The “individual mandate” and health reform: small steps, big challenges

Here on campus, many of us have spent the past few weeks cramming. Cramming for an epidemiology final. Cramming one more get-together with friends on an impossibly full calendar. Maybe cramming one more piece of turkey onto a plate piled high with holiday food.  We missed a lot of things during these past few weeks — and I’ll try to cover some of the highlights for you in the new year — but let’s talk about one of the big ones:  the likely demise of the “individual mandate” in President Obama’s Affordable Care Act.

The individual mandate was meant to require everyone in the United States — at least, those who can afford it — to purchase a “minimally comprehensive” insurance policy. So if you don’t have insurance in place (through an employer, as many Americans do), and can afford it, you’ll pay a fine: $695 a year (per adult) or 2.5 percent of your income, whatever’s higher.  Back in March, Virginia judge Henry Hudson declared the law unconstitutional, one in a series of Republican-led demonstrations contesting what is frequently referred to as “Obamacare.”

The response to this challenge is mixed: some health care reformers (Howard Dean among them) believe the bill doesn’t need the individual mandate in order to succeed.  Others (health insurance industry advocates, for example) believe we do: that insurance providers will not be able to compete fairly and transparently without a large pool of insured Americans, both healthy and sick.

Health care providers in Massachusetts would likely argue the latter. Their state’s mandate, enacted by a Republican governor in 2006, increased the number of insured residents to 98.1%– the highest rate of insured in the United States, according to a new report from the state’s Department of  Health and Human Services. This, in the midst of a serious recession wherein many Americans have lost insurance coverage.

The good news: politics can change, and quickly.  Government-sponsored health plans have been pitched before, even by staunch Republicans.  Although the individual mandate may fail, an “opt-out” option may satisfy both parties — allowing individuals to opt out of the general insurance pool, and later return. Children whose parents opt-out, meanwhile, could remain covered under existing programs. For a great explanation of the opt-out option, click here: http://www.prospect.org/cs/articles?article=averting_a_health_care_backlash

World AIDS Day 2010

Today is World AIDS Day 2010 and the U.S. is joining more than 200 countries around the globe to call attention to the worldwide epidemic.

Roughly 33 million people are estimated to be living with HIV or AIDS around the globe. The Centers for Disease Control and Prevention (CDC) estimates that 56,300 new HIV cases occur each year in the U.S. and that 1.1 million Americans are currently living with HIV. Since 1982, 9,163 people in Minnesota have been diagnosed with HIV infection, and 6,552 people are reported to be living with HIV/AIDS in the state.

This year’s theme is ‘Universal Access and Human Rights’. “Global leaders have pledged to work towards universal access to HIV and AIDS treatment, prevention and care, recognising these as fundamental human rights. Valuable progress has been made in increasing access to HIV and AIDS services, yet greater commitment is needed around the world if the goal of universal access is to be achieved. Millions of people continue to be infected with HIV every year. In low- and middle-income countries, less than half of those in need of antiretroviral therapy are receiving it, and too many do not have access to adequate care services.” http://www.who.int/hiv/pub/2010progressreport/en/index.html

The White House has released a presidential proclamation: http://www.whitehouse.gov/the-press-office/2010/11/30/presidential-proclamation-world-aids-day

The Global AIDS Alliance gave President Obama a less-than-stellar “C” this year (an improvement over last year’s D+).  Summing up the administration’s “strong policies with inadequate funding,” Zeitz acknowledges the innovative National HIV/AIDS Strategy, but also noted the funding shortfall for AIDS Drug Assistance Programs. (To learn more about ADAP and waiting lists, this NYT article is a good primer: http://www.nytimes.com/2010/07/01/us/01aidsdrugs.html)

To find out about local events and resources, visit the Minnesota Department of Health (MDH) web site at: http://www.health.state.mn.us/divs/idepc/diseases/hiv/worldaidsday/index.html

For an overview of HIV/AIDS around the world, read a progress report, “Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector” (compiled by WHO, UNICEF, and UNAIDS), available here: http://www.who.int/hiv/pub/2010progressreport/en/index.html

For additional World AIDS Day resources visit these links:
http://www.cdc.gov/Features/worldaidsday/
http://www.worldaidscampaign.info/
http://www.hhs.gov/aidsawarenessdays/days/world/index.html

Over the past thirty years we have made important progress in addressing this global epidemic – but there is so much more to do. The upcoming issue of Healthy Generations, published by Center for Leadership Education in Maternal and Child Public Health, will focus on HIV and the unique concerns for maternal and child public health.  Look for it in early 2011!

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