Elizabeth A. W. Williams, Senior Vice President & Chief Communications Officer for Independence Blue Cross
As recently as last year, nearly 50 million Americans didn’t have health insurance. With the implementation of the Affordable Care Act (ACA), this has started to change. Beginning January 1 of this year, millions of Americans, including hundreds of thousands in the Philadelphia region, have gained access to health insurance for the first time.
But the reform law is just a first step. The U.S. health care system still faces significant challenges — first among them, inconsistent quality and costs that continue to rise. These problems are so large and complex they cannot be addressed with yesterday's solutions.
In fact, finding sustainable solutions to raising the quality and lowering the cost of health care requires a level of change and innovation that the law simply does not provide. Fortunately, this region has all the right components to create the health care innovations needed to tackle these challenges: world class universities, renowned teaching hospitals, talented and dedicated physicians, a strong health and life sciences economy, and an active entrepreneurial community.
Donald Schwarz, MD, MPH, Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
If Pennsylvania were looking for new slogan, it might consider this: “Our state needs workers!”
In 1950, there were 8.7 working adults in Pennsylvania for every person aged 65 and older. Today, that number has dropped to fewer than four.
It’s clear from this demographic shift that Pennsylvania should be doing everything it can to retain and increase its workforce. Our tax base and our economy depend on it.
Antoinette Kraus, Director of the Pennsylvania Health Access Network
Last week, headlines read: "Devastating News for Obamacare: Over Two Million Workers Will Lose Jobs,” and Obamacare will push two million workers out of labor market." Contrary to these fear-inducing, sensationalized storylines, instead of losing jobs by the millions, Americans, for the first time, will enjoy the freedom and flexibility of leaving the workforce voluntarily. The CBO report that incited critics of the healthcare law actually makes it clear that the decline in workforce participation is not due to employers cutting jobs, but rather to workers choosing to work less.
The CBO report finds that the Affordable Care Act markedly increases the number of Americans with health insurance. The law gives individuals and their families the ability to access healthcare beyond the restrictions of employer-sponsored coverage. This coverage is portable and affordable, meaning that workers now have the freedom to choose -- they're free to take a risk and start a small business, free to take two years out of the workforce and get that college degree they never got a chance to finish, free to simply scale back their hours and spend more time at home with the kids.
Earlier this week, we met a mother of five from Philadelphia who, for years, had worked both a full-time job and a second, part-time job just so she could have health benefits. The 60+ hour work weeks exacted a heavy toll on her, keeping her away from her young children, and leaving her with the anguish of choosing between the health care she needed and seeing her children grow up. Frustrated and exhausted, she chose her family, and left the part-time job, knowing that it would mean gambling with her health. That was in 2012 -- she's been uninsured ever since. On March 1st, her new Marketplace health coverage will kick in and she'll have the peace of mind that comes with being covered.
David B. Nash, MD, MBA, Founding Dean of the Jefferson School of Population Health
After four years of medical school, physicians enter that “twilight zone” known as residency training. This intensive, hazing-like program of on-the-job training is characterized by very long hours and increasing levels of responsibility. I’m sure many readers have been in the great teaching hospitals that are bursting at the seams with residents. However, even the most educated people oftentimes have no idea that they are not only paying for this training, but they’re sometimes getting a raw deal to boot!
Post-medical school training, called Graduate Medical Education, or GME, is primarily funded with public money, to the tune of $10 billion dollars a year, paid by Medicare. Your tax dollars, in part, go to pay the salaries of physicians in training. Currently, the average resident makes $112,642 per year, but on an hourly basis, that’s about on par with an unskilled laborer without a high school diploma.
GME is divided into two components. Direct GME takes up about one-third of the dedicated Medicare funding; that pays for the trainees and the supervising faculty who watch over their work in the hospital. The other two-thirds is called Indirect GME. This compensates teaching hospitals for the higher costs associated with training new physicians and for the “lower clinical efficiency” - these new doctors tend to order more tests and are not as efficient as their older, more experienced colleagues.
What does the future hold for traditional Medicaid? Some believe that, in the future, traditional Medicaid and commercial insurance will converge so that patients who move from Medicaid to commercial insurance will see no disruption in coverage, service, or the provider networks from which they receive medical treatment. While full convergence may still be a long way off, there are strategies that policy makers can begin to implement now on the pathway to a healthy Pennsylvania.
First, it is important to minimize coverage gaps. Pennsylvania should opt to continue Medicaid eligibility until the end of each month to allow beneficiaries to maintain coverage until they are covered under a commercial health plan (known as a qualified health plan) at the beginning of the following month. This provides individuals experiencing an increase in income with a smooth transition to commercial insurance enrollment at the end of their Medicaid coverage period.
Another strategy is to ensure continuity of care and of providers for traditional Medicaid recipients. For example, Pennsylvania could require insurers that offer both qualified health plans and traditional Medicaid to use the same provider networks in each. It could also require insurers to honor the current treatment plans of patients.
Drew A. Harris, DPM, MPH, Director of Health Policy Program at the Jefferson School of Population Health
Not everyone is cheering when more people have health care coverage. Some pundits are making dire predictions of long waits and overworked doctors when people newly insured under the Affordable Care Act (“Obamacare") seek care for long-ignored ailments.
Opponents of the ACA have even argued that we should continue to deny coverage to the uninsured because it will encumber the care of those fortunate enough to have insurance. This is like saying we should close food banks and cut food stamps for hungry people because the increased demand means less food for everyone else.
Despite these concerns, things may not be as bad as predicted. In the short term, waits for care may increase but in the mid to long term, I believe the system will adjust. Here are a dozen reasons why:
Jeffrey Brenner, MD, Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
For nearly 15 years we’ve had the secret to delivering better care at lower cost in America. The information has sat, hidden away in the medical literature, and barely mentioned among physicians. It’s a remarkable story of bias. The neglect of this information by the medical community tells you a lot about our failings as a profession and the poor training we receive. It’s also a powerful commentary on the values of our society and the biases built into our society’s view of health and healthcare.
In the 1990’s, a physician at Kaiser Permanente in California, Dr. Vincent Felitti, conducted a mail survey with 17,000 middle class patients. He asked them questions about traumatic events that might have happened to them as children. Incredibly, over 70% of people receiving the survey responded, and they gave permission to connect their survey answers to their medical records.
The survey asked questions about things like death of parent, physical abuse, sexual abuse, and substance abuse by a parent. Nearly 50% had at least one Adverse Childhood Event (ACE) and he coined the term “ACE score” for the point score created for the survey.
Tine Hansen-Turton, Chief Strategy Officer of Public Health Management Corporation
Where can you find the accessible, affordable, quality healthcare that the Affordable Care Act promises to provide? One of the best places, and one you may have overlooked, is a local retail-based convenient care clinic. There are over 1,600 clinics in 39 states today. Their growth is expected to accelerate as consumers who are newly insured under the law confront an increasing shortage of primary care physicians.
The growth of these convenient care clinics is also promoted by an ongoing shift in the way providers are paid. Reimbursement is moving from fee-for-service to payments based on value. The success of the new approach will depend in part on patients' ability to find high-quality, low-cost care, the kind that convenient care clinics are uniquely positioned to provide.
As part of the growth trend, an increasing number of large healthcare systems are partnering with convenient care clinics, and in some cases opening their own clinics. This allows them to deliver the most cost-effective care and to help find a regular primary care provider for the roughly 40 percent of convenient care patients who say they don't have one.