Despite the progress made by President Obama’s health care reform law, the United States still faces significant challenges in improving the quality of its health care, according to three panelists who spoke at a forum on the future of health care reform last night.
Christopher Koller, Rhode Island state health insurance commissioner, Ira Wilson, professor of health services, policy and practice and Glenn Tung, associate dean for clinical affairs at the Alpert Medical School, spoke at the forum, held in MacMillan Hall. Health Leads Providence, a group of students who work with urban health clinics to connect low-income individuals with better health resources, sponsored the discussion.
Koller gave the audience an overview of the major changes enacted with the Patient Protection and Affordable Care Act of 2010, saying he believes the health care reform law is a step in the right direction. He said while the law is controversial today, the reforms may become more popular once they have been implemented.
“If we do a good job implementing the Affordable Care Act, then in 40 years, it will be regarded just like Medicare,” Koller said, adding he hopes Americans in the future will consider today’s large number of uninsured individuals to be “barbaric.”
About 50 million Americans are currently uninsured, but this number will fall substantially as key reform provisions kick in, Koller said. The law will expand health insurance coverage by extending Medicaid eligibility to all individuals with incomes below or equal to 133 percent of the federal poverty line, he added. The poverty line for a family of four is $23,050.
Americans with incomes below or equal to 400 percent of the poverty line will be able to purchase insurance through a new network of government-run exchanges that will enable them to compare the costs and benefits of different insurance plans, Koller said. The law also establishes an individual mandate, which kicks off in 2014, to buy health insurance and establishes a penalty for anyone who can afford to purchase insurance but fails to do so.
“The basic idea is that you have to buy it. If you can’t afford it, we’ll help you pay for it,” Koller said, adding that the law will be financed through a combination of tax measures and savings found in Medicare, including eliminating Medicare waste.
Koller praised the insurance exchanges as a way to allow individuals to consider what policy best suits their needs, saying state governments will be able to choose whether to receive aid from the federal government or to set up the exchanges themselves. He said Rhode Island has decided to build its exchange by itself to best cater to its localized health care market.
State governments currently possess a high degree of control over the business practices of state insurance companies, with wide variance between right-leaning and left-leaning states, Koller said. “It’s really a red state, blue state thing,” he said, adding that once the health care reform law is fully implemented, national regulations will more closely resemble those of more liberal states.
Wilson described the health care reform law’s impact on patients, saying the act seeks to plug systemic gaps in the health care system. He said universal health insurance is the first necessary step in controlling long-term health care costs. Since many Americans who currently lack insurance will eventually contract serious chronic illnesses, it makes sense to extend coverage to them before they get sick, Wilson said.
Wilson noted the link between addressing the nation’s long-term fiscal problems and curbing health care costs.
“Both the right and left agree about certain facts about the rate of increase in the cost of Medicare and Medicaid,” Wilson said, adding that he believes the federal government must develop a strategy for dealing with the budgetary problems associated with these two entitlement programs.
Tung addressed the need for further reforms for health care providers, saying Obama’s reform law creates the potential for future changes to the health care system. He highlighted three areas for further improvement-creating a more integrated health care delivery system, standardizing the quality of care nationwide through cost-benefit analysis and aligning the medical industry with the digital era.
Tung said the United States could save about $35 billion in wasteful health care spending by facilitating greater coordination between doctors, nurses and other providers. He also stressed the necessity of cutting down on paperwork in the medical community, saying the United States spends $161 billion on health care administration when only half that amount is truly necessary.