The Torch, Spring/Summer 2010

8 TORCH | Spring–Summer 2010 JENNIFERTETRICK What problems with our health care system did Congress seek to resolve? There was genuine agreement among Republicans and Democrats that the health care system needed reform. America leads the world in medical innovation and provider excellence, but the system costs about 50 percent more than that of most other industrialized nations. Health insurance premiums have more than doubled over the last decade, the Medicare program is running out of money, the Medicaid program is plagued with poor access and fraud, and millions of Americans lack health insurance. What are the most significant changes? The new law adds 32 million people to the current health care system, but it does not fundamentally change the way health care is reimbursed or delivered. Consequently, the system will still face unsustainable costs, and there will be new quality of care implications. The core elements of the bill all focus on increasing health care coverage. Specifically, it substantially reforms insurance laws, including requirements that health insurers cover every American, regardless of health status or a pre-existing condition. To reduce the incentive for individuals to wait until they get sick to get insured, Americans will be required to buy government-approved coverage and include compliance information on their tax returns. Massachusetts enacted the prototype for the new national law in 2006, and much can be learned from its experience. While the state covers 97 percent of its citizens, those citizens often have trouble finding a primary care doctor and frequently end up in the emergency room for routine care. Massachusetts expanded coverage before solving the cost problem. Consequently, its costs have risen between 21 and 46 percent faster than the national average. What aspects of the legislation were the most controversial? Many opposed the bill because it did little to lower the actual costs of health care. The law includes a few provisions to address costs such as a new tax on health care benefits, payment reform demonstrations in Medicare, the Payment Advisory Board, and new research on comparative effectiveness of medical treatments. However, the evidence indicates that these reforms barely scratch the surface of unsustainable systematic costs. Estimates from the nonpartisan Congressional Budget Office show that small businesses will face the same unsustainable premium increases and that individuals purchasing coverage on their own will see their premiums increase by 10 to 13 percent. An estimate from the Obama Administration’s chief actuary found that the nation will actually spend $311 billion more on health care as a result of the new law. The new federal and state spending required by the bill was another significant point of contention. In order to expand coverage, the Stephanie Carlton, a 2002 graduate of Cedarville University, serves as the health policy advisor to Sen. John Cornyn (R-Texas), a member of the Senate Finance Committee and Republican leadership. The Finance Committee is the key Senate committee on health care with jurisdiction over Medicare, Medicaid, and tax policy. Through the lens of her direct involvement in Washington, she answers questions about the new health care legislation.