What Health Reform Will Actually Achieve

We here at the From Poverty To Opportunity Campaign believe that accessible affordable health care is a human right that should be afforded to every man, woman, and child. This country is at a crucial turning point in which, with the proper health care reform, this needed human right can finally be achieved. Pulling from extensive knowledge of providing health care services throughout Chicago, Heartland Alliance has developed 11 key principles that need to be included in any health care reform for it to have an actual, meaningful effect on the people of this country.

Given the expansive scope of health reform, 1,000 page reform bills and media focus on specific aspects of health care reform, it can be immensely difficult to determine what health care reform will actually accomplish.

Thankfully, the good folks over at the Henry J. Kaiser Family Foundation have analyzed all of the major health care reform proposals and provided a side-by-side comparison of each one. Below is an analysis of the House Tri-Committee Proposed Plan, The Senate Finance Committee's Proposed Plan and the Senate HELP Committee's Proposed Plan as compared to three of our key principals. Those three principles: health coverage for everyone, prevention and wellness services and expanded primary care are key components in realizing health care as a human right.

Coverage For Everybody

All three of the bills propose to expand health care coverage by lowering eligibility requirements for Medicaid and offering health care subsidies for individuals and families who otherwise could not afford coverage.

The Senate HELP Committee's plan expands Medicaid to families who make up to 150% of the Federal Poverty Line (FPL), The House Tri-Committee's plan expands it to 133% and the Senate Finance Committee increases coverage to families up to 115% of the FPL.

This initiative is important because Medicaid does not currently cover everybody. According to Families USA 43 states do not provide Medicaid for low-income childless individuals, and only 16 states provide the program to individuals who live up to 100% of the FPL. Simply decreasing eligibility requirements could provide coverage to 17 million more citizens.

Each of the three bills would provide subsidies for individuals and families who make below 400% of the FPL. Currently, families who are ineligible for either Medicare or Medicaid receive no assistance from the government to purchase health insurance. This reform would aid this very population.

Prevention and Wellness

Each of the three bills plan to bolster prevention and wellness by providing incentives for health care providers to administer more preventative services while also increasing the amount of professionals who provide these services.

Primary care providers are the most effective at administering preventative treatments. Unfortunately, payment for Medicaid services is usually slow in coming, overly-complicated, and does not match the cost of services provided. This, combined with a lack of regulations forcing doctors to treat Medicare patients has created massive disincentives to treating Medicare clients. The House Tri-Committee's plan would fix this by increasing Medicaid payment rates to 100% of Medicare rates and providing bonuses for primary care practitioners.

The Senate Finance Committee's plan is more patient-based, with a focus on providing incentives to individuals, business' and states to provide and participate in prevention and wellness programs. Medicaid and Medicare recipients would receive "rewards" for completing behavior modification programs. Small businesses would receive grants for implementing wellness programs, while states would get grants to implement innovative wellness programs

The Senate HELP Committee's bill requires hospitals to report preventable readmission rates; hospitals with high re-admission rates will be required to work with local patient safety organizations to improve their rates. It also requires health insurers to provide financial incentives to providers to better coordinate care through chronic disease management.

Primary Care/Primary Care Workforce Development

Due to the increasing pay rates of specialty care, the USA is on the verge of a Primary Care Provider Shortage, that is only going to get worse. Primary care providers play a key role in providing holistic services that prevent chronic sickness and disease; therefore it is important to increase this dwindling population. Each of the health reform bills has specific language that addresses this shortage.

The Tri-House Committee and the Senate HELP Committee propose to reform the sustainable growth rate for physicians, with incentive payments for primary care services and for services in efficient areas while also reforming Graduate Medical Education to increase training of primary care providers by redistributing residency positions and promote training in outpatient settings and support the development of primary care training programs.

The Senate Finance Committee's proposal would provide bonus payments to certain primary care providers and providing reimbursements for certain care management activities for patients with hospital stays related to a major chronic condition.

Where We Go From Here

Although these health reform bills are on the table, consensus on what this health reform will actually look like is far from definitive. If these three bills are any indication, the reformation of this countries health care system would increasingly coincide with Heartland Alliance's principles for realizing health care as a human right. However, until the Senate, Congress and President agree upon reform and sign it into law, nothing is certain and nothing is guaranteed. It is important to continue the fight for health care as a human right. If you believe that health care needs to be reformed, let your voice be heard!