It is going to affect all of us, it’s meaningful and exciting and full of opportunities, and it’s safe to say that it’s complicated and painful! It, of course, is healthcare reform. Here’s the rundown.
On June 19th, the House Tri-Committee released a draft bill on health reform that includes a public plan financed by premiums. It would initially reimburse healthcare providers using Medicare’s lower rates. This, in turn, triggered predictable responses from the American Medical Association, the health insurance industry, and House Republicans:
- Doctors and hospitals say a public plan that forces them to accept lower payments (Medicare rates) would shrink their incomes dramatically.
- Insurance companies say a public plan would have “built-in advantages” that would allow it to “take over” the insurance market.
- Republicans worry that a public plan would amount to a “government takeover” of health care that would cost untold trillions.
In response, the House Republicans proposed individual tax breaks for buying health insurance and “pools” of states and small businesses to get lower-cost healthcare plans. They also proposed increasing incentives for people to build health savings accounts, allowing dependent children to stay on parents’ policies until age 25, and encouraging employers to reward employees for improved health. This, of course, assumes that the uninsured/underinsured have the money to save, get tax refunds, etc.
The Obama Administration says that a public plan with millions of members would:
- Use its large market share to negotiate lower reimbursement rates for doctors and hospitals
- Let Americans keep their coverage when they moved, changed jobs, or weren’t working
- Have lower overhead because it would not have the marketing expenses, broker commissions, and profit margins of private insurance and so would have lower premiums
- Would provide uniform and large-scale reporting of healthcare procedures and costs—-data that could be used to improve efficiency.
- A Medicare-based plan in which providers would be paid the same rates as Medicare reimbursements. Premiums would be the lowest of any model, but government costs would be the highest.
- A self-sustaining plan in which premiums would cover the cost of claims. Patients would pay more than under the Medicare model but less than for private insurance.
- A triggered plan in which the “public plan” would kick in only if private insurers did not sufficiently expand coverage and lower costs to certain mandated levels at some as-yet unspecified future date.
- Regional co-ops that would be owned and operated by states/regions and would collect premiums and provide coverage (keeping the Federal Government out of it).
So where are the Blue Dog Democrats? Pretty much between a rock and a hard spot!
Fiscal conservatives are concerned about costs (estimated at $1 trillion—and government estimates are notoriously low!), yet facing a public that actually is demanding reform and a Democratic Administration that is determined to reform health care. They are both caught and key. Without their support, Republicans will prevail…and the U.S.A. will continue its failed experiment with market-based reform. There’s no escaping it: Healthcare reform is bitter medicine. Lawmakers are going to have to stifle their reluctance to impose mandates and—yes—some form of taxes. Lobbyists for the insurance and pharmaceutical industries are fighting tooth and tong to protect their constituent’s profits. And AMA, while favoring reform, is not supportive of any plan that will cut physician reimbursement. So far, the hospital industry is the only one making any concessions. Last week, Vice President Biden announced that the hospital industry pledged to contribute $155 billion in Medicare and Medicaid savings in the next decade. And this undoubtedly will affect how much everyone who works in a hospital, including nurses, actually gets paid.
So where are you nurses? Make your voices heard…whatever happens, you, we, all of us, will feel the results!