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Friday, March 23, 2012

Happy Birthday Health Care Reform! "Obamacare"/ Affordable Health Care Law Turns 2

Pres. Barack Obama signed the Health Care Reform bill into Law on March 23, 2010.

Health reform turns 2

Health-care reform turns two today, and it's not going to be a particularly happy birthday. On Monday, the Supreme Court will begin to hear oral arguments on the constitutionality of the individual mandate.

The law remains unpopular among the public and loathed by Republican politicians, who have pledged that repeal will be their first order of business if given power in 2012. Implementation is proceeding jerkily, in part because many states are waiting till the legal and political uncertainty clears to commit to the law.

And yet, out in the health-care system, the law's second birthday will be a happy one. As Sarah Kliff reports, the hundreds of pages devoted to moving American health care away from fee-for-service and towards pay-for-quality are having a dramatic effect on the way medical providers across the country actually do business.

The Affordable Care Act included 45 reforms aimed at changing how health care is delivered. Fifteen of those reforms focus on payment practices. At the moment, most are voluntary, but they are quickly becoming mandatory. Starting in October, for instance, hospitals with high rates of "preventable readmission" -- that is to say, high rates of patients returning with complications from earlier procedures -- will lose one percent of their Medicare revenue. In the current system, conversely, a patient turning up with a complication from a previous procedure actually provides the hospital with more revenue.

In answer to some of these reforms and in preparation for others, health-care systems across the country are either undertaking or accelerating long-overdue changes to the way they do business. Kliff follows Baptist Health System, a five-hospital network in San Antonio, Texas, which saw four surgeons quit as they moved to implement the new, quality-based payments metrics, but which has now seen performance on those measures rise to 98 percent.

Kliff's article -- which you should read, now -- is an unusually concrete look at a dimension of the health-care reform law that is often passed over in the public debate but is perhaps the single most ambitious effort ever launched in this country to lower costs and improve quality in the system. And unlike most of the bill, which hasn't been implemented yet and may or may not survive the election, it's happening now, all around us.

Two years later, health care reform has faced some challenges in implementation. "When the health-care overhaul became law after a bitter debate, many Democrats predicted Americans would grow to like it as they started enjoying some of the early benefits. The day after the president signed the bill into law, which happened exactly two years ago, an average of major polls collated by the website Real Clear Politics showed 50.4% of Americans opposed. This week, that had changed only by a tenth of a percentage point, ticking up to 50.5%.

The health law remains a tough sell for reasons that go beyond the drumbeat from Republicans for its repeal and questions about its constitutionality that will be debated next week at the Supreme Court. Several of the law's early pieces, designed to win public support, haven't worked as well in the real world as on paper and have irked even some of the Americans they were designed to help." Janet Adamy and Louise Radnofsky in The Wall Street Journal.

But it is already transforming the health-care system. "The Affordable Care Act is mostly known for its mandate to expand health insurance to 30 million more Americans within a decade. That’s the side of the legislation Democrats touted last week, when the law hit its two-year anniversary. It’s also the point that has roused the most ire from opponents. Insurance expansion is at the heart of legal challenges the Supreme Court will take up on Monday, which argue that forcing people to buy insurance coverage is unconstitutional.

But much of the law’s 905 pages are dedicated to an effort that’s arguably more ambitious: an overhaul of America’s business model for medicine. It includes 45 changes to how doctors deliver health care — and how patients pay for it. These reforms, if successful, will move the country’s health system away from one that pays for volume and toward one that pays for value. " Sarah Kliff in the Washington Post.

Sources: C-Span, Washington Post, Wall Street Journal, Youtube

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