This is it

Af­ter a cen­tury of bat­tles and a year of con­tentious de­bates, U.S. health­care is chang­ing. So what does this all mean for you?

Modern Healthcare - - Cover Story - By Jen­nifer Lubell and Matthew DoBias

Hos­pi­tals, doc­tors and other providers view the na­tion’s largest over­haul of the health­care sys­tem in nearly 50 years as a pos­i­tive step—while brac­ing them­selves for sig­nif­i­cant changes in the way they get paid and how they de­liver care to pa­tients.

Af­ter months of po­lit­i­cal wran­gling, back­room ne­go­ti­a­tions, count­less hear­ings, votes and headaches, Pres­i­dent Barack Obama achieved clo­sure on one of his top do­mes­tic pri­or­i­ties, uni­ver­sal health­care re­form. Amid the taunts from GOP naysay­ers and protests and death threats from pub­lic op­po­nents of the leg­is­la­tion, the $940 bil­lion pack­age was ap­proved by Congress de­spite some last­minute pro­ce­dural de­lays.

The larger piece of the re­form pack­age—an $875 bil­lion sweep­ing bill ap­proved by the Se­nate last De­cem­ber—was signed into law on March 23 by Obama as the Pa­tient Pro­tec­tion and Af­ford­able Care Act. Af­ter some par­lia­men- tary de­bate and ping­pong­ing from the House and Se­nate, law­mak­ers man­aged to ap­prove a $65 bil­lion com­pan­ion bill that re­flects some changes House mem­bers orig­i­nally de­sired, such as elim­i­nat­ing spe­cial deals made to cer­tain states, wa­ter­ing down an ex­cise tax on high-cost in­sur­ance plans, and clos­ing Medi­care’s cov­er­age gap or so-called “dough­nut hole.” To­gether, the two bills would cost $940 bil­lion over 10 years, but pro­jected cost sav­ings in the bill would re­duce the deficit by $143 bil­lion dur­ing this time pe­riod and by $1.2 tril­lion for an ad­di­tional 10 years, ac­cord­ing to con­gres­sional ac­tu­ar­ies. The aim is to cover 32 mil­lion more Amer­i­cans, or about 94% of the pop­u­la­tion.

“Amer­ica’s hos­pi­tals have long been com­mit­ted to en­sur­ing health­care cov­er­age for all. While the path to uni­ver­sal cov­er­age has been long, to­day we are closer than ever to reach­ing this im­por­tant goal,” said Richard Umb­den­stock, pres­i­dent and CEO of the Amer­i­can Hospi­tal As­so­ci­a­tion, af­ter the pres­i­dent’s his­toric sign­ing of the Se­nate bill last week. (For more of Umb­den­stock’s per­spec­tive, see Com­men­tary, p. 25.)

Physi­cian groups, which helped shape parts of the law de­spite los­ing out on a mea­sure that would have scrapped the ex­ist­ing Medi­care pay­ment for­mula, said the new re­form pack­age works to strengthen the bond be­tween doc­tor and pa­tient. Fred­er­ick Tur­ton, chair­man of the Board of Re­gents for the Amer­i­can Col­lege of Physi­cians, high­lighted a num­ber of changes to Medi­care and Med­i­caid that would serve to bet­ter bridge care. Some of those in­clude new ben­e­fits for pre­ven­tive ser­vices, fund­ing for qual­ity-of-care pi­lot tests, phas­ing out the cov­er­age gap un­der the pre­scrip­tion drug pro­gram and more, he said.

Other changes in store for the Medi­care and Med­i­caid pro­gram have providers well aware of the fact that re­duc­tions in their pay for fed­eral in­sur­ance pro­grams—as well as a new vig­i­lance for im­prov­ing the qual­ity of

Pres­i­dent Barack Obama signed the Pa­tient Pro­tec­tion

and Af­ford­able Care Act into law

on March 23.

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