President Barack Obama promised that his health care reform legislation would increase access to health care, lower costs and improve quality. It will achieve none of those goals; indeed, it will likely exacerbate our current challenges with access, cost and quality.
However, that does not mean that health care reform is dead.
Reform is happening at a rapid pace, and it’s doing so in spite of the Patient Protection and Affordable Care Act (ACA) rather than because of it. In fact,
Health IT is an umbrella term that generally refers to a number of more specific technology-related health care functions: the effort to expand electronic health records (EHR); e-prescribing; the growing adoption and adaption of mobile devices such as cell phones and tablets for medical purposes, referred to as mobile health, or m-health; and the use of the Internet to see medical providers, known as tele-health.
Congress has gotten involved recently by passing legislation that gives the U.S. Food and Drug Administration (FDA ) some oversight to regulate certain software and apps that function as a medical device. And the ACA hands out billions of dollars to encourage hospitals and other health care providers to embrace EHRs. But for the most part health IT is not on
But health IT should be on state legislators’ radar, because there are so many areas associated with it where states are the primary regulators: pharmacies, hospitals and clinics, physicians and nurses, insurance, communications networks, Medicaid, the State Children’s Health Insurance Program, nursing homes and assisted living centers. And while states may not have primary oversight on privacy issues, they may end up playing a role.
Take, for example, tele-health. This could be one of the most important changes in health care because it eliminates the distance factor. The ability of patients, especially those in rural areas, to see their physician or a specialist creates huge new efficiencies. A tele-health visit, ideally with both the doctor and patient sitting in front of a screen, does not and should not do away with the face-to-face visit. But it might work very well for a quick follow-up visit, and it is already demonstrating both efficacy and savings for mental health care.
The problem is that a patient’s health care provider(s) could live in a different state, which creates a practice-licensing problem.
It is fine if the patient wants to travel out of state to see a physician; but seeing a physician across state lines will run afoul of most state medical licensing laws. It’s an issue that will have to be addressed if tele-health is ever going to reach its full potential.
Next consider Medicaid. The federal-state health insurance program for the poor has already become the largest budget item for many states and will be soon for many more—and that’s before an estimated 16 million more Americans become eligible for Medicaid under the ACA.
However, as Dr. Anand Iyer of WellDoc, Inc., a company that specializes in helping patients use mobile technology to manage chronic care conditions, nearly everyone has a cell phone, regardless of income. WellDoc has demonstrated significant benefits in helping diabetics manage their condition, thereby keeping them out of the hospital, which keeps costs down. There are similar programs to help pregnant mothers manage their pregnancy and to help smokers quit. Could some similar type of system be applied to Medicaid patients with chronic conditions or the need to improve their health habits?
New apps also help pharmacists monitor a patient’s medications, which can help medical professionals detect whether a patient has a medication that could interact negatively with his other medications.
And the day may come when Medicaid patients—indeed all patients—cover their co-pays by using their phone as a mobile wallet or as a place for keeping their basic medical history, a personally kept electronic medical record.
Then there is health insurance, which is largely regulated by the states—or at least it was until the ACA passed. There are new companies creating apps that interact with a person’s health insurance, showing how much of the deductible has been met, what the co-pay should be, etc. One company is working on an app that would identify doctors in patient’s vicinity and how much they would charge for a particular type of procedure, given the patient’s health coverage.
And let’s not forget taxes. The states have the ability to tax many of these providers and services. Will they see health IT as a burgeoning cash cow that could help fill state coffers? Or will they shy away from taxing medical care and information, as they have in the past?
Health care is entering the telecommunications age, and that development has significant ramifications for the access, cost and quality of health care. States have not been involved yet, but they soon will be. State legislators need to familiarize themselves with these issues, while asking how they can apply ALEC’s principles of free markets and limited government. Health care reform can increase access, lower costs and improve quality of health care— but it will require technology, not the Affordable Care Act, to do it.
Merrill Matthews is a resident scholar with the Institute for Policy Innovation and the Policy Level Private Sector Chair of ALEC’ s International Relations Task Force/Federalism Working Group.
Bartlett Cleland is policy counsel for IPI and the private sector co-chair of ALEC’ s Communications and Technology Task Force.