If the bailout bill is depressing you, at least your health insurance will now cover the therapy.
In a rather convoluted (even by Congressional standards) procedure, the financial bailout given final approval by the House today was technically rolled into legislation that will require insurers to put mental illness on the same footing as any other health condition.
The Paul Wellstone-Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, sought by mental health advocates for more than a decade, would require insurance companies to have the same fees and co-pays for mental illness as for other diseases, give the same access to prescription drugs, and have the same annual and lifetime caps and limits. (It does not mandate that a health plan cover mental illness, but for those group health plans of 51 or more employees that cover mental illness—and most large health plans do—must treat it the same as other illnesses). President Bush has said he would sign it into law.
People who don't get their health insurance at work and have to buy it in the individual market often pay higher prices for fewer benefits, with fewer consumer protections. Some health reform proposals would expand the individual market—without bolstering the protections or making it work more fairly and efficiently. The National Women's Law Center took a look at the problems women, in particular, faced in the individual market. It's a long list. Here are some highlights from the center's report, "Nowhere to Turn: How the Individual Health Insurance Market Fails Women."
- Health insurers can reject women applicants for reasons often unique to women. For example, in nine states and the District of Columbia insurers can legally reject survivors of domestic violence. Some insurers also refuse to sell policies to women who have had a cesarean section.
Back in March we told you about the preview of Critical Condition, a documentary that shows that for the uninsured, health care is too little, too late. It's airing on PBS this Saturday night, and it's also being shown at town meetings and forums across the country. Wonder what the patients profiled here—at least the ones that are still alive— would think about conservative health activist John Goodman's recent comments that we don't really have uninsured people because our emergency rooms solve their problems....
We see a lot of gloom and doom out there about how the Wall Street bailout won't leave any money left over for health reform (or anything else for that matter). We have often pointed out that the question shouldn't be whether we can afford health reform, but whether we can afford NOT to do health reform given its impact on federal and state budgets, the manufacturing sector's ability to compete globally, and ordinary people's pocketbooks up and down "Main Street" (to use the term of choice this week).
Jane Sarasohn-Kahn over at Health Populi makes similar arguments. Each one percent increase in unemployment, means one million more uninsured (and another million on Medicaid and SCHIP). State tax revenue is falling, while medical bills are growing. ERs are swamped. Ordinary people are delaying care—even necessary care. You can read her full post but her bottom line for health reform: "The lesson from financial markets is not to put off to 2012 what we can and should do in 2008."(We think she means 2009 but you get the point.)
National security is the theme of the first presidential debate this week, but don't worry, health care will get its turn. To get citizen input, the Commission on Presidential Debates has partnered with WebMD to encourage people to submit questions for the second debate, a town hall format to be moderated by NBC's Tom Brokaw.
WebMD says it gets more than 48 million visitors a month, and it has put up brief summaries of the candidates positions (so brief that voters may not understand all the implications). The web site's top topics often seem to be about sex and reproduction (although we do see that Earwax is in today's top 10), but people have taken up the chance to question the candidate... or mouth off about the candidates.
Several themes emerge.
First, it struck us how many of the questioners are disabled, struggling with both health care costs as well as with the Social Security and/or Medicaid bureaucracies.
Second, cost was the dominant theme. People wanted to know how the candidates would make health insurance and prescription medicines more affordable—and wanted specifics, particularly from Obama, on how new health reform initiatives would be financed.
In drafting ballot initiatives, sponsors often face a choice. They can give their measure a better chance of winning by making it vague. A specific provision is easier to attack. But vague provisions often provoke legal challenges that block successful initiatives from taking effect. Such may be the case with Arizona's Prop 101, the ballot initiative designed to prevent the sort of health care reforms passed in Massachusetts and pursued in California. (Speciifically, the initiative bans the state from requiring people to get health care coverage, and would seem to bar a single-payer system). In this Arizona Republic story on the measure, critics suggest the initiative is so ambiguous that its real meaning might be decided in the courts.
And now the head of the state's indigent care system suggests the initiative, if passed, would force his department to close.
Old McDonald had a farm and on that farm he had health insurance purchased from the non-group market. With a higher premium here and more out-of-pocket spending for care there, he ended up paying twice as a much as those who received their health insurance through employment elsewhere ($11,200 to $5,600). E-I-E-I-Ouch.
Ok so we're mixing our musical metaphors. But for many of the two million plus family farms which account for 85 percent of the U.S. agricultural production, this is more than just a troubling tune. It's a harsh reality, made clear in the latest issue brief on rural health care and financial hardship from RWJF's Access Project.
Here are some of the take home points from the issue brief based on data from the 2007 Health Insurance Survey of Farm and Ranch Operators:
Elizabeth Edwards re-emerged yesterday with a strong plea to not let Americans' concern about their health care get buried in the avalanche of other grim economic news. "I'm more discouraged than I was before," she said.
Edwards, who had been low-profile for obvious reasons for the past month, spoke about health care at the Constitution Center in Philadelphia. Her message was 1) we can't ignore the crisis 2) John McCain would worsen the crisis and 3) she still wishes Barack Obama had included a health insurance mandate but his plan still moves the country well ahead.
Her talk got a fair amount of news coverage but we were pretty surprised at a two-minute CBS piece (below) which devoted half the time to rehashing the John Edwards affair scandal, and played up Elizabeth Edwards' primary season policy differences with Obama, and didn't report anything on her views of McCain's health care.
An analysis of John McCain's health policy on the website of the journal Health Affairs concludes that it will cover few of the uninsured in the short run—perhaps a net gain of a million or so—and expand the overall number of uninsured Americans in the long run. And those who do have insurance, the authors conclude, can expect to pay more for less.
McCain would convert the current employer tax exclusion into a fixed dollar tax credit—$2,500 for an individual, $5,000 for a family, and it would not be inflation-adjusted. This means consumers would pay taxes on health benefits they get on the job, which are currently tax-free. They could use the credit to purchase insurance in the individual market, which the authors of the Health Affairs article described as "relatively unregulated" with higher administrative costs and fewer consumer protections. (We'd note that there are other bipartisan proponents of reducing or eliminating the tax break on employer-sponsored health insurance, which is regressive, but they want to use the money to cover the uninsured in a regulated insurance market with consumer protections.)
We asked Leif Wellington Haase, director of New America's California Program, and Micah Weinberg, a research fellow in the California program, to update us on where health reform stands in California a few months after the state's major coverage initiative collapsed.