The $787 billion American Recovery and Reinvestment Act – or ARRA – was a good way for the Obama administration and the new Congress to begin healthcare reform efforts.
The legislation contains significant changes to current healthcare law that could improve access to care, in particular with regard to Medicare and Medicaid, COBRA insurance coverage, and healthcare information technology.
The ARRA provides a temporary increase in federal Medicaid contributions, with a base contribution to all states, enhanced payments in high unemployment states and additional disproportionate share hospital allocations.
Unfortunately, the final legislation did not include a provision which appeared in the original House version of the bill that would have extended Medicaid coverage to unemployed but otherwise eligible low-income families. I find it troubling that Congress still insists on making the fraudulent distinction between the “deserving” and “undeserving” poor when it comes to healthcare.
Frankly, if poor families need medical care, I believe our society should subsidize that care, whether they happen to be employed or not. The truth is, we end up paying for it anyway, if they ignore illnesses and show up in the emergency department for treatment of illnesses that could have been adequately handled by primary care physicians.
The healthcare IT provisions of ARRA also affect Medicare and Medicaid spending.
For instance, Medicare will offer financial incentives for adoption of electronic health records targeted at physicians and hospitals that make “meaningful use” of EHRs, while the Medicaid healthcare IT incentives provide for full federal funding of EHR adoption by Medicaid providers that serve a high volume of Medicaid – or in some cases simply “needy” – patients.
While I don’t think that IT adoption alone is the answer to the quality and cost ills that bedevil the U.S. healthcare system, the Medicare and Medicaid aspects of the technology provisions should help to improve quality of care for underserved populations.
Another part of the legislation I like is the short-term subsidy for COBRA health insurance coverage for those people who lost their jobs between September 2008 through December 2009.
The COBRA premium assistance lasts a maximum of 9 months, and is available to individuals with annual incomes below $125,000 or couples below $250,000. And a particular benefit for small employers is the availability of the subsidy for continuation coverage if required by states for employees not otherwise covered by COBRA.
Again, I’m disappointed that certain COBRA provisions in the House bill were left out of the final product. I’d have liked to see unsubsidized COBRA coverage extended to older and long-service workers until they reach Medicare eligibility or acquire coverage under another group health plan.
But given the practical aspects of getting the bill passed, and Obama’s promise for a more comprehensive approach to healthcare reform, we must be thankful for the piecemeal efforts that made it through Congress.
Another aspect of ARRA that deserves praise is the inclusion of $1.1 billion for comparative effectiveness research.
Most healthcare policymakers are convinced that research on clinical outcomes, and the effectiveness and risks of various medical treatments, will lead to improvements in quality of care and, ultimately, to cost savings. I agree with them.
While the economic stimulus legislation was decidedly not a comprehensive healthcare bill, its healthcare provisions are timely and worthwhile. Let’s hope they are but precursors for more systemic reform in the coming months.