Consumer Health: Health Care Reform

So where have we been/what’s changed? many states’ assistance rolls include working folks; employers will need to contribute/share cost with state health care was previously a commodity to be bought and sold, change in thinking to “right” to health care* *HC always a right in the ER; federal law meant we all, ultimately, paid for others’ care if they couldn’t all health care decisions were made by the market; government will now play a greater role insurers could make huge profits; they still can

So where have we been/what’s changed? younger/healthy people NOT buying insurance means higher premiums for others 16% of the GDP covered about ½ of us adequately; other nations spending less to cover everyone (combined costs of inequality and premature death were $1.24 billion) Medicare Advantage plans are private plans receiving govt subsidies; large bulk of cuts will go to these plans

What hasn’t changed? someone has to cover costs of care for uninsured people in an emergency who does that? what’s the law? when was it passed? https://www.cms.gov/Regulations-and- Guidance/Legislation/EMTALA/

What was the fight? The constitutionality arguments and states’ rights perspectives Is it constitutional to force people to purchase health insurance? Some people said absolutely not, some said absolutely. Is it a violation of states’ rights to expand Medicaid eligibility? Some said yes, some said no. The Supreme Court upheld the law. Here’s a brief summary of their decision: http://kaiserfamilyfoundation.files.wordpress.com/2013/ 01/8332.pdf NOTE: States that filed amicus briefs in support of the Medicaid expansion in the federal district court include Colorado, Iowa, Kentucky, Maryland, Michigan, Pennsylvania, Oregon, Vermont, and Washington. In some states, the governor and the attorney general filed briefs on opposite sides.

Finally, we can explore perspectives & discourse (talk) public health perspective/discourse – where do we find it? our professional orgs, grassroots/advocacy orgs our peer-reviewed journals certain news outlets free market perspective/discourse – where do we find it? industry/trade associations

What we “get” about an issue often depends on how we talk about it “government takeover” vs. “public-private system” “stifling regulation” vs. “important consumer protection”

Industry thinking – one way? Nope, doesn’t seem to be: Q31/32. You said healthcare costs are most important. Which of the following issues do you care about the most? [Combined] 38%  Keeping healthcare costs low for American families 30%  Replacing the Affordable Care Act 29%  Giving employees more choices and control over their healthcare options 25%  Making healthcare costs more affordable for small businesses 20%  Finding state-based solutions to healthcare coverage issues 19%  Promoting innovation in the healthcare sector to reduce costs and save lives 18%  Expanding access and coverage to more people 10%  Reducing government regulation and red tape 10%  Freedom to decide whether to provide benefits like birth control

Who’s right? Whose language is more powerful?

What we see depends in part on where we look Stewart CNN FOX O’Reilly WSJ NPR NY Times Limbaugh Time The Nation Krugman National Review Reid Krauthammer Maddow Brooks PBS US News

Int’l & Indie News? What and how do others report on events in the US? BBC, the Guardian, Al Jazeera, and other English- language foreign sources What does news “look like” when smaller companies that don’t carry ads (or carry different ads) are the ones doing the reporting? Pacifica Radio, Mother Jones

The Federal Health Care Website http://www.healthcare.gov/ What can you learn here that might change your mind or someone else’s? Say you had a concern or dislike of the law, and that question or dislike was grounded in a question you had or piece of information you needed? Does this site help change that?

There are different perspectives EVEN within groups Public health professionals are more, or less, individual and behaviorally focused; more, or less, focused on environmental/system-level change Bottom line: Health care reform that allows more people to have access to primary and preventive care will improve population outcomes, and that’s where our groups tend to focus

SOPHE perspective