Health Care Reform

Historically, our health care system has cost too much, didn’t cover enough people, and incentivized inefficiencies. Reforms 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 continued improvements 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. 

Starting in October 2013, individuals began signing up for health insurance through the state health insurance exchanges – websites where individual consumers and small businesses can compare and shop for health insurance plans available in their state. Five key provisions of the law came into effect at the start of 2014: 1) the individual mandate; 2) pre-existing condition coverage; 3) employer mandate; 4) subsidies; and 5) online health insurance exchanges.  Further, the law enhances the quality of healthcare for those on Medicare and disallows 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 remain on their parent’s health insurance plan. 

Though the Affordable Care Act is by no means a cure all to challenges faced in the health care sector, it provides a good opportunity to begin to rein in excessive costs, improve quality of care, and expand access.  In the coming months and years, it will be necessary to monitor how these policies are implemented and make adjustments as necessary. 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 Affordable Care Act 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. 

Medicare Reimbursement Rates in Washington State

The current Medicare reimbursement rate formula fails to reward efficient health care systems, such as that in Washington State, at a fair rate and instead rewards the quantity rather than the quality of services.  As a result, Washington State has very low reimbursement rates compared to other regions of the country. With the national average cost per Medicare beneficiary at about $8,600 a year, the average reimbursement rate for a Medicare beneficiary in the Puget Sound Region is about $7,500 where the average reimbursement rate for a Medicare beneficiary in Miami, FL is about $17,300.  These low reimbursement rates in Washington State make it very difficult for doctors, hospitals, health clinics, and health care providers to offer quality care at an affordable price.  Too often, Medicare is not reimbursing health care providers enough to cover the costs of serving Medicare patients.  Many providers in our state do not accept Medicare patients because of these low reimbursement rates, while all others have to charge non-Medicare patients more to offset the losses caused for treating Medicare patients.  This must be changed.

We should find ways to encourage more doctors to be willing to serve more Medicare beneficiaries by fixing our system of paying doctors. While some have expressed concern over the Medicare Advantage program, Medicare Advantage offers Washington State seniors a choice and allows doctors to participate in Medicare when they would otherwise be unable to provide for Medicare patients because of low reimbursement rates. I support a change to the basic Medicare reimbursement formula so more Medicare beneficiaries, especially those in Washington State and other states with low Medicare reimbursement rates, have a greater choice in their providers.

Medicare Physician Payment Cuts

Our system of paying doctors who treat Medicare patients is deeply flawed and must be fixed.  I am continuing to work with my colleagues to come up with a permanent solution to the very serious problem of physician reimbursements.  The current formula we use to reimburse health care providers, which is known as the Sustainable Growth Rate (SGR), is not adequate and does not consider the steep increases in health care costs.  The SGR must be replaced with a more permanent formula that considers the real costs of health care.  In the meantime, Congress has passed several short-term extensions of the current physician payments to prevent scheduled cuts over more than 10 years.  However, we must work towards a stable, permanent fix to this problem. 

Any permanent fix to the Medicare physicians' formula must meet two overarching criteria.  First, it should be paid for without adding to our already overwhelming debt.  Second, it must address the problems of regional disparities that are so harmful to Washington State. 

Health Information Technology

Advancing and streamlining our nation's health information technology system is one way in which to increase efficiency, as well as to improve the quality of care and reduce overall health care costs.  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 increase costs and reduce the overall quality of health care.

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 health care lags significantly behind information technology in every other sector of our society.  The lack of health information technology (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 certain requirements around health IT in health care facilities and provided 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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