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Panel: Obamacare won’t improve costs nor quality

New Hampshire Union Leader

October 02. 2012 9:24PM

CONCORD - The Affordable Care Act, or Obamacare, will increase access to health care and reduce the number of uninsured, but will do little if anything to control costs or improve quality.

That was the underlying theme from both the keynote speaker and panelists Tuesday at the fourth annual New Hampshire Business Review Health Care Forum, which attracted nearly 300 business leaders, human resources executives and health care professionals to the Grappone Conference Center, all looking for insight into the complex legislation.

'The Supreme Court is not going to take away the ACA, nor is November (election) going to take away ACA,' said panelist Lucy Hodder, chair of the Health Care Practice Group at the law firm of Rath, Young & Pignatelli. 'The ACA is here to stay. It may be tinkered with, but if you do away with it, you still have to deal with costs.'

Keynote speaker Aaron Carroll, a pediatrician and director of the Center for Health Policy and Professionalism Research, based at Indiana University, told the crowd that the impact of the ACA may be overstated when it comes to the scope of changes needed in the health care system.

'We have made some strides in terms of access,' he said, 'but cost is a real issue, and we haven't even touched on quality.'

Carroll said the new health care law is primarily targeted at the uninsured. He said individuals who now get insurance through their employers, Medicare, Medicaid, the Veterans Administration or other government programs are not likely to notice much change as major provisions of the law take effect.

Businesses with fewer than 50 employees are exempt from the mandate to provide health insurance or pay a fine, and most companies with more than 50 employees already provide some form of coverage that would be acceptable under the law.

'Things aren't going to change that dramatically for most businesses,' said panelist Chara Stevens, director of the Human Resources Council of New Hampshire. 'For the most part, it's going to be business as usual.'

The individual mandate to have health insurance and the expansion of Medicaid will improve access, but the problems of high cost and poor results are not being addressed despite the huge investment, Carroll said in an interview after the event.

'The ACA is all about expanding access,' he said. 'It does that with about $1 trillion more in spending over a decade.' That investment will do little to improve outcomes or contain costs, he said.

Carroll used statistics in his presentation to challenge many of the assumptions held by both ACA supporters and detractors regarding cost control. 'There's no magic here,' he said, regarding the tension between cost, access and quality. 'If we cut spending, either the number of people we have to cover or the quality of care has to suffer. There is no third way.'

Efforts to contain costs so far have not sat well with providers, who are feeling most of the burden. Cuts in Medicare and Medicaid reimbursement rates are a good example. 'We're worried about going out of business because we're not being paid enough to cover our costs,' said John Starr, chairman of Littleton Regional Healthcare, during a break.

Panelist Frank McDougall, vice president for government affairs at Dartmouth-Hitchock Medical Center, said the state is defunding Medicaid to the point of bankruptcy, with the lowest reimbursement rates in the country. 'We've surpassed Mississippi for that,' he said.

He said a plan to turn management of Medicaid in New Hampshire over to a managed care organization is like 'rearranging the deck chairs on the Titanic. It's not going to address the problem; it's not going to reduce spending.'

Collaboration among hospitals is producing positive results, according to panelist Rachel Rowe, executive director of the Granite Healthcare Network, a statewide collaborative of five hospitals - Concord Hospital, Elliot Hospital in Manchester, Southern New Hampshire Regional Medical Center in Nashua, and Wentworth Douglass Hospital in Dover.

'Five hospitals coming together to share best practices, pool resources and improve outcomes is going to achieve much better results than what we could each do individually in our communities,' she said.

While the problems surrounding health care in New Hampshire were well-documented, the conference was short on solutions. Amy Schwartz, director of health care cost containment at UNH, said a new clinic that opened at the Durham campus in February with two doctors paid a salary, instead of fee per service, is proving to be very effective. 'Our fees are reasonable and we hope to see some savings from it,' she said.

'I think the big message is that it's a local market issue, and you have to see what solutions will work for your market and your population.'


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