The road to passage for this provision, not to mention the health care reform effort as a whole, is perilous. This particular provision has not been scored by the Congressional Budget Office (CBO). (CBO is the independent office chartered by the Congress to provide independent financial analysis of legislation.) That means no one knows how much more money to add to the $1.6 trillion bill to cover providers not currently eligible. And we won't have that answer until after the 4th of July recess. It promises to be a staggering number.....
WELLNESS AND PREVENTION: COST VS. SAVINGS
You should be asking why inclusion of practitioners who successfully treat and prevent chronic disease would add cost to our system. The CBO premise is not clear, although it includes an assumption that increasing access to new types of providers drives utilization, and therefore costs, up. CBO has stated it has no way to value the savings associated with improved health status, ergo an inability to score savings for health and wellness programs. Of all the obstacles Senator Harkin's amendment will face - this is the single most important issue to address.
Should sticker shock occur, one alternative being discussed includes incorporation of a 'point of service' option, a common health care insurance provision allowing for consumers to seek care outside of network and pay a larger co-pay. Also being considered is a provision to include providers who are licensed in 26 or more states.
Yesterday morning (June 24), I had the opportunity to ask Senator Grassley what the national organizations representing practitioners who are either unutilized or underutilized in federal programs could do to affect the position of the CBO. Conversations around that issue are now underway, and an opportunity to address this issue more fully with the Senate Finance Committee is possible. As those of you who met with Congressional staff and Members know from the FLI - Congress understands that real reform transforms the current disease management program to one that is rooted in wellness and prevention programs. We are taking a lead role in working to find the answer to how this can be accomplished given the Congressional process and procedures.
IS REFORM IN OUR FUTURE
In the larger context, this reform effort faces many significant hurdles.
The Senate Finance Committee is already scaling back its proposal significantly in light of the Senate HELP Committee's bill's estimated cost of $1.6 trillion
It is estimated that in order to finance the reform effort, 95% of the total number of uninsured must be covered in the new system. These estimates include assumptions of savings incurred by keeping uninsured consumers out of the emergency rooms through early detection and treatment.. The Senate HELP bill falls far short of that and Senator Dodd has declared the number left uninsured in the proposal is a "nonstarter."
More than 10 Democratic Senators are reportedly very concerned about proposed provisions. There is fear that a "public plan" will result in a significant shift out of private insurance coverage, and a proposal to tax employer contributions for health care costs jeopardizes union support.
Efforts to incorporate the two Senate bills into one will be challenged by leadership battles and any desire to maintain bipartisan support - just to name two of the central elements.
Then there is the House of Representatives, where Democrats are standing strong for a "public plan" in a climate where such an offering creates enormous consternation by the key (well-funded) stakeholders in this conversation.
CALL TO ACTION
What next? The White House is reportedly supportive of increasing the provider pool by adding practitioner types. Our message is being heard, and we are hoping to meet with the Secretary of HHS on the topic in July. We have partners we are working with across the city. Is there a call to action? I am acutely aware that each of you is anxious to impact this change and I suspect that once we see the CBO score on inclusion of state licensed providers the airwaves will be abuzz with renewed energy. I ask that each of you take a proactive step now. Take one story about how you transformed the health status of one patient and significantly impacted their ability to function, the quality of their life, and how that impacts their reliance on the conventional system. Be concise - confine your story to one paragraph of no more than 100 words. Be precise - speak to the condition, the specific changes in lifestyle you enabled, the reduction in costs of conventional and/or drug therapy, the benefits of integrated care. Do not over-educate. (No need to describe the therapeutic modalities to us lay folk in Washington DC.)
Click here to access our action alert.
The next legislative call is scheduled for July 8. To register log in to your AANP account and click on "register for events."