The Top Health Policy Stories of 2011, Part Two

Last week, I shared four of the top policy stories of the year that told us something about how health policy has been trending over the past decade or more.  This week, I’m offering four more to close out the year that tell us a little about where health policy is going in the future.

4.  Connecticut Employees Choose Health.  Back in the early days of managed care, when HMOs were not yet a four-letter word and they emphasized wellness as much as health care cost containment, they proved to be popular with members.  In August, the State of Connecticut revived the concept, giving its employees the choice of a lower cost health insurance plan that emphasized wellness or their traditional comprehensive plan.  It expected 50% to choose the new wellness plan.  But the state got a big surprise.  When the dust settled in October, 97% had opted for the wellness plan.  This will cost the state much more in the first year, but will also produce more than the $100 million in health care cost savings the state originally projected for the future.

The implication for future policy – people want do more for their health, and will if they see a direct financial benefit.

3. The Florida Legislature Puts the NRA In Charge of Medicine.  During its 2011 legislative session, the Florida legislature attracted some national attention when it decided to include the National Rifle Association (NRA) in the doctor/patient relationship.  The NRA asked the legislature to prohibit pediatricians from even asking parents if there were firearms in the house so they could counsel them about firearm safety – despite well-known evidence that children are more likely to die from unintentional injury than any other cause.  The bill passed, and the pediatricians were eventually forced to go to court to stall its enforcement.  With big lobbying organizations being allowed to sit in the doctor’s office with us, is it any wonder that people wonder whose side government is on?  

The implication for future policy – Patient privacy protections will erode if “smaller government” cedes more power to private entities.

2.  The Attack on Public Health.  After the loss of almost 30,000 public health jobs nationwide between 2008 and 2010, the Association of State and Territorial Health Officials (ASTHO) headlined an April press releasewith the words “Cuts to Essential Public Health Services Jeopardize Americans’ Health.”  The proof came in an article published in Health Affairs in August, which showed that a 10% change in public health funding changed infant death rates, as well as death rates from cancer, diabetes, and heart disease. 

The implication for future – we and our children will be less healthy tomorrow because of the cuts our policy leaders have made today.

1. The Implementation of the Affordable Care Act.  The implementation of the Affordable Care Act (ACA) was once again the health story of the year.  The public is still divided.  A plurality supports it, but the combined numbers of those opposing it either because they believe it did too little or too much comprise the majority.  Meanwhile, the law has begun to affect significant numbers of Americans.  For example, in September, CMS announced that 1.3 million Medicare recipients had received drug discounts averaging over $500 per person, and another 1.3 million had gotten a free wellness visit as a result of ACA.  And this month, the National Center for Health Statistics reported that 2.5 million young adults had insurance because of ACA provisions enabling them to stay on parents’ policies.    The election campaign and the expected May or June Supreme Court ruling on its constitutionality guarantee that this will be the story of 2012, too.

The implication for the future – government’s role in determining our health care future is going to grow, not diminish.  Policymakers will continue to struggle with our expanding $2.5 trillion health care economy and the public will continue to try to figure out whose side they’re on.

In early December, Our Health Policy Matters was averaging over 2,500 readers per month, and had recorded its 20,000^th reader – not too bad for the first year of a once-a-week column focused entirely on health and mental health policy.  I appreciate you all, especially those of you who printed and shared columns with your friends, used them with your students, and offered them to readers of your own electronic journals and web sites.

I’m always interested in your ideas about how to improve the column, and how to get it in front of more people.  Please let me know (gionfriddopaul@gmail.com) if you have any suggestions for me. 

And thank you all for engaging in the health policy debate, and my best wishes for a happy, healthy, and prosperous 2012!