Uninsured

Here in Sacramento County, CA, mental health patients are overwhelming hospital emergency departments, seeking treatment for various psychiatric disorders that the ER staff is not well equipped to provide. A reduction in mental health spending over the past few years forced the county to close its mental health crisis stabilization unit, a primary resource for poor and uninsured mental health patients.

In case you missed the news coverage of this week's D.C. C.A.R.E. free clinic (our story here), we wanted to draw your attention to this excellent segment from ABC 7's Washington affiliate WJLA:

Yesterday, the National Association of Free Clinics put on the seventh of a national series of massive free clinics, this time choosing D.C.’s Walter E. Washington convention center for the deployment of their hospital-in-a-box.  Being a burgeoning health-wonk, and wanting to put a face on the frequently abstract issue of the “uninsured,” I ventured out of the confines of the think tank and volunteered as a “patient-escort” at the clinic.

I’ve heard Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, speak several times, but until this week, I never had a chance to just sit down in her office and ask what’s on her mind. The agency is probably best known for its outcomes and effectiveness research (the AHRQ division she led before becoming director in 2003). For instance it just did a study on rotator cuff treatment, and AHRQ is doing a series of consumer guides to diseases like breast or prostate cancer, which present patients with complex treatment choices. But I was less interested in specifics of this treatment or that treatment, than in how the agency’s work -- Research and QUALITY -- fits into health care in an era of reform.

Clancy is particularly interested in how to make medicine serve the patient -- patient-centered research. Here are some of the thoughts she shared.

The moment health reform passed, the countdown to implementation started. Next up is the launch of state-based high risk pools, where Americans with pre-existing conditions can get coverage. Starting today (a little over the 90 days required by law, but still an achievement that reflects round-the-clock efforts at HHS and hard work in the states), people who have been denied coverage for more than six months can enroll. The pools, now called “Pre-Existing Condition Insurance Plans” will provide coverage starting Aug. 1 and will end when the  health insurance exchanges open in 2014. 

"For too long, Americans with pre-existing conditions have been locked out of our health insurance market," HHS Secretary Kathleen Sebelius said in a statement today. "The Pre-Existing Condition Insurance Plan gives them a new option... This program will provide people the help they need as the nation transitions to a more competitive and fair market place in 2014."

A new Kaiser tracking poll shows growing public support for the health reform law. It follows on the heels of a Gallup poll last week also suggesting that reform’s support now outweighs its opposition.

A map of states that have decided to run the new high risk pools versus the states that have declined falls along fairly predictable red-blue lines. With some exceptions, Democratic governors are embracing the opportunity created by the Obama administration and a Democratic Congress and Republican governors are saying no thanks, Washington, you do it (even though high risk pools are historically quite popular with Republicans).  There are a couple of surprises. Alaska is joining most Democratic states in agreeing, while Delaware (probably for size not ideology reasons) is opting out. Purplish states are in both categories. (Here's the HHS list, although it’s a few weeks old.)

How much does that tell us about what course these states will choose as it comes time to start developing their insurance exchanges, which need to be up and running by Jan 1, 2014?

According to a new report by the Commonwealth Fund, young adults are going to win under the new health reform law. Nearly all of the 13.7 million uninsured young adults will get insurance coverage over the coming years, largely from significant Medicaid expansions, the provision that allows young adults to stay on their parents' insurance until the age of 26 and from the new exchanges and federal subsidies launching in 2014.

Starting in 2014, everyone earning a certain salary must carry health insurance. The Congressional Budget Office maintains that the "compliance of young adults will be particularly important in terms of creating broad and diverse risk pools in the exchanges and individual markets" and estimates that "the influx of young and health people into the exchanges and individual markets will lower premiums by 7 percent to 10 percent."

As our deputy director (and in-house “recovering litigator”) Julie Barnes jokes, the Patient Protection and Affordable Care Act could be called the “jobs bill for lawyers.” New insurance regulations? Fraud and abuse? Payment reform? Medicare? Medicaid? New contractual and business relationships for hospitals and other providers? You got it. If you're a health lawyer, business will come knocking at your door.

The American Health Lawyers Association hosted a program on reform this week, inviting lawyers from all over the country to learn and review the nuts and bolts of the new law. Julie's presentation kicked off the program Tuesday morning, reminding the sold-out crowd why comprehensive reform was so important. Failing to cover everyone is a national embarrassment, for one. Skyrocketing healthcare costs, two. No longer can we afford the status quo -- not the federal or state governments, not consumers, not employers, not insurers, not pharmaceutical companies and not the provider community. Julie's panel addressed commercial insurance, explaining that the goals of reform included making health insurance coverage affordable, creating minimum coverage standards and making insurance markets work better for all Americans. Panelists described how the new law seeks to achieve these lofty objectives.

There were moments during the long national debate on health health reform when California Gov. Arnold Schwarzenegger was critical of the legislation being considered in Washington. That has now changed, and it's a politically significant shift.

The Republican governor of the largest state in the Union came out forcefully yesterday in favor of marshaling all state resources to quickly and effectively implement federal reform, starting with the high risk pool next month. He promised to call a special session of the legislature if necessary to pass enabling legislation as the state and the country move ahead with health reform implementation.

For those of us in attendance, it was 2007 all over again: here was the governor talking about his positive experience with universal health care in Austria and making a compelling case that health care reform is neither a Democratic or a Republican issue.  "I am a public servant, not a party servant," he said, when asked whether his decision not to join some fellow Republican governors in filing lawsuits to block national reform could drive a wedge between him and the rest of the Republican party.