MMA Viewpoint
Litmus for Reform
Since the passage of national health care reform, I’ve heard plenty of opinions and reactions from colleagues ranging from celebration to confusion, consternation, and even castigation. But the aspect of reform that I’m most interested in is, what’s in it for my patients?
As a family physician, I find it hard to settle on a single answer. I see patients with acute and chronic conditions, patients covered by public and private insurance, and patients without coverage at all. What I do know is that the most significant changes will not come until 2014. At that time, nearly all of my patients will finally have reliable health insurance coverage: Approximately 260,000 more Minnesotans will become eligible for Medical Assistance, and approximately 1.4 million others will receive financial subsidies to purchase private coverage. I look forward to having conversations with my patients about their best care options, rather than whether care is an option.
Between now and 2014, a variety of other changes are in store. Many of my patients have children who are in college or between jobs or education plans. The new law will make it easier for young adults up to 26 years of age to retain coverage as dependents—a simple yet helpful change. For my patients with serious, complex, or chronic conditions, the law immediately removes any lifetime dollar limits on their insurance coverage. A small change, but a critical one for these seriously ill individuals.
Preventive services gain some much-needed respect under the new law. Starting this year, all insurers must provide full coverage (without cost-sharing such as copays) for a range of preventive services. Even Medicare is on board with expanded coverage for preventive care beginning in 2011.
For many Medicare patients who need expensive prescription drugs, the Part D “donut hole” will begin to shrink. Under the new law, patients falling into Medicare’s prescription coverage gap will get a $250 rebate in 2010; in 2011 they will receive a 50 percent discount on brand-name drugs purchased out of pocket, and by 2020, there will be additional brand-name discounts and generic subsidies. This should help my patients obtain the medications they need. A Kaiser Family Foundation study has found that about 15 percent of individuals whose drug costs put them in the donut hole stop taking their medications altogether.
Many of my colleagues and I are looking forward to adopting the medical home model in our practices as a way to deliver more patient-centered, coordinated care. The federal reform law could further advance the work already being done in Minnesota by increasing the federal share of payments for care coordination provided by health care homes, thereby easing the burden on the state’s budget. The law also opens up the possibility of Minnesota securing funding as part of a demonstration project to include Medicare enrollees in its health care home initiative.
I do see some potential benefits of the new reform legislation for patients in Minnesota. But the scary part is what’s unknown; and in this case, the unknown is how the details of the law will be implemented. We as doctors need to join together to shape the implementation of this law so that in the end it really does help create a better health care system for our patients.