Health + Fitness

Health reform: On track or a "hot mess"?


A record number of health care writers have turned up at the Association of Health Care Journalists annual conference in Boston this week, due in no small measure to implementation of the federal Affordable Care Act that is currently underway.

The journalists are from all across the U.S., and what they’re hearing is still a lot of division over whether the law is shaping up as planned or a “hot mess”, as one speaker put it.

Massachusetts Gov. Deval Patrick, a Democrat, said his state’s health plan, which was the prototype for national health care reform, has been a success, improving health by such benchmarks as decreases in cervical and prostate cancer sue to increased screenings and more affordable care.  One drawback he noted was a shortage of primary care physicians, something Gov. Rick Snyder said he was concerned about but that studies showed it should not be an issue in Michigan.

“I get to see my primary care physician when I want to, but I think that’s because I’m governor,” Patrick said.

One leading health care expert said  the federal health care law can be expected to look like a disaster by the end of 2014 but “this is going to be an enormous success by the end of 2015.”

“We are fine in the long run and a mess in the short run, and we need to ‘Keep calm and carry on’ in the words of Winston Churchill’,” said Jonathan Gruber, an economics proffesor at the Massachusetts Institute of Technology, who has advised Michigan policy makers on health care issues.

Cheryl Smith, former director of the Utah Health Exchange, isn’t so sure. Now director of health exchange practice at Leavitt Parners, a health care consulting firm, she said there’s no way states are going to meet the tight timelines for establishing exchanges set down by the federal government. She’s also worried the government won’t be able to manage the massive amount of data required from the states.

“It probably would have been a good idea to get through all the issues associated with establishing a federal data services hub first,” Smith said.

“It’s going to be a hot mess.”

Gruber said he expects all states will eventually agree to the Medicaid expansion allowed under the Affordable Care Act.  Snyder has joined a growing number of Republican governors to call for the expansion, bucking up against some GOP legislators who have vowed to oppose implementation of Obamacare.

The Medicaid expansion would add 450,000 people to Michigan Medicaid rolls, and the federal government would pay 100 percent of the cost through 2016.  Michigan’s cost would ramp up to 10 percent between 2017 and 2020, and then remain at 10 percent.

It’s unclear whether the state Legislature will go along with the governor’s expansion proposal, but how they handle the health exchange could leave us a clue.

The Senate is currently considering legislation that would sanction the federal partnership exchange called for by Snyder, and authorize use of an $11 million federal planning grant to set up the exchange.

The legislation passed in the House, but indications are it could be blocked by Senate Republicans, and Gruber said he’s been watching those developments closely.  States that don’t develop their own state-run exchange or a federal partnership exchange, will have an exchange set up for them by the federal government.

“Michigan will be doing a huge disservice to its citizens (if the partnership is blocked),” Gruber said. “You’ve got a real smart governor and citizens—why not put them in the position to design (the exchange).  Why leave it all to the feds?”

— Karen Bouffard