UCSF Community Reacts to Health Care Reform Law

By Lisa Cisneros

Members of the UCSF community say the signing of health care reform into law is historic, but more work must be done to ensure that other problems not addressed in the legislation are fixed in the future.

Many say that the law is is imperfect and others worry if the political will can be counted on to fully realize the provisions to expand coverage that will not be implemented until 2014. Still others are cautious about attempts to repeal the legislation.

Despite its flaws, Mark Laret, chief executive officer at UCSF Medical Center, says the legislation represents “a new era in American health care.”

Laret was among a group of academic medical center leaders and the board of the Association of American Medical Colleges (AAMC) who recently came to a unanimous decision on the health care bill. Read that story here.

While acknowledging some weaknesses of the legislation on his blog, Robert Wachter, MD, professor and associate chair of the Department of Medicine at UCSF, focused on some of its positive aspects: “The most heinous aspects of the under-regulated insurance system—particularly the exclusions for preexisting conditions and the possibility of losing insurance after becoming ill—will become memories of a crueler American past, like slavery and McCarthyism.”

Wachter, who is also chief of the Division of Hospital Medicine, and chief of the Medical Service at UCSF Medical Center, says that maybe Americans can come away from the grueling year-long political process with a “renewed sense that Washington can tackle hard problems.”

Kevin Grumbach, MD, professor and chair of the UCSF Department of Family and Community Medicine at San Francisco General Hospital, commended the Democratic leaders for getting the job done.

“The President, Speaker Pelosi, and other congressional champions of health reform have shown us that progress really can be made towards assuring that all people in this country have health security. A bill that will expand coverage to 32 million more Americans is something to celebrate.”

Grumbach, who helped shape the health care proposal, says one of the benefits of the legislation is enticing more medical students to pursue primary care, which is a good thing since less than 10 percent of those who graduate from the UCSF School of Medicine go into family medicine.

The legislation provides a 50 percent increase in Medi-Cal reimbursements for primary care over the next five years and more money to invest in training programs in primary care and loan repayment programs for primary care physicians who are willing to work in underserved settings, Grumbach said.

Here is the rest of what Grumbach had to say and the comments of others who weighed in on the hot topic via email:

Kevin Grumbach, MD, professor and chair, UCSF Department of Family and Community Medicine and Chief, Family and Community Medicine, San Francisco General Hospital:

Enactment of the health reform bill is an historic step in the nation’s long journey towards universal coverage. What excites me most about the passage of the bill? Probably the single most significant achievement of the bill is that it has triumphed over the knee-deep accumulated morass of cynicism and special interest lobbying that has thwarted numerous prior health reform efforts. The President, Speaker Pelosi, and other congressional champions of health reform have shown us that progress really can be made towards assuring that all people in this country have health security. A bill that will expand coverage to 32 million more Americans is something to celebrate.

There are also some very good provisions in the bill about an issue I care deeply about—revitalizing the nation’s primary care infrastructure. The Administration and Congress heeded the lessons of the Massachusetts state health reform bill of 2006, where many newly insured people were not able to find a primary care medical home due to the lack of primary care capacity in the state.

The federal reform bill includes many measures to strengthen primary care, such as increased Medicare and Medicaid fees for primary care, medical home demonstration projects with additional care coordination payments, increased funding of primary care training grants, increased National Health Service Corps funding for primary care scholarships and loan repayment, and a new Primary Care Extension Program to help primary care practices transform into high-performing, patient-centered medical homes. These measures are critical for making sure that reform will provide people in this country access to comprehensive, coordinated, patient-centered care.

What concerns me about the bill? My main concern is whether it goes far enough. Many of the provisions to expand coverage will not be implemented until 2014, and there is a risk that these provisions could be deferred or rolled back in the intervening period, depending on the results of the 2010 and 2012 elections. Also, time will tell whether the reform bill’s reliance on a pluralistic financing system that preserves a strong role for private insurance can achieve the types of efficiencies, cost control, and better health outcomes found in nations with publicly administered universal coverage programs. 

So while an historic step, this remains just that: a step towards the goal of a sound system for universal coverage in the United States. It will be incumbent on all of us to continue to work to assure that the promise of reform written into the bill is achieved in actuality in the coming years of implementation, and to continue on the long climb towards a sustainable system of truly universal coverage in the United States.

John Maa, MD, assistant professor of surgery and director of the Surgical Hospitalist Program at UCSF Medical Center:

Now that a health reform bill has passed, the time has arrived to define improvements to the Federal Emergency Medical Treatment and Active Labor Act (EMTALA) and address the medical needs of undocumented immigrants, and thereby strengthen an overwhelmed emergency care system that is in great need of repair.

This important first step with the passage of health insurance reform should now allow us to turn our attention equally to other sectors of the health industry complex in need of change, and to explore ways to address the high prices of medical care in America.

Hopefully, we may build momentum upon this historic occasion of insurance reform, and continue to make progress forward in the difficult arena of health reform, which will likely take decades to achieve.

Perhaps a key next step will be to ensure that the addition of large numbers of insured patients will not overwhelm the delivery system, and to ensure that that the quality of care across America is not adversely impacted.

Carole Joffe, PhD, professor of Obstetrics, Gynecology and Reproductive, Bixby Center for Global Reproductive Health:

I agree with others in the UCSF community that the passage of health reform is a tremendous achievement in that it will bring health care to approximately 30 million people who now are without health care coverage. 

I am additionally heartened by the passage of this bill because it represents an important turning point in our political culture—namely, President Obama and others have been able to use the powers of government to achieve an important domestic goal. This is the most important domestic policy achievement since the Medicare and Medicaid bills of the 1960s. In the intervening years, government has been demonized and many Americans have been convinced that their government could not work on their behalf.

I am disappointed however that this victory was apparently reached with new and continued restrictions on abortion coverage. The Executive Order that was signed in order to gain support from anti-abortion forces will make it virtually impossible to overturn the Hyde Amendment in the foreseeable future—overturning this amendment, which forbids public funds being used for poor women’s abortions except under very limited circumstances, has been a prime goal of reproductive justice advocates. 

Furthermore, health policy scholars have concluded that the effect of this legislation will lead to a situation in which insurance companies will ultimately drop coverage of abortion, because of the cumbersome restrictions demanded by the bill. This will particularly hurt those women needing later abortions, because of fetal anomalies or maternal health, which can cost thousands of dollars. Women should not have to face bankruptcy at the saddest moment in their lives.

Nevertheless, I remain deeply gratified that so many who are currently without basic health care will now have access to it. 

Related Links:

Obama Signs Health Care Overhaul Bill, With a Flourish
New York Times, March 23, 2010

House Passes Landmark Bill Making Health Care More Available
UCSF Today, March 22, 2010

Wachter’s World

This is What Change Looks Like
White House Blog