Our Health Policy Matters

“In 2011, mental disorders accounted for more hospitalizations of U.S. service members than any other diagnostic category.” – Armed Forces Health Surveillance Center Medical Surveillance Monthly Report, June 2012 Recently, my daughter Elizabeth told me about a friend who stopped in to see her at the mall where she works while attending college.  Like her, he’s in his early twenties.  They worked together at a toy store a few years ago, and she hadn’t seen him since then. He had enlisted in the army.  He was deployed overseas twice, and served a tour in a war zone.  He sustained a minor physical injury, now healed, while serving. She said that he seemed a little down in the dumps when she saw him.  He told her that he is having trouble with his relationships since his return, but doesn’t think there’s anything wrong with him.  He’s pretty sure he doesn’t have PTSD, and sees no reason to seek counseling or other mental health supports. Instead, he mostly keeps to hims

A couple of months ago, I was invited to the 40 th anniversary celebration and new building dedication of the Community Health Center in Middletown, Connecticut.  I regretted that I couldn’t go – a family obligation came first. The Community Health Center started as a free clinic in a converted, second floor apartment in a downtown building.  It was about the time I was starting college, and a number of students at my alma mater, Wesleyan University, were among those who got it started.  One was John Hickenlooper, now the Governor of Colorado.  I remember when it started to see its first patients, when it began to grow, and when it hired its first full-time doctor.  Believing the health care was a right, not a privilege, its Board and CEO, Mark Masselli, worked hard to meet the need for safety net health care in the community. By the time I entered the State Legislature in 1979, it was a fixture in my legislative district.  I got to know the operation fairly well o

Within days of the Supreme Court’s ACA ruling that made the Medicaid expansion optional, the governors of Florida, South Carolina, Iowa, and Louisiana all announced that they wanted to opt out of it. The governors of six other states were considering the same thing . However they frame their views for the media, they are in fact an attack on two different constituencies.  The first is lower income uninsured families, elders, and single adults, 17 million of whom expected to become insured as a result of the expansion.  The second is safety net providers - nursing homes, hospitals, community health centers, mental health facilities, and others - who need Medicaid dollars to offset the costs of caring for people who have no insurance. Some hospital providers will even get hit twice - once when they lose direct Medicaid dollars and again when they lose their Medicaid Disproportionate Share (DSH) payments that were cut by ACA in anticipation of the Medicaid expansion. The

Now that the ACA decision is behind us, what’s on the horizon in the world of public health, mental health, and health policy? The truth is that ACA was essentially neutral with respect to prevention and public health.  3% of our nation’s health funding went to these services last year, and 3% will continue to go to these services with or without ACA. That won’t stop the assault on public health.  Federal, state, and local governments have all cut public health services in recent years and, unless we have a public health crisis, may well cut further. And Chief Justice Roberts took a swipe at public health programs in his majority decision, when he wrote on page 22 and 23: “To consider a different example in the health care market, many Americans do not eat a balanced diet. That group makes up a larger percentage of the total population than those without health insurance…. The failure of that group to have a healthy diet increases health care costs, to a greater exten

In the wake of the Supreme Court’s decision on the Affordable Care Act, the future of the two biggest government health insurance programs – Medicare and Medicaid – just became much more interesting. The Affordable Care Act made significant changes to both programs, and they will change the landscape of federally-financed health care in the future. Most noteworthy, it closed the Medicare prescription drug donut hole. This is no small matter to the 3.6 million people who benefitted in 2011 alone.  Altogether, they saved $2.1 billion in drug costs, an average of over $600 per person, according to the Center for Medicare and Medicaid Services (CMS). In addition, Medicare recipients are receiving a whole new set of free preventive services, including annual physicals.  In the first five months of 2012, CMS reported that 14.3 million recipients received at least one free preventive service as a result. But these benefits didn’t come without a cost.  And even before the p