Managed Healthcare Executive - March 2009 - (Page 5) NEWS ANALYSIS Down payment sets stage for reform Economic Recovery Act expands safety net, boosts investment in health IT, promotes research JILL WECHSLER | Mike Kemp/Rubberball Productions/Getty Images WASHINGTON BURE AU CHIEF The package also bolsters Medicare by killing proposed reductions in reimbursement to teaching hospitals and hospice providers. There’s an adjustment in payments for nursing homes, too. COMPARATIVE EFFECTIVENESS NATIONAL REPORTS — To jump start the economy, Congress last month approved the Economic Recovery Act with billions in tax breaks and government investments, which include substantial support for staterun Medicaid programs as well as support to modernize the nation’s healthcare system. When coupled with the recently reauthorized State Children’s Health Insurance Program (SCHIP), the new legislation shows the “down payment” the Obama administration has made toward expanding coverage and setting the stage for future health reform. Key health provisions include: $87 billion in additional funding for Medicaid; $25 billion to help laid-o workers pay health insurance premiums under the COBRA program; $19 billion to establish interoperable health information technology and to provide incentives for doctors and hospitals to use electronic medical records; $10 billion to fund National Institutes of Health (NIH) research for cancer, Alzheimer’s disease, heart conditions and stem cell research, and to improve NIH facilities; $2 billion to expand and modernize community health centers; $1.1 billion to fund research on the relative e ectiveness of healthcare services and treatment options by the Department of Health and Human Services (HHS), NIH and the Agency for Healthcare Research and Quality (AHRQ); and $1 billion for prevention and wellness programs that support vaccination and ght disease. SUPPORTING THE SAFETY NET $87 billion Additional funding for state Medicaid programs Most of the money in the stimulus bill devoted to healthcare aims to expand coverage for the uninsured. The funds will bolster state Medicaid programs, support hospitals that provide emergency care, continue Medicaid for low-income workers shifting from welfare to work, and help newly unemployed workers retain previous group insurance. The nal compromise dropped an earlier proposal that would have expanded Medicaid to cover more higher-income individuals who lost their jobs. Instead, the legislators agreed to increase federal payments to Medicaid programs and let states determine how to provide needed coverage. Although comparative e ectiveness (CE) research and health IT provisions are not likely to create many new jobs or expand the healthcare safety net, their potential for reducing healthcare costs justi ed a place in the economic stimulus package. The legislation provides $19 billion to bolster IT operations and encourage physicians and hospitals to install and use EMRs. As part of a lengthy section that details how the government can promote electronic health information in order to modernize healthcare delivery, the bill o cially establishes a national health IT coordinator in HHS to head up these efforts, sets deadlines for establishing interoperability standards and provides a format for doling out subsidies to IT adopters. Insurers, payers and providers are concerned, however, that the push to strengthen privacy protections for individual medical records will stymie efcient dissemination of health information and erect roadblocks to providing e ective care. Privacy advocates won the legislative battle and gained authority for patients to review personal records; now See “Down payment” on page 6 MARCH 2009 5
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