What a difference a few months makes when it comes to healthcare reform.
President Obama has made reforming the country’s swelling $2.5 trillion healthcare system one of the top priorities in his first term, arguing that fixing the system is critical to long-term economic health.
But hopes for a quick fix have faded in the wake of continued anxiety about the still-soft economy as well as the loss of a Senate seat last month that cost Democrats a 60-vote “supermajority” that would break procedural hurdles toward passing a bill.
In January fiscally conservative Republican Scott Brown won a special election to fill the seat of the late Democratic Sen. Edward Kennedy in Massachusetts. Brown made opposition to Obama’s healthcare reform a key hallmark of his campaign.
He has help from conflicts within the Democratic Party.
Majority Democrats in the House and Senate have passed different versions of laws that aim to expand access to health insurance for millions of Americans, but they haven’t been able to reach agreement on a final bill.
Brown recently said on ABC News’ “This Week” program that he believes the entire healthcare reform deal that’s now before Congress should be scrapped and called for going “back to the drawing board and (doing) it in a transparent, bipartisan manner.”
The healthcare overhaul could cost $1 trillion over 10 years and will impose new obligations on Orange County residents and businesses.
Elements that could be in any bill include requiring Americans to buy health insurance, helping people who can’t afford to buy it and obliging most large and many small businesses to contribute to healthcare costs for their workers.
In addition, health insurers would be banned from charging more or declining to cover people because of their medical histories.
But it appears that some elements, such as a government-run “public option” plan, won’t be in any final healthcare bill, if there is one at all.
Some members of the House had insisted on including a public option to compete against health insurers. But that proposal was called a “government takeover” by minority Republicans in both houses and ran into loud opposition at town hall meetings.
And other analysts said that the focus on the public option, which wasn’t included in the final Senate bill, diverted attention from core concerns such as affordability and added to the delay in passing healthcare reform.
Pushback also appeared from other fronts.
Health insurers are pouring lobbying dollars into fighting sweeping changes. And even Democrats were arguing among themselves on how to pay for the bill.
Business Journal healthcare reporter Vita Reed asked a sampling of OC hospital executives to share their thoughts on what now becomes of healthcare reform in the midst of the changing landscape of the Senate and with midterm elections coming up later in the year.
An edited version of their answers follows.
Do you expect some sort of healthcare reform to pass this year?
Richard Afable
Chief Executive
Hoag Memorial Hospital Presbyterian, Newport Beach
Yes, I expect a much more focused and “toned down” healthcare reform package will be enacted by the end of the session in August. I wouldn’t expect work on this until late spring or summer. The emotion and heat from the general public needs to dissipate before the politicians will take this on once again.
Barry Arbuckle
President and Chief Executive
MemorialCare Health System, Fountain Valley
With all the controversy, it would be easy for lawmakers to abandon health reform and move to another issue. But elected officials cannot turn their backs on the most basic human need: access to quality healthcare for all Americans.
While it is unlikely current Congressional versions will pass, expect a series of bills debated on less comprehensive elements of the President’s plan. Debate is changing daily, even hourly.
Marcia Manker
Chief Executive
Orange Coast Memorial Medical Center, Fountain Valley
While current Con-gressional plans re-main in peril, too much is at risk to place reform on the back burner. Communities are experiencing a health delivery system moving from the critical list to life support. Hospitals struggle to survive while paramedics search for available emergency rooms. Businesses are reducing or eliminating benefits to stay afloat, and patients are postponing care until conditions turn into chronic, debilitating diseases.
Congress must act soon.
Deborah Proctor
Chief Executive
St. Joseph Health System, Orange
At this point, it’s still too early to say whether (reform) will pass this year. Recent events, particularly the Massachusetts election, have provided us with a glimpse of the dynamics that Congress is facing in an election year. Once the dust settles, I think we will have a better idea of whether or not healthcare reform will move forward from this point.
Nevertheless, we will be disappointed if healthcare reform is once again pushed to the background. The need for reform remains urgent and compelling with the need particularly around the issue of securing healthcare for the poor and uninsured.
But that is only one step. Step two is recognizing that today our system is focused on illness, which costs each of us personally in our health and has a great financial burden with it. We need a system that focuses on both wellness and illness.
Let’s provide access to preventive care as well as hospital care. Let’s ensure that people receive the right care at the right time from the right provider.
If some sort of reform does pass, what would you expect to see in it?
Afable
I expect to see elements that are gen-
erally agreeable to most stakeholders. Examples include insuring some part of the 40 million uninsured through an expansion of Medicaid (Medi-Cal in California), guaranteed issue regardless of underlying condition and portability of insurance between employers.
We still expect significant reductions to payment for governmental-sponsored services. We thought this would be the means to pay for healthcare reform. Now, it looks like this will merely be a deficit reduction activity, not specifically tied to healthcare reform. We also expect pay-for-performance, transparency and quality of care activities to be incrementally adopted into payment changes during the next three years.
Arbuckle
The reform package should include tax credits for businesses that allow them to more affordably offer benefits to more workers. Another element may be incentives for healthcare providers to improve quality and safety. We could also see relaxation of regulations that will allow hospitals and physicians to work closely together to improve patient care and decrease costs while sharing in the savings that result from these efforts.
Manker
Universal coverage requires universal responsibility for financing, utilization and delivery shared by employers, individuals, government, health plans, providers, physicians and patients. Everyone must understand the business of healthcare, create reforms covering the uninsured, protect long-term stability of providers, safeguard access to care and improve how healthcare is delivered.
Red tape, administrative requirements and barriers to government programs and private coverage must be minimized.
Proctor
Until we see what will happen in the coming weeks, it’s just a guessing game. There are still many twists and turns on such a complex issue and we will have to see how it all plays out. But our hope is that expansion of coverage will be in the final reform proposals.
We would also like to see strong actions that promote wellness, rather than just “sick care.”
Do you now expect reform to be scaled back?
Manker
Scaling back certainly represents the easier path. But when you concentrate on simple wins, everyone potentially loses. Without a comprehensive package, millions of Americans remain uninsured or underinsured and turn to costly care, like emergency rooms, for their most basic needs. Any reform package needs to consider how to create affordable healthcare for all income levels, which may require subsidies and further competition in the marketplace.
Proctor
There are many proposals for scaling back the reform. Analysts have projected for some time that we could end up with only an insurance reform bill, not a healthcare delivery reform. While we would hate to lose the momentum around covering the uninsured, it would not help to flood the current system with millions of new patients.
If reform is scaled back to simply cut Medicare and Medicaid reimbursement, both patients and healthcare providers will be burdened.
How would a change in reform affect your operations?
Arbuckle
In anticipation of continued reduced reimbursement, growing numbers of
uninsured and increased demand for
our services, MemorialCare Health System engages our 10,000 employees, 3,500 physicians and our volunteer leader-
ship to identify more efficient ways to reduce costs in every department.
We are working with countless busin-esses and community groups to advocate for comprehensive health reform, in-
crease prevention efforts, expand affordable education for tomorrow’s clinicians, encourage patients and providers to contain costs, improve medical outcomes and ensure all Americans can access quality healthcare.
Manker
Despite challenging economic times, we remain committed to being a leader in innovation and advanced patient care. This is evident with our new patient care pavilion that offers services unavailable in other facilities.
We are also completing our electronic medical record system. This translates into improvements in safety, clinical outcome, quality and satisfaction for patients and better efficiency, accuracy and productivity for physicians and staff that can easily and immediately retrieve comprehensive, computerized patient information.
Proctor
Clearly, we don’t have an answer for this until we know what the reform includes. But it will not significantly change our operations.
St. Joseph Health System will continue to focus on meeting both the wellness and sick care needs in our communities. We will work with other providers in the county to make sure that those in our communities who are most in need are provided access to care. That is the essence of our mission as a Catholic health system.
However, having said that, we do worry that the hospital system in this country will crack under the excessive load of charity care and uncompensated care now being borne by community hospitals. If the status quo persists, we will continue to see hospital and clinic closures across the country.
