In late November, the U.S. House of Representatives passed its Patient Protection and Affordable Care Act.
On Dec. 24, the U.S. Senate passed its Affordable Health Care for America Act.
The next step in federal health care reform (“Health care reform or deform?”, Marketplace, Dec. 22, 2009) is for a House–Senate conference committee to put the two bills together for a final Congressional vote in late January or early February.
The questions now for Northeast and Central Wisconsin health care providers are the provisions in the final bill President Barack Obama signs into law, and what they’ll have to do to adapt to it.
“Most of the changes that we as a health care organization will be doing won’t go into effect for a couple of years,” says Rachel Roller, vice president of government affairs for Aurora Health Care. “Most of what will be affecting us disproportionately still has to go through the rule-making process.”
“We’ve been primarily following the Senate, mainly because of gut indications that that’s the one the president is favoring,” says Sheila Jenkins, president of the Network Health Plan division of Affinity Health.
“I think they’ve made good movement on the Senate bill,” says Duane Erwin of Aspirus Health Care in Wausau. “I think there’s a lot of potential that we’re going to focus on.”
“My number one focus has to be how we can work with whatever comes out of Congress, so we can take care of as many patients as we can and employ as many people as we now employ,” says Dr. Ashok Rai, CEO of Prevea Health (“Steering the health care reform train,” Marketplace, Aug. 4, 2009) in Green Bay.
What makes what will happen in the conference committee difficult to predict is that the final bill may not be just a combination of the two proposals.
“Those two bills are radically different,” says Dr. John Toussaint of the ThedaCare Center for Healthcare Value. “There certainly isn’t in the Senate version taking care of liberals’ concerns in the house by any means. It’s going to be interesting just to see what reconciliation occurs. They are light years apart, that’s for sure.”
“You saw a quick turnabout to providing Medicare to people 55 to 65,” says Erwin. “That was in one day and out within a week.”
Health insurance vs. health care
“We, like most people in the health care industry, are supportive of health care reform to make our system more inclusive and to put incentives in place to support quality and efficiency,” says Dan Neufelder, president and CEO of Affinity Health. “Having said that, health care reforms are really about health insurance reform now than they are about health care reform.”
“This is an insurance reform bill, not a health care reform bill, and that needs to be clearly delineated,” says Toussaint. “It will not change delivery of health care; it will only increase the number of Americans insured.”
“Instead of trying to reform health care, their priority was to insure the uninsured population,” says Rai. “My biggest concern is that the patient will be insured, but there will be nobody to see the patients.”
One issue that isn’t dealt with is getting more doctors to choose primary care over specialties.
“That’s an issue regardless of what happens in health care reform,” says Erwin. “That issue is already here. Clearly your specialists do make more money than primary care providers. That’s obviously an incentive to go into the specialties, so the focus should be on attracting people to become primary care providers.”
Erwin sees more use of physicians’ assistants, and efforts to keep soon-to-retire doctors in health care, possibly by allowing them to practice part-time. Erwin says a large number of doctors are nearing retirement age.
Even though the bill isn’t law, it already has had an impact on Northeast Wisconsin health care and insurance.
“We were looking at rolling out an individual [health insurance] product in the spring,” says Jenkins. “I don’t know that we’re going to be able to do that,” because “market reforms that allow you to operate in the individual market less expensively” will not happen until later this decade. “Right now we’re sitting on our business plan.”
What about Wisconsin?
The effects of Congress’ health care reform specifically on Wisconsin aren’t clear.
“I do not believe for the state of Wisconsin that proposed health care reforms are going to have a very great impact on this state,” says Neufelder. “We already have the second lowest rate of uninsured in the U.S., and our threshold levels to get into the Medicaid program are actually lower than the proposed thresholds in the Senate health care bill.”
“Medicaid expansion will be a benefit to the country, but we’ve already made a lot of progress in Wisconsin, so that won’t affect us that much,” says Erwin. “I think Wisconsin is pretty well positioned largely because of what we’ve done with Medicare already.”
“Wisconsin really loses, especially Northeast Wisconsin in this legislation,” says Rai, who cited two reasons in addition to Wisconsin’s low rate of uninsured. The legislation will result in “more taxes — the largest employers in our area are really small businesses at heart — so it’s taxes paying for the benefit of other states,” he says. Higher taxes would be acceptable if benefits came from those higher taxes, “and none of that’s in this bill. If anything, this bill hurts jobs in Northeast Wisconsin. Not that this is supposed to be a job-creator, but it shouldn’t be a job-killer.”
One major issue remains provider reimbursements for Medicaid, health care for poor people, and Medicare, health care for the elderly. Wisconsin reimbursements are 20 percent less than actual costs. “Those payment levels aren’t uniform across the U.S., and certainly parts of the country get paid more than others,” says Neufelder.