Our Health Policy Matters

It sometimes seems like policymakers go out of their way these days to pick on people with mental illness. According to a report released last week by the American Mental Health Counselors Association , 3.7 million people with mental illness will remain uninsured because of the decisions of states not to expand Medicaid.  And if you believe some earlier data from the Kaiser Family Foundation  about the total number of people who will be left uninsured because of states' failures to expand Medicaid, then you can only conclude people with mental illnesses account for nearly 80 percent of all those who are being denied insurance coverage in non-expanding states. This includes 652,000 in Texas and 535,000 in Florida, and around 200,000 each in Pennsylvania, Indiana, Georgia, North Carolina, South Carolina, Tennessee, and Louisiana. The association characterizes this as “dashed hopes” and “broken promises.” You might also call it a national disgrace. For...

It sometimes seems like policymakers go out of their way these days to pick on people with mental illness. According to a report released last week by the American Mental Health Counselors Association , 3.7 million people with mental illness will remain uninsured because of the decisions of states not to expand Medicaid.  And if you believe some earlier data from the Kaiser Family Foundation  about the total number of people who will be left uninsured because of states' failures to expand Medicaid, then you can only conclude people with mental illnesses account for nearly 80 percent of all those who are being denied insurance coverage in non-expanding states. This includes 652,000 in Texas and 535,000 in Florida, and around 200,000 each in Pennsylvania, Indiana, Georgia, North Carolina, South Carolina, Tennessee, and Louisiana. The association characterizes this as “dashed hopes” and “broken promises.” You might also call it a national disgrace. For...

It is never easy to absorb unpleasant information. And when I was a policymaker, if someone told me that my decisions were going to cost innocent people their lives, then I usually chalked it up either to hyper-sensationalism or hyperbole.  After all, would passing a small increase in a business tax really force an employer to imperil workers by cutting corners on safety?  Would gun registration really leave a homeowner defenseless in the case of a break-in? Would cutting back welfare a few dollars actually result in a choice between eating or heating in the winter? In most instances, it was hard to see the direct connection. But the more I learned about health issues, the more I understood that there really were some decisions that were a matter of life and death.  These were the issues that taught me humility.  These were the issues that taught me that I needed to set aside my political ideology and embrace both theology and hard data whenever...

It is never easy to absorb unpleasant information. And when I was a policymaker, if someone told me that my decisions were going to cost innocent people their lives, then I usually chalked it up either to hyper-sensationalism or hyperbole.  After all, would passing a small increase in a business tax really force an employer to imperil workers by cutting corners on safety?  Would gun registration really leave a homeowner defenseless in the case of a break-in? Would cutting back welfare a few dollars actually result in a choice between eating or heating in the winter? In most instances, it was hard to see the direct connection. But the more I learned about health issues, the more I understood that there really were some decisions that were a matter of life and death.  These were the issues that taught me humility.  These were the issues that taught me that I needed to set aside my political ideology and embrace both theology and hard data whenever...

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 ...

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 ...

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...

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...

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...

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...

We hear so often that the Republicans have offered no alternatives to Obamacare that we think it must be true.  It isn’t.  They presented at least two alternatives to the Affordable Care Act in 2009.  And neither would be better than what we have today.  One would have had all the Obamacare implementation problems.  And the other would have insured no more than a thimbleful of people.  The first was called the Patients’ Choice Act, offered by Paul Ryan.  The other was called the Affordable Health Care Act for America, offered by John Boehner. Elements of the Ryan plan , which was introduced in the spring of 2009, will sound very familiar to you: “The federal government partners with states to create State Health Insurance Exchanges.” These exchanges became a core component of Obamacare, and would look exactly like the exchanges in place today. “The Exchange would require all participating insurers to offer coverage to any...

We hear so often that the Republicans have offered no alternatives to Obamacare that we think it must be true.  It isn’t.  They presented at least two alternatives to the Affordable Care Act in 2009.  And neither would be better than what we have today.  One would have had all the Obamacare implementation problems.  And the other would have insured no more than a thimbleful of people.  The first was called the Patients’ Choice Act, offered by Paul Ryan.  The other was called the Affordable Health Care Act for America, offered by John Boehner. Elements of the Ryan plan , which was introduced in the spring of 2009, will sound very familiar to you: “The federal government partners with states to create State Health Insurance Exchanges.” These exchanges became a core component of Obamacare, and would look exactly like the exchanges in place today. “The Exchange would require all participating insurers to offer coverage to any...

The House of Representatives voted to repeal the Affordable Care Act for the 40 th time last week.  It did this before balancing the budget, passing a jobs bill, reforming election laws, or anything else that might actually improve its standing in the eyes of the general public. So what began for some members of Congress as principled opposition to federal “overreach” has turned into a political punch line: “How many more votes will it take for the House of Representatives to repeal Obamacare?  It doesn’t matter, because the House doesn’t count anyway.” The very first column I wrote after the mid-term election in 2010 was entitled “ Six Reasons Why Health Reform Won’t be Repealed .”  In it, I argued that there were at least five substantive reasons why the Affordable Care Act would not be repealed in spite of the Republican House takeover.  These included the popularity of the expanded Medicare benefits, the benefits to early retirees, the benefits to...