A blueprint for healthcare reform, shaped by political leaders inside the Beltway and pursued by incoming President Barack Obama, has garnered the much-needed support of healthcare leaders outside of Washingtonthe very ones who will be tasked to turn policy into practice.
Dear Mr. President,
Opinion leaders offer the Obama administration their take on what healthcare priorities need to be, with most respondents in favor of a national health insurance exchange to expand coverage
As a result, the appetite for broad healthcare reform can be seen not only on Capitol Hill but also in the executive suites of hospitals, physician offices and the living rooms of million of Americans, many of whom could be one hospital stay away from bankruptcy.
The latest Commonwealth Fund/Modern Healthcare Opinion Leaders Survey underscores the case for reform. The survey, the 17th of its kind, focuses primarily on proposals championed by the incoming Obama administration, federal lawmakers, health-policy analysts and a raft of hospital administrators and physician leaders. The survey, conducted by Harris Interactive online in December 2008 and which included opinions from 194 influential health-policy shapers, shows that a majority fully back the key components of a healthcare-reform package favored by the president-elect.
If members of Congress have as much a consensus on health reform as the opinion leaders do, then it would be a slam-dunk, Commonwealth Fund President Karen Davis says, referring to the chances for reform. The industry, she adds, supports moving forward simultaneously with efforts to reform the healthcare delivery and payment system in a way that helps improve quality and efficiency.
At the outset, those who work within the healthcare sector say that the Obama administration should push ahead with its plans to take a giant bite out of the millions of uninsured and underinsured Americans as part of broader health reform and economic stimulus.
Realizing that Obama will have a number of areas of concern that need to be dealt with, 66% of those surveyed say that they want the new administration to work toward a system of universal coverage as it tackles other initiatives, such as driving down costs and boosting the quality of care.
Theres broad support for reform, says Davis, a fixture at healthcare debates in Washington. Obviously, Congress is getting the signal from the incoming administration that this is a top priority for them.
Bill Novelli, chief executive officer of the AARP, says he agrees. This is an exciting time, he told reporters last week on Capitol Hill. Its an enormous opportunity to put America back on track. We have a crisis that demands it, a new administration and new Congress with a mandate for change and a public thats ready for it.
For instance, respondents overwhelmingly say that they would support the expansion of certain federal health insurance programs, such as Medicare and Medicaid92% vs. 4% who say theyre opposed to such a move.
Other key majorities include: Eighty-six percent say that they favor federal insurance rules, such as guaranteed issue and community ratings; 81% favor a requirement for employers to either offer coverage or pay a percentage of their payroll to help finance expanded coverage; and 76% want to see a public plan option, such as Medicare, in a new national health insurance exchange.
While all of those provisions are outlined by the Obama administration, details remain scarce. There are, however, some certainties. Congressional leaders say they plan to move quickly on legislation that reauthorizes and expands the State Childrens Health Insurance Program. A bill could be ready for Obamas signature shortly after he takes office on Jan. 20.
But other legislation is also being eyed as a possible vehicle for healthcare reform. An in-the-works economic stimulus package likely will contain billions of dollars for the implementation of health information technology and billions more as a lifeline for state Medicaid programs.
Both provisions enjoyed strong support by respondents to the survey. Eighty-three percent of respondents called the expansion of SCHIP absolutely essential or very important. Similarly, 78% say that federal investment in health IT is absolutely essential or very important.
The Commonwealth Funds Davis credits this to a number of factors. Obviously the fact that the new administration has made a commitment to acting on health reform increases peoples support for it, she says. But I think its just mostly hearing from the American people. Weve had increases in the number of uninsured and underinsured.
The latest data show that as many as 72 million Americans fall into that category, Davis says. Couple that fact with the ongoing recession, and the fear of being one hospital stay away from bankruptcy hits close to home for many. Statistics show that for every percentage point increase in unemployment, 1.1 million people lose their insurance, she says.
Jeff Korsmo, executive director of the Mayo Clinic Health Policy Center, says that the Obama administration must be able to multitask.
There is a clear indication in these survey results that many elements of healthcare reform need to be addressed simultaneously, and this is something that we have also heard from leaders in multiple sectors through our health-policy-center activities, Korsmo says in an e-mail. The need for coverage for all Americans needs to be addressed in conjunction with improvements in quality, safety and service, and a reformed system that pays for better outcomes, he says.
On the payment front, 71% of respondents say that they favor a move away from the traditional but complicated fee-for-service payment system under Medicare in favor of bundled payments with bonuses for high quality.
While many lawmakers bemoan the current payment system, its uncertain whether a specific proposal will emerge that would overhaul how doctors are reimbursed.
Still another issue that garnered positive responses centers on allotting federal dollars to help spur the adoption and use of electronic health records and other aspects of health IT. Three out of four survey respondents say that they support federal funding to speed up adoption.
A provision to do just that likely will be included in a broad economic stimulus package, though details on how muchand how it will be dispersedare still under wraps.
But the lack of detail at this point has some concerned. Veterans of the last go-round with healthcare reform remember that part of what sank that plan in the early 1990s was a prolonged delay.
Theres a lot of skepticism in the industry because people who have been around a long time sort of have prepared for major changes in the past only to not see them happen, says Bruce Vladeck, senior health policy adviser at Ernst & Young and a former administrator of the Health Care Financing Administration, the CMS predecessor agency.
That lack of detail is particularly visible on the healthcare IT front, where some predict that an economic stimulus bill could include about $50 billion in federal funds to help spur the use of EHRs.
For all the consensus, were not going to get there without both some considerable federal investment and much more proactive leadership on standardization, Vladeck says.
While health IT will prove a good investment down the road, its immediate financial impact is mutedat least from the provider side, Vladeck says.
Other respondents, however, were more bullish on health IT. Seventy-eight percent say that they feel it is highly important that the government helps defray the costs to automate.
There have been so many failed efforts in the past, you have to be foolish to express any confidence, but I do think that theres probably more optimism and probably more reason for optimism of the prospects for significant reform this year, Vladeck says.
Andy Stern, president of the Service Employees International Union and a vocal proponent for health reform, says that the dynamics this year for change are different than they were more than a decade ago when the Clinton administration pushed a healthcare platform.
I think this is the year, Stern says. I think all of the Clinton policymakers who argued in 1993 that we had to deal with the deficit first and healthcare later have come to the conclusion that this is not 1993. Healthcare reform is about deficit reform. If we dont cut the trend line of healthcare, were never going to solve the problem.
I think at every level people feel like, why wait, Stern says. The longer we wait, the worse it gets.
However, there is not one single answer to reform, Korsmo says. By addressing these issues simultaneously, and by keeping reform centered on patients, we will be able to effect substantive reform that improves access and outcomes for patients while lowering costs, he says.
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