 10% mo

If you watched HBO’s Real Time with Bill Maher on November 12th, you heard Mike Huckabee propose a public option as part of a health reform fix.   With “repeal, revise, and replace” stories in the news every day, shouldn’t this be worth at least one national headline?   Governor Huckabee didn’t just flirt with the public option; he married it to his opposition to requiring insurers to cover people with pre-existing conditions.      Defending his position, Huckabee argued “when you buy insurance you’re buying something in the private sector.   Now maybe there’s a place to say if you’re really, really sick and you can’t access a traditional marketplace then should we have some form of safety net?   Yeah. I’ve said that; I did that when I was Governor.”    He called for “a partnership between government and the private sector” to insure people with pre-existing conditions. So what did Mr. Huckabee propose?   He cited the Arkansas TEFRA program he started for families of children with ser

Health insurance reform is being implemented now, and it's no surprise that there’s a big battle going on pitting consumers against insurers.   The surprise is that the state regulators charged with protecting consumers are siding with insurers on some key issues. The Biggest Consumer Protection in Health Reform If you ask 100 people what the biggest consumer protection in the health reform law is, I would guess that fewer than 10 of them would tell you it’s the loss ratio mandate. The what, you say?    We know about lifetime caps and pre-existing conditions and minimum benefit packages.   Few of us know about “loss ratios.” As we’ll see, consumers have a lot at stake in the loss ratio battle, including – for some – hundreds of dollars of premium costs per month .   What’s a loss ratio? What’s a loss ratio, and why should you care?   Simply put, a loss ratio is the percentage of dollars taken in through premiums paid back out in benefits.   For example, if a plan pays out $75 in be

Discussing health reform over the weekend, House Republican leader Eric Cantor told the New York Times that “ it is my intention to begin repealing it piece by piece, blocking funding for its implementation and blocking the issuance of the regulations necessary to implement it.” Congressman Cantor’s Problem To which “it” does Congressman Cantor refer?   The “it” creating a new long term care insurance program so that elders will be able to fund nursing or home care as they age?   Or the “it” creating a new catastrophic care insurance plan so that healthy young people will be able to afford some insurance coverage as they age out of their parents’ plans?   Perhaps it’s the “it” that provides new grants to community health centers, or the “it” providing new training for primary care physicians to recognize and treat chronic conditions, or the “it” creating thousands of needed new jobs in the health care workforce.   Congressman Cantor’s problem is that there isn’t an “it” to be repealed