Regulations
The bills contain some essential elements in different forms. There are requirements for individuals to purchase health insurance, and requirements for companies of certain size — payment or gross revenues — to provide insurance or pay penalties. Both bills include unspecified basic-benefits packages — the House bill has four levels of coverage, from 65 percent of health care costs to 90 percent of costs. Preexisting-condition coverage exclusions are banned.
“There is significantly more regulatory stuff on insurance companies to meet certain of these new regulations,” says Toussaint.
“It’s interesting to me that Congress says we have to reduce health care costs, and then pile on layer upon layer of regulation that makes it impossible to reduce health care costs,” says Rai. “You can’t have your cake and eat it too; they have to pick one or the other. The health care systems are more than able to find a solution if they’re allowed to find a solution.”
To cut, or not
Congress voted several years ago to cut Medicare to balance the federal budget, but each year Congress has voted to rescind the cuts, Toussaint says. Medicare cuts are in the health care bills, he says, “but it’s only one year, and then we’re right back to the same problem in 2011.”
An estimated $250 billion is “the difference between if these cuts actually go through the next 10 years vs. if they rescind them,” he says.
On the other hand, cutting either program will result in higher costs to patients and less reimbursement for doctors.
“Our goal was essentially to end Medicare reimbursement as it exists today,” says Roller. “That would require us to have a lot of political muscle, which we don’t have today.”
Rai is concerned about how Medicare cuts will affect the elderly: “How we help them understanding increasing cost burdens or less services they’ll face is extremely important to health care leaders in Northeast Wisconsin.”
One positive aspect of the health care reform bills is the Accountable Care Organization pilot project, which Roller says provides “an avenue for us to pursue reassessing the true value of integration” as a health care system.”
“It finally takes a look at how care is reimbursed,” says Michael Brophy, Aurora vice president and chief communications officer, “reimbursement based on quality and value rather than on procedures.”
“It’s exciting to me, especially in Northeast Wisconsin, where we do try to coordinate care as much as possible,” says Rai. “Unfortunately, they’re only in pilot language.”
The cloudy future
Whatever Congress passes will affect businesses and individuals, but to what extent and in what ways it will affect them is unclear.
“There is a huge amount of work that has to be done with HHS,” the U.S. Department of Health and Human Services, says Toussaint.
On the other hand, says Neufelder, “I suspect this will not be the last time we talk about health care reform on a national basis.”
“I’m a capitalist, not a socialist, so I believe that if we create a marketplace that’s functional, we’ll have the highest delivery at the lowest cost,” says Toussaint. “If thoughtful people in Washington are actually willing to listen to those of us who have been there, this could actually work out.”