Report Card: Tobacco & Teens

By Meg Reid, Undergraduate Research Fellow, April 5, 2012 at 7:30 am

Minnesota recently got its report card back, and it doesn’t look good. We’re doing well in Smokefree Air (we got an A!) but received a D in Cessation. Worst of all, we’re failing Tobacco Prevention, Control, and Spending. That’s right – a big, red F.

At the same time, we’re losing ground in the campaign against adolescent smoking. A wave of energy for prevention and cessation programs after a 1994 Surgeon General report about smoking in teens resulted in significant declines in tobacco use, but this trend has stagnated since 2007. A new Surgeon General report, released earlier this month, highlights the importance of continued commitment to this cause. Rates of tobacco use, which were falling steadily, have been slowing their decline. Some demographics have seen increased use – for example, cigar smoking among African-American high school females. Many states, including Minnesota, have been slashing budgets for prevention and cessation programs – and losing teens we might have reached with continued support for anti-tobacco programming.

Let’s look at the numbers for Minnesota:

We know that for people who start using tobacco before the age of 18, smoking stunts lung growth, causes lung function to decline more quickly, and damages blood vessels, thus increasing the risk of heart attacks and strokes. Young people can become dependent on nicotine more quickly than adults. For every person who dies because of smoking, two “replacements” will start smoking – and 90 percent of these will have first tried tobacco before the age of 18.

Clearly, we need to step up our game. Right now, Minnesota spends only 33.4 percent of the CDC-recommended level on tobacco prevention. The Campaign for Tobacco-Free Kids advises that states need educational and media campaigns, community & school-based programs, meaningful law enforcement to stop minors from buying cigarettes, assistance for cessation programs, and strong evaluation systems in order to sustain what used to be significant downward trends in teen tobacco use.

There’s no extra credit possible here, so we need to buckle down in order to improve our grades. Instead of slashing budgets, let’s invest in tobacco prevention for the health of all Minnesota’s teens.

Posted in Health Care | Related Topics: Children's Health  Preventative Care  Public Health 

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The Best Health Care?

By Jim Weygand, Hindsight Community Fellow, April 4, 2012 at 1:30 pm

During the recent Supreme Court Hearings, I heard one member of Minnesota’s Congressional delegation comment about her concerns that the Affordable Care Act would damage the world’s best health care system. This is not the first time that I have heard that the US has the best health care in the world, and that Obamacare will ruin it. Do we have the best health care in the world? Certainly if you are wealthy, a member of Congress, or have an employer that provides top-of-the-line medical insurance, it may be the best in the world. Unfortunately, many of us do not fit into those categories. Then it is not the best. Instead of listening to conservative rhetoric let's look at the facts.

One measure of our health care would be Life Expectancy (LE). Searching the web I found the CIA (yes that CIA) World Factbook. For life expectancy they show the US in 2012 at number 50 with a life expectancy of 78.5 years. In the top ranked country, Monaco, you could expect to live eleven years longer. Monaco might be an exception, but the table below lists life expectancy and infant mortality for several countries we are more familiar with.

There are many factors besides health care that affect life expectancy. Another measurement of our medical care is infant mortality. We are ranked 49th on infant mortality, just behind the Faroe Islands and ahead of Croatia. Our infant morality is 6.0 deaths of infants (under age of one) per 1000 live births in the same year. The number one nation again is Monaco with an infant mortality of 1.8. Japan ranked number two with 2.2 infant deaths per 1000 births has 3.8 less deaths per 1000 births than the US.

 

Country Rank L.E Life Expectancy Rank I. M. Infant Mortal.
Canada 12 81.5 41 4.9
France 14 81.5 11 3.4
Netherlands 21 80.9 19 3.7
Germany 28 80.2 15 3.5
Portugal 49 78.7 36 4.6
United States 50 78.5 49 6.0
Taiwan 51 78.5 44 5.1

It is hard to talk about the US having the best health care based on these results. For the developed world our health care is poor. But, there is one category we are a world leader and that is cost. In fact, according to Infoplease, the per capita health costs in 2007  for the US was over $6,000—almost twice that of the next highest. The summary is that we get poor results compared to the rest of the developed world, and it costs us a lot more.

I do not have a solution for our health care issues, but I can say the current system is not working and we need to make changes. The Affordable Care Act may not solve all the problems, but it seems to be a step in the right direction. Maybe if our politicians were more interested in our health than winning political power, we could have the best.

Posted in Health Care | Related Topics: Health Care Reform  Medical Care 

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Happy Public Health Recognition Week!

By Meg Reid, Undergraduate Research Fellow, April 3, 2012 at 1:00 pm

Governor Dayton has designated this week (April 2-8) Public Health Recognition Week, in honor of Minnesota’s commitment to protecting its citizens with public health initiatives. I’d like to take this a step further: even as we recognize the accomplishments of Minnesota’s stellar public health system, we should reaffirm our support for a strong public health infrastructure.

Public health is an essential yet often overlooked government service, because the benefits of public health spending are often invisible. Public health initiatives like clean water and sanitation, safe food and drugs, vaccination campaigns, environmental health inspections, and infectious disease control were incredibly important in increasing Americans’ life expectancy over the 20th century—25 of the 30 years of life gained are attributable to public health interventions. A study published last year in Health Affairs found that public health spending is effective in preventing mortality; for example, every 10% increase in public health spending means a 6.85% reduction in infant mortality and a 3.22% decline in deaths due to heart disease.

Such programs are preventative, averting disease and saving lives before people can get sick, so public health goes unrecognized. Funding can get put on the back burner—this is precisely the reason that we should remember the importance of such funding this week.

The Affordable Care Act created the $15 billion Prevention and Public Health Fund, intending to shift the focus of health care to prevention and wellness. The Fund is the first comprehensive public health strategy with dedicated funding in federal law. So far, the money has reinforced public health programs facing budget cuts, supported efforts to increase the number of primary care health professionals, and provided funding for efforts aimed at tobacco prevention and physical fitness. But the Fund is consistently challenged. Earlier this year, the federal government cut the fund to $10 billion in order to pay for other programs. And congressional conservatives continue to attack the fund for being unnecessary or wasteful.

As Dayton says in his official Proclamation (pdf), Minnesota is a role model for promoting its citizens’ health. Health care in this state is widely known to be innovative and effective. Minnesota can continue to be a role model by continuing our commitment to public health.

Posted in Health Care | Related Topics: Governor Dayton  Public Health 

Exchange Interchange

By Meg Reid, Undergraduate Research Fellow, April 2, 2012 at 10:30 am

I was excited to attend the Minnesota Health Care Reform Town Hall at the University of Minnesota’s Center for the Study of Politics and Governance a few weeks ago, because I wanted to get a closer look at how our legislature is moving along on health care reform. The panel featured legislators from both sides of the aisle that are highly engaged in this year’s important discussions about reform.

I was impressed by how knowledgeable each legislator was about health care policy and reform. The discussion was nuanced and informed, and it gave me hope. Even though making progress on health care legislation will be difficult, there is real potential for innovative, Minnesota-appropriate solutions that have bipartisan support.

I was disappointed, however, in conservative members’ continued refusal to move forward on a health insurance exchange, which would create a central marketplace where consumers could compare insurance rates.

Conservatives continue to assert that Minnesotans do not want a health care exchange. But a December Kaiser Family Foundation poll found that exchanges are very popular—79 percent of the general population supports the implementation of an exchange, and even 62 percent of Republicans support it.

If the year passes without the adoption of an exchange bill, the federal government will begin making plans to implement a federal version of the exchange in Minnesota. This is why conservatives should be contributing to the discussion on health insurance exchanges—we can either create an innovative solution that fits Minnesota, or we can let the federal government create the exchange for us.

But instead of working towards an exchange, conservative representatives would rather implement a different program and then ask the federal government why this program isn’t good enough. Does that seem like a good solution when we have the chance to create an exchange that Minnesotans want?

The entire legislature—both sides of the aisle—should be joining in on the health care exchange discussion. That’s what Republican Senators Abeler, Davids, and Hoppe did by supporting the Minnesota exchange bill. Let’s let our representatives know that we want a fair chance at a Minnesota insurance exchange.

Posted in Health Care | Related Topics: Health Insurance  Health Care Reform  Minnesota Legislature 

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What’s an “Exchange,” Anyway?

By Meg Reid, Undergraduate Research Fellow, March 29, 2012 at 10:30 am

The health insurance exchange is a central component of the reform bill, but it is easily overlooked in media coverage. This is because it’s more complicated than some of the simpler parts of the bill, like extending coverage to young people under their parents’ plans until the age of 26 or banning insurance companies from rejecting people based on pre-existing conditions. Opponents of health care reform don’t like to bring it up because – shh – the insurance exchange was originally a conservative idea. That’s why it’s a central part of “Romneycare” and is included in Senator Paul Ryan’s (R-Wisconsin) budget plan.

So what’s an insurance exchange anyway?

The reform bill calls for the creation of an online marketplace where small businesses and individuals who aren’t covered by their employers can buy private health insurance. The exchange model will help to control costs by pooling these consumers.

As a part of the exchange’s emphasis on consumer-friendly format, consumers would be able to easily compare prices and benefits across the board, creating competition between plans and making it easier for consumers to understand what they’re purchasing. Insurance plans will be organized into tiers that facilitate comparison of coverage levels.

Individuals could also be eligible for financial assistance to help with the cost of insurance, including credits that will go towards premium costs and subsidies to limit the out-of-pocket costs.

Minnesota will truly benefit from creating its own insurance exchange. The provision mandating the creation of an insurance exchange allows for many decisions to be made by the state. We could allow larger employers to buy insurance through the exchange. We can determine which types of plans qualify for inclusion in the exchange. We are even allowed the freedom to create our own public option. This flexibility means that we can tailor our exchange to reflect Minnesota’s commitment to high-quality, accessible health care.

The health insurance exchange is consumer-friendly, using market pressures to increase coverage and control costs. Remember – exchanges were originally a conservative solution to health care costs. So why would conservatives in the Minnesota legislature oppose the adoption of an insurance exchange? I’d guess that the reason is more political than ideological.

Posted in Health Care | Related Topics: Health Insurance  Health Care Reform 

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Graph of the Day: Obamacare Increases Preventive Care in MN

By Michael Diedrich, Policy Associate, March 28, 2012 at 7:30 am

So, we've established that Obamacare has been good for nearly 60,000 Minnesotan Medicare beneficiaries (to the tune of nearly $35 million). What about the rest of us?

Take a look:
[ graph: click title to view in browser ]
(Data from HHS)

This shows the number of Minnesotans estimated to be receiving expanded preventive care coverage under Obamacare. The total comes in at just over 1 million people, including over 280,000 children.

It shouldn't even need to be said, but these are savings that keep on saving. More preventive care means a quicker response to developing conditions, and that means that long-term savings on the costs of complications down the road. Not to mention, you know, healthier kids and adults.

What kinds of treatments are we talking about? Pediatrician visits, vision/hearing screening, immunizations, anti-obesity support, and more are on the list for kids. For women, covered preventive care options include pap smears, mammograms, colonoscopies, and other cancer screenings, not to mention vaccinations for HPV, meningitis, and pneumonia. Men benefit from similar options (with a couple substitutes based on what kind of cancer we're screening for).

Thanks to Obamacare, one out of every five Minnesotans has more access to this efficient care. Add up all the other states, and we've got 54 million people with better chances for healthier lives. That's roughly one out of every six people in the country.

I should also note here that all these numbers are for people under 64. As we've already seen, Obamacare has done other good things for those 65 and over. Obamacare is just plain good for people, and more people need to know this.

Despite the fears conservatives monger about “death panels” or the creep of socialism into medicine, people deserve the truth. Our duty as progressives is to spread it.

Posted in Health Care | Related Topics: Health Care Reform  Preventative Care 

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What’s So Funny ‘Bout Peace, Love and Affordable Healthcare?

By John Van Hecke, Executive Director & Fellow, March 27, 2012 at 7:30 am

The Federal Patient Protection and Affordable Care Act is working. It’s been working for the past two years. It will continue working into the future, bringing affordable healthcare to Minnesotans and Americans. But, listening to conservative voices, you’d never know it.

ACA’s core idea—health care insurance exchanges facilitating coverage—was championed by the conservative policymakers that now bitterly oppose it. Conservative candidates for public office can’t seem to exhale without vigorously condemning healthcare reform in the same breath. Minnesota’s conservative legislative body majorities have tried to prevent Governor Dayton from setting up Minnesota’s healthcare exchange, ACA’s operational centerpiece.

The health care exchange creates a public clearing house for private insurance companies to compete for customers. It’s a model used in some European countries, notably Germany. ACA creates a sliding public subsidy scale, aiding low income people in purchasing healthcare insurance. The program will expand the number of Minnesotans covered by health insurance.

Over the past decade, the percentage of health insured Minnesotans has steadily declined. Compared to other states, Minnesota ranks near the top for percentage of health-insured population. That’s substantially due to Minnesota Care, Minnesota’s sliding-scale health insurance program. Conservative state policymakers have been trying to eliminate or reduce access to this project, using the recession’s public revenue strain to cover their efforts.

ACA isn’t an extension of Minnesota’s affordable healthcare policies but Minnesotans will find a lot of familiar ground. We’re used to private health insurance. We’ve helped developed both the group health model and the Mayo Clinic salaried physician team care model. We’re a non-profit health insurance and hospital state. We view affordable, high-quality healthcare as a key element of Minnesota life and competitiveness.

Consequently, ACA’s program elements continue our healthcare tradition rather than altering it. ACA will reverse the declining percentage of health insured Minnesotans. This all make sense except for the curious resistance to healthcare reform.

I can’t escape my suspicion that conservative ideologues don’t actually want Minnesotans to have affordable healthcare that increases the number of insured families while using the free marketplace to drive down costs. But rather that dwell in skepticism and conspiracy theories, let’s continue making the case for ACA’s expansion of affordable healthcare. The present model is costly and unsustainable. It has to change. ACA creates a path forward. Let’s stick to it.

Posted in Health Care | Related Topics: Health Insurance  Health Care Reform 

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Stick with the Exchange

By Meg Reid, Undergraduate Research Fellow, March 26, 2012 at 10:00 am

State Representative Steve Gottwalt (R-St. Cloud) and State Senator David Hann (R-Eden Prairie) have introduced what they say is an improved alternative to a health insurance exchange. Their plan is to provide health premium accounts (HPAs) to Minnesotans, a plan that Sen. Gottwalt calls “consumer-driven and market-based.” But the health premium account plan is hardly superior to an exchange.

First, allowing people to pool their money from different sources, as the HPAs would do, doesn’t mean that they will be able to afford coverage. The insurance exchange would create a marketplace where individuals and small businesses could compare the price and benefits of different plans. Competition and clarity would control premium costs so that these customers could afford coverage. The HPA plan doesn’t create this kind of marketplace, leaving individuals and small businesses to navigate the current, confusing insurance market.

Second, the creation of a health care exchange is crucial for the implementation of other provisions of the reform bill. For example, the bill provides tax credits that will help people to afford coverage, which are only available if the individual buys coverage through the exchange. Creating a system of health premium accounts would forfeit these subsidies.

Third, it is still unclear whether the HPA plan would be enough to satisfy the federal government’s requirement that the state create an exchange. If Minnesota is not sufficiently prepared to implement such a program by January 1, 2013, the federal government will step in to implement its form of the exchange. It’s in Minnesota’s best interest to create an insurance exchange that is tailored to the needs of Minnesotans.

Last month, an AARP survey (.pdf) of registered Minnesota voters ages 30-64 found that 74 percent supported “an exchange that negotiates competitive prices for consumers.” Is that not enough evidence that Minnesotans are demanding an insurance exchange?

Sen. Gottwelt says that HPAs are “the Minnesota way.” They most certainly are not.

Posted in Health Care | Related Topics: Health Insurance  Health Care Reform 

ACA vs. Supreme Court

By Meg Reid, Undergraduate Research Fellow, March 22, 2012 at 6:00 am

Monday will see the first oral arguments for Florida v United States Department of Health and Human Services, the Supreme Court case that will determine the fate of the Affordable Care Act. The justices will hear 6 hours of argument – that’s more than has been allotted for any case since 1966. This case is crucial to the future of health care reform, so it’s important to be informed.

The main issue is that of the individual mandate – whether the federal government has the power to mandate the purchase of health insurance. If the Court rules that the mandate should be considered a tax, the case will be deferred until 2015.* The Court will also make a decision about the severability of the mandate – whether the rest of the ACA can remain law without the mandate. Finally, the Court will decide whether the expansion of Medicaid called for by the ACA violates state sovereignty by requiring them to spend more or forfeit current federal money.

But for now, let’s focus on the arguments for and against the mandate:

Arguments For the Individual Mandate

Arguments Against the Individual Mandate

Let’s also consider what will happen if the mandate is struck down. According to the Robert Wood Johnson Foundation, if the ACA is implemented without the mandate, about 42 million people will remain uninsured versus 26 million with the mandate. Because the bill bars insurance companies from denying coverage based on pre-existing conditions, people could wait until they got sick to get insurance. This would undermine the bill’s cost-control measures. RWJF also found that without the mandate, premiums could rise by up to 25 percent.

The individual mandate is crucial to the success of the bill. Keep an eye out for audio recordings of the debates, and stay tuned for the Supreme Court’s decision in June.

*The Anti-Injunction Act of 1867 bars federal courts from deciding the constitutionality of tax laws until after payments are due (in this case, 2014).

Posted in Health Care | Related Topics: Health Insurance  Health Care Reform  Courts & Justice 

Graph of the Day: Obamacare Works for MN

By Michael Diedrich, Policy Associate, March 21, 2012 at 7:29 am

For the next few months (as with the past several), we can expect to hear conservatives invoking the name “Obamacare” as if it was a curse word or some abomination blighting this country. They've got themselves freaked out about imaginary death panels or the dreaded “socialized medicine” that they've completely missed the fact that Obamacare, formally known as the Affordable Care Act, is doing its job and helping out regular people.

To wit:
[ graph: click title to view in browser ]
(Data from the Centers for Medicare and Medicaid Services, for 2011)

This is just a taste of Obamacare's effects for Minnesotans. In the last year, it has helped nearly 60,000 of our citizens get discounts on prescription drugs including medications for the management of blood sugar, cholesterol, asthma, blood pressure, mental health conditions, blood platelets, and cancer. This saved those folks almost $35 million just in one year.

That's $35 million available for other spending or social support. For some beneficiaries, their savings mean that they personally have more to spend elsewhere. Others would have had to rely on their families or on private charities for support, and now those family members and social services have more to spend on themselves or on other people in need.

Let's also not forget the long-term savings that come from making prescription drugs easier to come by. Some Medicare beneficiaries would have needed to forgo or cut back on medication without Obamacare, increasing the chance of a more expensive emergency or complication down the road. By helping people take better care of themselves, Obamacare helps our society as a whole save more.

The bottom line is that Obamacare is about shoring up our social safety net, something which has taken too many hits through a combination of economic recession and the misguided conservative obsession with “austerity.” Now more than ever we need strong public investment in our most vulnerable citizens.

Posted in Health Care | Related Topics: Health Insurance  Health Care Reform  Medicare/Medicaid  Graphs 

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