The bill is HR 3962, the Affordable Health Care for America Act

The Whatcom Alliance for Health Care Access is a long time community health care study group that I participate in, which is dedicated to improving access and quality of care in Whatcom County, Washington. It is composed of citizens from all walks of life and segments of society. On November 2, 2009, they reviewed HR 3962 and released their findings. What follows is my edited version of their conclusions.

General Comments on the Bill

• This is a very comprehensive reform package that lays the ground work for providing changes and incentives to the delivery system that will reduce waste and improve outcomes overtime.
• Strong, thoughtful approach to Medicare payment reform that will result in implementation of recommendations over time
• Recognition and inclusion of reform initiatives. Specifics include a focus on wellness and prevention, expanding support for primary care training, creating opportunities for state and community level pilot projects and innovations and recognition of the importance of consumer engagement in reducing costs and improving outcomes.

Specific Comments Relative to Principles of Reform

1. Need to provide coverage and care for all people at all times regardless of age, employment status, economic circumstances and preexisting conditions
• Bill effectively addresses underwriting issues relative to age, health status and pre-existing conditions and creates level playing field for public and private market
• Bill provides options for all individuals (including low income) and most businesses to access affordable and in some cases subsidized health coverage through the exchange or through Medicare or Medicaid

2. Need to improve patient outcomes and reduce waste through improved care coordination, and a focus on primary care and preventive care.
• Emphasis on reduction of waste and fraud throughout bill including provisions in Medicare and Medicaid changes are seen as addressing this issue
• Reform elements throughout bill to increase primary care training including expanding residency options seen as positive
• Medical home recognition and including support of medical home pilot programs and shared decision making seen as effective
• Elimination of co-payments and deductibles for preventive services in Medicare and Medicare supports access to preventive care
• Grant program to help small employers to strengthen workplace wellness programs and support of community preventive services grants seen as important steps.

3. Need to assure consumer choice of providers and public and private plans
• Addressed through establishment of exchange and creation of a self sustaining public option.

4. Need to simplify the system (insurance administration, etc.) so that it is user friendly (understandable and transparent to consumers.)
• Creating level playing field in terms of underwriting and enactment of administrative simplification to reduce paperwork, standardize transactions and improve transparency seen as important step forward

5. Need to control costs and improve quality of care by reforming the payment system so that it rewards results and not activity and holds providers accountable for outcomes not procedures.
• Increased payments for primary care under Medicaid important step
• Addressing of Medicare payment rates based on geography and geographic variations in health spending through IOM studies with provisions for adopting recommendations is needed for cost control and quality improvement in Medicare
• Provisions for Center for Medicare and Medicaid Innovation creation and empowerment, creation of Accountable Care Organization program and Comparative Effectiveness Research Agency all needed to identify quality measures, provide the science to implement evidence based care and provide the incentives for the delivery system to implement those changes
• Changes to Medicare Advantage plans seen as supporting this principle

Some Persisting Questions and Issues

1. Affordability will be an ongoing challenge that needs to be monitored and addressed. How will that be handled?
2. What role will the public options play in health reform proposals to drive innovation?
3. Is financing adequate and sustainable?

The Party's Over

Up until now, we have seen some superficial co-operation among disparate interests over needed healthcare reform, but now the wheels seem to be coming of the bus. Republicans, conservative groups and some business organizations have begun accelerating efforts to derail legislation, by calling the Democratic proposals costly and dangerous experiments in "government-run" health care. Their main goal is to slow down the pace of the legislation in Congress in the hope of fomenting wider opposition. Sen. Jim DeMint (R-S.C.) has been quoted in the Washington Post as saying, "If we're able to stop Obama on this, it will be his Waterloo." "It will break him."

What we are talking about, of course, is regulation of the market, and figuring out how to cover all of our citizens. That is not "government-run" health care. In the many countries of Europe, for example, very few of them "run" the health care system, Great Britain being the notable exception. By trotting out their tired old stereotypes, I think that conservative activists are discrediting their cause, and depriving us of a real debate on substance.

The fact is that we already do have one "government-run" health care program", and that is Medicare. I will be the first to tell you that it does have faults, but it is highly rated by those it serves, and it is quite efficient in it's management, far more so that private plans are. So much for the evil, clumsy government.

We already have a dysfunctional healthcare mess for which we spend more than anyone else on the planet. The money we waste may not be a government tax, but we are paying it every time we buy a product made by a US firm or pay your insurance premium.

A Practical Approach to Health Insurance reform

When it comes to change on a national level, new ideas and needed reform proposals often come from the states. Maybe that will now happen with health care insurance reform.

On May 18, the Whatcom County Medical Society hosted a presentation by Washington State Insurance Commissioner Mike Kreidler, who accepted our invitation to speak to us about his innovative and practical plan for health insurance reform in Washington State, known as the Guaranteed Health Benefit Plan. As insurance commissioner, Kreidler has developed a wealth of knowledge, that includes experience running a health insurance company when KPS Health Plans were put into receivership. He has clearly put his experience to good use in the design of this plan.

Commissioner Kreidler’s Guaranteed Health Benefit Plan would provide health care coverage for all Washington residents up to age 65, by virtue of residency in the state for one year, while it also preserves the individual's freedom of choice to pick the plan they want. Keidler described how it would work:

• All residents get catastrophic coverage for health care costs exceeding $10,000 a year.
• Limited preventive care is covered, which includes an annual checkup, immunizations and age-appropriate cancer screenings.
• Funding comes from a payroll tax, shared by the worker and employer.
  
• Consumers and employers can choose additional coverage for other care from any insurance plan serving the state, and costs will be much less, since the roulette wheel of catastrophic cost has been removed.
• All insurance "customer service" – both catastrophic and routine, is provided by the private insurers.
• For expenses in excess of $10,000, the insurance company pays at their contracted rates, and deals with the state for the payment to them
• Individuals with no coverage of any kind are at leas covered for some preventive care, and all "catastrphic" care that exceeds $10,0000.

Commissioner Kreidler's approach is refreshing and very interesting. He builds on the structure we have now, while the plan causes minimal disruption to the existing system, extends coverage to all without mandates, and yet still respects choice in the system. It is a way to get moving on this important issue now. As he noted in his talk, all advanced countries have migrated to their own health care systems by building conservatively on the unique features of their pre-existing systems, and it is unlikely that we will have reform as a "big bang" event.

After his talk, Commissioner Kreidler left to fly to Washington, DC for talks with key legislators there. As the health care debate continues, I think that his is a welcome voice for common sense. and a practical choice to help people quickly!

You can get details about the plan by clicking here.