Big changes loom for health care: Are we ready?

Tuesday, October 9, 2012

Remember the Y2K or “Millenium Bug” that was supposed to hit on Jan. 1, 2000? Planes were going to fall from the sky, banks would close and we’d never be the same, because none of our computers would boot up that morning.

Health care faces its own Y2K milestone moment. Jan. 1, 2014, is coming, and fast. That date heralds substantial and system-shifting changes for health care providers and consumers across America.

Starting Jan. 1, 2014, due to fundamental reforms in the Affordable Care Act – changes highly unlikely to be stricken regardless of Washington politics – we will see massive structural changes in how everyone gets and pays for health care. 

On many levels the Affordable Care Act is cause for celebration for those who have been left out of America’s broken health care system. Workers who have not received health insurance through their employer but who make too much money for public assistance may now have a path to affordable, quality care.

Guaranteeing access to insurance is not the same as guaranteeing healthy outcomes.

While there are many reasons to trumpet the arrival of ACA, we must not assume the federal legislation has “solved” the health care crisis, especially the problem of not providing quality primary care to all, including the less fortunate.  

Health care providers who focus on helping individuals with limited resources face a dramatically reshaped health care environment. The groups in Charlotte who provide a  health care safety net – driven by the selfless and heroic work of countless medical assistants and nurses and physicians who give their talents and time to those less fortunate – will have to adapt to survive in this new world.

Some provisions of the ACA are already in place. Young people can stay on their parents’ insurance policy until they are 26. Children can no longer be denied health insurance because they are sick. But many of the major changes will hit years after passage.

When we wake up Jan. 1, 2014, there will be new marketplaces for insurance in every state. Most Americans will be required to obtain basic health insurance or pay a fee to offset the costs of caring for the uninsured. Those earning between 100 percent and 400 percent of the federal poverty level will have tax credits to help them buy insurance.

So a benevolent tsunami warning has already been issued. Major change is coming. The way we finance, access and provide health care will change when those parts of the ACA come to life.

At my organization, Care Ring, and many other providers, advocates and administrators of programs serving vulnerable and at-risk populations, we are looking closely at how the changes will alter the way we care for the less fortunate in our region.

Rather than becoming unneeded after Jan. 1, 2014, the need for aggressive health care outreach for the underserved will become even more important in the coming years. So will enlightened public health policies.

Access to insurance may not equal access to good care

The ACA will dramatically expand insurance coverage for those currently left out of our health care system, and that will be a boon for many. However, providing access to insurance is not the same as ensuring access to quality care. Ensuring that many more people have health insurance does not ensure a system that invests in healthy outcomes for all.

Just because an individual has a new card in his wallet that says he has health insurance does not mean his health and long-term wellness will automatically improve. Making a significant impact on many of the crushing diseases of modern life – such as obesity and its related health challenges – requires continued vigilance from public health leaders and the safety-net community.

At Care Ring, we know from our work with first-time mothers through the Nurse-Family Partnership program that many of the best health care outcomes result from intense and long-term interaction with patients and their families. The Nurse-Family Partnership produces a raft of positive health outcomes for mothers and their babies, including stopping smoking, more breastfeeding and a greater likelihood of babies being born full-term.

Those kinds of programs go to the heart of many of the disparities in health care in our society and they’ll become increasingly important in coming years.

What comes next for Charlotte?

We need a serious and sustained conversation with the business, faith, academic, philanthropic and medical leadership communities in Charlotte about how the ACA will alter the way we provide care to those most in need and how we make the most of its potential  to best serve everyone in our community. For instance:

  • Will we have enough of physicians and allied health providers to care for a sudden increase in the number of people with health insurance?
  • If not, where will the newly insured go for care?
  • How will those with limited resources and limited experience with receiving care learn about the best places to get it?
  • For those who are eligible but don’t sign up for publicly provided health care, where will they go for care?
  • Who will care for the undocumented?
  • Will our community embrace proven public health programs that go beyond providing direct health care, and address some of the most difficult public health issues through intense and sustained interventions?

 On Jan. 1, 2000, Y2K did not hit with the vengeance and impact that was predicted. Businesses, governments and nonprofits asked the tough questions about Y2K and developed contingency plans to address what they saw coming.

Charlotte’s health care Y2K bug lands in less than 15 months. Are we ready?

Don Jonas

Views expressed here are the authors and not necessarily the views of the UNC Charlotte Urban Institute or the University of North Carolina at Charlotte.