HFMA VIEWS

Healthcare reform proposals have been flying as thick and furious as the snow here in the Chicago area. Two of the stories in this week’s HFMA News--including the hfm magazine web exclusive commentary by nominated Office of Management and Budget director Peter Orszag and the story on America’s Health Insurance Plans’ reform proposal--discuss blueprints for reform. And as reported in today’s Wall Street Journal, nominated Health & Human Services Secretary Tom Daschle is urging “that Americans hold holiday-season house parties to brainstorm over how best to overhaul the U.S. health-care system.”

A holiday snowfall can make everything seem sparkling and bright, but when you get out the shovel, you realize that it is going to take a lot of work to clear the path. An op-ed in this week’s New York Times, for example, argues that a goal of universal coverage--achieved in part through expansion of state Medicaid enrollments--would drive demand for healthcare jobs, including expanded primary care positions for nurses and physician’s assistants. But this assumes that workers can easily move into these careers. As reported in this week’s news, America’s schools of nursing lack the capacity to address current and future nursing shortages. The American Association of Colleges of Nursing estimates that almost 28,000 qualified applicants were turned away from entry-level baccalaureate nursing programs in 2008 because of faculty shortages. And as reported last month, shortages of primary care physicians also loom.

The goal of universal coverage is also sure to raise issues for healthcare providers, especially if it is achieved through expansion of existing government programs such as Medicaid.  Margins for providers depend upon a payer mix, and an increase of Medicaid payments--at least as the program exists today--could adversely affect that mix.

It’s the season of excitement and miracles. But after the holidays pass, it’s time to take down the lights, get back to work, and look forward to shoveling a lot more snow. There's sure to be a lot of shoveling necessary to uncover the many issues affecting health care as a new Congress and a new administration try to determine the best path to reform.