Special to Medical Journal –
By Dan Stult z, M.D.,
President/CEO, Texas Hospital Association
After months of heated debate and many delays, health reform has finally passed and the President signed the measure into law. Many people are angry at the process, but seem to agree with the content of the legislation. Some people are concerned about the bill’s funding sources and the impact on the debt their children will inherit. Others are skeptical that the legislation will stick, especially if Republicans regain control of Congress. Only time will tell. What we do know is that the political drama will intensify as we get closer to the November General Election.
As I talk to groups around the state, I am careful to point out that this bill is not the “silver bullet” that will fix our nation’s health care system overnight. It is merely a beginning. Like any other major legislative initiative, some issues need to be revisited and tweaks will be needed over time. Although some provisions take effect within 90 days, comprehensive change will not occur immediately. The legislation will be phased-in over time, and will require extensive regulatory activity, a process where hospitals and other stakeholders can influence actual implementation.
Overall, I believe there are more positives in the legislation than negatives. Some 32 million Americans – including 4.1 million Texans – will be covered. Despite the lack of “scoring,” the delivery system demonstration projects and pilot programs will save money and improve quality and patient outcomes. But remember, this massive reform of health care delivery and financing will take time to work.
In the short term, some situations may get worse:
- Health insurance premiums likely will increase due to adverse selection and higher costs associated with more utilization, which is fed by pent-up demand.
- Rising premiums will intensify the pressure on individuals and businesses, and some may drop coverage.
- Today’s physician shortages will intensify, and longer wait times are likely
- Hospitals’ losses initially may increase due to implementation of cuts without the offsetting increase in insured patients.
Longer term – when Medicaid expands in 2011 and state insurance exchanges are available in 2013 – the benefits of health reform will be more visible:
- More insured patients
- Increases in the health care workforce
- Evidenced-based medicine, improved quality, better patient outcomes
- Greater use of information technology
- More efficiency, lower costs
The Texas Hospital Association is contacting every member of the Texas Legislature about the federal legislation and talking about what it means for the upcoming legislative session. Perhaps the most important point to make with lawmakers is that the choice was never between this bill and the status quo.
Rising health care costs and the nation’s growing deficit made action imperative. Health reform offers the opportunity to systematically reduce costs while changing the delivery system to be more efficient and effective. Better patient outcomes will provide a return on investment than far exceeds the investment in coverage.
Other federal issues also deserve our attention. Over the next few months, THA will be working with its national partner, the American Hospital Association, to make needed changes to the provisions in the health information technology rules. Hospitals also will be pressing for an extension of the Medicaid Federal Assistance Matching Percentage to help states fund Medicaid; a “fix” to the Medicare physician payment reduction; extension of the COBRA subsidy; and continuation of several Medicare provisions that help support rural hospitals.
While the health reform legislation is not perfect, it’s a start. Hospitals look forward to working with the White House, the Congress and other stakeholders to implement the changes outlined in the legislation and truly reform our health care delivery system. As new approaches to delivering and financing care are phased-in, hospitals are hopeful that all Americans can enjoy healthier, more productive lives.