Health Care Reform Newsmakers Series

The Kaiser Family Foundation, Families USA and the National Federation of Independent Business are sponsoring a series of “reporters only” briefings regarding health care reform. Wednesday, April 15, Nancy-Ann DeParle, Director of the White House Office of Health Care Reform was the featured guest. Ms. DeParle was administrator of the Health Care Financing Administration - what is now the Centers for Medicare and Medicaid Services - during the Clinton administration. She also worked at the Office of Management and Budget and in the private sector.

In introductory remarks, Ms. DeParle noted that unlike the health care reform efforts of the ‘90s, this time more groups are at the table and no one wants the status quo. Every group wants to lower costs for businesses and for families. Reporters quizzed Ms. DeParle on a number of aspects of reform. Some of the questions and answers are summarized below.

1. Does the administration support taxing health benefits? Ms. DeParle responded that the president wants to build on the current employer based plans.

2. What options are being considered to lower Medicare costs? Ms. DeParle replied that options for lowering costs to Medicare include more equitable payments to Medicare Advantage Plans, bundling payments to hospitals to create incentives to reduce readmissions, promoting comparative effectiveness so that physicians and patients are able to make better decisions that will reduce costs in the long run, encouraging health information technology to improve care, lower costs and reduce errors, and emphasizing wellness and prevention to reduce utilization.

3. How do you respond to questions that have been raised about the public plan option? Ms. DeParle related that confusion exists about what a public plan is. She mentioned that often the concern is not whether a public plan should be available but the details of how a public plan will work. Some concerns have been raised about payment rates and options available. She noted that examples already exist including the state health plans that administer health coverage for state employees and use private health plans.

4. Will the administration support continuation of fee for service plans? Ms. DeParle reminded the audience that the president wants to strengthen fee for service and change incentives such as the bundling of payments to hospitals to avoid readmissions. She said that the emphasis on health information technology (HIT) assumes a robust private fee for services system. She noted that HIT is not a silver bullet but thinks that HIT will provide overall improvements to care and will lower administrative costs.

5. How does the concept of a medical home fit into the reform plan? Ms. DeParle noted that the idea is to create a less fragmented health care experience for patients with a medical clinician coordinating care so that patients are referred to the right specialists and are prescribed the right medications.

6. How will we pay for the reform? Ms. DeParle said that some “game changers” are included in the plan such as HIT and emphasis on wellness and prevention that will generate savings.

7. What strains do you foresee for the health care system if the 45 million uninsured suddenly have health care coverage? Ms. DeParle reminded the reporters that when Medicare began in July of 1966 millions of older adults were added to the health care system without overwhelming it. She also noted that different parts of the country have different capacities and that we need to make additional investments in the health care workforce.

In closing, Ms. DeParle reiterated that health care reform is one of the most important issues we are facing as a nation. It is clear that we all want better health care outcomes and stability in costs.