The new U.S. health care law left many unanswered questions for the health care providers that must implement it and for businesses that need to know how it will affect their employee health plans.
Although most provisions of the law won’t take effect until 2014, employers and health care leaders need to know how they will work soon so everyone can plan ahead. Rules for implementing the law need to be published quickly so problems — and there will be problems — can be identified and resolved before problematic provisions take effect.
Making the law work for Montanans was the focus of discussion Tuesday at a forum sponsored by the Big Sky Economic Development Authority. It was standing room only at the Billings Clinic, where about 150 business people, health professionals and community leaders filled a large conference room to hear a panel that included Billings Clinic CEO Nick Wolter, St. Vincent Healthcare CEO Jim Paquette and Liz Fowler, chief health care counsel to the Senate Finance Committee chaired by Max Baucus. Paquette and Wolter lead organizations that are critical to both the quality of life in our community and the local economy as two of Yellowstone County’s largest employers.
Reducing cost shift
A major goal of the law is extending health insurance coverage to most of the Americans who have none. Covering the uninsured will reduce the cost-shifting that now occurs.
“Being uninsured isn’t the same thing as being untreated,” Paquette pointed out, noting that hospital emergency rooms constantly treat people who need care but have no insurance. “Those of us who pay for our health care pay for those who don’t and in most cases can’t pay,” he said.
The average American family pays about $2,000 a year for uncompensated care provided to those who don’t pay, Fowler said.
The Billings Clinic “is seeing an unprecedented spike in people who can’t pay for their health care,” Wolter said, noting the increase in charity care in the past year. “We’re glad to do it as long as we can. There is an inevitable cost shift.”
Wolter noted that Billings Clinic participates in a national demonstration project that has shown daily outpatient monitoring of congestive heart failure patients keeps these folks healthier. In fact, Billings Clinic patients in the project have 40 percent fewer hospital admissions than patients who didn’t get daily phone contact. That improvement in patient health also saved Medicare $3 million.
None of the hoped-for savings from such quality initiatives is included in the Congressional Budget Office calculations of how much the new law will cost/save. If they work, the law could be a bigger money saver that the CBO said.
Less in Medicare payments
Paquette noted that U.S. hospitals agreed to a reduction in annual Medicare rate increases to help hold down costs in the new law. Over the next decade, that smaller “market basket update” will amount to $150 billion less in Medicare payments than hospitals would have received without the new law. However, hospitals expect a decrease in need for charity care as more Americans become insured. Also, the best hospitals will start getting rewarded for their high quality care.
Asked what worries him most about the new health law, Paquette said that as hospitals and other providers try to work more collaboratively to improve care under the new law, they may also run into barriers set by antitrust and Internal Revenue Service rules. Thus, other laws and rules may have to be revised to make health reform work.
“The challenge we have in taking policy and turning it into action is huge,” Wolter said. His biggest concern is getting needed changes made to the new law in a hostile political climate.
Hospital leaders and other Montanans will need answers to many detail questions as the law is implemented. Federal agencies must make the rules workable for consumers and businesses. Congress, in particular Sen. Max Baucus, who authored much of the new law, must be vigilant in monitoring implementation and prompt in correcting problems that will inevitably appear with a law this far-reaching.