AAMC Reporter: January 2009
Despite Economy, Health Care Reform Still a Priority for President,
Congress
Health care reform may slowly be moving from theory
to reality in Washington as the Obama administration enters the
White House and a new Congress settles in on Capitol Hill.
Even as the persistently sour economy tempers expectations,
proposals for major changes on several fronts of health care policy—including
areas of particular importance to medical schools and teaching hospitals—are
or could be in play over the coming weeks and months.
President-elect Barack Obama has repeatedly made
clear his desire for health care reform. Another signal of Obama's
intentions came in November when he selected former Democratic senator
and vocal reform advocate Tom Daschle to lead the U.S. Department
of Health and Human Services and a newly created White House Office
of Health Reform. Both lawmakers support sweeping health care initiatives,
including the creation of new federal entities that would set standards
for all federal health programs and create a nationwide marketplace
in which Americans could easily compare and purchase health insurance
plans. Critics charge that the measures are too costly and would
result in undesirable government expansion.
In a sign that congressional leaders may be ready
to walk in step with the new administration, prominent senators
such as Edward Kennedy (D-Mass.) have signaled that health care
is a high priority for the next congressional session. Sen. Max
Baucus (D-Mont.) released a detailed health reform plan containing
many of the same ideas supported by Obama and Daschle.
"The economy dwarfs every other issue, but health
care is still important," said Ross Frommer, deputy vice 4
AAMC January 2009 president for government and community affairs
at Columbia University College of Physicians and Surgeons. "Health
care will be looked at through the lens of the bad economy, but
even so, it is still on the agenda of President-elect Obama and
the House and Senate."
It may be a long time before debate begins in earnest
on the largest planks in Obama's health platform, but in the meantime,
plenty could be accomplished more gradually.
"My hope is that any incremental approach takes
into account both the challenges to practical implementation, the
cost to the taxpayer, and the impact on providers," said Atul
Grover, M.D., AAMC director of government relations. "The question
is, will incremental changes add up to what we want the health care
system to look like 10 years from now?"
Many health policy experts agree that Obama and the
new Congress will make changes soon after taking office. Chief among
these could be a reversal of President Bush's executive order banning
federal funding for embryonic stem cell research, and a reauthorization
of the State Children's Health Insurance Program (SCHIP), which
provides billions of dollars to states to cover uninsured children.
President Bush twice vetoed SCHIP reauthorizations after Congress
approved the measures.
Some experts speculated that the National Institutes
of Health (NIH) might see a significant budget increase after six
years of relatively flat funding. Last year, House and Senate versions
of the appropriations bill that funds NIH included $1 billion in
extra funding for the agency, before ultimately being rejected.
Last fall's economic stimulus package included $150 million for
NIH and $250 million for other research agencies, and congressional
leaders now want to include $1 billion for NIH in a second stimulus
package.
"We have our best opportunity in a number of
years for a major addition to the NIH budget," Frommer said.
"The NIH has been in the debate on the new stimulus package,
which may be dealt with as soon as the first few days after Obama
takes office. That would be a real shot in the arm. So there is
real recognition that NIH and research funding is important."
"As it
is, physicians are generally paid to do more, not do better. So
how do we figure out a payment system that rewards physicians for
doing the right thing while not eliminating important services?"—Atul
Grover, M.D., AAMC director of government relations
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Another encouraging sign for medical educators is
a recommendation from Baucus to address a widely predicted physician
workforce shortage.
"America's current system undervalues primary
care relative to specialty care," Baucus wrote in his plan,
titled "Call to Action: Health Reform 2009." "Increasing
the supply of primary care practitioners and redefining their role
in the health system—by using federal reimbursement systems
and other means to improve the value placed on their work—is
a necessary step toward meaningful reform."
Other aspects of health care reform are less certain.
The Sustainable Growth Rate (SGR), the federal methodology used
to calculate Medicare payments to physicians, is in dire need of
overhaul, critics say, in order to avoid massive payment cuts of
10 percent or more. In previous years, the payment cut has been
temporarily avoided through piecemeal legislation. A longer-term
resolution could be costly.
"Physician payment policies have to be fixed,"
Grover said. "At a minimum, we have to sustain payments under
the SGR, but to fix it over the long term would have a $200 billion
to $250 billion price tag."
A retooling of the physician payment system as a whole
could also be in the works.
"We'll start to see changes that reward quality
in the Medicare incentive system," Grover said. "As it
is, physicians are generally paid to do more, not do better. So
how do we figure out a payment system that rewards physicians for
doing the right thing while not eliminating important services?"
Proposals to spur development of health information
technology are already wending their way through Congress. Health
policy experts welcome health IT legislation, but caution that privacy
controls in the bills may be imperfect.
"Everybody agrees that we need an IT infrastructure
that is interoperable and allows information to flow freely,"
Grover said. "However, the proposed legislation is overburdened
with requirements on researchers and others who want to use that
information to improve the quality of care. We need some flexibility."
The AAMC has shared its "Principles for Health
Care Reform" document, along with several issue briefs on matters
of importance to academic medicine, with the president-elect's transition
team.
—By Scott Harris
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