Health and mental health policy stories dominated 2012. From how the Affordable Care Act framed the health policy debate at the start of the year to how the Sandy Hook tragedy framed the mental health and public health debate at year’s end, 2012 will go down in history as the most significant year in health policy since the 1960s.
Here are summaries of a few of the biggest news stories.
The Supreme Court Decision on the Affordable Care Act. Nothing quite compares to the drama of the day in June when the Supreme Court ruled the Affordable Care Act to be constitutional. Few people guessed right in advance that the decision would come down to finding the “individual mandate” to be constitutional because it is a tax, but mandatory Medicaid expansion unconstitutional because it tied future federal funding for the existing state Medicaid programs to the Medicaid expansion.
People on both sides of the debate came away wanting more, and states reluctant to accept the decision waited months to see if the fall election would change the policy environment. It didn’t. So as the year drew to a close was whether they, or the federal government, would implement the insurance exchanges.
The Debate over the Future of Medicare. In the campaign, we all learned more about the two major parties’ competing visions about the future of Medicare. The Democrats want the current structure of the program preserved; the Republicans would like to make the current Medicare program just one option available to seniors among a variety of private health insurance plan choices.
When the dust settled, the Democratic vision had carried the day. Nevertheless, Mitt Romney’s supporters argued afterwards that he actually “won” the Medicare debate when he took a majority of the vote of senior citizens. But even that “victory” may have resulted from the fact that he opposed the $716 billion cut.
Meanwhile, a little compromise is all we really need to preserve Medicare – but not the increase in the age of eligibility policymakers have recently pushed.
The Medicaid Expansion. The governors of seven southern states declared in the summer that with Medicaid expansion now an option, they weren’t planning to implement it. They cited the significant cost of doing so. Florida, for example, said it would cost $351 million a year, and Texas trumped that with a $4.4 billion price tag.
But by the end of the year those states were faced with the fact that it will be at least 9 times more expensive not to expand the program. Not embracing the expansion would cost Florida at least $3.2 billion and Texas $39.6 billion in annual lost federal revenue.
That’s a lot of money to turn down – especially when the alternative is asking state taxpayers to foot the bill.
The Cuts to State Mental Health Services. As of 2012, the tally of state budget cuts to mental health services grew to $4.6 billion over the past four years, with no end of cutting in sight. I wrote about the real-time effects of these cuts in Anna Brown’s Death, California Screaming, the Mental Health Policy Mistakes We Make and the Sons and Daughters Who Pay for Them, and, focusing on veterans, in Iraq and Back and Answering the Call.
There’s a depressing bottom line to all these stories: people with mental illness got lip service or worse.
Athletes – and Others – Dying Young. When Pro Football all-star Junior Seau died in the spring, it revived talk of the Curse of the 1994 San Diego Chargers. He was the 8th member of that team to die before turning 45. Were these deaths the cumulative effect of concussions? Or related to long-term side effects of performance-enhancing drugs that ruined the legacy of Lance Armstrong and a host of steroid-era baseball superstars, like Mark McGuire, Barry Bonds, Sammy Sosa, and Roger Clemens?
Not exactly. At least in the case of the ’94 Chargers, former professional athletes weren’t dying young from concussions or performance-enhancing drugs, but for many of the same reasons – accidents, obesity, heart conditions, and complications from diabetes – non-athletes die young, too. It’s avoidable, but not when we cut $5 billion from public health as we did this year.
Sandy Hook. We need to say it again. Violence is a public health problem, not a mental health problem. If we learn nothing else from tragedy, I hope it will be these three things: anyone of us could be a victim of violence; we can prevent much of it by treating it as a public health problem; and blaming people with mental illness for the increase in violence in America will only lead us down a dark path.
I wish you all a safe, peaceful, and Happy New Year.
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