April 26, 2013
As I am sure most of you are acutely aware, the medical profession in our country is undergoing rapid unprecedented change.
In a little more than six months, major provisions of the Patient Protection and Affordable Care Act (ACA) – the driving legislation behind the national effort for health care reform – will be implemented, undoubtedly reshaping the national system for delivering care for years to come.
Some of you have already felt the effects of the ACA in your day-to-day practice. Perhaps you have treated a patient whose only avenue for coverage was a temporary high-risk pool plan designed to ensure that her pre-existing condition could no longer be denied coverage. Or maybe you have simply noticed an influx of young adults into your office, a result of the provision allowing children to remain on their parents' insurance until age 26.
While these reforms are laudable, the bulk of the planned legislative reforms will be introduced and overseen by an entirely new entity in the nation’s health care delivery model – state-based health benefit exchanges.
Beginning on January 1, 2014, these state-based exchanges will introduce new, online insurance marketplaces through which consumers will be able to purchase health coverage subsidized according to their income levels. Between the exchanges and the planned expansion of Medicaid programs across the country, as many as 32 million Americans are expected to gain coverage over the next few years.
With the January deadline drawing near, the pace is frantic, and as providers begin to plan for this massive influx of new patients, state and federal regulators are still issuing guidance outlining exactly how these exchanges will function.
We are changing out our jet engines mid-flight, while the runway we approach is still being built.
But while there is still much to be done, California physicians are making progress toward a successful implementation.
Only days after the federal enacting legislation was signed, California emerged as the leader in ACA implementation by authorizing formation of its own health benefit exchange. Now called Covered California, our state exchange has since that time selected an executive director and board who have been aggressively assembling preparing for the opening of a successful marketplace in 2014.
This progress has not come easily.
Throughout the effort, the exchange board has been faced with input from many competing interests. Every decision, no matter how large or small, has come with comments and suggestions from payors, consumer advocates, hospitals and, of course, your California Medical Association (CMA).
CMA staff has worked diligently to position our association as a prominent stakeholder in the development and future function of Covered California, ensuring that our state does not end up with a model of health care in which quality is measured in dollars, value is available only to those who can pay for it, and medical decisions are controlled by payors and regulators rather than by doctors.
Only physicians know how to balance medical care wisely as we figure out how to realign incentives towards a sustainable health system and stable fiscal future, and our leadership at this juncture is critical.
Furthermore, with important major tasks still yet to be accomplished, design and implementation of the exchange continues to hold significant risks for California physicians. Only now, roughly six months before the exchange goes live, is the model contract being finalized. Following that, the exchange must select which insurance providers will be eligible to offer a plan in the new, online marketplace.
As these decisions are finalized, it is vital that physicians pay attention, educate themselves and choose wisely the nature and extent of their future participation.
The choices we make today – both individually and collectively – will have important ramifications for how medicine is practiced in California for years to come. As you consider these choices, you can rest assured that CMA will be there to help
And as we begin to land our re-tooled aircraft on a brand-new runway, the efforts we have made as physicians and as CMA members will help to ensure a safe, sensible and successful journey into a professional future we have helped to both envision and create.
With only months to go, it is critical that we remember and reaffirm the importance of physician leadership in the California health care reform effort, knowing that absent our involvement and our effort, the default future would have been much different. Physician leadership – in the vision for, implementation of and provision of medical care going forward – is the only way to ensure the people of California have access to the health care system they truly deserve.
Thank you for your leadership. It has – and will – make all the difference.
Paul R. Phinney, M.D.