Kirsten Beronio, vice president for public policy and advocacy at Mental
Health America, tells congressional staff at a September briefing that health
care reform could help control the future growth in costs if the final measure
includes the mental health and substance abuse prevention, detection, and
treatment provisions of some bills under consideration.
Credit: Rich Daly
Although the exact size and scope of a final health care overhaul measure
remains unclear, many experts continue to view as inevitable enactment of some
type of reform legislation this
The ability of President Obama and Democratic leaders in Congress to get a
health care reform measure passed this year was cast into doubt because of
massive cost estimates released in July by the Congressional Budget Office and
raucous town-hall meetings in August dominated by constituents opposed to
But those developments have not altered the basic realities that employees
expect employers to provide health insurance and that health insurance is
becoming increasingly unaffordable for both parties.
"When push comes to shove, even if it ends up just being the interest
groups with the Democratic Party, I think you will in fact see something that
is relatively comprehensive" this year, said Dallas Salisbury, president
and CEO of the Employee Benefits Research Institute, at a forum sponsored by
the Alliance for Health Reform last month in Washington, D.C.
His belief that Congress will enact some type of health reform was based on
his research indicating that employers know their workers need insurance
coverage but are increasingly unable to pay for it. For instance, he found
that 35 percent of employees identify their employer's health insurance policy
as the most important reason they sought their job.
The same inexorable cost pressures led Gail Wilensky, who once headed the
agency now known as the Centers for Medicare and Medicaid Services, to agree
that it is inevitable that Congress will pass a bill this year that not only
reforms health insurance but also overhauls how health care is provided.
"We need expanded coverage and reforms of the health insurance
market, but sustainability in spending and improving the quality and clinical
appropriateness are even more important," she said.
Among the key reforms to reduce costs that Wilensky expects Congress to
enact are incentives to reduce unnecessary hospital readmissions and cuts in"
generous" Medicare nursing home reimbursement rates. Halving the
number of unnecessary hospital readmissions—which demonstration projects
have attained in some locations—would reduce Medicare spending by $100
billion over 10 years, according to Glen Thorpe, chair of the Department of
Health Policy and Management at Emory University.
Thorpe also expects a reform measure to be passed this year; however, he
suggested that an incremental approach is possible. It could take several
years of passing small reform packages to meet the two general goals that have
drawn broad consensus: universal insurance coverage and cost control to slow
health care spending growth.
The two main cost-control approaches that Thorpe expects to be part of a
reform law will aim to reduce the number of clinically obese Americans and
improve care for people with chronic illness. He hailed several pilot programs
to improve care coordination for Medicare beneficiaries with chronic illness,
who now have almost no such integrated care, even though 95 percent have
multiple chronic conditions. Effective reform would identify which
approaches—such as programs that assign one physician as a patient's
coordinator—are most effective and then quickly expand the use of those
approaches throughout Medicare.
Mental health advocates also remained very optimistic about enactment of a
health care overhaul before Congress adjourns for the year.
Rep. Patrick Kennedy (D-R.I.) told congressional staffers and advocates
that the public would become more supportive of reform if it was framed as a
way to expand Americans' freedom to obtain needed care and independence from
the burden of untreated illness. Advocates should stress that the lives of all
Americans would be improved by having access to high-quality medical care, he
"We're going to define health care in the broadest sense so that
[Americans] are able to live long lives that are not impeded in any
way," Kennedy said.
Information on the Alliance for Health Reform forum is posted at<www.kff.org/ahr090409video.cfm>.▪