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Unformatted text preview: SPECIAL SECTION: HEALTHCARE REFORM Gail R. Wilensky C O M M E N T A R Y healthcare reform version 1.0 The nation has taken a significant step, if not a giant one, toward addressing the serious challenges that lie ahead for our healthcare system. But many more steps are still needed. After a tumultuous year of proposals, negotiations, closed -door sessions, town hall meetings, and what has seemed like endless talk-shows and debates, President Obama signed The Patient Protection and Affordable Care Act into law on March 23. Although many of us who spend our professional lives focused on the issues covered in the act thought we would never tire of discus- sions on healthcare policy and reform, all of us in Washington and many outside the Beltway have breathed a collective sigh of relief that we would be spared further discussion of these issues—for at least a little while. People need to understand, however, that as important and sweeping as the legislation is, it represents no more than a first step on a path to reaching universal coverage and reform of the healthcare delivery system. Inpart, this is because even after full enactment, there will still be 5 to 6 percent of the population who remain uncovered. More important, most of tbe potential reforms to the delivery system are tied to the pilot projects. Hopefully, at least some of them will be successful and provide insights into whether cer- tain types of changes could lead to improved out- comes and lower spending. Actually implementing these changes and understanding which are more likely to be successful under what circumstances will be a challenge. That and finding ways to suc- cessfully slow spending while improving out- comes and patient safety will require many more rounds of legislation. And then there will always be those unintended consequences that will present themselves, with the need for follow-on legislation to fix the most egregious of them. In the short term, everyone involved in Medicare, Medicaid. and any other aspect of health care will be focused on the implementation challenges of the legislation. What Ihe Legislation Does It is impossible to list here all or even most of the changes included in the legislation. Several groups have produced useful summaries, such as the one available on the Kaiser Family Foundation web site Cwww.kff.org) and on HFMA's web site (www.hfma.org). I will do no more than summa- rize the most salient portions here. The primary focus of the legislation is on reform- ing insurance and expanding coverage. After full implementation, there will he S-¿ million fewer uninsured, implying a coverage rate forthe nation of 94 to 95 percent as opposed to tbe cur- rent 85 percent. Of these, 16 million will be on Medicaid and 24 million vrill be receiving subsi - dies to purcbase negotiated insurance policies in state-based insurance exchanges. Not all of those receiving subsidies will have been previously uninsured. Some will be working for small employers who can make use of the insurance exchanges....
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This note was uploaded on 02/11/2012 for the course BUSINESS 345 taught by Professor Roselli during the Spring '10 term at Berea.
- Spring '10