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With costs escalating and demand for care increasing, healthcare in the United States is at a tipping point. Our panel of industry leaders weighs the social, technological and policy changes that can set healthcare back on a sustainable path.
We’d like to thank Dave Gessel, vice president of government relations and legal affairs of the Utah Hospital Association, for moderating the event.
Blaine Benard, Holland and Hart
Dr. William Hamilton, Intermountain Healthcare
Dave Gessel, Utah Hospital Association
Scott Barlow, Central Utah Clinic
Ryan Bingham, Spectra Management
Dr. Ronald Ruff, Mountain Medical Physicians
Earl F. Hurst, Moreton & Company
Dr. Ken Johnson, Weber State University
Aimee Whetman, MountainStar Healthcare
Dr. Michelle McOmber, Utah Medical Association
Dr. Vivian Lee, University of Utah Health Sciences
Dr. Richard Sperry, University of Utah
Dr. Doug Hasbrouck, HealthInsight
Dean Sanpei, Intermountain Healthcare
How will federal healthcare reform impact your business in a positive or negative way?
HURST: The legislation that has been passed by the Obama Administration will have a significant impact on Utah businesses as well as benefits that employers or employees have not had for several years, one of which is the preexisting condition clause within that legislation. It will allow employees who were ruled out of having health insurance in the past to have access to health insurance.
How that clause will impact businesses will be through increased costs. To insure someone who has a preexisting condition very well could mean that they have a condition that will cost a lot to care for, and that will have impact on the cost of insurance.
BINGHAM: There is definitely a love/hate relationship with the legislation. It’s going to open up opportunities for some, but for those who see cost being the No. 1 component, they vacillate back and forth, especially with the introduction of community rating for smaller employers creating kind of a levelized dollar amount. For those that are in that lower-risk tier, their rates will go up substantially, whereas a number of our clients that may be in those highest-risk tiers will see their rates potentially go down. So it really depends on what side of the line you are on. But with the introduction of preventative care being covered at 100 percent, hopefully a number of other parts of the healthcare reform will be quite popular.
BARLOW: The biggest difficulty is still the unknowns. There are a lot of details that aren’t very clear still, but a lot of changes are already underway. Payment has got to change dramatically, and everyone knows that. Transparency is developing and we now have better tools to measure outcomes—but we also worry about tools being presented to the public that aren’t that refined yet.
HAMILTON: There is so much unknown that a lot of physicians I deal with are not sure what to think. There are varying opinions among the physician community, all the way from people who think the Affordable Care Act didn’t go far enough and we need a single-payer system, to the other end of the spectrum where most physicians that I deal with in Utah are probably at. This is a more conservative state. They’re suspicious of the Affordable Care Act and what is coming.
LEE: Overall there is a sense that for the health of the population, it’s important to provide access to health insurance and healthcare. So in the big picture, that’s a good thing.
What it will do is create an enormous demand on health services. And, of course, at the same time we have tremendous pressure to reduce our costs. What we are hoping is that we’ll shift from the very high utilization, for example, of the ER in place of primary care. But then we also have to acknowledge that we don’t have enough primary care physicians to manage it in the way that we’d like to. There is going to be an enormous shift, and whether or not the system is able to manage that shift fast enough and effectively enough is a bigger question.
How do you think the federal reform will proceed based on the federal election?
SANPEI: There are things that for sure are going to stay in place. Some things could change dramatically—there is a lot in the legislation that is left up to rule-making authority. Just one example is with the Medicaid expansion in the states. Do you have to do the entire expansion? Could we do some incremental piece of the expansion? Instead of expanding Medicaid for 133 percent above poverty, can we do it just to 100 percent or some iteration between?
If you get past all the reform elements, there are still the underlying issues associated with healthcare access, with healthcare expenses and the healthcare growth curve. Much of this evolution that has begun is going to continue.