Published by: Larry Gage on 9/23/2010 10:45:20 AM
Health reform has reached an important milestone today, on the six month anniversary of its enactment. Today, a number of key provisions will take effect for the first time. Most of the provisions going into effect today are targeted at protecting consumers and imposing new requirements and restrictions on health plans. These are important protections – they include a ban on discrimination against children with pre-existing conditions; a ban on lifetime caps and on canceling coverage when a patient gets sick, and expanding the ability of young adults to continue coverage under their parents plans, among other reforms.
These reforms are also important because they should generate additional understanding and support for reform among all Americans, and enable those who support reform to respond effectively to those who would call for its repeal. Certainly, these provisions provide benefits and protections that cannot and should not be rolled back or repealed.
At the same time, most of the provisions of reform that directly affect safety net providers and the uninsured patients they serve are still in the future – in some cases, several years off.
By 2019, CBO estimates that 32 million Americans who are currently uninsured will gain coverage. Of these, 16 million will enroll in Medicaid. Many newly covered patients will not have received health care for some time and will need primary and specialty care, requiring an expansion of capacity and coordination among community health centers and safety net health systems.
NAPH pledges to work together with the Administration and other safety net partners to ensure that there will be sufficient capacity to serve all the newly insured, including accessible medical homes and community health services to meet the anticipated surge in demand.
In the meantime, NAPH has identified a number of specific issues that we will be tracking carefully over the next several years. Those include:
- We will work to ensure that all those who become eligible for coverage, whether under Medicaid or through the newly created exchanges, are actually enrolled in plans that provide true access to needed health care.
- We will encourage the development of an adequate network of preventive, primary and specialty care providers to serve all newly enrolled individuals, as well as the coordination and integration of care and reform of the delivery system. To accomplish this goal, we expect to build on successful models that already exist and ensure that there is adequate funding for many of the mechanisms built into the reform legislation to restructure the delivery system. Those include:
• Implementation of the provision in health reform authorizing the development and funding of Coordinated Care Networks;
• Participation of safety net providers in global payment demonstrations;
• Ensuring that the programs and services supported by the new CMS Innovation Center include a major safety net focus;
• Building nationwide safety net collaborative to share best practices in the integration and reform of the delivery system;
• Work to promote Accountable Care Organizations for Medicaid as well as Medicare; and
• Generally identify or create opportunities for safety net providers to participate in a wide range of demonstrations and innovations
- We will also work to ensure the adequacy of payments for providers under health reform in order to guarantee that providers will be available to serve the newly covered populations. In particular, we will pay careful attention to:
• Address the adequacy of Medicaid payment rates for primary care, hospital care and specialty services; and
• Ensure that some of the payment mechanisms built into health reform, such as the reduction of DSH funding, are implemented carefully and equitably and are phased in only as expanded coverage genuinely reduces the volume of uncompensated care.
- In that regard, we intend to pay careful attention to the residual service and funding gaps that will remain in the system even when the current legislation is fully implemented. These will include gaps in coverage, such as for immigrants, as well as potential shortfalls in needed funding of public health services and community-wide resources such as trauma care.
- Finally, we will be working closely with our members and with both government officials and other organizations to develop mechanisms to measure and improve quality, patient safety and efficiency in the nation’s health care delivery system. This will include assisting our members to be ready for the implementation of new payment mechanisms, such as value based purchasing, that will depend on their ability to meet the highest standards of quality care.
NAPH expects to continue to work closely with those in government who must implement reform, as well as with a wide range of other organizations that represent providers and patients, to ensure that health reform. Only by paying attention to every one of these important elements of health reform will we be able to ensure that health reform is implemented fully, fairly – and with equity and justice.