Our Health Policy Matters

Herman Cain’s ascendant Presidential campaign brings into focus the limited health policy thinking that has dominated the campaign so far.   Here are our current major health policy challenges: Reversing the trend toward lower investments in the public health and prevention activities that have accounted for half of our increased longevity in the last century;   Assuring fair coverage of the chronic conditions, including mental illness, cardiovascular disease, and cancers, that affect 60% of our population; Giving even the uninsured 16% of our population access to high quality, comprehensive, integrated primary, specialty, and hospital care; and Figuring out how best to pay for all this. Despite the urgency of these challenges, the current health policy debate can be condensed into a four word sound bite – “Repeal Obamacare Individual Mandate.” Here are the specifics of what the candidates have been talking about the past couple of weeks. Mitt Romney

There are 4 million or more Americans who can’t get regular insurance because of a pre-existing condition.   You might be one of them.  Now there’s a policy that costs less than $300 per month and covers all of your medical needs, including your pre-existing condition.   Will you buy it?  Apparently not. And that may signal the beginning of the end of private insurance in America. I first wrote about the diminished role of private insurance in a column last month entitled America’s Health Insurance Myth .   Privately-financed private health insurance today pays only 17% of America’s health care bill. Two recent developments suggest that this share will become even smaller in the future. The first was last week’s death of the CLASS Act .   As a result, long term care will continue to be an out-of-pocket and government expense only for nearly everyone. The second was the report of first-year enrollment numbers for the new Pre-existing Condition Insurance Plan (PCIP) .

Opponents of the Affordable Care Act (ACA) are now looking to the Supreme Court to overturn the 2010 law before time runs out on them. After ACA became law eighteen months ago, they were optimistic that they could beat back several of its key provisions.   These included the minimum medical loss ratios, the expansion of Medicaid, the health insurance exchanges, and the individual mandate. A brief review of the current status of each shows why the individual mandate is the last one standing.   But as the arguments for and against it have crystallized in the Courts, they show how the Supreme Court could open a Pandora’s Box best left closed.   Minimum loss ratios ACA mandates that all private insurance plans will have to pay at least 80 to 85 cents in benefits for every premium dollar collected, or rebate the difference to policy holders beginning in 2012.   Opponents argued that many existing plans would be forced out of the market because of high administrative costs.

The next time Florida’s Governor tells you that the only way to create private sector jobs is to cut public sector health spending, don’t believe him.   According to news reports , the Governor’s Office is already warning state health agencies to expect more budget cuts in 2012.   He wants the dollars to implement his 7-7-7 plan to create 700,000 jobs in 7 years. source: US DOL data, 2011 How’s the plan working out for Florida so far? Dismally, by two different measures.   The first is the 2011 state unemployment claims data.   The second is the story of why Florida just lost another 7,500 jobs in health research. The 2011 unemployment data show that Florida’s Governor has been more effective at killing jobs than creating them.   The week before Governor Scott took office, 14,139 Floridians lost their jobs and filed new unemployment claims.   In 36 of the 37 weeks since then, the number has been higher than that.   Another 15,713 Floridians filed new unemployment claims