Cath Lab Digest

Challenges Include Cost Concerns, Legal Disputes

Despite bipartisan opposition in Congress and failure to win support of a majority of the public during months of debate, federal lawmakers were able to enact a comprehensive reform bill that creates new ground rules for the health insurance industry. The market reforms will improve access for millions of Americans who previously could not afford or qualify for enrollment in a health plan, but employers and insurers are warning about the lack of cost controls and the expense of new insurance mandates. Compounding the challenges of implementation, some states are disputing the mandate for individuals to purchase insurance as well as provisions that would expand state Medicaid programs.

The healthcare bill that ultimately became public law, the Patient Protection and Affordable Care Act (HR 3590), passed the Senate on December 24, 2009, by a 60 to 39 vote. The House of Representatives cleared the bill for the White House on March 21, 2010, by a vote of 219 to 212, and it became public law on March 23. President Obama signed a separate reconciliation bill that amended the new healthcare reforms, titled the Health Care and Education Reconciliation Act (HR 4872), on March 30.

For several months before the new reforms were enacted, public opinion polls consistently found more Americans opposed to the Democrats’ healthcare plan than in favor. And after HR 3590 was signed, 50% or more of respondents to Rasmussen Reports, USA Today/Gallup, and Washington Post polls were opposed, with 42%, 47%, and 46%, respectively, in favor. In the USA Today/Gallup poll conducted from March 26 to 28 that included 1033 adults, 65% said the reforms will expand the government’s role in healthcare too much and 64% said it will cost the government too much. Fifty-eight percent of respondents said the bill does not do enough to curb rising costs.

Despite public concerns about some of the less popular aspects of the healthcare bill, the president expressed confidence at the signing ceremony that Americans would come to support the reforms. “When I sign this bill, all of the overheated rhetoric over reform will finally confront the reality of reform,” he said, calling passage of the bill “a testament to the historic leadership—and uncommon courage—of the men and women of the US Congress.”

In an interview with First Report – Managed Care (FR-MC), Georganne Chapin, president and CEO of Hudson Health Plan, said she expects that as a managed care organization that works with Medicaid and other government health programs, “our business is going to continue quite as usual for now.” Hudson Health Plan, a nonprofit insurer that provides medical and dental coverage to more than 90,000 members in New York’s Hudson Valley, ranked highest in New York’s 2009 Quality Incentive Program, an annual grading of Medicaid managed care plans by the New York State Department of Health.

Under the newly minted healthcare laws, states are provided federal funding to set up insurance American Health Benefit Exchanges and Small Business Health Options Program Exchanges by 2014. The exchanges are intended to allow individuals and small businesses to participate in larger risk pools, but Ms. Chapin said that creation of the insurance exchanges will be a difficult step in the implementation process. “We’re going to be hard pressed as a nation and on a state-by-state level to get these exchanges in place,” she said. “Massachusetts did it, but they are a little state with a lot of resources.”