CHRT Policy Brief Demystifies National Health Care Act; Shows Choices, Opportunities at State, Local Levels

May 24, 2010 | Publication

The Center for Healthcare Research & Transformation (CHRT) today released a national policy brief on the Patient Protection and Affordable Care Act (“Act”) that summarizes state requirements, as well as opportunities at the state and local levels to shape health care delivery.

“This Policy Brief is a tool to help policy-makers, providers of care, foundations, and individuals understand the scope of the Patient Protection and Affordable Care Act, and point out where the opportunities exist to collaborate on improving health care delivery and public health,” says Marianne Udow-Phillips, director of CHRT. “Media coverage of the Act so far has focused principally on health insurance reform. But, there is much more involved, including provisions that will affect the way care is delivered and paid for in every hospital and doctor’s office. In fact, each state has important provisions to implement and choices to make beginning this year.”

The Act includes many options for health care providers and organizations at the community level to test new ideas for health care quality and efficiency improvements, expanding public health and delivering care to special populations. One important issue for advocacy groups and others to focus on early is that many parts of the Act include worthy concepts where funding has not yet been committed. The Congressional Budget Office has estimated that more than $115 billion in funding has been authorized but not appropriated.

“It will benefit Michigan policy leaders and citizens to act collaboratively to advocate for funding for important initiatives included in the Act and then capitalize on these opportunities,” says Udow-Phillips.

The Policy Brief is an easy to understand seven-page summary of state responsibilities in health reform and state and provider/community delivery system options included in the nearly 1,000-page Patient Protection and Affordable Care Act.

State requirements cited in the CHRT Policy Brief include (among others):

  • Establishment this year of a temporary high risk pool for those who have been excluded from insurance coverage because of pre-existing conditions;
  • Establishment by 2014 of insurance exchanges for individuals and small businesses to obtain coverage from qualified health plans;
  • Expansion of Medicaid coverage by 2014 to all of those with incomes up to 133% of poverty.

The Policy Brief discusses options and funding available at the state and local level for demonstration, research and training projects. Examples include:

  • A demonstration grant for “health homes” for Medicaid recipients with chronic disease;
  • Grants for demonstration projects to test alternatives to tort litigation for malpractice;
  • An optional State basic health program for those with incomes between 133 and 200% of poverty;
  • Funding for the Center for Medicare and Medicaid Innovation (CMI), to test innovative payment and service delivery models to reduce cost and improve quality. More than $10 billion is appropriated for this work from 2010-2019;
  • A $100 million authorization (but no appropriation) for up to 20 centers of excellence in depression in 2011, up to 30 by 2016;
  • Initiatives related to medication management, regional trauma centers, nurse managed clinics and chronic disease strategies;
  • Funding for development (but no appropriation for operational funds) for expansion of school based health centers and federally qualified health centers; and
  • Expansions of primary care, advanced practice nurse and preventive medicine training (no funding is yet appropriated for these initiatives).

“The Patient Protection and Affordable Care Act provides tremendous opportunities at the state and local level beyond health care coverage alone,” says Udow-Phillips. “Those most interested in influencing the future of health reform would be well served to identify the state and local options of most interest to them, become involved in shaping their implementation and design, and work to assure federal, state, and local funding for those options.”