Health Care Reform

Health Care Reform

Our health care system costs too much, doesn’t cover enough people, and incentivizes inefficiencies.  Reform must expand access, reduce the overall amount of money we spend on health care, and promote quality of care over quantity. In order to succeed, real reform must be built on these three pillars, without which we will not be able to provide sustainable universal access. With these concerns in mind, Congress passed and the President signed into law the Patient Protection and Affordable Care Act, which is simply known as the health care reform law.  

This piece of legislation is by no means a cure all, but it gives us a good opportunity to begin to rein in excessive costs, improve quality of care, and expand access.  In the months and years ahead, we will have to adjust these policies and monitor how they are implemented.  One of the most challenging aspects will be keeping costs under control, and we will have to diligently enforce the implementation of programs designed to meet this goal. For instance, the bill contains a number of opportunities for meaningful changes to our inefficient fee-for-service system, but we must follow through and ensure these changes are aggressively implemented.

This bill will cover an estimated 30 million additional Americans and save more than $1 trillion in the long-term.  The law will enhance the quality of healthcare for those on Medicare and disallow health insurance providers from denying individuals coverage based on preexisting conditions.  It would close the Medicare drug coverage gap known as the “donut hole” and allow recent college graduates to stay on their parent’s health insurance plan.  These are huge steps forward in the reform process. 

This legislation makes several good steps in reforming both how we deliver and pay for health care in this country.  The numbers demonstrate that this bill will not only help reduce costs in the short-term, but also help bend the long-term cost curve.  It begins to shift away from the failed fee-for-service model that encourages high levels of utilization regardless of the quality of that care and instead encourages accountable care organizations (ACOs), which emphasize overall quality of care over the sheer number of visits, tests, and referrals. 

The reforms include a number of proposals from both sides of the aisle, such as portability, which allows insurance companies to sell insurance over state lines.  It also encourages employers to provide incentives for their employees to manage controllable health factors known to lead to long-term health issues.  These incentives will help create an overall healthier society, and encourage individuals to control their own health care costs.

Medicare Reimbursement Rates in Washington State

Currently, physicians who serve Medicare patients in Washington State are reimbursed at considerably lower rates than doctors in other parts of the country for providing the same services.  For example, the average Medicare patient in Miami received over $17,000 in annual benefits, and the average Medicare patient in Seattle received only $7,300 in annual benefits.  This is unfair and needs to be addressed.  My colleagues and I in the Congressional Quality Care Coalition have worked hard to ensure that steps were taken in the health care reform law to address this issue of regional disparity in Medicare reimbursement rates. 

Among these steps were two studies to be conducted by the Institutes of Medicine looking at both the geographical factors that lead to legitimate differences in payment rates and the quality of care that is delivered.  I am hopeful that the results of these studies and changes made in the health care reform bill will lead to a more fair and equitable reimbursement system for Washington State Medicare patients.

In addition to assessing the problem of regional rate disparities with studies, I have written a bill called the MediFAIR Act, which would enact increases to Medicare payments to physicians who practice in regions with payment rates lower than the national average. This bill would increase seniors’ access to doctors, provide better resources to people living with disabilities, and create needed stability to those patients.

Medicare Physician Payment Cuts

Our system of paying doctors who treat Medicare patients is deeply flawed and must be fixed.  For years, doctors have been faced with devastating cuts to the reimbursement rates for the services they provide to Medicare patients.  Congress has staved off these cuts with multiple short-term fixes over the past 10 years, but this has left Medicare doctors and patients with uncertainty about their ability to provide and receive medical services.  We need a stable, permanent fix to this problem.
Any fix must meet two overarching criteria.  First, it must be paid for without adding to our already overwhelming debt.  Second, it must address the problems of regional disparity that are so harmful to Washington State.  We cannot replace our current system with one that adds to our record high deficits and rewards regions that have been historically inefficient with Medicare. 

Health Information Technology

In spite of providing the most advanced medical care in the world, America’s healthcare system is overly reliant on paper-based prescription and record keeping techniques that are expensive, inefficient, and sometimes lead to fatal healthcare mistakes.  Inadequate health information has resulted in medical errors, misdiagnosis, and needless test duplications that increases costs and reduces the overall quality of healthcare.  Investing in healthcare information technology (Health IT) is a solution that can improve the quality of care, increase efficiency, and reduce overall healthcare costs.
Studies have found that widespread, interoperable information technology could save the United States billions in health care costs each year.  Greater potential savings are forecast from lower death rates, fewer complications, and fewer employee sick days from chronic diseases.  Additionally, savings are predicted from improved efficiencies and reductions in duplicate tests, preventable medical errors, and streamlined administration.  Despite all these benefits, the use of information technology in healthcare lags significantly behind information technology in every other sector of our society.  The lack of Health IT at the point of care is depriving our doctors, nurses, and other healthcare providers of the opportunity to provide the highest quality of care to patients.
Health IT has been a part of several important bills signed into law.  The American Recovery and Reinvestment Act included nearly $26 billion for hospitals and physicians to implement and improve Health IT.  Additionally, the Patient Protection and Affordable Care Act included a grant program for long-term care facilities to purchase, lease, develop, and implement certified electronic health record technology. 
Much more remains to be done to implement best use of Health IT around the country and I am committed to ensuring that Congress does its part to ensure the success of Health IT. 

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