I’ve had the privilege over the last few weeks of traveling around Iowa and meeting with hospital leaders in IHA’s seven districts. The goals of these meetings were to discuss where IHA has been in the past year; provide a current environmental assessment of hospitals; and look into the near future of what’s at stake for hospitals during the debt and deficit debate, which will flare up as the polls are closing on November 6.
As with most interactions with members, these meetings presented opportunities to refine the Association’s message and further evaluate how best to engage hospitals’ various constituencies concerning health care reform and the national debt. For example, one question recently fielded was, “Which political party position on health care is best for hospitals?” As tempting as it may be to allow one’s personal philosophy on government to overrun this question, further reflection on the object of the question, “hospitals,” makes providing a thoughtful response much more challenging.
Health care policy supported by President Obama expands coverage via private market insurance and Medicaid expansion, yet turns over future payment policy for hospitals to an independent (bureaucratic) board, while incenting hospitals and state governments to save money on Medicare and Medicaid with systemic reform, aka Accountable Care Organizations and shared savings programs.
Governor Romney articulates repeal of these provisions and replacement with a consumer-oriented system of premium supports for Medicare that will grow based on an inflation index of health care spending as a percent of gross domestic product. For Medicaid, his position is to block grant federal support to the states and limit federal government financial exposure with an inflation index applied to each state’s grant.
Setting aside one’s personal philosophy on government (if that’s possible), the preference of these competing policy options largely relies upon the demographics of the local health care market and one’s individual financial resources. Consumer-oriented or managed care plans for Medicaid and Medicare have worked in densely populated areas where critical mass exists and government payments to insurers are high enough to elicit a plurality of players in the insurance market. Yet, these options have done little to slow the growth of government expenditures in those markets. At the same time, these options exist in limited capacity for less densely populated or rural regions of the country, with Iowa being a case in point. One limited exception to this experience was the initial Medicare drug program which provided additional benefit to seniors while restricting government exposure with a “carve-out” that placed payment responsibility back with the beneficiary.
IHA has focused on the government’s need to pay for value in Medicare and Medicaid. If the system is truly focused on value, health care costs will decline as unnecessary utilization and infrastructure is curtailed. That’s also why IHA launched our “We Care, We Vote” campaign with this fall’s district meetings.
There’s a great deal at stake for hospitals and our country as the debate on the federal debt ensues. There will be many decision points and battles over how to preserve resources to which hospitals currently have access.
IHA’s goal is not only to engage that segment of the electorate employed by Iowa hospitals and make the connection between policy in Washington, D.C. and Iowa’s community hospitals, but also to find voices of reason and moderation that understand the need to preserve what’s best about America’s health care system while we seek to reshape it.