Our Health Policy Matters

Why is mental illness the only chronic disease we don't begin to treat until Stage 4? I posed that question in a presentation for over 400 attendees at last week’s winter meeting of the North Carolina Hospital Association.  For an audience that witnesses first-hand the crowding of patients with mental illnesses into general hospital beds and emergency rooms, the question resonated. Stage 4 of a chronic disease is associated with the imminent threat of death – a widely metastasized cancer, for example, or kidney disease so advanced that only dialysis or a transplant keeps the person alive. The odds of recovery are long. It is the same with mental illness.  Either the patient's life or someone else's needs to be at stake before we guarantee access to treatment.  That's Stage 4. Diagnosing and treating a disease at Stage 1, 2, or 3, always improves the odds of survival and recovery. Why not apply that standard to mental illness, too?  In Stage 1

The reasons that 25 states chose not to participate in creating a new health exchange aren’t exactly the ones they’ve been claiming – that Obamacare is too complicated, too anti-consumer, or too politically unpopular.  The truth is that they have never done a very good job of protecting the health and well-being of their people – especially their children – and they were not ready to start now. Now that all fifty states have decided whether or not they will at least participate in running their own health insurance exchanges as allowed by the Affordable Care Act (you can see the updated information about what each state decided on my state rankings page ), a clear picture is emerging of what distinguished the states choosing to participate from those refusing to do so. On the whole, when compared to one another, the 25 states that have chosen to participate in running their exchanges (17 by themselves, 8 in partnership with the federal government)do a much better job of

For many, the fight over whether or not to expand Medicaid is just about the money.  But they overlook the fact that the lives of more than 36,000 people may hang in the balance.  That’s the conclusion that can be drawn from a study published last summer in the New England Journal of Medicine.  The study was entitled Mortality and Access to Care Among Adults After State Medicaid Expansions .  In it, the authors calculated the numbers of lives saved as a result of an earlier Medicaid expansion in three states. The three states were Arizona, New York, and Maine.  And while none of these expansion populations matched exactly the expansion population in the Affordable Care Act, they were similar enough to suggest that we might see the same results in the ACA Medicaid expansion population. The authors concluded that Medicaid expansions could save 19.6 lives for every 100,000 people between the ages of 20 and 64.  There are over 185 million Americans between the ages of 2

All over the country, governors are finally beginning to propose new mental health services funding in the aftermath of last year’s mass shootings in Aurora and Sandy Hook. Notes: OH funding is from existing OHT appropriation. CT funding is bond money, some of which may be used by non-MHSA providers. There will be a long road back to policy sanity.  We have to dig ourselves out of the mess caused by $4.6 billion in state mental health cuts over the last few years.  But these governors give us hope that the funding-cut nightmare over which many of them have presided may be finally coming to an end.  In recent weeks, both Republicans and Democrats have announced new community behavioral health funding initiatives, typically ranging between $5 million and $20 million.   But support for community mental health services is not universal.  In states with the worst track records in funding mental health services, their governors continue to be sadly out of step with their co