Sunday’s keynote speaker Neera Tanden, former advisor to President Obama on health reform, seemed to tailor her presentation to the early morning session. She said that health insurance is different from other items out on the marketplace because when people go to the emergency room, doctors are required to treat them. As she explained it, if I want a new TV or a new car nobody is required to give them to me, but if I need medical treatment and I go to an emergency room I will be seen by a doctor.  She argues that this distinguishes health care and health insurance from other goods. It reflects our value of human life and justifies regulation when our health care system becomes ineffective.

Tanden also responded to the first panel’s federalism discussion. There are aspects of federal and state authority scattered throughout the bill. States will retain significant control over their Medicaid programs and will be able to regulate new health insurance exchanges after the bill takes effect in 2014. She also argued that many aspects of the new law that are thought to be breaches of federal authority – like the individual mandate – are actually rooted in a moderate conservative philosophy that emphasizes state’s rights.

What does this all mean for mental health in Texas? The Affordable Care Act presents opportunities for expanded access, increased quality of mental health services and parity with physical health. However, from the diversity of opinions I witnessed at the Texas Tribune Festival it seems we are far from agreement on the appropriateness of the law.