Tuning in to end-of-the year economic forecasts has been buoying over the past two weeks. And if you are in the health policy business, reports on ObamaCare enrollment — both in subsidized private insurance and Medicaid — are further cause for uplift.
The natural proclivity of many in the policy business — even if they are not economists — is to look for the signs of gloom and doom on the horizon. Aside from the uncertainty created by the upcoming Supreme Court decision on the federal exchange and stubborn budget shortfalls in a number of states, there are some promising signs on the horizon for 2015:
- Enrollment is up. Yes, there continue to be backlogs and other pockets of technological problems in enrolling those who are eligible into coverage, but the dramatic reduction in the percentage of uninsured Americans in every state across the country is truly reshaping the face of the U.S. health care system. The newly covered millions could generate greater popular support for both the premium tax subsidies and Medicaid expansion that are the foundation pieces of the Affordable Care Act (ACA) and move the nation further toward achieving universal health care for low- and moderate-income Americans.
- Health care delivery is being reengineered to focus on value. Equally exciting for many in the policy implementation trenches are the changes in the nation’s health care delivery system. From CHCS’ vantage point in working primarily with state innovators and their contracted health plan and provider partners, it seems as though a new day is dawning. We established CHCS in 1995 because the shift to managed care was rapidly transforming the Medicaid landscape. In 2015, we see the potential for transformational changes in publicly financed care that could exponentially accelerate the move away from a volume-based delivery system to one focused on the value of the services provided. That value will increasingly be defined not just by any near-term reductions in avoidable high-cost services driven by a single clinical intervention, but also by longer-range outcomes in terms of overall health and quality of life for those using the system.
- Cross-program integration of care is taking root. It is gratifying for CHCS to be part of concerted efforts across the country to overcome the gaps between programs — Medicare and Medicaid, physical and behavioral health, health care and supportive housing, health care and criminal justice — that have left so many high-need, high-cost patients with multiple chronic conditions at the mercy of siloed systems of care. We are encouraged by the cross-system collaboration occurring at the national, state, and local levels and expect this to be a “hot topic” for further policy innovation in the years ahead.
This overall progress will have many healthful consequences for individual Americans and for the nation as a whole as it continues to rein in health care cost growth. We don’t want to be Pollyannas and fall prey to over-confidence in these recent developments, so it is critical to keep supporting and monitoring the progress. But, supporting progress is a good challenge to have. We welcome it in 2015.