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'Movement toward health care reform is likely irreversible'

By Dr. David C. Pate, News and Community
April 16, 2012

"With, from left, Jim Girvan of Boise State University; Bill Deal of the Idaho Department of Insurance; and Susan Johnson, regional director for the U.S. Department of Health & Human Services."

Last night, I had the pleasure of sitting on a panel with Susan Johnson, director for Region 10 of the U.S. Department of Health & Human Services, and Bill Deal, director of the Idaho Department of Insurance.

The panel discussion, sponsored by Boise State University and the Idaho Public Health Association, was moderated by Jim Girvan, professor emeritus in the Department of Community and Environmental Health and former dean of the College of Health Sciences at BSU.

Following are some of the thoughts I shared at the public forum, “Health Reform in Idaho:  A Panel Discussion on the Impact of the Affordable Care Act on Idahoans.”

St. Luke’s Health System did not support the enactment of the Patient Protection and Affordable Care Act, not because it does not have some very good elements, but because it did not do enough to control costs. The act is the focus of recent Supreme Court hearings, and you can read my earlier posts on the issues the court is considering.

The government’s assertion that you could add health care coverage for 32 million to an already broken health care delivery system and somehow save money seemed implausible, and we also were concerned because the burden of caring for half of those 32 million uninsured people would be placed on state Medicaid programs.

What are the good elements of the health care reform law?

  • Access for more people to insurance and care
  • The requirement to offer coverage for adult children up to age 26 on parents’ policy
  • The guarantee issue provision, which requires health plans to offer health care insurance to any individual who applies for it, regardless of health or risk factors
  • The prohibition on excluding pre-existing conditions, which would keep health plans from turning down anybody because of a pre-existing condition.  It also prohibits imposing a waiting period before coverage becomes effective.
  • An adjusted community rating system, which significantly reduces the variation in rates health plans could charge based on applicants’ medical history and risk factors
  • The creation of the Medicare & Medicaid Innovation Center
  • The establishment of the Medicare Shared Savings Program and Accountable Care Organization functions
  • The requirement to establish insurance exchanges
  • The requirement of private health plans to cover certain preventive health services without cost-sharing
Because of the delayed implementation of the health care reform act (many provisions do not take place until 2014), the impacts to Idaho have not been fully felt.  However, the coverage for children and young adults up to age 26 has already benefited many Idahoans.

The Idaho Legislature failed to enact enabling legislation to provide for a state-run insurance exchange, so unless the health care reform law or this portion of it is struck down, or the law is repealed, Idaho will end up with a federal exchange in 2014.

Assuming that the law continues in effect, the major impact to Idahoans will occur in 2014. By 2019, projections are that somewhere between 85,000 and 115,000 new enrollees will be added to the Idaho Medicaid program, and state spending for the Medicaid program will increase by $18 million to $22 million.

The best thing about the health care reform law is that it focused the national conversation on the deficit, the unsustainability of the Medicare Trust Fund given the current rate of growth in health care expenditures, and the magnitude of the problem of the uninsured. It also has fueled a movement toward pay for value instead of fee for service.

Regardless of what happens with the Supreme Court decision or the upcoming elections, movement toward health care reform is likely irreversible. The underlying case for change will not be affected by either the Supreme Court decision or the elections, and health care providers and insurers are already aligning in many parts of the country around this new paradigm of pay for value, which I believe is the only reasonable solution to the health care crisis.

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.