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ObamaCare's Future Is Now in States' Hands

ObamaCare's Future Is Now in States' Hands

By Eric B. Schnurer and Sarah Dash - June 22, 2013

It’s been a year since the Supreme Court upheld the Affordable Care Act and three years since Congress first enacted it, but the debate surrounding Obamacare rages on.

This week the administration attempted to seize control of the message with a new ad campaign by the advocacy group Organizing for Action, touting better coverage and lower cost. But these high-profile efforts -- like the continuing attempts in the House of Representatives to repeal the ACA -- obscure the fact that the real focus of health care reform has moved on: The ACA, rather than being the federal takeover critics fear, has already created a framework for both states and private providers to implement their own strategies to improve people’s health -- and they are doing so.

The future of health care lies not in posturing over national politics but in state-level efforts to tackle the country’s real health challenges by addressing three interrelated, synergistic goals: better health, better care and lower costs. By meeting this triple challenge, some states are already leading the charge and paving the way for true reform.

West Virginia, for example, ranks 12th in the nation in per capita health spending, yet it ranks a dismal 48th in the overall health of its people. Gov. Ray Tomblin commissioned our organization, Public Works, to undertake a comprehensive review of the state’s health agencies in order to identify new approaches to improve efficiency and to uncover integrated, cost-saving solutions that don’t necessarily lead to more care, but will ultimately result in needing less care over time. For instance, since heart disease, stroke and diabetes are leading causes of death in West Virginia, focusing the state’s resources on reducing occurrence of these diseases would both produce healthier people and lower health system costs.

Efforts are already underway in a number of states -- as diverse as Arkansas, Ohio, New York, and Oregon -- to harness new ways to collect and analyze data on health care costs and quality, identify the highest-cost or most prevalent health care problems, and bring together health care providers, public health experts, and others to generate improvements.

The need for greater integration has long been a problem in health care. Specialists often treat conditions independently instead of working together to treat the whole patient. But new resources and technologies are making collaboration easier -- think, for example, of health information technology that allows teams of care providers to track which of their diabetic patients need their blood sugar checked instead of waiting for patients to show up with dangerous complications.

Similarly, the evidence is overwhelming that better health happens not just in the provider’s office but in real life -- where we live, work, play and learn. For example, bike sharing programs, walkable streets, and park access aren’t just about the environment, public safety, or recreation -- they really do encourage better health, and need to be thought of as part of our health system.

State policymakers are beginning to recognize the need to look beyond hospitals and clinics to these kinds of programs, and to break down the silos within government itself in order to foster better health at lower cost. Policymakers need to foster integrated collaboration between state government agencies (housing, transportation, environment, health, other social services, parks and recreation) and harness proven strategies that have improved health and lowered costs through an integrated, comprehensive approach.

No discussion of health care reform would be complete without considering Medicaid, the largest health care line item in state budgets. Lowering health care costs is a major objective of reform, and Medicaid will continue to be a major focus of cost containment efforts.

But cost containment must go beyond raising co-payments, cutting benefits, and focusing on Medicaid alone in its own silo. There is a better way to look at cost containment -- one in which lower costs happen because of better health (tackling the crisis of preventable disease and injury that is filling hospital beds and nursing homes, but siphoning away people’s health and productivity) and better care (ridding the system of inefficiencies that have plagued health care for far too long).

More money spent on more care doesn’t necessarily mean better health, if it did, Americans would be the healthiest people in the world, but we’re not. But by focusing on achieving better health, we can deliver the right care and stop spending money on the wrong care, lowering costs overall while improving outcomes. Never mind the continued national drama over Obamacare; the state level is where the real work of health care reform -- and innovation -- now must occur. 

Eric B. Schnurer is president of Public Works LLC, a national public policy consulting firm. Sarah Dash, a member of the research faculty at the Georgetown University and former congressional staffer on the Affordable Care Act, consults with Public Works LLC. 

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Eric B. Schnurer and Sarah Dash

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