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New York Times: Health care reform, the most ambitious domestic policy initiative of our time, is now law. And already there is talk of how to make it even better. Some want to improve the subsidies and financial protections, so that people aren’t as exposed to high medical bills. Others would like to add some sort of public option, whether it’s a new stand-alone government-run plan or expanded access to Medicare.
Those are good ideas. But making the most out of the Patient Protection and Affordable Care Act will also depend on something a little less exciting: putting the existing plan into action. The challenges ahead fall into four categories.
DELIVERING THE DELIVERABLES President Obama promised that some of the benefits of reform would appear in the first year. For starters, within 90 days the Department of Health and Human Services must set up a high-risk pool as a temporary source of insurance for people who have pre-existing conditions.
Some of the new consumer protections will take effect within six months; first, though, federal officials have to translate that law into regulation. The government is also supposed to provide a new, easy way for consumers to compare benefits from insurer to insurer.
EDUCATING THE PUBLIC It’s one thing to create a health insurance program and quite another to get people to sign up for it. Today, many more people are eligible for Medicaid than actually enroll, in no small part because some states — wary of adding too many people to the rolls — make it hard to apply for and stay in the program.
That said, more than 97 percent of people in Massachusetts now have insurance, thanks in part to an aggressive public relations campaign that enlisted the Red Sox to raise awareness about the state’s own health care overhaul. A similar effort to increase public knowledge and to undertake direct outreach to individuals will be necessary. While states and nonprofit organizations will play vital roles, the federal government should probably take the lead.
HANDLING THE INSURERS Speaking of Massachusetts, that’s the one state with a fully working model of an insurance exchange: a place where individuals and small businesses can buy relatively affordable coverage, with clearly defined benefits and no exclusions or mark-ups based on the health of the people applying. And the model seems to work overall. But replicating that in 49 other states won’t be easy.
It requires appointing people to run the exchanges and figuring out how Americans will use them, but it also means preparing to regulate insurers more closely than anybody regulates them now. The law creates minimum standards for what insurance covers and requires insurers to spend most of their money on actual patient care, to name only two obvious changes. The states will have primary responsibility for enforcing these standards, but first the federal government will have to write them.
BENDING THE CURVE Dozens of new initiatives are intended to control, or at least reduce, the cost of medical care. But most of them require work to get up and running.
Everyone hopes that wider use of electronic medical records can improve quality while reducing expensive duplication. Again, somebody first has to set up a standard for the records. Studies show we’d save money if we stopped paying for so many treatments that don’t work (or don’t work better than the alternatives). But we can’t start paying for treatments more intelligently without better information about what drugs and procedures do work, not to mention which ones doctors and hospitals already use.
Progress on many of these goals is already under way. (Development of electronic records, for instance, began with the stimulus.) But there are obstacles ahead: some states are eager to do their part; others are busy suing the federal government because they don’t like the law. The Obama administration also needs to find the right people to manage these programs.
Getting reform right may ultimately require making sure one official is responsible for coordinating activity among the different agencies and levels of government. It should probably be someone who reports to the White House but is also accountable to Congress; someone with a head not just for politics but also for the world of insurance, regulation and medicine; someone who can push the many groups and institutions that will need pushing, while also listening to people’s concerns.
Much as the Iraq war wasn’t over when American forces conquered Baghdad, so health care reform didn’t end when President Obama signed the bill. If carrying out the legislation doesn’t get the same sustained attention that passing it did, then this week’s historic victory will lose much of its luster.
Jonathan Cohn is a senior editor of The New Republic and the author of “Sick.”Click here for reuse options!