Health Reform Implementation

Tinker Ready hosts the latest edition of the Health Wonk Review over at Boston Health News. Today's theme is totally killer doctors in Boston. But in addition to the notorious medical murders in Boston's past, contributors this week also talk about overworked doctors, the Dartmouth Atlas, health IT, insurance reform, and the VA health system (including our own series of posts here on our colleague Phil Longman's book Best Care Anywhere.) Check it out, as they say in Boston, it's wicked awesome!

President Obama and Health and Human Services Secretary Sebelius addressed a live teletown hall meeting at the Park Multipurpose Senior Center in Maryland on Tuesday. The focus was Medicare and how health reform affects seniors. As the president said, seniors are targeted most often by those spreading misinformation about reform, and he wants to set the record straight.

The president started by comparing health reform now to Medicare reform in the 1960s. Both programs were derided as “socialist” and likely to bring about the end of the free market insurance system. But Medicare didn’t lead to a government takeover of health care -- and neither will new health reform law. “Medicare made a promise to seniors that they would have health coverage” said Obama, “and the Patient Protection and Affordable Care Act renews and strengthens that promise.”

Starting in 2014, the new health reform law will expand Medicaid coverage to most of the population below 133 percent of federal poverty level, amounting to about 15.9 million newly eligible enrollees by 2019. In a new report from the Kaiser Family Foundation, John Holahan and Irene Headen of the Urban Institute crunch the numbers and provide a state-by-state breakdown of what the Medicaid expansion means to states -- and their budgets.

The expansion is great news for the millions of low-income Americans (including childless adults) in need of health care. By 2019, there will be a 45 percent reduction in the number of uninsured adults under 133 percent FPL. Cash-strapped states might have mixed feelings about the expansion, but there is some good news for them -- the federal government will pick up the tab for covering the newly eligibles. For the first three years, the federal government will pay 100 percent of the costs, and in subsequent years, the federal government’s share will phase down to 90 percent of the cost of extending coverage. All told, between 2014 and 2019, the federal government will pay out an average of $443.5 billion (about 95 percent of the total cost), while states will contribute $21.2 billion.

Amid all the cheering and jeering over the health-reform legislation recently signed into law, there remains one sober fact about our medical system that every American ignores at his or her peril: Contact with the health-care system remains one of the leading causes of death in the United States. The most recent confirmation comes from a new study from the independent ratings company Health Grades, which found that between 2006 and 2008, nearly 100,000 Medicare patients died due to medical errors.

Pennsylvania Gov. Ed Rendell, an enthusiastic backer of national health reform and a leader at the state level through his Rx for PA initiatives, spent some time talking with health care writers here in DC this week courtesy of Health Affairs. Rendell, a Democrat, said he would have preferred that the national legislation had stronger cost control components, and pointed out that his own state had learned that it is in fact possible to lower costs while improving quality and safety. He specifically spoke about these state achievements or new initiatives:

• The state's Medicaid program (and I'm guessing maybe that includes PA's state children's health insurance program but he didn't specify that) will not pay for "never events." Not paying doctors and hospitals for things that absolutely should not happen, such as amputating the wrong limb, is a "tremendous incentive" to make sure they don't happen. 

President Obama in his weekly address talked about where we are now -- and where we're going -- with health care reform, including a forthcoming "patients bill of rights." The president touted the early benefits of the health reform law, including the $250 prescription drug rebate for seniors in the Medicare Part D "doughnut hole," limits on rescissions, help providing insurance coverage to early retirees, allowing young adults to stay on their parents' insurance until age 26, and tax credits for small businesses. (Some of these benefits were highlighted by Nancy-Ann DeParle earlier). Cautioning that it will take a lot of work to "keep the promise," the president said the law is on its way to empowering American consumers, providing more affordable health care choices and holding insurers accountable.

The New America Foundation's health policy program has a new director for a new era. Kavita Patel, MD, MS, is a primary care physician who has more than ten years of policy experience, working on national health care reform at the Senate's HELP Committee and in the White House Office of Intergovernmental Affairs and Public Engagement. She has a particular interest in developing national policies to support innovation in health care delivery including payment reform and quality improvement. She also still loves practicing medicine. In her first post, she writes about medical homes -- an area where her policy interests and her priorities as a physician overlap.

Since the passage of the historic law affectionately known as PPACA, we have seen a flurry of activity, including Health and Human Services Secretary Kathleen Sebelius's call to end insurance discrimination against women with breast cancer, encourage private plans to allow young adults to stay on their parents’ plans until age 26 and really push the envelope to narrow the administrative costs of health insurance plans so that more of each premium dollar is spent on patient care.

More than one in five Americans (under Medicare age) have a pre-existing condition, according to a Families USA report. Pre-existing conditions, which can be anything from cancer to diabetes to high blood pressure to a past sexual assault, are frequently used by insurers to deny coverage to people trying to purchase health insurance on the individual market. So according to the report, “Health Reform: Help for Americans with Pre-Existing Conditions,” approximately 57.2 million people under the age of 65 (22.4 percent) of Americans are at risk of being denied coverage. And that’s just counting diagnosed pre-existing conditions. The true number could be even higher. (Keep reading to learn how this will change under health reform!)

Our colleagues in California are holding an event today to discuss how Californians and their leaders can get the best bang for their health care buck as we implement the new health reform law, and to officially roll out the recommendations of the California Task Force on Affordable Care. The event, "Making Reform Affordable," is from 12:00 to 2:00 pm PT in Sacramento (that's 3:00 to 5:00 pm for our fellow East Coast residents, and don't worry -- the event will be webcast live). We'll be live-tweeting the event on our Twitter page, (hashtag #hcr, #CA) so be sure to follow along!

Nancy-Ann DeParle, Director of the White House Office of Health Reform, recently offered us a look at what health reform has accomplished in a few short weeks. And HHS Secretary Kathleen Sebelius Tuesday announced how it's going to help early retirees stay covered before reaching Medicare age. The pace is pretty impressive.

Deparle listed the current accomplishments of health reform on the White House blog:

Help Small Businesses Lower Costs. As we’ve said before, the rising cost of health care makes it increasingly difficult for small business to stay afloat. Often, employers in danger of losing their businesses have to make agonizing choices about firing employees or cutting benefits. Under the new health reform law, small businesses are eligible for tax credits to help purchase health insurance for their employees. Specifically, these tax credits will help businesses with 25 or fewer full-time employees, who pay for at least half of their employees’ health insurance coverage. The tax credits will be phased out by 2014, when small businesses will be able to purchase high-quality, affordable health coverage in the new health insurance exchanges.