After more than a year of debate and countless meetings, votes, and speeches, Congress passed sweeping health reform legislation last month, and President Barack Obama signed it into law. By an overwhelming majority (89%), leaders in health care and health policy think the new reform law will successfully expand access to affordable health insurance to the millions of Americans who currently go without it. The latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders survey—which was fielded while the legislation was still pending in Congress—also found that virtually all key features of the health reform law are supported by a large majority of opinion leaders.
In addition to coverage expansion, large majorities of opinion leaders supported the inclusion of major elements of reform in the new law. Income-related subsidies to help individuals afford coverage (90%), new insurance market rules (90%), and quality improvement and public reporting (88%) were important or very important priorities for health reform, opinion leaders said. In addition, around eight of 10 said innovative payment reform initiatives like patient-centered medical homes (86%), accountable care organizations (81%), and a new payment innovation center to be housed within the Center for Medicare and Medicaid Services (78%).
"The U.S. will now join all other major industrialized countries with a system for ensuring access to essential health care," said Karen Davis, president of The Commonwealth Fund. "Opinion leaders agree that the new law will help lay the foundation for a high performance health system that yields access to care for all, improved quality, and greater efficiency. It is a victory for all Americans, who deserve the finest health system in the world."
While there was substantial consensus on major components of the law, experts were less likely to agree that the legislation will improve the affordability of health insurance for Americans who already have coverage (38%) or that it would begin to control rising health care costs and not add to the federal budget deficit (35%). Differences among respondent categories on these questions were particularly sharp, with half of those in academic and research institutions believing the law would improve affordability, compared with 25 percent of those in business, insurance, and other health care industries.
Opinion leaders also identified several areas of potential concern as the nation begins implementing reform. Nearly nine of 10 health care leaders (88%) said they are concerned or very concerned about the nation's supply of primary care providers, while more than three-quarters (79%) are concerned about state capacity to implement reform. Enforcement of the individual mandate (75%) and adequate financing of the U.S. Department of Health and Human Services (68%) were also seen as potential problem areas.
Longer term, nearly all (95%) the experts surveyed believe it is either important or very important to improve affordability provisions for low- and moderate-income families in the next two to three years. Eighty-nine percent said prevention and control of chronic diseases and stronger cost controls are also important goals.
Other findings from the survey include:
# Opinion leaders identified uniform expansion of Medicaid (73%) and the creation of an Independent Payment Advisory Board (67%) as important or very important health reform priorities. In contrast, only 43 percent said that ensuring Medicare private plan competition was important or very important.
# More than nine of 10 health care opinion leaders (92%) support the U.S. Department of Health and Human Services taking administrative action to pursue Medicare and Medicaid payment reform pilots.
# Three of four experts (76%) support undertaking medical malpractice and tort reform as health reform strategies.
# Opinion leaders expressed strong support for strategies that provide relief to the uninsured while the nation's economy continues to struggle. More than eight of 10 support accelerating receipt of federal funding for coverage expansion for states that take on innovations like cost control and payment reform. Eight of 10 also support extending the higher federal matching rate for Medicaid until the economy recovers. Large majorities favored increased funding to safety net providers (78%) and extending federal COBRA subsidies to unemployed workers and their families (72%).
The survey is the 21st in a series from The Commonwealth Fund, and the 13th conducted in partnership with the publication Modern Healthcare. Commentaries on the new reform law by former Senate Majority Leader Tom Daschle and former Utah Governor and Secretary of Health and Human Services Michael Leavitt appear in the April 5 issue of Modern Healthcare. The commentaries are also posted on the Fund's Web site, along with a Commission data brief discussing the survey findings.
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