Health Reform Unraveled: A Health Professional’s Perspective

Last week, Congress passed arguably the most comprehensive health legislation since Medicare. After over a year of passionate debate (and nearly a 100 years in the making), the bill was signed into law. Though not a perfect bill, far from it for many, the legislation establishes a fundamental social precedent where we as a society have decided that basic access to health care is a right and not a privilege. Unfortunately, the political rhetoric has overshadowed many of the benefits in the new law and with it has created large amounts of misinformation. I would like to take the next few paragraphs to explain just a few of the benefits.

The major Pillars of the law (the individual mandate, health insurance exchanges, tax subsidies for individuals, and Medicaid expansion) don’t activate for a number of years, but there are numerous provisions that go into effect much sooner. As soon as the President’s pen(s) signed the bill, small businesses with less than 25 employees became eligible for a 35% tax credit to offer their employees health insurance and seniors in the dreaded Medicare Part D ‘doughnut hole’ became eligible for a rebate to help pay for the costs of prescription drugs. Effective immediately are also a number of new funding streams to improve access to care like appropriations for nurse-managed health clinics ($50 million annually) and the National Health Service Corps (increasing from $320 million annually), and funding to encourage investment in therapies to prevent, diagnose and treat chronic disease ($1 billion over two years). In addition, nearly $500 million will be awarded to the Cure Acceleration Network to pursue many high-need cures with $35 million appropriated annually for mental/behavioral health education and training. The law makes an immediate investment in public health with appropriations for fellowship training grants in the field ($40 million annually) and the creation of the Prevention and Public Health Fund, dedicating $500 million annually (eventually increasing to $2 billion) to expand and sustain public health and prevention programs.

In September, health insurance companies will be forever banned from detrimental actions like dropping coverage for individuals who get sick, denying coverage to children with pre-existing conditions, and placing lifetime and restrictive annual caps on health insurance coverage. New private plans will also be required to cover preventive services and children will be able to stay on their parents’ insurance until their 26th birthday.

In January, primary care physicians will be eligible for a 10% bonus payment in Medicare, new funds will be available for community health centers (increasing from $1 billion annually), and health insurers will be required to cover tobacco cessation programs for pregnant women. Chain restaurants and vending machines will be required to display nutrition information (calories, grams of fat, grams of sodium) with each item, which will begin to help foster a more widespread discussion and strategy regarding the obesity epidemic. The New Year will also produce a $200 million grant program for small businesses to initiate wellness programs, further strengthening a newfound investment in prevention and lifestyle improvement.

These are just a few of the short-term benefits from one health professional’s perspective. No doubt, I take issue with a number of disconcerting provisions such as some of the revenue streams (taxes) as well as cost-containment methods that attempt to address the uncontrolled growth in health care costs. Long-term endeavors to slow the rate of health spending in public and private programs will be needed in order to maintain America’s competitiveness in the global marketplace and will take decades. Though the hard-fought bill was passed, this is truly only the beginning of the reform process. No matter your position of support, it is important to understand that there will be ample opportunity to augment/improve/re-work many of the provisions in the law, especially over the three-year implementation period preceding the 2014 Pillars. The benefits of reform will soon be tangible for millions of working Americans, and we should continue to work together to lay the foundation for a healthier America while improving the value of the investment we make in our health care system with an evidence-based focus on efficiency and care coordination, rewarding quality over quantity, prevention, and wellness.