The Price Of Saying “No”

 Health Care, Wonkery  No Responses »
Jun 042013
 

Those Republican governors who still refuse to participate in the Medicaid expansion may be inflicting long-term financial damage on their states. A new RAND study finds that not only will these states will pay out nearly $1 billion more in uncompensated care and forfeit several billion more in federal Medicaid dollars, but they will also have more uninsured residents. Some conservative governors have concluded that expanding Medicaid is the best option for both their constituents and their budgets, but others (Texas Governor Rick Perry, for instance) remain committed to blocking the expansion on ideological grounds.

The RAND probably won’t persuade any of these leaders to change course. Not in the short term, anyway. But once 2014 arrives and other states implement the expansion without much fuss, the holdouts may decide the practical benefits of joining them may outweigh any political considerations. And if they don’t, their beleaguered local hospitals and medical providers will ramp up their lobbying efforts. That kind of political pressure may be difficult to resist.

That Medicaid Study Everyone Is Talking About

 Health Care, Wonkery  No Responses »
May 032013
 

Conservatives are seizing upon a new study that shows Medicaid recipients tend to consume more health care while their overall health remains unimproved as proof that the forthcoming expansion of Medicaid under the Affordable Care Act is a waste of money. It’s a willfully stupid conclusion for the following reasons:

  • People on Medicaid have low incomes. People with low income tend to have more chronic health conditions. So it’s no surprise that they would consume more health care once they receive access to affordable health care.
  • The study in question tracked people for only two years. It’s unlikely that a huge improvement in a chronic condition is going to show up after a couple years. And some conditions may never improve. Does that mean health care is wasted on such people? Is it wasted on me?  If we focus only on measurable improvement as the yardstick for justifying public health care expenditures, we’d better be prepared to have some really difficult conversations with our elderly and disabled.
  • The study did show that Medicaid recipients were substantially less likely to experience depression, which can be as debilitating as any physical impairment.
  • That lower incidence of depression might be related to the finding that Medicaid recipients experience far less financial stress.

Expanding Medicaid is undoubtedly a cost to society. But this study does nothing to undermine the basic assertion that Medicaid makes a real and positive difference in people’s lives.

Preparing For The Worst

 Health Care, Wonkery  No Responses »
Apr 172013
 

In what may be a sign of things to come, Senator Max Baucus delivered a stern warning to Health and Human Services Secretary Sebelius for not doing enough to educate people about what the Affordable Care Act means for them. He has a legitimate point; the feds need to step up their public relations efforts soon if they hope to get people enrolled in health coverage beginning in the fall. But Baucus should be more concerned about the implementation of the federal exchange that will be serving over thirty states. The success of health care reform hinges upon the work of anonymous programmers and web designers who must construct a website that is stable and functional on a massive scale from day one. Getting the word out is important, but it won’t matter much if the exchange website is overwhelmed or difficult to use.

The feds are certainly capable of pulling this off, but I wonder if elected officials really understand how much technical wizardry is necessary to make health care reform a reality. And I wonder how many other Democrats will start predicting failure as a means of political damage control.

A Few Thoughts On Disability Benefits

 Disability, Wonkery  2 Responses »
Mar 292013
 

NPR is receiving significant flak for its recent series of reports entitled “Unfit for Work”, which looks at the increasing enrollment in the federal Social Security disability program. Disability advocates accuse NPR of generalizing about beneficiaries based on anecdotal stories of individuals who happen to live in economically depressed areas and have little education. They also point out that disability programs provide vital support to millions of people who would otherwise be forced to live in abject poverty.

These are fair criticisms, but both NPR and advocates fail to address some key points about disability benefits:

  • The Health Care Angle: Disability benefits provide cash assistance, but they also provide much-needed access to Medicare and Medicaid. For people struggling with physical and mental health issues and no access to health insurance, this is a lifeline. They can receive treatment for their conditions and, in many cases, their health stabilizes or even improves. While Obamacare will improve access to health insurance, it does not require private plans to cover many of the specialized services that people with disabilities need. And those medical benefits disappear if disability benefits end. Which brings me to my next point…
  • It’s A Trap!: Disability benefits are not designed to end. If an individual earns more than a few hundred dollars per month, they lose eligibility for both cash and health care benefits. This leaves beneficiaries in quandary. They can abstain from working and receive sufficient benefits to address their basic needs. Or they can attempt to work and risk losing the supports that have provided some semblance of stability in their lives. For most people, it’s not much of a choice
  • Some Things Never Change: Disability and employment are still viewed as mutually exclusive concepts by policymakers, bureaucrats, and ordinary people. Rather than regarding disability as a continuum where individuals might require varying levels of support, our laws treat disability in binary terms. Either you are disabled and you can look forward to a lifetime of subsidized poverty. Or you aren’t disabled and you’re on your own when it comes to finding health care and any other supports you might need. Advocates become understandably defensive when disability benefits are questioned, but we shouldn’t be hesitant to question the assumptions and prejudices that inform our policies. The world is changing. Disability benefits were designed at a time when we were still an industrial nation, but that isn’t true anymore. We can still provide economic security for people with disabilities while giving them the opportunity to explore the possibilities of work.

 

Required Reading

 Health Care, Wonkery  No Responses »
Mar 042013
 

Steven Brill’s longform piece in Time on the high cost of health care is getting a lot of attention from policy wonks. I know what you’re thinking. Time? Isn’t this the same magazine that runs cover stories on pressing topics like Jesus’ favorite snack foods? Someone in the magazine’s upper echelons must still care about old-fashioned investigative journalism because the piece itself is quite good. It begins by looking at the exorbitant medical bills incurred by people with little or no insurance. In Brill’s quest to understand why people with the least amount of coverage are forced to pay the most outrageous prices for care, he examines the major players in the health care ecosystem: the non-profit hospitals that really aren’t non-profit, the medical device and pharmaceutical companies that can generate huge profit margins by charging whatever they like for their products, and a federal government that is legally prevented from negotiating prices that could make health care far less costly.

None of this is exactly news to those of us in health care policy circles, but the article is excellent at illustrating just how dysfunctional the health care marketplace has become. It also reminds us that the process of reforming our health care system didn’t end with the passage of the Affordable Care Act.

Evolving On Medicaid

 Health Care, Wonkery  No Responses »
Feb 212013
 

Republican resistance to the Medicaid expansion in Obamacare continues to crumble. Florida governor and Tea Party mascot Rick Scott announced yesterday that he will accept federal funding for a Medicaid expansion, joining a growing list of GOP governors who have developed amnesia about their previous fierce resistance to the health care law. Other states (I’m looking at you, Wisconsin) continue to hold out, but I’m guessing they’ll come around eventually–assuming they remain in office. Now, if only this epidemic of conservative sanity could spread to Congress.

Head Start

 Wonkery  No Responses »
Feb 132013
 

Count me among the fans of Obama’s State of the Union proposal to provide universal pre-K education, and not just for the usual wonkish reasons. My parents enrolled me in a pre-K program and, even though I was a white kid with middle-class educated parents, it made a huge difference in my life. From an early age, I learned to love school, to pay attention to my teachers, and (most importantly) to read. I may have been fine without this preparation, but I’m not sure I would have had the same success as an adult.

Incidentally, This American Life did an excellent report on the benefits of teaching “soft skills” to young children.

Making Obamacare User-Friendly

 Health Care, Wonkery  No Responses »
Jan 302013
 

Sarah Kliff writes about the challenges of  creating a health insurance exchange that is easy to use and that doesn’t overwhelm consumers with information. I’m not closely involved in the design of Minnesota’s exchange, but I’ve sat in enough design sessions to understand that this will be an iterative process. No state exchange (or the federal exchange, for that matter) will be perfect on day one. It will take time for officials to get the kinks out and optimize how information is presented. Unflattering news reports about how State X bungled its exchange implementation are a near-certainty in the coming months, but they shouldn’t be interpreted as the Fall of Obamacare. This is complicated stuff and complicated stuff takes time to get right.

The most important function of these exchanges is to ensure that people can get timely access to affordable health insurance. As long as that happens, states should have the breathing room they need to make necessary improvements.

Tinfoil Hats And Disability

 Disability, Wonkery  1 Response »
Nov 302012
 

Ken Blackwell joins other conservatives opposing ratification of the U.N. Convention on the Rights of Persons with Disabilities. Because freedom! Or something. Blackwell doesn’t give any substantive explanation for opposing the treaty. Instead, he just natters on about sovereignty and abortion. The only thing missing from his diatribe is mention of black helicopters. Meanwhile, former presidential candidate Rick Santorum calls the Convention an assault on families of children with disabilities.

I get that this opposition has little to do with people with disabilities and everything to do with right-wing paranoia, but it’s still disappointing. The Convention won’t end discrimination against people with disabilities anytime soon, but it’s the most significant declaration of disability rights to come from the international community. For the United States to refuse to ratify the treaty is an insult to every American who has advocated for those rights both here at home and around the world.

I’m hopeful that a more progressive Senate will ratify the treaty next year. Santorum and Blackwell are welcome to retreat to their underground bunkers for as long as they like.

Evangelizing Obamacare

 Health Care, Wonkery  No Responses »
Nov 212012
 

If health care reform is to be a success, the Obama administration must find a way to educate people about how the law affects them. As Sarah Kliff notes in another typically smart article, those who stand to benefit most from the Affordable Care Act have no idea how the law affects them. They don’t know that they may be eligible for insurance subsidies or Medicaid. They don’t know that they will be able to purchase insurance even if they have preexisting conditions.

A massive public education effort will be needed to spread the word about the law’s benefits before open enrollment begins in the exchanges next October. The administration has a clear interest in ensuring a successful kickoff, but so does another critical stakeholder group—the insurance companies. They need lots of people to enroll in their plans to cover the costs of covering people with more chronic health care conditions. That gives me some confidence that we’ll see a coordinated and effective public outreach campaign. The last thing the administration wants to see at this time next year is news headlines proclaiming the lack of interest in Obamacare.

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