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Posts Tagged ‘Medicaid’

I’m still amazed that a government agency is asking for our opinions – and better yet, they’re actually listening.

Check out this post for a little background. The verdict is in. The USDA is backing off on a proposal that might have inadvertently encouraged heavy drinking. They had originally proposed to ditch the daily recommendations and set weekly recommended quantities of alcohol, but the public spoke out. Since most people do their drinking only one to three nights a week, those who took the time to comment online were mostly concerned that drinkers would look at weekly guidelines and try to cram one week’s worth of drinking into one night. And that was a real possibility – most of us know how bright alcoholics are when it comes to justifying “let’s have another one!”

The USDA’s new guidelines retained a daily recommendation for alcohol consumption, and they now define heavy drinking and binge drinking as well. They admit there is evidence of health benefits of moderate drinking – apparently they’re trying extra hard not to give anyone the idea that it’s okay to drink like a fish – but they now give the stern “this is bad for your health” statement like you’ll find on a cigarette pack, listing all the health conditions that might get in your way if you drink too much.

According to Join Together, it was the online response from private citizens (both healthcare professionals and concerned consumers) that made a difference in the final policy decision. That is seriously encouraging. All government agencies should have a limited public commenting period like this every time new policies are being considered. 

Get ready to click again – someone else needs our input now. The Centers for Medicare and Medicaid Services (part of the Department for Health and Human Services) is asking what we think about Medicare covering alcohol screening and counseling in primary medical care.

This debate is about whether Medicare and Medicaid should cover alcohol abuse prevention, screening, and counseling. They already cover screening for other medical issues, but this time they’re considering doing that for something that might cross over into services that are normally performed by mental health providers.

Providing the service could mean a significant extension of prevention and early intervention services for individuals struggling with alcohol. It could also be pretty expensive, but then again so is the current drain on state and federal budgets when it comes to incarceration of drunk drivers and other alcohol-fueled criminals, child protective services, healthcare services for abused family members, emergency services for indigent people with alcohol poisoning, and anything else that relates to the public costs of excessive drinking.

A report on reducing underage drinking from the National Academy of Sciences found that government agencies, businesses, and individuals in the United States end up spending – and remember, this is just about underage drinkers – around $53 billion per year (including $29 billion due to violent crime and $19 billion from traffic crashes) because we can’t keep the alcohol away from the kids. Now that’s expensive. And that study was presented back in 2003. What are those numbers like today? And how much greater could the costs be for adults with alcohol problems?

If you want to get in on the debate, their National Coverage Analysis Tracking Sheet is open for comments until March 20, 2011. Let them know – especially if you work in healthcare – what you think about how this might work, who might coordinate the services, how often the services might be offered, or under what conditions Medicare or Medicaid might play a greater role in preventing a lot more unnecessary problems.

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The Patient Protection and Affordable Care Act (PPACA) began its journey into the wild blue yonder today.

You know the laundry list of benefits that went into effect today. There’s no way some part of the media has not reached you by now. Across the board, we’re getting ready to see:

  • elimination of lifetime coverage limits
  • restrictions on or phaseouts of annual coverage limits
  • extension of dependent coverage up to age 26
  • no more policy cancellations for sick people

And these changes are also being made, but only for employer plans or new individual policies – they may not apply if your insurer chooses not to amend your existing policy:

  • no more plans that deny or cancel coverage for children with pre-existing conditions
  • free evidence-based preventive care services
  • no more out-of-network increases for medical emergencies

Now, I think that making predictions about what these changes will or won’t do is a little like predicting whether getting a new job will make you a happier, more productive person. The grass may look greener, but you don’t know until you get there. There are too many variables involved.

But I have another list for you.

According to the Bazelon Center for Mental Health Law, we have the following facts staring us in the face:

  • 26% of Americans have a diagnosable mental disorder.
  • Only 29% of those people actually receive treatment.
  • 50% of Americans with a mental disorder have problems by age 14.
  • Mental disorders are the leading cause of disability for Americans age 15-44.
  • Major mental disorders cost America at least $193 billion per year in lost wages alone. This study only focused on comparative wage levels – it didn’t include the costs of presenteeism (showing up but being unproductive) or absenteeism (calling off work) on the job.

Insurance parity is an economic issue. Mental health parity is great, but it isn’t enough. Now we need to get people into treatment and back to productivity, and cost – lack of insurance coverage – is the biggest roadblock to getting that help.

Think of the cost savings if we could get people off of public disability assistance and/or Medicaid. Think of the extra cash flow that America could experience with additional payroll tax income, sales tax income, and property tax income because so many more people would be able to work and buy things like appliances and furniture and homes. Think of what could happen if all those kids got help and became productive citizens instead of being homeless or in jail.

No matter who reacts how to the new law, we’re taking another step in the right direction for the good of our country as a whole. You can talk about bleeding hearts all you want, but the return on investment here is too great to pass up.

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