Wednesday, May 02, 2007

For Students -- Health care reform

This is the next chapter in my Wednesday is Student Day series. Students, you have been slow in submitting other questions. If you don't have any, I'll have to make some up . . .

Rocky, a medical student, asks below: "Do you see the new Massachusetts Healthcare Plan having the potential to increase access to good quality care? How will undocumented residents and current free care recipients be affected by the new healthcare reform bill. Will large hospitals retain their freecare pool?"

I have not spent much, if any time, discussing the new Massachusetts legislation on this blog, mainly because the topic is very well covered on John McDonough's blog and WBUR's. I suggest you read those.

I think it is important to remember what the new law is designed to do and what it does not do. It is designed to provide as many people as possible with insurance. An underlying premise and hope is that people with insurance will have better and more appropriate health care. For example, they are more likely to have a primary care doctor -- assuming they can find one -- and go to that doctor for preventative care and low-level emergent issues, instead of showing up at a hospital emergency room. Although hard work remains on this front, the law has already been successful in providing insurance to tens of thousands of people who previously had none.

The law does not do much about the cost and quality of care in the state, except to the extent that insured people will have a better chance of earlier diagnosis and treatment. Although a Quality and Cost Council is established, as far as I can see, it has little authority. Perhaps, though, it will exercise its moral authority to push hospitals along.

Finally, on your question about the free care pool, which is designed to support care for people below a certain income level, we expect to see a transition of patients from that category to Medicaid or to the insurance plans offered through the Connector Authority. Whether that is a net plus or minus financially for a hospital is unclear: The free care pool has never fully compensated many hospitals for their care of uninsured people, but the payment schedules under the new state insurance plans -- just like Medicaid -- do not fully compensate hospitals either.

Just to be clear, none of this affects how we treat patients, which is to do our best to provide excellent care regardless of a patient's income or insurance status. The financial impact is made up by private insurance company payments from other patients and by philanthropy.


Anonymous said...

Good points. This law, while a good start, mandates everyone has insurance. It doesn't talk about the quality of care they receive from that insurance.

Massachusetts law requires drivers have auto insurance. It doesn't say anything about the quality or standards of their driving.

Hopefully the health law will have a better effect on health than the car insurance law has on driving.

Paul Levy said...

It certainly can't do any worse!!!

Brian Rosman said...

To specifically answer the question, we do not anticipate changes to Pool eligibility for immigrants when the current freeze on Pool regulations expires on October 1.

The way the Pool pays hospitals will change, and there may be changes in eligibility for people eligible for Commonwealth Care who do not enroll. But in general, Pool services and eligibility for low income uninsured and underinsured people should not change.

Paul Levy said...

Thanks, Brian.

For the rest of you, Brian Rosman is the Policy Director at Health Care For All. Prior to joining Health Care For All, Rosman was a senior research associate at the Schneider Institute for Health Policy of the Brandeis University Heller School, where he worked on federal health policy issues including the safety net, Medicaid reform and coverage expansions. Prior to his time at Brandeis, he was research director and general counsel to the Health Care Committee of the Massachusetts House of Representatives under then chairs John McDonough and Harriette Chandler. There he played a key role in the drafting and enactment of Chapter 203 in 1996 that raised the state’s tobacco tax to expand health coverage to every uninsured child in Massachusetts, and the Uncompensated Care Pool reform bill of 1997. He also worked for Patricia McGovern, chair of the Senate Ways and Means Committee in the early 90s.

AW said...

A student question:
As a student still in college, I find my friends and I vacillating between a number of future career paths. The options seem endless and overwhelming. When you graduated from college I doubt that you envisioned yourself as the CEO and president of a major hospital, and yet here you are. Do you have any advice for students with an interest in medicine/public health who aren't quite sure where to go after college?