The Top Health Policy Stories of 2013

It has been a busy health policy year.  Here are my choices for the top health policy stories.  They all may not have made big headlines, but all will reverberate for some time. 

The Slowing of Healthcare Inflation

This was on my watch list coming into this year, and I’ll lead with it today because it was the best health policy news of the year.  When healthcare inflation came in low this year, it did all sorts of good things.  It helped balance state budgets, extended the life of the Medicare Trust Fund, and dropped the price tag of the Affordable Care Act.  Inflation is supposed to jump up this year as millions more become insured, but we can at least hope that a more modest trendline continues.

Mental Health Parity

And for some more good news… It took five years and incessant lobbying from heroes like Patrick Kennedy, but the final rule implementing the Mental Health Parity Act of 2008 was finally released this year, coinciding roughly with the 50^th anniversary of President Kennedy’s signing of the Community Mental Health Centers Act of 1963.  This isn’t the end of the fight for fairness and equity for people with mental illnesses. It is just a new beginning. One that will test a new generation of policy leaders. Let us hope – and pray – that these leaders will rise to the occasion and make policy with justice for all.

And now for the not-so-good news….

The Lack of Action in the Aftermath of Sandy Hook

Didn’t you just assume that policymakers would give us much stronger gun laws and much more robust mental health screening and services in the aftermath of the Sandy Hook massacre?  But for most, once the wailing quieted down, so did their commitment to act – just as it did after Tucson, Aurora, Blacksburg, and D.C.  It is a year later now.  What has really changed to prevent such a tragedy from happening again in the future?

The Death of Itzcoatl Ocampo

Itzcoatl Ocampo may not be a household name, but when he died last month in a jail cell while awaiting trial for murder, it was a depressing denouement to the story which probably demonstrated most effectively how our social welfare policies have failed.  Ocampo was accused of killing four homeless men two years ago.  I wrote about this in a column entitled California Screaming. But those victims’ lives had value – to their families and society. And Ocampo was a decorated veteran.  His death was reported to be a suicide; his mental health needs may have been neglected.  I’ve known policymakers who would argue that this was one person gone bad, and no one could have foreseen the outcome.  But they are wrong.  This story is way too familiar, and ties together the way we too often neglect homeless people with chronic mental illness, veterans, and veterans who are both homeless and chronically mentally ill.

Magic Johnson Speaks Out – Again – about AIDS

It was twenty-two years ago when Magic Johnson announced that he was infected with HIV.  At the time, most people saw HIV infection as a death sentence.  But as he and others lived on with the AIDS virus because of advances in pharmaceutical medicine, two things happened.  We grew to understand that people could live with HIV infection.  And we became more complacent about preventing it.  As Johnson and others point out year after year, a quarter million U.S. residents are infected and don’t even know it.

The Tragedy of Allen Daniel Hicks, Sr.

When Allen Daniel Hicks died of a stroke in 2012, he died of an often-silent chronic disease that attacks African American men more frequently than other men and women.  And we know this.  What made Mr. Hick’s death so tragic, and what made it a story in 2013, were the circumstances under which he died.  After suffering his stroke while driving his car in Florida, he was initially brought to jail, instead of a hospital, for resisting an officer – apparently while incapacitated. A settlement was announced this year, making news headlines in Tampa. But the whole story reminded us that race does matter, in the ways diseases attack us, and sometimes in the way we respond to them.

The Obamacare Rollout

If it hadn’t been for the government shutdown and Duck Dynasty, the problems with the Obamacare rollout might have been the only news story of the last three months of the year. In fact, this was such a pervasive story (and, I think, a political winner for the Republicans), that it probably even prevented another budget crisis from happening.  (I bet you didn’t even remember that Congress had originally scheduled one for this month.) Thank goodness for small favors, but with over a million people already insured because of Obamacare the real story of the rollout will not be written until next year.

And so in the meantime, in the words of St. Nick, Happy Christmas to all!

Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/

The Top Health Policy Stories of 2012

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 8^th 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.