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Despite uncertainty about the coming U.S. Supreme Court decision on its constitutionality, the 2010 health care law already has triggered a long-term transformation in the way U.S. health care is delivered and paid for, a panel of specialists said on Tuesday.
“There’s a spirit out there in the country, and it starts with the great people who work hard every day to deliver health system reform, not in Washington,” said Dr. Richard Gilfillan, director of the Innovation Center at the Health and Human Services Department’s Centers for Medicare and Medicaid Services. “The Affordable Care Act put the seeds out and they’re blossoming.”
Speaking on a panel titled Obamacare at Work: Innovations to Deliver Better Care at Lower Cost and put on by the liberal Center for American Progress, Gilfillan cited as an example “the incredible response” his office received -- some 3,000 applications from private health care providers nationwide -- to a CMS grant offer soliciting models for interpreting data on the cost savings from bundling medical-care payments.
Gilfillan also called “emblematic” a conference CMS held two weeks earlier attended by 100 representatives of 51 health insurance companies, from seven markets representing 500,000 customers. Instead of sticking with “fragmented, siloed, inefficient care,” he said, the industry is “poised, ready, and starting” to create a new form of interaction between providers and payers that will create a “rapidly learning, accountable” health care system. “The world is shifting, and the marketplace brimming with new ideas and opportunities under the Affordable Care Act,” Gilfillan said.
Sen. Sheldon Whitehouse, D-R.I., whose state has pioneered health care reforms, said, “You either see health care as a problem of benefits or as a system problem. If you see it as a benefits problem and are wrong, you’ve made a terrific mistake and harmed a lot of people.” Whitehouse pointed to current Republican proposals to repeal the health care law and refashion Medicare. “It is a system problem, and we will continue on the path to system reform,” he said.
Citing potential cost-savings estimates ranging from $700 billion to $1 trillion dollars, Whitehouse said that 45 sections of the health care law give CMS responsibilities for pilot programs. He noted progress in Rhode Island on lowering hospital readmission rates, which requires better coordination between doctors and hospitals.
The programs that are not performing well are the ones Congress didn’t properly fund, Whitehouse said. Greater use of nursing homes, which are less expensive than hospitals, he said, could be achieved under “meaningful use” provisions of the law, and he urged CMS to pursue it.
Asked about the impact of a court ruling striking down all or part of the health care law, Whitehouse said, “The only part of the massive bill being challenged is the individual mandate. That’s the only aspect that, some say, the federal government can’t do, only the states, which is a very narrow question. So if the mandate falls, there is some logic -- not great logic, but if you stretch, some logic -- to that. But there is no logic” to going after the pilot programs that CMS is pursuing, he added, or repealing benefits from the law such as families being allowed to keep children on their parents insurance plans until age 26.
“That would be a sign that the court has really gone off the rails,” Whitehouse said. “We shouldn’t be stalling and dawdling while waiting for the Supreme Court to act. We don’t have that luxury.”
Dr. Ezekiel Emanuel, vice president for global initiatives at the University of Pennsylvania, said the coming movement toward bundling of payments is “the most promising way to cut costs because it’s easy for doctors to adapt to it. They can figure out how to reengineer their care process.” Ten years from now, Emanuel added, “all will be better in the field of health care, unless the Supreme Court does something silly.”
Gilfillan reiterated the position of HHS on the court’s looming decision. “We’re confident that law will be upheld, and we’re moving forward,” he said.