Achieving Sustainable Health Care Reform at the State Level

(05/22/2008)

10:21

They are preparing for the next panel, which will discuss sustainable health care reform at the state level.

The moderator for this panel is Dr. Mark McClellan, right, director of the Engelberg Center for Health Care Reform at Brookings and a former commissioner of the Food and Drug Administration.

The panelists are Tom Latkovic of McKinsey & Company; state Rep. Jim Raussen; Doug Anderson of the Ohio Department of Insurance; and Cristal Thomas, director of Ohio's Executive Medicaid Management Administration.

Thursday May 22, 2008 10:21

10:24

The previous panel ran about 7 minutes into the 10-minute break, so the audience remains on an extended break. You can review the last panel by going to the previous liveblog entry and clicking "Replay."

Thursday May 22, 2008 10:24

10:26

2 minutes from starting.

Thursday May 22, 2008 10:26

10:28

[Comment From StephanieStephanie: ]

The U.S. Centers for Disease Control and Prevention (CDC) has warned, "The United States cannot effectively address escalating health care costs without addressing the problem of chronic diseases." How can we address better manage and prevent chronic diseases at the state level, considering 6.7 million Ohioans had a chronic disease in 2003?

Thursday May 22, 2008 10:28 Stephanie

10:31

Stephanie's question came up during John McCain's visit in early May. Here is that exchange: "It will take federal money to help the needy and chronically ill. He agrees that further privatization probably shouldn't happen. But he doesn't think we should have greater government control. Refers again to the $5,000 credit that would allow individuals to shop online, go across state lines and find a health-insurance policy that suits them.

"Employer-provided insurance limits choice, or in the case of small businesses there often is no insurance."

Will see if anyone addresses it here.

Thursday May 22, 2008 10:31

10:38

Panelists are being introduced. Tom Latkovic will be the first will speak. Rep. Jim Raussen will speak second.

Thursday May 22, 2008 10:38

10:41

Read this Aaron Marshall story to learn more about Raussen's health-care legislation.

Thursday May 22, 2008 10:41

10:44

Latkovic (finally) kicks it off. He thinks it’s important recognize there is a health system. When we talked about reform, we need to talk about a system: a state health system and local health system. What has historically happened is that people have come to health care reform from one perspective (an employer looks at it employees, legislators look at budgets).

Thursday May 22, 2008 10:44

10:47

Latkovic: Most state reform efforts have looked at access, which is a noble goal. But there are other opportunities beyond access. First, “population health” – behavioral health issues, smoking, alcohol consumption, obesity, etc. These have a huge issue in cost in health and productivity.

20 percent of all obese people are morbidly obese. That population will double if nothing changes. I didn’t catch his time frame for that doubling.

Thursday May 22, 2008 10:47

10:48

Latkovic: Second, improve the payment system. We can do a better job in the delivery system: how do we create value-conscious consumption. And also, how do we use the money more efficiently than we do right now. These could be great state opportunities for improvement on the state level.

Thursday May 22, 2008 10:48

10:52

Raussen connects reform to the structure of Ohio government. With a term-limited government, reform becomes difficult. You are asking members with an average tenure of 5 or 10 years to fix health care.

Second, Ohio is a state of city-states. The People’s Republic of Cleveland. The People’s Republic of Cincinnati. “If Columbus burned down, either of our cities could care less.” Our city-states deliver our health care.

We are also an older, sicker and poorer than states that have done comprehensive care reform. “We are the TWA of states,” he says. “We are paying for our legacy.”

Thursday May 22, 2008 10:52

10:53

Raussen: Ohio needs flexibility in applying Medicare and for the feds to “stay out of our way.”

Thursday May 22, 2008 10:53

10:57

Raussen: The American public is getting wiser and craftier. In the old days of debate, you'd hear: We hate payers, hate medicaid and hate insurance companies. And we hate out-of-pocket costs. But now, you hear we have concerns about going to the best hospital, whether getting best oral health care (Ohio ranks 47th nationwide in oral health care), whether they're spending money the wisest.

Thursday May 22, 2008 10:57

11:01

Raussen: Here are some issues and solutions.

- IT is important, not just medical records but health information exchange so clinics and health providers can operate with one another.

- Health nutrition education has to get better. 10th to 14th in obesity. 5th in smoking prevalence. We're behind the times in health curriculum, stymied by school districts that want to do it their way.

- Need to raise dependant age in family insurance.

- Need to have an alignment on charity-care definitions.

- Need high-risk coverage for chronic conditions. A solution: re-insurance through state subsidies to get affordable coverage.

- Nursing shortage is a problem. Two-year waiting list.

- Health care reform is difficult because so many associations are involved in the debate (40 provider association alone in Ohio). Bipartisanship is critical.

Thursday May 22, 2008 11:01

11:04

Doug Anderson: 1 million Ohioans uninsured and don't have access to programs. He says 300,000 uninsured Ohioans have access but don't have insurance.

Thursday May 22, 2008 11:04

11:07

Funny comment made earlier by woman at nearby table: "I think I'm the only person in the room with a John McCain bumper sticker."

Thursday May 22, 2008 11:07

11:11

Anderson: Uninsured with health conditions are often stuck. Insurance plans will cover everything but the health condition and include riders with astronomical rates.

Thursday May 22, 2008 11:11

11:12

Some open enrollment plans in Ohio charge premiums up to $54,000 a year - Anderson.

Thursday May 22, 2008 11:12

11:16

Anderson:

- All Ohioans need access to affordable coverage.

- The state needs to use existing funding.

- Focus on primary care, care management and preventative care to keep them out of medical situations.

- Give help to Ohio businesses cover workers, while giving low-income Ohioans to take up employer-provided coverage.

- Create fair insurance plans will likely require a mandate for a guaranteed issue plans that cover ill and underinsured.

Thursday May 22, 2008 11:16

11:19

Lots of talk by the policymakers in this panel about what they have done, not ideas about what it will take to create a sustainable health-care market.

Thursday May 22, 2008 11:19

11:24

Cristal Thomas: State is working on a long-term care budget, that would build a more balanced and effective long-term care system. Eight months into the process.

Thursday May 22, 2008 11:24

11:26

Thomas: For Ohio, having a unified budget, a coordinated strategy for coverage, conditions and care will better manage costs in health-care programs.

Thursday May 22, 2008 11:26

11:27

Thomas: State is rearranging its claims-processing system which will allow access to real-time information, show where people are accessing care, etc. to better manage Medicaid patients.

Thursday May 22, 2008 11:27

11:28

[Comment From davedave: ]

Isn't health care reform the talk of every presidential election? After the election is held we see no real reform. Even now many democrats (at the national level) are backing away from universal coverage. Why doesn't Ohio simply bite the bullet and say, 'our citizens will have health coverage because we, as a state, have a compelling interest in the well-being of our citizens.'

Thursday May 22, 2008 11:28 dave

11:29

Dave's comment made me realize something: Almost no one today has used the term universal coverage. Instead, they plan to "make insurance available" to all Ohioans. They seem to accept - or be content - that many many people will not have coverage.

Thursday May 22, 2008 11:29

11:32

Raussen: Ohio needs a couple health-care reform "wins" to show voters that what they're trying works, and then gear up for big reform after the "silly season" of the presential campaign ends.

Thursday May 22, 2008 11:32

11:34

A doctor in the audience says the "system like malignant tumor that's about to kill us." Most of the discussion is a band aid. Asks Latkovic what he would do. He answers that a big part of the equation is figuring out what we do better and do it consistently.

Latkovic says we can't look at reform through one lens. Pull the stakeholders together. Reimbursement is a good idea, but no systematic discussion from federal, state, local stakeholders.

Thursday May 22, 2008 11:34

11:35

Riffing off Dave's comment again, there is a lot of optimism from panelists that this presidential season is different on reform because of the bi-partisan plans on the federal level and state-initiated reforms.

Thursday May 22, 2008 11:35

11:35

That concludes the second panel. Thanks for hanging in!

Thursday May 22, 2008 11:35

11:35

Thank you for reading today.

Thousands of users.
Millions of readers.
Free and simple to use.
Try CoveritLive today.