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Health Reform – Getting over the finish line

It’s looking more and more like Congress may actually act on health reform in the few weeks. The first vote in the House will be the hardest. If the House passes the Senate bill, what remains will be a simple up or down vote in the Senate on a series of amendments that would give more Medicaid money to the states, get rid of any special treatment for any state (read Nebraska), improve subsidies for families to buy coverage, and toughen regulations on the insurance industry. With the President making the case for quick action again yesterday, a look at just a few of the things reform will actually do for North Carolinians is worthwhile:

1. It will give people the security and peace of mind to know that they won’t lose their health insurance just because they lose or change their job.

2. Insurers will be prohibited from denying health coverage or charging more for pre-existing conditions – immediately for children and over time for adults as the health insurance exchanges get up and running.

3. Many small businesses will immediately get substantial tax credits – for up to half the cost – to enable them to start providing health coverage to their workers.

4. The so-called “doughnut hole” gap in Medicare drug coverage will be eliminated.

5. Parents will be able to immediately keep their kids on their own family insurance plan up until age 26.

Just as important, reform will start the changes we need to bring costs under control. In addition to reducing the federal deficit by over $100 billion over the next ten years according to the Congressional Budget Office, reform contains the critical changes we need to lower health costs. First, as this article [1] in the New England Journal of Medicine this week explains, the reform bill sets up series of pilot projects in Medicare to assess how different ways of paying providers can save billions of dollars. The authors cite one method tested already by Medicare of paying doctors and hospitals a global fee for taking care of a heart patient – this project showed immediate savings and is the kind of change that, once tested, can be implemented across our health system to save substantial amounts of money and improve care.

In addition, Medicare is made much more efficient by reducing overpayments to private insurers and streamlining the way Medicare pays for care. The savings from these efficiencies are half plowed back into Medicare itself, reducing costs for preventive services and helping close the drug “doughnut hole” gap. In addition, reform bills set up a center to compare treatments and figure out which ones work and are worth paying for, encourage state innovation in malpractice reform changes, and put a new emphasis on prevention and coordination of care.

Special interests can’t be allowed to get in the way of the care and cost savings so many North Carolinians need. I’m very optimistic that we are finally on the reform home stretch.