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Opinion: The work of reform continues in California health care

Our country’s health care system is in the midst of major reconstructive surgery.  The new health care law that passed earlier this year is not just a minor brow lift.  Nearly all aspects of health care delivery are in the midst of significant change.

Not only did the federal government pass sweeping reforms this year, but many provisions went into effect in just six months.  

To give a sense of the enormity of the transformation, you just have to look at the first round of change we experienced this year.

In September, several provisions of the new health care law went into effect:
•    The federal government and states started a special insurance program for people with pre-existing conditions.  
•    Health plans offering dependent coverage began covering children up to age 26.  
•    Rules changed to require coverage for children with pre-existing conditions.  
•    Lifetime benefit limits were eliminated
•    Rescission was banned.  
•    Co-payments and fees for preventive services are a thing of the past.

All of this national activity was coupled with a very busy legislative session in California.  State lawmakers moved aggressively to pass laws that begin implementing several major components of the new health care law.

Most significantly, California was the first state to establish a framework for an insurance exchange.  The state exchange will serve as a new marketplace for millions of individuals and small businesses to purchase coverage and receive federal subsidies.

The state also established new requirements for regulatory review of health plans rates.  And, new laws were written to give a state perspective on the federal provisions that are currently in effect.

Independently, each of these new laws and provisions represents significant systemic change.  Combined, they fundamentally impact the underpinnings of how health care coverage is offered.  

What does 2011 hold for health care?  First and foremost, the health care community and policymakers should focus their efforts on making sure the new laws meet the promise of access to quality health care for all.  

In a typical year, the California Legislature proposes about 200 new laws impacting health care coverage.  The bills do not have a common theme or address a clear strategy for improving our health care system, in fact they frequently increase the cost of health care.  

Instead, they address a random assortment of issues important to various stakeholders.  The legislation may suggest mandates that all health care policies cover various treatments and services, or rate regulation, or scope of practice issues for providers, or prescription drug coverage, or nursing home oversight, or government health care programs, or any other issue a group might bring forth.

In 2011, rather than advocating for the usual arbitrary batch of health care legislation, stakeholders and policymakers can focus their energy on ensuring all the new laws passed in 2010 are successfully implemented.

This is no small task. We need to make sure we don’t break what works well.  While the goal for health care reform is to make the system better and ensure more people have access to care, how the new laws are put into practice will ultimately determine if all of these new policies achieve the goal.

It is critical to track the impact the new laws have on our health care market.  Sometimes seemingly inconsequential changes can have a ripple effect.  Ultimately, it is important that changes do not limit access to health care coverage, drive prices up even higher or cause health plans, providers or others to leave the California market.

Regulators should work with health plans, providers and other stakeholders to translate a large body of new law into the everyday workings of health plans, providers and the health care community.  

All of us – the government, the health care community, employers and consumers – want this reconstruction to result in a better system.  One step in the right direction is to focus our energy on implementation and hold off on any other new ideas until we know that the surgery was a success.


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