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Welch: Health Reform Will Take Hold

Peter Welch

Peter Welch

Lebanon — Congress has moved past bickering over Obamacare and now appears ready to implement the health care reform law more than three years after it was passed, U.S. Rep. Peter Welch said Monday.

The Vermont Democrat and Norwich resident told an audience at Dartmouth-Hitchcock Medical Center that Congress was “moving past the political fight” over the 2010 Affordable Care Act. Now, the focus needs to be on figuring out how to use the law to control medical spending and implement payment reforms developed and touted by health care systems such as Dartmouth-Hitchcock.

“My prediction is that in the next election, health care is not going to be the major issue,” Welch said Monday. “Not because people are satisfied. Not because they think we’ve solved it. But they know we have to roll up our sleeves and get the work done to implement the new health care (system) that we need for the 21st century.”

The 2010 Affordable Care Act has survived legal challenges and numerous attempts at repeal by Republican lawmakers.

Recently, much of the attention has been on the troubled online insurance marketplaces. A key provision of the Affordable Care Act, the marketplaces are like online shopping malls for health insurance, in which individuals and small businesses can compare plans and enroll for coverage. But technical glitches have prevented many people from enrolling.

Just 1,569 New Hampshire residents had picked a plan as of Nov. 30, according to federal data released last week. In Vermont, which established its own marketplace, 4,987 people had selected a plan through the first two months.

Improving the marketplace website, HealthCare.gov, is just one of many issues that needs attention as health reformers and lawmakers work to curb health care spending and expand access for patients.

Welch told the audience of doctors, nurses and hospital administrators that he was optimistic House Republicans were ready to accept the law and work with Democrats to roll out its programs.

“The job that we have in Washington right now is to try to move past that old debate and to be very attentive to the real problems that emerge with the implementation of the health care bill,” Welch said. “Whether it’s the obvious one with the website, which has to be fixed, or some of day-to-day challenges that our institutions are facing, which is the payment model, the delivery model, and to be all in on listening to what you have to say about, ‘hey this is not working. Here’s how we can make it work better.’ And then to make adjustments.”

Payment reform has been a particular interest for Welch. Health reform advocates, including Dartmouth-Hitchcock CEO Jim Weinstein, want to move the health care system out of a “fee-for-service” world — in which doctors are paid according to the volume of care they provide — and toward one in which there are incentives to keep people healthy and out of the hospital.

One model, developed at Dartmouth and included in the Affordable Care Act, is accountable care organizations. These “ACOs” are aimed at reining in health care spending on Medicare patients while maintaining or improving the quality of care. The health care providers in the ACOs then split the savings with Medicare.

Dartmouth-Hitchcock has ACOs in both Vermont and New Hampshire. Dartmouth-Hitchcock was able to achieve its goals for quality while reducing costs in its New Hampshire ACO, which is into its second year. No results have been released for one in Vermont, which includes all of the state’s hospitals and was launched this year.

Welch said he pushed hard for the inclusion of ACOs in the health reform law.

“It just made a lot of sense,” he said.

But Congress still is passing legislation that frustrates health care providers and threatens hospitals’ financial health. The federal budget that passed the House last week, and for which Welch voted, kept in place a 2 percent cut in Medicare reimbursements for providers.

The cuts were part of the long-term spending cuts earlier this year known as “sequestration.” If approved in the Senate, the budget means that health care providers will have to take the hit for two more years. For Dartmouth-Hitchcock, the cuts equal about $10 million per year, said Frank McDougall, Dartmouth-Hitchcock’s vice president for government affairs.

“You have to be disappointed if you’re a hospital,” McDougall said of the budget.

Welch said he understood that hospitals must be frustrated, but emphasized that the budget deal was a positive step forward.

“Compared to shutdown and debt default, it’s progress,” Welch said following his lecture. “It’s not the bill we need, but it’s the bill we could get to keep government going and relieve us of the worst problems on the sequester.”

Welch said he would continue working on the short- and long-term problems in the nation’s health care system. Spending on medical care is an enormous pressure on the U.S. economy, providers and patients, he said.

There is “not a right answer” that will fix the system, he said. But the Affordable Care Act offers an opportunity to begin addressing it.

“There is going to be continuing pressure in trying to reform how we deliver care,” Welch said. “And that’s why the health care bill, with the accountable care organizations and the leadership that came from Dartmouth-Hitchcock, has some promise to start moving away from a fee-for-service to a performance-based health care system.

“We can stabilize health care costs, maybe even bring it down a little bit. But that’s a long term challenge.”

Chris Fleisher can be reached at 603-727-3229 or cfleisher@vnews.com.