Federal health care reform is starting a new chapter in Michigan. Beginning tomorrow, enrollment will open for the new high risk pool for those with pre-existing conditions who have been uninsured six months. Coverage will be effective Oct. 1.
This component of the health care reform law got off to a rocky start when the Michigan Legislature failed to approve the expenditure of the federal funds for the high risk pool. The federal government had to step in and make alternate arrangements.
Health care reform implementation merits ongoing and careful thought and planning by policymakers, with input and monitoring by consumers, to ensure the best possible outcome for all of us.
The Michigan League for Human Services developed a set of health reform principles in 1994 that are still relevant today and can serve as a good resource.
They provide a good road map for navigating many upcoming implementation issues including:
- The critical importance of a comprehensive package of benefits for those newly eligible for Medicaid (there is an option to provide a lesser package of benefits) as well as for those who purchase coverage through the Health Insurance Exchange (the “Expedia” of private insurance options). A comprehensive package would include the full range of mental and physical health services, as well as dental and substance abuse services.
- Adequate state regulatory and monitoring resources to ensure mandates are implemented timely and effectively, and that there are strong enforceable consumer protections.
- Availability of access to quality care both geographically and culturally. There are many opportunities in the law to expand or promote primary care.
- Reasonable and adequate provider payment rates in public programs to ensure that current and newly eligible persons have access to care and not just a card.
- An increase in the meaningful and cost-effective use of health information technology.
- Promotion of quality, not quantity, of care through incentives or payments for outcomes, or other payment reforms for providers; and quality consumer education to help guide treatment decisions.
- A priority for funding prevention and wellness options included, but not funded, in the law.
- Development of effective cost containment strategies that maintain or improve quality care and are not simply code words for cuts in programs or services.
Additional food for thought is provided by the State Consortium on Health Care Reform Implementation in a State Health Policy Briefing. This brief describes 10 aspects of federal health reform that states must get right if they are to be successful in implementation.
The group’s top priorities include:
1. Be strategic with insurance exchange
2. Regulate the commercial health insurance market effectively
3. Simplify and integrate eligibility systems
4. Expand provider and health system capacity
5. Attend to benefit design
6. Focus on the dually eligible
7. Use your data
8. Pursue population health goals
9. Engage the public in policy development and implementation
10. Demand quality and efficiency from the health care system.
(The State Consortium on Health Care Reform Implementation is a collaboration among the National Governors Association, the National Academy for State Health Policy, the National Association of Insurance Commissioners, and the National Association of State Medicaid Directors.)
There have been and will continue to be numerous opportunities for comment as federal regulations are developed and finalized. The federal government has established a website where you can readily view the regulations for which comments are being accepted. You are encouraged to take advantage of these opportunities and let your voice be heard in this historic process.
It will take ongoing vigilance to ensure the best implemenation for all.
— Jan Hudson