Federal Health Care Reform
Ten Points to Ponder

On March 23, 2010, the Patient Protection and Affordable Care Act (known as health care reform) was signed into law by President Obama. This law, which impacts individuals, families and businesses, is a major step forward for Health Foundation of South Florida’s goals of improving the health of South Florida residents and increasing the effectiveness of the health system.

1. Coverage and Affordability

The law aims to increase the number of people with health coverage mainly by giving individuals, families and small businesses the opportunity to compare and purchase health insurance plans through marketplaces better known as State Health Insurance Exchanges. Proposed Medicaid expansion to individuals with incomes up to 133% of the federal poverty level ($14,400 for an individual or $29,300 for a family of four in 2010) will cover those within this income range. The law also provides financial support to buy health insurance to individual and families in the form of tax credits. Increasing coverage and affordability is key to increasing access to important health services.

2. Insurance Regulations

The law includes provisions that align with the overall arching goal of increasing access, especially when they need it the most. These include: 1) allowing young adults to stay on parents’ coverage up to age 26; 2) ending the practice of dropping insurance coverage when a person becomes ill; and 3) eliminating the annual limits an insurance company will pay per year (annual limits) and for an individual over the course of their life (lifetime limits).

3. New Ways of Delivering Care

The law supports the development of innovative ways to deliver health care to promote higher quality, better coordinated care. These new approaches will encourage better communication and coordination among health care providers, patients and caregivers. This will allow providers timely access to patient and treatment information, which has the potential to reduce medical errors and improve quality of care. It may also mean a reduction in unnecessary service utilization since a more coordinated system can connect people with services that can help them manage their health.

4. Making Care More Patient-Centered

The use of patient experience measures and shared decision-making tools improve quality and reduce disparities in care. Health Foundation has been supportive of the medical home model which has features to ensure increased communication between provider and patient, adoption of electronic health records and increased care coordination. The new legislation calls for measures of patient and caregiver experience to be incorporated in new care models and payment strategies. Patients and caregivers should be empowered and equipped to make fully informed decisions about their treatment with appropriate guidance from their health care providers. The new legislation calls for development and use of tools that will facilitate this kind of patient and caregiver empowerment.

5. Investments in the Health Care Safety Net

The law makes several changes related to Medicare, the federal program for seniors, and Medicaid, the state-federal program for the poor. People enrolled in these programs will no longer have to pay for copayments for preventive services (e.g. annual physical exams and mammograms) which can be a financial barrier for many. Increased Medicare and Medicaid payment rates to primary care providers will help to ensure that patients have ready access to good primary care, which is particularly important for adults with multiple chronic conditions, who need a higher level of care coordination and care management. Significant funding is also available for community health centers which serve almost 200,000 patients in South Florida.

6. Coverage of Preventive Care Services

Beyond Medicaid and Medicare, group health plans and health insurers are now required to cover specific preventive care services and to do so without patient cost-sharing obligations. Plans may not charge any deductible, co-pay, or coinsurance for any service recommended by the U.S. Preventive Services Task Force. These services include screenings, tests, vaccinations, counseling, and more. For the most, any coverage that is new or renewed after September 22, 2010, must offer the free preventive services, with a few exceptions.

7. Availability of Funding to Combat Chronic Disease

The new law makes a substantial investment in preventive care and wellness activities over the next five years; a $15 billion commitment to wellness. The Prevention and Public Health Fund invests in proven strategies that prevent people from getting sick in the first place — and that save money down the line. It would provide much needed funding to support community-based tobacco cessation and prevention programs, initiatives to reduce diabetes and heart disease, breast and colon cancer screenings as well as adult vaccine programs.

8. Payment for High Quality, Coordinated Care or Payment Reform

New policies will help us move away from a system that values quantity over quality. The overall goal of payment reform is to find ways to reward providers financially for efficient use of resources while providing high quality care. By linking payment to quality and provider performance, much-needed incentives are created for quality improvement by hospitals, physicians, nursing homes, home health providers and others.

9. Improving Workforce Efficiency

With physician and nursing shortages looming, the law offers opportunities for states to conduct comprehensive workforce planning and strategies. Provisions aim to strengthen the primary care workforce through funding for residency programs, increased scholarship support for minority applicants for health professions, primary care extension program to educate providers about evidence-based health promotion, chronic disease management and mental health and overall enhancements to education and training opportunities.

10. Home- and Community-Based Services

The new law increases federal Medicaid payments for states that provide home- and community-based services to people who might otherwise need to be in nursing homes. State plan amendments, through a variety of mechanisms (e.g. Money Follows the Person demonstration, Community First Choice program) incentivize states that successfully move individuals out of institutional care. For vulnerable older adults and people with chronic conditions, being able to access needed services at home or in their communities is tied to a higher quality of life, more independence, and better health outcomes.

About Health Foundation of South Florida

Health Foundation of South Florida improves the health status of people in Broward, Miami-Dade and Monroe Counties through grantmaking and philanthropic leadership. The Foundation’s priority areas include: healthy lifestyles, oral health, preventive health measures and primary care. The Foundation also has a five-year healthy aging inititive to promote and preserve the health of older adults that delivers results through a regional collaborative.  To join us in actions or for more information, please contact  Health Foundation today.