2009 Agenda Links Economic Stimulus and Health Care Reform

With the nation and the world watching, President Barack Obama and the 111th Congress have an incredible opportunity, and a formidable challenge: to enact comprehensive health care reform. While the economy will unquestionably dominate the early days of the 111th Congress, a compelling case is being made that health care is a key economic issue.

Late in 2008, the presidential transition team worked to craft an economic stimulus package. Last month, Congress passed — and Obama signed into law — the $787 billion bill, which dedicates some money to help states with growing and underfunded Medicaid programs, and also funds to help physicians purchase health information technology.

In late December, the Congressional Budget Office (CBO) released a cost-benefit analysis of 15 health care reform options. While the general finding was that most of the options would place significant cost burdens on the government, the CBO predicted that fostering the use of health information technology (including electronic medical records) would save the federal government $7 billion over the first 5 years and nearly $35 billion over 10 years, primarily through reductions in medical errors, lower health insurance premiums, and avoiding unnecessary tests and procedures.

Another health-reform option predicted to positively impact the budget if enacted is a requirement (similar to that in the Massachusetts Health Reform Law) that all but the smallest employers who fail to provide health insurance to their employees pay a fee. The CBO estimates that this would result in $47 billion in new revenues.

The Massachusetts law continues to serve as a possible framework for national health care reform. Both the Senate Finance Committee’s proposal and President Obama’s stated health care positions support an ‘incremental universalism’ approach that includes Massachusetts-style elements such as ‘play or pay’ provisions for employers, expansions of Medicaid eligibility and other public programs, and some form of ‘connector’ to help people purchase more affordable health insurance.

Sen. Edward Kennedy continues to lead efforts in the Senate to develop a comprehensive proposal that would work at the national level. Kennedy recognizes that, while the principles of the Massachusetts plan are applicable nationally, there are significant differences between the state and national markets.

This year considerable attention will also focus on efforts to change the Medicare physician payment formula. While a solution is far from clear, there is no question that Congress wants to move away from using volume as a basis for physician payment and toward a still-undefined measurement of value and cost effectiveness. The Mass. Medical Society continues to work with the Massachusetts Congressional delegation and the American Medical Society to forge meaningful national health care reform.

Alex. Calcagno is director of Federal Relations for the Mass. Medical Society. She is responsible for advocating the MMS positions before the Massachusetts Congressional delegation, federal agencies, and the executive office. Calcagno has over 20 years experience lobbying in Washington, D.C. Before coming to Massachusetts she was assistant director of the Washington office for a national medical association and worked on Capitol Hill for a member of Congress.