St. Louis – Despite a spirited discussion of the pros and cons of the new Affordable Care Act (ACA) at a St. Louis Business Journal hosted seminar, Health Reform: The Impact of the Supreme Court Decision, a single concluding statement that drew the largest applause was a surprising summary: “It’s time to use the new law as the impetus to make major changes in our health care delivery systems to improve quality and reduce costs, because if we don’t, we’ll face the same problems in 50 years only the solutions will be so much more difficult.”
The seminar, held July 25 at the Missouri Botanical Garden, drew a standing room only crowd of over 500 businessmen, health care professionals and providers, labor unions, non-profit groups, insurance companies and real estate executives to hear a panel of experts talk about the implementation and impact of the new law. The Missouri Foundation for Health (MFH) sponsored the program.
Several conclusions can be drawn from the wide-ranging panel responses to audience questions:
• The reticent approach of the conservative Republicans in the Missouri Legislature to implement key provision of the new health care law is shortchanging residents, especially the poor and the unemployed middle class. As a result, the state faces the loss of more than $8 BILLION in federal health care funding.
• While the issue of expanding state Medicaid for the poor is left to the states, “It makes no sense for a state to turn its back on the expansion,” said Tom McAuliffe, a policy analyst for MFH. (The Republican-controlled Missouri legislature has said it will NOT follow that aspect of the federal law.) Given that now the federal government pays 60 percent of the state’s Medicaid costs and that under the new law, for the first two years they will pay 100 percent of the costs, 95 percent the next two years and 90 percent after that, Missouri stands to lose $8 Billion, McAuliffe said.
“If Missouri doesn’t expand its Medicaid program (and get the federal dollars for it), the potential for reducing health care premiums here is less likely” because the cost of treating the poor will be passed on to everyone with a health care policy through their insurance companies.”
OUR TAX $$ - GONE
Program facilitator Mary Joe Condon, a senior director of the St. Louis Business Health Coalition, stressed that if Missouri fails to act, “Missouri tax dollars will go to help finance health care elsewhere.”
• The new law will put doctors more in charge of their patients health care decisions which will improve care and, based on the incentives in the new law, will help them drive down costs.
• The law places a major emphasis on preventative care vs. emergency care, and long-term that will definitely drive down costs. Simpson pointed out that’s because too many people today don’t know how to get access to health care, thus they use the emergency rooms which is expensive.
• Technology will help drive down costs if everyone participates in developing the systems needed. Billions in the recent stimulus program went to help do just that.
• Many employers will consider moving away from a defined plan they have now to one where a specific amount is set aside per employee for health care and the employee makes the choices of where and when to get services. This approach was likened to a 401(k) plan for retirement instead of a defined benefit pension plan.
• For those states that do not set up the Insurance Exchanges required in the law to allow people to shop around for the best care and financial deal, the federal government will set one up for them. The Missouri legislature, again behind the curve, has said it will not set up a state exchange.
“There should be coverage across state lines,” said Dr. Johnetta Craig, medical director for the Family Care Health Centers here. A major round of applause in agreement.
NOT EASY IMPLEMENTATION
• Implementation of the new federal law is not going to be easy because too many organizations did not think the Supreme Court would uphold the law, thus they are way behind in preparing themselves. A survey by Mercer Consulting found that only 44 percent of large companies began planning even before the court’s decision; some 40 percent said they would wait until after the November elections.
• A recent poll by MFH showed that the majority of respondents disliked the law overall, but when discussions began about the “content” of the law, the majority actually approved of its benefits.
• There are already more than 50 health care systems across America using a new Accountable Care Organization (ACO) model for providing health care and are not only dramatically cutting costs, but they are providing better outcomes for patients. (ACOs provide coordinated health care under one umbrella by integrating primary care doctors, specialists, hospitals, labs and other health care services. Health care professionals in these groups receive monetary rewards from Medicare if they meet certain cost and care goals. A senior health care policy analyst for Consumers Union said ACOs should help patients by providing a more collaborative approach to health care.)
“Missouri is already behind the curve,” said Tim Simpson, principal, Mercer. “It should decide now” to consider these new approaches.
“The ACO’s are able to focus on preventative care as opposed to taking care of sick people which is far more expensive,” added Bill Hill, CEO of Visor, Inc., a full-service employee benefit consulting firm specializing in employee communication and education.