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Interpretations of Reform Coming Fast and Furious

MANAGED CARE June 2010. © MediMedia USA
Editor's Memo

Interpretations of Reform Coming Fast and Furious

John Marcille
MANAGED CARE June 2010. ©MediMedia USA

John Marcille

Dizzy yet? As if there aren’t enough think tanks poring over and trying to interpret the Patient Protection and Affordable Care Act, here comes another. As we were putting this issue to bed, the National Institute for Health Care Reform, sponsored by automakers and the United Auto Workers, released a study that posits that the $5 billion in federal funding for the high-risk pools is not nearly enough. The pools are meant to provide coverage for people who normally can’t get coverage because of pre-existing conditions, and are meant to be a bridge to when the insurance exchanges kick in — scheduled for 2014. (For a comprehensive discussion of both the high-risk pools and the coming exchanges, see contributing editor Martin Sipkoff’s article.)

The study states that “using one plausible definition of the eligible population, almost 7 million people are potential participants, or about 5.6 million if those with access to other coverage were excluded. The $5 billion in federal funding is sufficient to provide subsidized coverage to only a fraction of potentially eligible people.”

Perhaps in too short a time another study may state that the $5 billion is far too much, and sound an alarm about overspending. That’s just where we are right now when it comes to health care reform.

There is one thing that we’re fairly confident about, however. In his cover story about how plans and providers must cooperate more effectively, managing editor Frank Diamond cites the PricewaterhouseCoopers study “Prospering in a Post-Reform World.” That study, and Frank’s article, note that the very structure of reform dictates that the old tension between players will soon become less relevant. We’ll go way, way out on a limb in a maelstrom of information and say that’s a reasonable bet.