PPACA: Stimulus, Jobs, and Cost Control

Before we get into that, I'd like to draw your attention to some upcoming public forums (fora?) regarding proposed rules for implementing PPACA:
In the weeks ahead, the Administration will conduct an aggressive outreach campaign and ask for public comment on the three proposed rules from employers, consumers, state leaders, health care providers and insurers, and the American people. In addition to accepting written public comments for the next 75 days, the departments will hold forums. These forums will help ensure more Americans have the opportunity to share their views regarding the establishment of Affordable Insurance Exchanges. Forums will be held in: Atlanta, GA - September 13, 2011 Chicago, IL - September 26, 2011 New York, NY - September 21, 2011 Sacramento, CA - September 22, 2011
So please get the word out to everybody you know in those states and hey...if you're planning a vacation, why not go make some noise while you visit! Now, on to the main points, starting with stimulus. As indicated in the link above, states are moving forward with planning and implementation for the exchanges. The states are receiving grants from HHS to make these preparations:
On August 12, 2011, 13 states and the District of Columbia were awarded over $185 million dollars in Exchange Establishment grants. Three states, Indiana, Rhode Island and Washington, were awarded grants on May 23, 2011. These grants are just the latest in an ongoing series of Affordable Care Act grants to help states develop Exchanges. Already, 49 states and the District of Columbia received Exchange Planning grants, seven states received Early Innovator grants, and a number of states have indicated interest for future rounds of Exchange Establishment grants.
There are also grants awarded specifically to rural health care networks to implement the electronic records system and other aspects of health care IT, including training. All of which sounds like stimulus and jobs to me, as does PPACA's focus on building the health care provider base, especially in nursing.
PPACA reauthorizes and expands numerous existing PHSA health workforce programs. The law also creates several new PHSA workforce programs to increase training experiences in primary care, in rural areas, and in community-based settings. ...PPACA includes programs that provide training opportunities and fellowships to increase the supply of other types of providers with identified shortages such as pediatric subspecialists, public health workers, and geriatricians. Finally, PPACA modifies Medicare graduate medical education (GME) payment policy. Medicare subsidizes medical residency training through GME payments to teaching hospitals. PPACA’s changes to GME payments, along with a new health center grant program and a number of other provisions, are intended to promote primary care training in non-hospital settings.
HHS Secretary Kathleen Sebelius today announced $71.3 million in grants to expand nursing education, training and diversity. Nursing workforce development programs, reauthorized by the Affordable Care Act and administered by HHS’ Health Resources and Services Administration, are the primary source of federal funding for nursing education and workforce development. These programs bolster nursing education at all levels, from entry-level preparation through the development of advanced practice nurses. They also prepare faculty to teach the nation’s future nursing workforce. “These awards reflect the critical role of nurses in our healthcare system, and our ongoing commitment to attract and retain highly-skilled nurses in the profession,” said Secretary Sebelius.
PPACA has also set aside $50 million a year, 2010 - 2014, to support Nurse-Managed Health Clinics. Allowing Nurse Practitioners to serve on the front lines like this is an eminently sensible way to expand coverage. One needn't have a medical degree to recognize the symptoms of strep throat, for example, or to prep the culture to confirm diagnosis. Hell, I did that kind of culture in micro lab. This, of course, leads right into the last point about cost control, of which these NMHCs are just one example. The most recent and very exciting example comes in the form of new rules regarding (wanton) rate increases:
Today, health insurers seeking to increase their rates by 10 percent or more must submit their request to state or federal reviewers to determine whether they are reasonable or not. This rate review program, created by the Affordable Care Act, will bring greater transparency, accountability, and, in many cases, lower costs for families and small business owners who struggle to afford coverage. ...Rate review will shed a bright light on the industry’s behavior and drive market competition to lower costs,” said Kathleen Sebelius, Secretary of Health and Human Services. “We are pleased to team with states to bring this important new protection to consumers and employers.” As of today, insurers proposing double digit increases will have to provide clear information that indicates what factors are causing proposed increases. Experts will closely examine information about the underlying cost trends in health care to flag instances when insurance companies are unjustly raising costs. ...Starting mid-September, consumers in every state can go to HealthCare.gov to view easy-to-access, consumer-friendly disclosure information explaining proposed increases that are 10 percent or higher than last year’s rates. Consumers will see a summary of the key factors driving rate increases and an explanation provided by insurance companies for why the proposed increase is needed. And, for the first time, consumers in every state will also be given the ability to comment on large proposed rate increases. ...“Thanks to our Affordable Care Act grant funds, our rate reviews are more in-depth, and we recently proposed to use future grant funds to incorporate public hearings into our rate reviews,” Oregon Insurance Division Administrator Teresa Miller said. “We have already received valuable feedback from consumer groups and look forward to continuing to improve our rate review process"
Slowly but surely, PPACA is making a big difference. On the Medicare front, it's already kept spending growth at below 4%, when it's been double-digit for decades.
Various hospital executives have told me they have already begun to prepare for less generous reimbursement from Medicare as the new federal health-care-reform law takes effect and there is a greater focus on value. They are therefore trying to become more efficient now. ...The Mount Sinai experience may be instructive. From September 2010 to May 2011, the hospital’s Medicare revenue rose only 2 percent over the previous year -- in part because the number of inpatient cases fell. Why was that? One important reason was that the number of patients readmitted to the hospital within 30 days of discharge was 5 percent less than what it had been the previous year. Reducing readmissions is one of the objectives of the federal health-care-reform law enacted last year.
Does any of this change the fact that we needed single payer, like, years ago? Of course not. But PPACA is a damn sight better than what was and we can still follow Vermont's lead and work for single payer in our states. We'll go Canuck and do it one region at a time! Whatever it takes. rAmen!

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