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Thoughts in the Aftermath of the Government Shutdown and Budget Stand-Off

Senator Cruz and the Tea Party appear to have miscalculated in several ways. First, they thought that the President and Senate Democratic leadership would blink and agree to repeal or gut the Affordable Care Act. Second, they believed that the American people would rally to their side. Third, they believed that all Republicans would stand solid in support of this quest to repeal the Affordable Care Act in the face of the potential for a national and global financial meltdown.

The public polling shows ever stronger public support for implementing the ACA and fixing the computer glitches along with the other important changes needed to make implementation successful. As people who are uninsured or with individual coverage get enrolled in Covered California and appreciate the prices and access to care under this new coverage opportunity, support will continue to build. If health costs and insurance premiums skyrocket, support will evaporate.

Now is the time to do several things: enroll all the eligible, implement the payment and delivery system reforms needed to slow the rise in spending, improve the quality and outcomes of care, educate Californians about the multiple facets of improvement in health care under the ACA, and design and agree on the next steps of reform here in California and nationally.

The medical equipment manufacturers and suppliers, unions and others were right on the spot with Democratic and Republican lawmakers trying to repeal the aspects of the comprehensive reforms in Affordable Care Act, which impacted them. Those favoring comprehensive reform were ardent in defending the ACA, yet lacked a game plan and proposals to fix the law and move reforms to the next level. In part because the roll out is a work in very early progress, it is hard to know what to fix beyond computers. Additionally, it appears to be a fool’s errand to find bi-partisan agreements when the Tea Party and its adherents are fixated on repeal. But beginning now and before January 1, 2014, we all need to be ready.

Based on the trainings, workgroups, research, and community forums we have conducted, I am going to suggest the following and would love to hear your thoughts and recommendations.

  1. Design payment reforms that reward provider efficiency, improved outcomes and excellent quality and penalize the opposite
  2. Promote cultures of coverage, prevention and wellness
  3. Fix the affordability of employment based coverage for low, moderate and middle income families
  4. Integrate behavioral and physical health coverage and care
  5. Design and finance integrated safety net care for the remaining uninsured and replace program silos with integrated systems of care.

We must all find common ground to effectively fix the implementation glitches as they appear and build bi-partisan agreement on the next steps of reform.

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