Our Health Policy Matters

The President focused on income inequality in his State of the Union speech.  This is an important issue; as the gap widens between those rich and poor. But income inequality is built into our public policy at so many levels – and even at the lowest ends of the economic spectrum sometimes the “wealthier” individuals receive better benefits than those who may need them even more.  A case in point is how the insurance subsidies work in the Affordable Care Act in the aftermath of the Supreme Court ruling of 2012. In these, the poorest individuals and families – those living below poverty level – fare the worst. This is an inequality that could be repaired easily and immediately. Here’s how this particular inequality works.  If you are a single person earning $11,375 per year, you pay the highest percentage of your income for insurance as anyone in any income bracket .  An example:  If you want to buy “silver plan” health insurance on the open market, it will cos

It was good news when Congress recently agreed on a budget for the first time in forever.  It was the product of compromise, and everyone expected to give at least a little.  But when the details came out last week, it turned out that some had to give more than others.  And the ones who probably gave up the most were the people who have saved the greatest number of lives over the past century – the public health and prevention community. Last week, the House introduced the FY2014 Omnibus Labor, Health, Human Services, and Education bill – one of twelve appropriations bills that will implement the FY2014 budget.  As the bill summary noted, the legislation includes $156.8 billion in discretionary federal spending for all these important areas combined. That is a big number, and comes to around $500 per person.  By comparison, Defense – which is often considered to be the other “big” area of discretionary spending – will get around $1500 per person. But the disappointi

Last week, I was talking with a new acquaintance about health and mental health policy. He was a successful businessperson, smart, very well educated, and well-informed about public policy.  Like most of us, he follows the news about Obamacare closely.  And he has strong opinions about it.  But I realized as we talked that there were things he thought he knew about Obamacare that were not actually true.  But we both had heard them many times before. So here are five often-repeated “facts” about Obamacare that you, too, have probably heard, and happen to be wrong. 1.  The Affordable Care Act was supposed to reduce health care costs significantly.  Untrue – when the Affordable Care Act was passed, the Congressional Budget Office projected that it would cost more than $1.2 trillion over ten years.  After the Supreme Court decision in 2012, CBO lowered its projection to under $1.2 trillion.  (When these numbers were updated in 2013 , they did not change dramatica

Now that 2014 and Obamacare are both here, there will be plenty of stories about Affordable Care Act implementation.  Some will be newsworthy; but others will just be history.  Last week, we got our first history story characterized as exploding news. The Washington Post reported on a newly-released Harvard study that analyzed the impact of the 2008 Oregon Medicaid expansion on hospital emergency department visits.  The study found that there was a 40 percent increase in the number of emergency department visits made by the new Medicaid enrollees. For the Post article, an MIT health economist (I guess no Harvard ones were available!) commented  that he viewed it “as part of a broader set of evidence that covering people with health insurance doesn’t save money,” something he went on to characterize as a “misleading motivator for the Affordable Care Act.” And Forbes went farther, claiming the study results are “ undermining [the] central rationale ” for ACA. But

Let’s open 2014 with four health policy predictions.  Here are the first three: Obamacare enrollments will top 5 million. Uninsured rates will come down. Health inflation will tick up. Here’s why you can count on these.   First, 1.1 million people have already enrolled in Obamacare.  The Administration hopes for 7 million by March.  That may be optimistic, but there will be another burst of enrollments in a couple of months.  And there will be another open enrollment period toward the end of the year.  So at least 5 million enrollments seems reasonable.  And here is a bonus prediction.  If that many sign up, the politics of Obamacare in the half of the states that have embraced it will probably shift during the 2014 election cycle.  Their people will, too. Second, the number of people who are uninsured will go down.  A 1 or 2 percent decline will be attributable to Obamacare.  The improving economy will also help.  And this means that the numbers will be b