Lost in the woods on health care reform

By Richard Haugh

Compared to places in the East, Grand Junction doesn’t have a lot of trees. When Steve ErkenBrack took his 7-year-old son to visit his parents in Virginia, the boy was awed and a little overwhelmed by a walk through the forest.

“With all the trees around, he couldn’t tell where he was,” said ErkenBrack, president and CEO of Rocky Mountain Health Plans in Grand Junction. “My son is a metaphor for Congress right now. They don’t know where they are for sure on health reform.”

ErkenBrack was one of six speakers Tuesday at a conference in Greenwood Village that looked at national health care reform efforts and their impact on the nation and Colorado. The summit was hosted by the Colorado Hospital Association.

Five reform bills have been competing in Congress over the past few months. The number dropped to two on Nov. 7, when a $1.05 trillion health care reform bill struggled out of the U.S. House of Representatives on 220-to-214 vote just as another version of health care reform passed out of the Senate Finance Committee.

Capitol observers don’t expect debate on the Senate bill to start for a few weeks and doubt that the issue will come to a vote before the end of the year.

“Nobody’s seen a bill yet. They’re still waiting to get it scored,” said Rick Pollack, executive vice president for advocacy and public policy for the American Hospital Association in Washington, D.C.

Pollack said most beltway observers think the Senate would be doing well to look at the first few pages of the bill at the beginning of December.

Both bills would prohibit insurers from refusing to accept people with pre-existing conditions, create health insurance exchanges that would allow the uninsured to comparison shop, and offer a public option — a government-run plan that would negotiate rates with providers, much as private insurers do now.

They both also would penalize qualified employers who don’t offer health insurance to their employees as well as individuals who choose not to be insured. Improving access to insurance and boosting the number of people eligible for Medicaid also are on the wish list. Low- and moderate-income wage earners would be eligible for government subsidies for private insurance premiums, or they could enroll in the public plan.

The House vote reflected deep partisan splits. Colorado’s lawmakers voted along party lines, except for Rep. Betsy Markey, D-Fort Collins, who voted against the bill. Of the 39 Democrats who joined Republicans in voting against the bill, 38 are from districts that Sen. John McCain, R-Ariz., carried in the 2008 presidential election. Markey’s CD 4 went for McCain by 1 percentage point.

The public option has become a lightning rod for sharply divided political ideologies. Democrats feel a public plan would rein in insurance premiums by providing competition with private insurers. Republicans fear a public option would encourage the federal government to encroach on private business.

Terry Brooks claimed to be an agnostic on the public option, but said it’s probably needed. She pointed out that Medicare, Medicaid, Veterans Administration health care and military health care all are “public options.”

“To the extent that people are arguing about it, it’s become somewhat of a Trojan horse,” said Brooks, an attorney and Capitol Hill lobbyist for the Washington law firm Polsinelli Shughart. “Not necessarily for single payer, but for people to argue about a lot of philosophical things. Maybe there’s a back agenda here.”

In fact, that’s what the health care reform debate is all about, said Len Nichols, a health economist and policy analyst who directs the Health Policy Program at The New America Foundation in Washington, D.C.

“That’s why this is so emotional,” he said. “What kind of government do we want? What kind of society do we want? This whole debate has become a proxy for a much deeper discussion.”

There’s also a personal component. Reforming health care isn’t just about politicians and providers, said Maureen Tarrant, president and CEO of Sky Ridge Medical Center in Lone Tree. The process also involves a commitment to an individual mandate and consumers taking personal responsibility for their role in health care.

“I’m always troubled by people who can get up and get an annual ski pass and choose to spend money that way instead of buying health insurance,” she said.

Any legislation that passes has to signal a commitment to change, said Nichols, who noted that if nothing changes, the country won’t be able to pay for health care in the future.

“We’re on a pathway to hell,” he said. “We’re on a pathway where, in 10 years, half our people will have to spend a third of their income to pay for health insurance as we now know it.”

On the other hand, reform of Colorado’s health care system could mean reining in cost growth and freeing up fiscal resources for other state priorities. That would be welcome relief. Gov. Bill Ritter has proposed cutting $1.02 billion from the state’s budget for 2010, which begins July 1, 2010, following two other rounds of budget cuts in the past year or so. Under his proposed cuts, Medicaid providers will be required to take another 1 percent reduction in reimbursement rates next year, matching last year’s reduction. In a sign of the dismal state economy, Ritter’s 2010 budget contains a $157 million increase in Medicaid spending, reflecting the increased number of Coloradans who must rely on the program.

The AHA’s Pollack noted that conditions have changed since the 1990s, when the Clinton administration attempted to reform the health care system, and the time may be ripe for fundamental health care reform.

“It’s no longer politically viable for politicians to say we’re going to spend trillions of dollars on a broken system,” he said.

“The status quo is not something to preserve. It’s a disaster,” echoed Larry McEvoy, M.D., CEO of Memorial Health System in Colorado Springs.

He called for building a culture that allows all parties, including consumers, to innovate on the standard delivery of health care services. Although he doesn’t think legislated reform will achieve that, he does believe that legislation signaling a clear drive toward collaboration and coordination would.

“This dysfunction we have now is too deep to fix in 30 days or a year,” he said. “We need a generation to start making substantial change.”

McEvoy said the reform debate in Washington can be terrifying to hear for hospitals and the physicians they work with, but it’s also healthy. Business as usual can’t continue, he said. Providers must change how they build and deliver medical care.

Tarrant said she’s glad all stakeholders are being asked to work together for change.

“I think providers can be pretty good, if we’re forced to be innovative on cost reduction,” she said.

The ideological issues that underlie the debate have led to hardball politics and brass knuckles issues marketing. Nichols is afraid that could get in the way of substantive change.

“When you’ve got people buying ads to say you’re killing Grandma to pay for coverage, it throws a real chill on congressmen to deal with change,” he said. “We have to get beyond this and have a real discussion of health reform.”

All participants agreed that politics as usual won’t get the country to a new health care system. ErkenBrack, of Rocky Mountain Health Plans, noted that earlier this summer the goal of politicians on one side of the aisle seemed to turn to handing President Barack Obama a political defeat, and then shifted to politicians on the other side of the aisle trying to assure an Obama win.

“When you’re all of a sudden changing this to ‘Are we going to win or are we going to lose politically? And how is that going to affect the next election?’ — wow, good luck coming up with the innovative policy,” he said.

That led Pollack to this prediction: “The political stakes are too high for Democrats to fail at this. My guess is something will get passed this year, and we’ll call it health reform.”