WCRI Conference: Day One

March 12th, 2014 by

Four sessions today, beginning with MIT’s Jonathon Gruber in a stemwinder. Gruber, one of the principal architects of the Affordable Care Act (ACA), and, with John McDonough, a prime mover in the Massachusetts health care reform of 2006, must spend 80% of his waking hours debunking rumors, which have become urban myths, which have turned into alleged “facts” regarding all things ACA. Witness for the prosecution – Sarah Palin’s Death Panels.
Dr. Gruber pointed out that one of the important differences between the Massachusetts reform, which he convincingly demonstrated was the template for the ACA, and the ACA was that Massachusetts did not have to focus on costs, because Ted Kennedy and Governor Mitt Romney had maneuvered to have the costs covered with an annual infusion of $500 million dollars of federal money. The Massachusetts reform could not have happened without this.
Nonetheless, the goal of Romney’s reform was to provide health insurance for all of Massachusetts’s citizens. And with more than 97% of the population covered, this has happened.
Gruber went on to say that, despite the rocky beginning, the federal exchanges are now running “as they should.” He suggested that a prime goal of the ACA, Medicaid expansion, is falling behind expectations, because many of the governors in the southern states have chosen to not participate. In effect, they have turned down 100% federal funding for three years and 90% funding thereafter. Frankly, I consider this an abomination. Millions of Americans will be harmed because of this politically idealogical decision. Perhaps, this will change in the future. One can hope.
Dr. Gruber reminded attendees that it took about three years to find out if the Massachusetts reform was working the way it was supposed to (It was). He suggested that a similar period would have to pass before we know if the ACA has done what it was engineered to do. Until then, we should be “humble” to recognize what we don’t know and “patient,” because the ACA is a process, not an event.
The rest of the day was devoted to Dr. Carol Telles reporting on the results of health care reforms in Texas, where costs have declined significantly, and Dr. Rebecca Yang reporting on the effects of the Illinois 30% reduction in the medical fee schedule. It appears that in Illinois costs of professional services (primary care and the like) have declined by 24%, but costs of surgical services have risen significantly to a point where they are now 382% higher than Medicare. It would have been nice to know the impact on total health care costs.
I look forward to a stimulating day tomorrow.