2010 was the most significant year in health policy since the 1960s. It dominated the policy agenda for the first few months of the year, and it stayed in the news throughout the election season. As the year drew to a close, conflicting lower court decisions about the constitutionality of the individual mandate foreshadowed a continued policy debate into the foreseeable future.
What makes a health policy story big in a time of change? It’s not just the attention it commands in the media. It’s the impact it has on our lives.
This week and next, I’ll countdown ten. Using the impact criterion, there were actually some that weren’t part of health reform!
Here are my choices for numbers ten through six.
10. The Election of Senator Scott Brown. It is hard to remember that as we entered 2010, the Democrats seemed to be putting the finishing touches on a bill that could pick up 60 votes in the Senate. Lincoln, Lieberman, and Nelson were among the ones to whom everyone was paying attention. Then, Scott Brown was elected in Massachusetts, and everything changed. The Democrats lost control of the issue and public opinion. That one special election almost derailed the entire effort and ultimately changed the look of the final legislation.
9. The Change in Tax Treatment of Dependent Health Insurance. Until the IRS changed the rule in March, when you kept your child on your health insurance up to age 26, you paid taxes on the benefit. Had this not been changed, then the health reform provision allowing parents to keep adult children on their insurance would have been a mixed blessing at best. Many might have refused or been unable to do so when they factored what could have been hundreds of dollars of increased taxes.
8. The Death of the Public Option. Even though it had majority support in both chambers, Congress put the public option to rest early in the year when leaders realized that they could not muster the 60 votes necessary to overcome a Senate filibuster against it. Once it was gone, public sentiment tilted slightly against health reform. Reform-minded Democrats were upset with their Congressional leadership, and a portion of the Democratic base disappeared along with it. Proponents and opponents of reform seemed to agree on one thing – if a public option had been offered to people, many would have chosen it because it likely would have been less expensive than some or all of the private alternatives.
7. The Rebirth of the Public Option. No one called it this, but when the final health reform bill included an expansion of Medicaid reaching 17 million new people in 2014, including nearly every family with income under $30,000, the public option was alive again – at least for people at lower income levels. With Medicare also a public program, the only people left in the private insurance market were those under age 65 earning $30,000 and up. And the reform law provided for subsidies for most of them. We may not yet have the single payer system that progressives wanted, but we might still be headed in that direction.
Public options are not going anywhere soon. Mike Huckabee, who will likely be a significant early player in the Presidential campaign, favors repeal of the new law. This fall he argued for a further expansion of the Medicaid program as an alternative to the mandate that insurers cover people with pre-existing conditions. It’s pretty clear. In the light of the day and out of the heat of the moment, so long as public options are called something else, they often generate support across the ideological spectrum.
6. Mental Health Parity. Mental health parity this year was an under-the-radar policy story with sweeping consequences. New mental health parity provisions, enacted in 2008, finally became law in 2010. For the first time ever, mental illness must be given the same treatment in insurance as other chronic conditions.
It became harder than ever for public officials not to do this as increasing numbers of people with mental illness advocated for fairness, and as other chronic conditions, like diabetes and hypertension, became more common and more costly. Parity is a big deal, especially to the millions of people with serious mental illness, but when it happened at the beginning of the year it got little attention in media consumed by the fiery health reform debate.
Ironically, the mental health parity law also attracted little news attention when it was passed in late 2008. Why was this? It was tacked onto the first major financial bailout bill signed into law by former President Bush!
Next Wednesday, I’ll give you my top five health policy stories of the year.
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