The new health care
law is already transforming the way care is delivered, and the
changes will continue regardless of how the Supreme Court rules on the
mandate for most Americans to carry health
insurance, a Democratic senator and an Obama administration official
said Tuesday.
The comments by the senator, Sheldon Whitehouse of
Rhode Island, and the official, Dr. Richard J. Gilfillan, director of the
federal Center for
Medicare and Medicaid Innovation, indicated how Democrats were
preparing for a Supreme Court ruling on the 2010 law. The law, which President Obama pushed
through Congress on a party-line vote, promises to be a salient issue in
elections for the White House and Congress this year.
Mr. Whitehouse said “there is
no link, no link whatsoever,” between the insurance mandate and the work of Dr.
Gilfillan’s agency, which promotes innovations in Medicare and Medicaid.
“The delivery system reforms
will survive, and we should not be stalling and dawdling because we are anxious
about what the court will do,” Mr. Whitehouse said at a forum held by the Center for
American Progress, a research and advocacy group with close ties to
the White House. “We don’t have that luxury, and I don’t think it’s a genuine
risk.”
Dr. Gilfillan said, “We are
confident that the law will be upheld” by the court. But in any event, he said,
“the marketplace is boiling with new ideas, new opportunities,” and the private
sector is seizing the opportunities.
Increasingly, Dr. Gilfillan
said, private insurers are embracing ideas that Congress authorized for
Medicare, like coordinating care, rewarding providers who deliver superior care
and penalizing those who subject patients to needless risks.
As an example, Dr. Gilfillan
cited a recent announcement by Wellmark Blue Cross and Blue Shield of Iowa and
the Iowa Health System that they would team up to form an accountable care organization,
intended to coordinate care and hold down costs. This collaboration is not for
Medicare patients, but for 25,000 people with group or individual coverage
provided by Wellmark.
Dr. Gilfillan and Senator
Whitehouse said other changes in the delivery and financing of health care were
gaining momentum. These include paying a fixed amount to doctors and hospitals
for a bundle of services, rather than a separate fee for each service;
designating a “medical home” with a primary care doctor to coordinate services
for each patient; and imposing financial penalties on hospitals with large
numbers of patients who are readmitted within a few weeks after they are
discharged.
Mr. Whitehouse said these
efforts could be contributing to a slowdown in the growth of health spending,
first observed during the recent recession.
Dr. Gilfillan said “there is
too much work going on for it not to be having some effect.”
But, recalling how the growth
of health costs seemed to slow when President Bill Clinton tried to remake the
health care system, Dr. Gilfillan said: “We saw this in the 1990s, a pause and
then bang up again. We don’t want to relax.”
Republicans said the changes
described by Dr. Gilfillan could speed the consolidation of hospitals,
physician groups and other health care providers, increasing their ability to
charge higher prices to patients and insurers.
The new law “scrambles the
economics of America’s health care system in a way that reduces competition,”
said Representative Lamar Smith, Republican of Texas and chairman of the House
Judiciary Committee. He and other Republicans cited that as a reason for trying
to repeal the law.
No comments:
Post a Comment