Our Health Policy Matters

Did the Supreme Court save private health insurance, or just drive another nail in its coffin? Ironically, it might well turn out to be the latter. Keep in mind that from a consumer perspective, much of the Affordable Care Act was about trying to keep private insurance affordable in America.  But “affordable” is a relative term.  When your employer pays most of the cost, insurance is a lot more affordable than if you’re paying the bill yourself.  At over $20,000 per year for a typical plan providing family coverage, health insurance now costs around 40% of the median household income of $49,445! Being mandated to take on that expense – even with the generous subsidies ACA provides – understandably rankles people.  It’s no wonder that millions of healthy people may still choose to roll the dice and go without. But even though we have spent so much time arguing about the cost of insurance and the private insurance market, the fact is that it pays only a small part

Are you ecstatic, happy, neutral, sad, or devastated about the Supreme Court’s ruling upholding almost all of the Affordable Care Act? The answer may depend on your politics, but it more likely has everything to do with what the ruling means for you and the people you care about. Back in March, I wrote a column entitled “ How We Really Hope the Supreme Court Will Rule on the Affordable Care Act .”  Now you’ve heard pundits, politicians, and public officials tell you how to feel, let’s recap where you might really stand on the decision . Let’s start with your policy views. If you favor a single payer, “Medicare-for-all” program:  You’re devastated. Your only real hope for resurrecting “Medicare for all” was if the individual mandate was thrown out.  It wasn’t.  You may have Medicaid and Medicare expansions, but over the long haul that probably won’t be enough for you.  If you want a market-driven insurance environment, where insurers compete for your business w

The Supreme Court decision on the constitutionality of the Affordable Care Act is finally in. Before it was announced, most people seemed to think that the individual mandate would be overturned.  It did not play out that way.  The individual mandate was upheld – not under the Commerce Clause of the Constitution, but as a tax.  Justice Roberts proved to be the swing vote. Also left intact are the expansions of Medicaid eligibility and, as a result, the entire law, with all of its consumer protections. However, there is a major caveat here. States can opt out of the expansion of the Medicaid program without jeopardizing the rest of its Medicaid funding.  In other words, the Court is allowing a state to refuse to expand Medicaid eligibility to 133% of poverty and to refuse to cover all of the ACA-mandated basic benefits in its program.  If it does, it will only have to give up the new federal money that pays for these benefits. The consequences may be devastating f

Here’s why you don’t need to be holding your breath while awaiting the announcement of the Supreme Court’s decision on the Affordable Care Act. Its immediate impact on you may be a whole lot less than you think. And here’s why you should be holding your breath. How the Court rules could ultimately determine whether private health insurance or public health insurance is the way we finance health care in the future. The reason is this.  ACA expanded both the role of private insurance and public insurance in providing healthcare coverage in the future.  It added a projected 13 million people to the private insurance rolls and 17 million to Medicaid.  The 13 million were added to private insurance primarily through a mandate that individuals who can afford it buy insurance.  The 17 million were added to Medicaid through a mandate that the states expand the Medicaid-eligible population. The Supreme Court was asked to rule on the constitutionality of both mandates

Note: After the Supreme Court releases its ruling on the Affordable Care Act, OHPM will be publishing analysis and commentary on what the decision means for key subgroups of the population.  Come back to this site early and often for writing that will cut through the noise!  Just before he was forced out of his job as a senior Florida public health official – joining thousands of his colleagues across the country who have recently met the same fate – Daniel Parker commented that “we are victims of a false portrayal of public services as waste .” He is so right. Source: CMS Data, Health Affairs, June 2012 (online) Last year, we spent over $86 billion on public health services. That may seem like a big number.  But it represents only 3% of our nation’s total health spending.  For that 3%, we have doubled our life expectancy over the last century.  We’ve immunized our children, improved the quality of our food and water, and gotten dangerous chemicals out of our

Special Note:  The Supreme Court's decision on the Affordable Care Act is expected soon, and when it comes there will be implications for us all.  The OHPM publication schedule may change that week to provide timely analysis, and may publish more than once. I remember how surprised I was the time I was told that a member of my family had hit his lifetime limits on some of his health insurance benefits.  He had about sixty more years of life expectancy!  I knew then that capping health insurance benefits could be a cruel and bankrupting blow to those who need them the most. That’s why Monday’s announcement by UnitedHealthcare that, no matter what the Supreme Court decides, it will keep in place some of the new  Affordable Care Act-mandated consumer protections was good news. As reported in Kaiser Health News , the nation’s largest health insurer said that it would keep free preventive services, allow children up to age 26 to stay on parents’ plans, and have no lifeti

My daughter was sick last week, with a fever and a sore throat.  She has a history of strep infections, and she thought about going to the doctor and getting checked out. But her co-pays went up recently, and she was conscious of the cost.  So she checked her own throat in the mirror, decided that she didn’t see any white spots, and stayed home to recuperate on her own. She’s not the only one treating herself these days.  People are increasingly risking their health by delaying care because of cost – and this isn’t going to change no matter how the Supreme Court rules on the Affordable Care Act. According to recent data from the Department of Health and Human Services Health System Measurement Project , more than 10% of Americans now report delaying care because of cost.  These include: more than 15% of those below 250% of poverty; nearly 20% of those with a disability; 30% of those already in poor health. Many delay care because they don’t have insurance.