MMA Viewpoint
Weighing Reform
January showed that you can never be too certain about politics. Early in the month, details of the federal health care reform plan were coming into focus, and it looked as if Congress was only a few weeks away from passing a bill. Then the country received a Massachusetts surprise. Now, the direction of reform is far from certain.
As Congress re-evaluated its options, your MMA Board of Trustees evaluated the proposed legislation as well as the pros and cons of taking a formal position on national reform. To find out how members felt about the bills coming out of the House and Senate, MMA President Benjamin Whitten, M.D., and I emailed a survey to members mid-month. About two-thirds of those who responded said the MMA should take a position on federal reform. But they were evenly split on whether we should support or oppose the Senate and House proposals. Opponents said the proposals lacked significant tort reform, were too costly, and were an expansion of government that would result in unfunded mandates and inadequate reimbursements. Those in favor of the bills noted that they promised to provide millions of Americans with health coverage and curb insurance industry practices that deny people coverage when they need it most. Supporters saw this as a rare opportunity to fix a broken system.
Without clear direction from members, the Board looked to existing MMA policy to point the way. In many ways, it is remarkable how much of our Physician’s Plan for a Healthy Minnesota can be seen in the federal proposals.
Our plan calls for health coverage for all Minnesotans, using an approach that combines private insurance, government programs, and subsidies. The Senate bill would expand health care coverage to approximately 30 million uninsured Americans through insurance reforms, use of an insurance exchange, and expanded Medicaid eligibility. The MMA’s plan calls for an individual insurance mandate coupled with a reformed insurance market. The Senate bill includes an individual mandate but retains a role for employers to provide coverage. The House and Senate bills would prohibit insurers from denying coverage to those with pre-existing conditions and require them to spend 80 to 85 percent of premiums on nonadministrative costs.
Our plan calls for a strong public health system, an emphasis on disease prevention, public reporting on cost and quality, and a payment system that reimburses clinicians for not only responding to diseases but also for managing and preventing them. The federal proposals include additional public health spending and initiatives to establish medical home pilots and payment reforms that reward physicians for providing high-quality, low-cost care.
We asked ourselves whether Minnesota would benefit from the proposed legislation. The answer is yes. The Medicaid expansions outlined in the bills would save our state as much as $500 million. One provision in the Senate bill allows states to access federal dollars as early as April 2010, which would provide up to $250 million for Minnesotans covered by GAMC. A House provision would improve Minnesota’s notoriously low Medical Assistance payments by raising them to Medicare payment levels for primary care providers by 2012.
Clearly, some provisions in the federal bills are consistent with MMA policy and would benefit Minnesota. At its January 23 meeting, the Board came to a consensus that reform should move forward. Given the diverse views of MMA members, however, it decided not to take a position on either bill at this time. Instead, Board members agreed that the MMA should continue advocating for provisions consistent with its reform vision. Although this may disappoint some, it allows us to push for portions of the federal bills that are in the best interest of physicians and their patients.