WASHINGTON, D.C. — With a potentially game-changing Supreme Court decision brewing a few blocks away in one direction and election-year demonstrators occupying White House sidewalks a few blocks the other way, health care policymakers met in the middle this week to hear unapologetic, sometimes acrimonious, partisan opinions from Wall Street to Capitol Hill.
The annual AcademyHealth National Health Policy Conference offered more than 800 policy wonks a varied overview of the industry at the start of what many feel will be a pivotal year in the evolution of the nation’s health care system.
The two days of workshops ranged from nuts-and-bolts discussions about how states are building — or in some cases ignoring — health insurance exchanges to hard-edged investment forecasts.
“There’s no question that emotions are running high, and that’s one of the reasons that understanding all the factors in play in health care is so important,” said Ted Kennedy, Jr., who moderated a panel discussion Tuesday on investment trends and opportunities as the Affordable Care Act continues to unfold. Kennedy works for the Marwood Group, an investment services firm.
Kennedy’s contention that the ACA brings millions of new customers into the insurance market and offers new opportunities was in stark contrast to those of Carl McDonald, analyst for Citi Investment Research who addressed the conference the day before.
“Only good things can happen if Republicans win,” said McDonald, who tracks the managed care industry. “If you own managed care stocks and you want them to go higher, you’re rooting for Romney,” McDonald said.
Conflict, Agreement on Capitol Hill
Differences of opinion were also clearly displayed on a panel of Capitol Hill staffers discussing challenges faced by health care policymakers. Republicans and Democrats representing committees and leadership from the House and Senate were predictably partisan — and sometimes brisk.
But they did agree that politicians and Capitol Hill staffers need all the information they can get and that health services research like that from AcademyHealth provides valuable guidance.
“I think we all share the common goal of improving health care and the better informed we all are, the better the chances are that we can move toward that goal,” said Adrienne Hallett, representing the majority staff of the Senate Committee on Appropriations.
Jeanne Lambrew, representing the White House, said it a different way.
“Facts matter,” Lambrew, deputy assistant to President Obama on health policy, said in her conference-opening address to a room largely filled with health policy researchers.
“We all have a lot on our agenda going forward and there’s a lot of rhetoric involved, but when you look back at where we’ve been and what we’ve done, you have to look at the facts,” Lambrew said.
California Contingent
California policies and policymakers were evident throughout the conference from California Health Benefit Exchange board member Kim Belshé serving on a panel examining state health insurance exchanges to Molly Coye, chief innovation officer for the UCLA Health System, moderating a panel on “Using Evidence to Build a Learning Health Care System.”
Belshé, California’s HHS secretary during Republican Gov. Arnold Schwarzenegger’s administration, prefaced her remarks about building an exchange and health care reform in general by saying, “This is not an undertaking for the faint of heart. I usually say it’s not for sissies.” Belshé added, “But AcademyHealth is a more refined group, so I’ll say faint of heart.”
California, the first state to authorize and embark on building a reform-driven exchange, is much further along in the process than many states, especially Iowa. Iowa Insurance Commissioner Susan Voss, serving on the panel with Belshé, said she’s considering drastic measures to get things moving in her state.
“I’m thinking about tequila as part of the essential benefits package,” Voss said. “Get everybody in a room with a table full of tequila shots and maybe we’ll get somewhere.”
Voss, who has served as insurance commissioner under three governors, said political differences — and now judicial uncertainty — have stalled efforts to start an exchange.
“In Iowa, we’re all waiting until the Supreme Court decision comes down. Then maybe something will give,” Voss said.
Political differences in California have moved beyond the exchange-building plateau and now include debate over whether the state should offer a Basic Health Plan option for low-income residents as described in the ACA.
“Legislators have to look at the larger picture,” Belshé said, “but from an exchange perspective, I’m very concerned about the Basic Health Plan option.”
She said establishing a Basic Health Plan in California — whether it’s offered through the exchange or not — could have a negative impact on the exchange’s overall clout and its ability to negotiate favorable insurance contracts.
Data as Oxygen
Farzad Mostashari, national coordinator for health IT, said gathering and evaluating data in new ways has the potential to fundamentally change the way health care is delivered. In the session moderated by Coye, Mostashari said health services research was helping to move the use of data “out of the rarefied, elite strata” and into every day applications.
“Data is oxygen and there is a lot more oxygen in the environment right now and there will continue to be more and more,” Mostashari said.
Coye, pointing out that more than 50% of the country’s physicians are now employed by hospital systems, said institutional gathering and application of data will become more important as health care matures.
“Leadership issues are very important,” Coye said.
“How our systems learn and apply that knowledge is a big challenge,” Mostashari said, “but it also has incredible potential.”
Is Health Care the Next Bursting Bubble?
In a panel exploring health care’s role as an economic engine during a long, deep recession, Joanne Conroy, chief health officer of the Association of American Medical Colleges, posed the question:
“We had the dot-com bubble grow and pop, then the mortgage bubble … is health care the third bubble? Are we going to allow this sector to pop, or are we just going to let a little air out?”
Ten of the 20 fastest-growing occupations in this country are related to health care, according to AcademyHealth. Before the end of the decade, health care is projected to account for 20% of the country’s economy, a total thought to be unsustainable as little as a decade ago.
“Something has to give, clearly,” said panelist Kathleen Nolan of the National Association of Medicaid Directors.
“This isn’t about big government vs. small government. This is about the growth of a whole segment of our society and how we want that to happen.”
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