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 pay...

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 pay...

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 consequen...

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 consequen...

Imagine what a nightmare healthcare scenario might look like. You are diagnosed with a debilitating chronic disease while young.  At first, you can’t even work because of it, and you are dependent on a family member’s insurance to help pay your medical expenses.  Eventually, your disease goes into remission, and you find a job with health insurance.  You go off your family member’s plan.  But your employer goes bankrupt, and you’re left with no job and no insurance.  Then you get another chronic disease. You try the individual health insurance market, but the only insurance available to you comes from a high risk pool in which everyone else also has at least one chronic disease.  The price is outrageous, but you pay the bill as long as you can. Eventually, you can’t afford it, and you become uninsured for a few months.  You apply to your state’s Medicaid program for help.  You are denied because your state has already s...

Imagine what a nightmare healthcare scenario might look like. You are diagnosed with a debilitating chronic disease while young.  At first, you can’t even work because of it, and you are dependent on a family member’s insurance to help pay your medical expenses.  Eventually, your disease goes into remission, and you find a job with health insurance.  You go off your family member’s plan.  But your employer goes bankrupt, and you’re left with no job and no insurance.  Then you get another chronic disease. You try the individual health insurance market, but the only insurance available to you comes from a high risk pool in which everyone else also has at least one chronic disease.  The price is outrageous, but you pay the bill as long as you can. Eventually, you can’t afford it, and you become uninsured for a few months.  You apply to your state’s Medicaid program for help.  You are denied because your state has already s...

The Affordable Care Act has finally had its days in court this week. And commentators who were certain on Monday that the Supreme Court would uphold the individual mandate were just as certain on Tuesday that it would not.  Perhaps they have some special insight into the thinking of the Justices. I don’t.  I’ll just wait for the decision.  In the meantime, I’m wondering not how each of us thinks the Court will rule, but how we hope it will rule. The answer isn’t so simple, because we divide into – and often move among – three competing minority camps about health reform in general: The Affordable Care Act represents the best compromise for insuring more people while preserving most of our current public/private payer system. Expanding reform to a single payer system like those favored by other developed nations would be better.  Replacing ACA with a private market-based system is at least worth a try. If we’re as uncertain as polls cited by ...

The Affordable Care Act has finally had its days in court this week. And commentators who were certain on Monday that the Supreme Court would uphold the individual mandate were just as certain on Tuesday that it would not.  Perhaps they have some special insight into the thinking of the Justices. I don’t.  I’ll just wait for the decision.  In the meantime, I’m wondering not how each of us thinks the Court will rule, but how we hope it will rule. The answer isn’t so simple, because we divide into – and often move among – three competing minority camps about health reform in general: The Affordable Care Act represents the best compromise for insuring more people while preserving most of our current public/private payer system. Expanding reform to a single payer system like those favored by other developed nations would be better.  Replacing ACA with a private market-based system is at least worth a try. If we’re as uncertain as polls cited by ...

Public policy attacks on public health and mental health, intrusions in doctor/patient privacy, the continuing fight over the Affordable Care Act, and our collective loss of faith in private health insurance were among the top health policy story lines of 2011. This year, eight stories make my short list.  Not all of these stories made big headlines during the year.  But they have had, or will have, an outsized impact on our lives. I’ll begin the countdown this week with four that capture and continue some of the major trends of the recent past.   Next week, I’ll offer four more that hint at where health policy may go in the future. 8.  The Shooting of a Congresswoman .  In January, the first big health policy story of the year was about violence and mental illness – the horrible wounding of a member of Congress, and the murder of several people around her.  As the media struggled to make sense of this, it raised once again the relation...

Public policy attacks on public health and mental health, intrusions in doctor/patient privacy, the continuing fight over the Affordable Care Act, and our collective loss of faith in private health insurance were among the top health policy story lines of 2011. This year, eight stories make my short list.  Not all of these stories made big headlines during the year.  But they have had, or will have, an outsized impact on our lives. I’ll begin the countdown this week with four that capture and continue some of the major trends of the recent past.   Next week, I’ll offer four more that hint at where health policy may go in the future. 8.  The Shooting of a Congresswoman .  In January, the first big health policy story of the year was about violence and mental illness – the horrible wounding of a member of Congress, and the murder of several people around her.  As the media struggled to make sense of this, it raised once again the relation...

There are 4 million or more Americans who can’t get regular insurance because of a pre-existing condition.   You might be one of them.  Now there’s a policy that costs less than $300 per month and covers all of your medical needs, including your pre-existing condition.   Will you buy it?  Apparently not. And that may signal the beginning of the end of private insurance in America. I first wrote about the diminished role of private insurance in a column last month entitled America’s Health Insurance Myth .   Privately-financed private health insurance today pays only 17% of America’s health care bill. Two recent developments suggest that this share will become even smaller in the future. The first was last week’s death of the CLASS Act .   As a result, long term care will continue to be an out-of-pocket and government expense only for nearly everyone. The second was the report of first-year enrollment numbers for the new Pre-existing Condi...

There are 4 million or more Americans who can’t get regular insurance because of a pre-existing condition.   You might be one of them.  Now there’s a policy that costs less than $300 per month and covers all of your medical needs, including your pre-existing condition.   Will you buy it?  Apparently not. And that may signal the beginning of the end of private insurance in America. I first wrote about the diminished role of private insurance in a column last month entitled America’s Health Insurance Myth .   Privately-financed private health insurance today pays only 17% of America’s health care bill. Two recent developments suggest that this share will become even smaller in the future. The first was last week’s death of the CLASS Act .   As a result, long term care will continue to be an out-of-pocket and government expense only for nearly everyone. The second was the report of first-year enrollment numbers for the new Pre-existing Condi...