Richard L. Clarke, DHA, FHFMA
President and CEO, HFMA
A few weeks ago, the Democratic Party regained control of the U.S. Congress for the first time in more than a decade. What does this mean for health policy in the near future?
The new Democratic leaders of the House and Senate have stated they will focus on several non-healthcare issues such as dealing with the war in Iraq, raising the Federal minimum wage, and changing immigration policy. These issues will require significant time and attention and may limit the Democrats’ ability to make much progress on other issues, including health policy. It is likely, however, that revisions to the Medicare drug benefit will be an important focus of the Democratic leadership. In addition, Democrats wish to deal more effectively with the growing number of uninsured Americans.
Whether progress is made on any of these fronts depends on the nature of the working relationship Democrats develop with the Bush administration and the Republicans in the Senate. Initially, both sides have signaled an interest in working together to develop solutions. And given the very slim margin that the Democrats have in the Senate, bipartisanship will be critical in that body. But we have seen the initial honeymoon between the two parties break down before--especially over contentious issues. So now what?
If progress is made dealing with the war in Iraq, and if both parties can come together on the Federal minimum wage and immigration policy, then national attention will shift to health policy. In fact, pre-election polls placed healthcare issues down the list of priorities behind concerns about terrorism and the war in Iraq, energy policy, and immigration. If progress is made on these issues, however, policymakers will face increased pressure from the public to address healthcare issues.
The most pressing healthcare issue is dealing with the uninsured. A recent survey by the Commonwealth Fund identified access to reliable, affordable health insurance as a top healthcare concern among Americans--not surprising given the almost 47 million Americans who lack health insurance. This situation destabilizes the health delivery system and results in inadequate access to care for the uninsured and distorted pricing and payment for healthcare providers. Relying on market forces and cost shifting is not the answer.
During the next two years, healthcare and business leaders, community activists, and politicians must work together to develop local and national solutions to this problem. These solutions may look like the approach developed in Massachusetts that engages all sectors of society to make coverage more affordable and available, or elements of the payment system used in Maryland that standardizes payment among all payers to reduce cost shifting. Certainly, none of these approaches is “the answer,” but accepting the status quo is no longer acceptable.
What is needed now is the courage in leadership to address the destabilizing effect of the uninsured. Now is the time for all of us to get involved.
