Despite a recent Kaiser Family Foundation poll showing that 22 percent of Americans believe that the health reform law has been repealed and another 26 percent are not sure, the law is not dead. It is alive and even kicking. You can be forgiven for thinking that the law has been repealed, given the rhetoric of Republicans. They bravely predicted (and I noted that in a post back in November) that they would "repeal this monstrosity" as soon as the House came back in session in January of this year. The House, having come into power on the promise of more jobs, strangely made health reform repeal one of their first actions in the new Congress, and the House did indeed pass a mainly symbolic bill attempting to do that. The bill is unlikely to pass in the Senate, and if it should make it to the president's desk, it would be vetoed there. So, in addition to paying more attention to symbolism than the creation of new jobs, Republicans have failed to repeal health reform but they have vowed to take it apart piece by piece.
How is that going? Not all that well. Of the many targets of health reform that the Republicans would like to defeat, only one aspect of the law, a minor reporting requirement that would have placed a lot of pressure on small businesses (called the "1099" reporting requirement) has, in fact, been repealed, with Democratic support. The only remaining issue to resolve is how to pay for the revenue that the reporting requirement would have added. The other targets, like the individual mandate, are making their way through the courts and will likely end up in the Supreme Court. So far even the most anti-reform judge, Judge Vinson in Florida, has declared that implementation can go forward while the issue makes it way through the courts.
Meanwhile, there are a lot of changes occurring in the health care system as I write this -- some are positive -- others not so much. So here's a little summary of what has been happening since health reform passed almost a year ago:
1. In prior posts I have listed some of the changes that occurred in 2010 that benefited many of us -- young adults covered under their parents' plans until age 26; no limits on lifetime benefits; ability of states to review rate increases and (in some states) actually deny those increases; prohibition on the ability of insurers to rescind your policy unless there is proven fraud; prohibition on insurers to deny coverage because of pre-existing conditions for children under 18; coverage of preventive services for Medicare and many private plans; assistance to employers who continue to provide coverage to early retirees; new appeals process for denials of coverage; all kinds of grants to states to help them prepare for health reform; new programs to train physicians and nurses to meet new demand; a new board that will oversee research on the effectiveness of medical treatments (PCORI); grants to streamline data reporting and provide better information to patients and physicians; new rules about paying nurse midwives more equitably; coverage of annual wellness visits for Medicare beneficiaries -- and I could go on.
If you have not yet seen the results in your own health care, that doesn't mean that results are not coming. Hospitals and physician groups are busy figuring out how to deliver better quality care at lower cost (imagine!), because new payment systems will reward those that can do that effectively. Those who provide medical care are proceeding "as if" there will be massive changes to the way health care is delivered. Who am I to doubt them?
2. In addition to the substantive changes mentioned above, there has been a lot of churn and a lot of media around the legality of the individual mandate -- is it constitutional to require someone to participate in an insurance program? And what if the Supreme Court overturns the individual mandate? Not everyone thinks this would be the end of the world -- some policy folks think you could still get a lot of people into the system via the subsidies to make the premiums more affordable; you could also implement a waiting period for people who decided not to choose insurance coverage or penalize them for every year they wait to get it. The President ran on a platform that did not include an individual mandate. He believed at that time that most people want coverage and if you make it affordable, they will elect it. It is too soon to know how the courts will decide that issue.
3. There are other issues about health reform that have taken up way too much media space in my opinion -- whether or not the current head of the Centers for Medicare and Medicaid, Dr. Don Berwick, should be permanently confirmed, for example. When Gov. Christie of New jersey speaks the "truth", he is applauded. When Berwick speaks the truth, he is trashed. He has actually said that at some point we will have to figure out a way to contain costs (duh!) and he has said he admires the ability of the British Health Service to deliver care at a fraction of what we pay in the U.S. (And don't kid yourself, the quality of care is pretty darn good -- I have studied that system and they do an amazing job with the resources they have.) I don't know if Berwick can survive, but I hope he can. (See my prior post about him.)
4. What to watch out for? The Republicans are just getting started in their intention to dismantle health reform, so I am not suggesting that we sit back and congratulate ourselves, by any means. Already, draconian bills have passed the House related to the coverage of abortion and the funding of Planned Parenthood. Whether they will pass the more deliberative Senate is less likely. Still, the targets remain in their sights -- making it more difficult for States to expand Medicaid; taking away funding from programs like the Patient Centered Outcomes and Research Institute (PCORI) or the Independent Payment Advisory Commission (IPAB). These two bodies were identified by the Congressional Budget Office has having significant impact on reducing health care costs in the long run.
Since much of the health reform action has moved to the State level, we all need to monitor what is going on in our own backyard. This Kaiser Family Foundation report can help you find out what is going on and how you can stay informed.
I cannot imagine a family that does not have at least one person who has been uninsured, had a medical bill that they can't pay, a treatment they needed but could not get, or had some problem getting coverage and care. Until we begin to see the real results of health reform in 2014 and beyond, we all need to stay informed and vigilant. Health reform is not dead. That doesn't mean it can't be seriously injured.