Re­form im­mi­nent, near-term changes are not

Modern Healthcare - - Special Report -

With a broad health over­haul bill in its fi­nal stages on Capi­tol Hill and pas­sage likely, provider groups say they are pre­par­ing for a year that is at once dif­fer­ent and yet strik­ingly sim­i­lar to years past.

If 2009 was dom­i­nated by con­gres­sional ef­forts to shape the mas­sive re­form bill, then 2010 will be the year that the in­dus­try be­gins to see where the chips will fall.

While both the House and Se­nate have passed their own bills, Congress has yet to of­fi­cially meld the two to­gether. So even though the gen- eral con­tents of the 2,000-page leg­isla­tive pack­age are known, “It’s go­ing to take months and months to fig­ure out re­ally what it all means,” says W. Reyn Archer III, manag­ing di­rec­tor of the health­care prac­tice at Bur­son-Marsteller, a pub­lic af­fairs com­pany.

An over­worked Congress is push­ing to have a fi­nal bill ready for Pres­i­dent Barack Obama to sign into law pos­si­bly later this month—just be­fore he de­liv­ers the an­nual State of the Union ad­dress. But long­time pol­icy ob­servers in Wash­ing­ton say that it’s just the beginning of what could be a pro­tracted bat­tle to try to steer the im­ple­men­ta­tion process. “The job is re­ally to let the dust set­tle and then be­gin to eval­u­ate what some of the egre­gious things are,” Archer says.

The idea is to avoid what law­mak­ers and stake­hold­ers call “un­in­tended con­se­quences.” For the lob­by­ing com­mu­nity, it’s ex­pected to be a full-time job this year.

Com­pli­cat­ing mat­ters, the all-en­com­pass­ing na­ture of the re­form bill has sucked up most of Congress’ leg­isla­tive re­sources. Other op­por­tu­ni­ties to in­tro­duce new mea­sures to make other changes to the health­care sys­tem likely won’t sur­face in 2010.

Health re­form 2.0

Richard Pol­lack, ex­ec­u­tive vice pres­i­dent at the Amer­i­can Hospi­tal As­so­ci­a­tion, also notes the need to help fur­ther shape the bill. “Leg­isla­tive cor­rec­tions are in­evitable, and fix-its are in­evitable,” he says. “If you want to call this health­care re­form 1.0, then there will be a 2.0.”

Pol­lack says he ex­pects the fo­cus this year to be on how newly cre­ated pro­grams—such as the re­form pack­age’s in­sur­ance ex­change and the dozens of pi­lot pro­grams—play out. “There is a hu­mon­gous amount of work as­so­ci­ated with how re­form gets im­ple­mented in terms of reg­u­la­tory de­sign,” he says, adding that much of that work gets done at the agency level rather than on Capi­tol Hill.

One area, how­ever, that hospi­tal groups will track is im­mi­gra­tion re­form, which could prove nearly as daunt­ing to law­mak­ers as the re­form bill. Both the House and Se­nate bills have the po­ten­tial to leave mil­lions of il­le­gal im­mi­grants unin­sured, which cre­ates a fi­nan­cial hit to hos­pi­tals that have to treat them.

“We are cre­at­ing a health re­form (bill) that ex­tends cov­er­age to a lot of peo­ple, but we’re still leav­ing out a lot of folks,” Pol­lack says.

Pol­lack adds that the AHA would work with

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