Healthcare Delivery in the Post-reform Era

Across the country, a major issue in our recent elections was access to quality affordable healthcare. Hoping to provide more information on the topic, the Larchmont/Mamaroneck Local Summit, at its November 12 public breakfast, presented a panel of experts to discuss “A Snapshot of the Post-Healthcare Reform Era.” The experts were drawn from business, government and academia, each presenting his or her view on where our health care delivery system is headed.

The panel’s first speaker, Professor Adam Block, an economist and Assistant Professor of Public Health at the School of Health Sciences and Practice, New York Medical College, started the conversation. Prof. Block, who had worked for the Obama Administration on the Affordable Care Act (ACA), explained that the ACA was more focused on expanding coverage and reducing the number of uninsured than on overall cost reductions. He stated that the greatest reduction of uninsured persons occurred through the Medicaid expansion program, describing the program as the “workhorse” of the ACA.

Notwithstanding the success of Medicaid expansion, Prof. Block stated that he doesn't believe that a single-payer system - - where the government is the primary payer of healthcare - - will be adopted any time soon. In his view, the only pathway to a single payer system is through state waivers that would allow states to implement innovative ways for providing quality, affordable healthcare for citizens while retaining the basic protections of the ACA and not adding to the federal deficit.

Panelist Stana Nakhle, the Regional Director for the Small Business Marketplace of the New York State of Health (NYSoH), concurred with Prof. Block that the primary goal of the ACA was to decrease the numbers of uninsured, which declined from 14% to 9% nationwide after the ACA was enacted. New York State did even better, she said, enrolling 4.3 million people since 2013 and watching its uninsured rate drop from 10% to slightly under 5%.

Ms. Nakhle explained that New York quickly set up its own health care exchange run by the New York State Department of Health. New York operates both an individual marketplace and a small business marketplace. She reminded the attendees that financial assistance is available for families beneath a certain income level and tax credits are available for small businesses.

Panelist Desmond Hussey, Regional Vice President of Marketing and Product Development for UnitedHealthcare Northeast, agreed with Prof. Block that he doesn’t see a single-payer system being adopted in the near future. Not all audience members, however, shared this view. Attendee and retired physician, Dr. Elizabeth Rosenthal, an active member of Physicians for a National Health Program, opined that single-payer is an achievable goal and that, contrary to the program’s title, we are not yet in the “post-reform” era as, in her view, we haven’t yet achieved sufficient reforms. She challenged the notion that a free market is appropriate for health care.

Both Prof. Block and Mr. Hussey predicted that the use of technology and electronic records, required by the ACA, will lead to different healthcare delivery methods to patients. Mr. Hussey expects that every patient’s medical data will be portable and initial care may increasingly be provided by Physician’s Assistants and Nurse Practitioners. This may result in an evolution of the role of Primary Care Physician into that of specific disease specialist. Also, electronic communications will hasten change as patients begin to utilize “text-to-doctor” and “text-to-nurse” communications, as well as telemedicine, an interactive communications tool which is becoming more common in the mental health care field. Mr. Hussey also noted the great impact the development of new drugs will have on healthcare.

Prof. Block also addressed the spate of hospital and health network consolidations that have taken place recently. He says the data shows that these consolidations generally lead to higher prices with no change or improvement in the quality of care delivered. However, he saw one benefit of the consolidations in that they will probably compel offices to incorporate more technology into their practices, which should enhance record-keeping and efficiency.

Visit LMC-TV.org to see a rebroadcast of the November 13 Summit program.

This breakfast forum was hosted by The Larchmont-Mamaroneck Local Summit. Its next program will be Tuesday, December 11, 7:45 a.m. at the Nautilus Diner in Mamaroneck. Our guest speaker will be County Executive George Latimer. All are welcome. Breakfast $8.