Support, but some questions, about health care reform at U of M eventby Lorna Benson, Minnesota Public Radio
Minneapolis — Minnesotans with a stake in the health care reform law voiced support for the changes, in general, at a forum at the University of Minnesota Friday.
But some raised concerns about whether the new law will actually contain health care costs, or fix Medicare payment disparities that penalize states like Minnesota.
U.S. Sen. Al Franken, D-Minn., headlined the event. He told a packed auditorium that the legislation keeps health insurance companies in line and puts the country on a path to better health.
There are hundreds of provisions in the new health care reform law. But Franken only had time to highlight a few during his keynote address.
He began by talking about a new fund that will spend $15 billion over 10 years to remove barriers that make it hard for people to make healthy choices. These factors are known in public health circles as the "social determinants" of health.
The new fund will give money to communities, neighborhoods and schools that want to change unhealthy policies or improve their physical and social environment.
"When there are kids in the Phillips neighborhood who don't feel safe playing in the park, we know that's not good for their health," said Franken. "When people can't afford fresh fruits and vegetables in the many food deserts in our cities -- and in rural areas, ironically -- it's hard for them to eat healthier."
Minnesota has some of the highest health disparities in the nation, despite the state's generally well-regarded health care system. So Franken says the state could really benefit from the new prevention and health promotion fund.
He says the law could also help Minnesota resolve payment disparities in the Medicare program that favor high-cost health care states.
The legislation sets up a task force that will look at creating a value index that pays doctors for delivering high-value care. Currently Medicare rewards the doctors for the quantity of the procedures they perform.
"In Minnesota we get about $6,500 per Medicare patient from Medicare. In Texas they get about $9,500," said Franken. "We have better outcomes. This is perverse, and we're going to turn that around."
But the health care law doesn't guarantee that Medicare will move to a value index. Changing the current system is a complicated process, and there are a lot of stakeholders who stand to lose a significant amount of money if Medicare's payment formula is revised.
"If I have any criticism of the bill, it's a little weak on the cost-containment," said state Rep. Tom Huntley, DFL-Duluth, who chairs the Health Care and Human Services Finance Division in the Minnesota House.
Huntley hopes Minnesota will prevail in the Medicare dispute. In his many trips to Washington this past year, he says he heard a lot of talk about the need to change how we pay for health care. But he says in the end, many of those ideas were overshadowed by other priorities.
"As David Brooks said when the Senate bill finally came out, he said, 'Well, it's clear that what we're going to get is health insurance reform and not health care reform.' And so we need to be very conscious of that," said Huntley.
Other speakers also voiced concern about rising health care costs, and the potential threat that poses to the new health care law.
Richard Norling is the recently retired CEO of Premier, Inc., an alliance of more than 2,000 nonprofit hospitals in the United States. He says 35 million new patients will be coming into a health care system that may not be ready for them.
Norling says if providers are being asked to deliver higher quality care for less money, then they need time to figure out the best way to do that.
"How long before draconian measures hit that are inconsistent with the fundamental redesign of care -- around medical or health homes, around bundled payment, around accountable care organizations -- all of which I think are great concepts, and deserve the time to be explored and implemented," he said.
Norling's group represents one-third of the nation's nonprofit hospitals. Compared to many other states, he says Minnesota is actually well-positioned to handle some of the impending changes in the health care system because it has been a leader in health care innovation.