Editorial: Reform Moves Ahead

Editorial: Reform Moves Ahead
Copyright by The New York Times
Published: July 18, 2010
http://www.nytimes.com/2010/07/19/opinion/19mon1.html?_r=1&ref=opinion


Less than four months after Congress approved historic health care reform legislation, the Obama administration has been making good progress in bringing some early benefits to fruition and issuing rules to guide the reform process. Despite all of the critics’ hype and scare tactics, some polls suggest that the public perception of reform is slowly improving.

That hasn’t stopped the critics. More than a score of Republican attorneys general and governors have filed suit to nullify two important requirements of the new law — that everyone obtain insurance or pay a penalty, and that states expand their Medicaid programs. The White House will have to keep pressing back and keep explaining why reform is in the clear interest of the nation.

Most of the major elements of the reform law don’t go into effect until 2014, but some important benefits start this year. Administration officials had two early successes: pressuring insurance companies to immediately end their indefensible practice of rescinding coverage after a policyholder becomes sick and to immediately start covering children with pre-existing conditions. Officials also persuaded insurers and a handful of employers to allow parents to keep their dependent children on family policies until age 26.

A few hundred thousand Medicare beneficiaries who have reached the “doughnut hole” in Medicare drug coverage have gotten or will soon get small, $250 checks to help pay their drug costs; millions more will get checks when they reach the gap later this year. The administration has already proposed language for contracts that will be signed with the manufacturers of brand-name drugs to provide 50 percent discounts next year to patients who hit the gap. A small blizzard of regulations, each requiring painstaking drafting, has been issued, including new rules issued Wednesday requiring insurers to eliminate cost-sharing for recommended preventive care, such as screening tests and vaccinations.

Not everything has moved smoothly. The new law requires insurers to spend at least 80 percent of premium dollars on medical care. But agreeing on a definition of care (versus administrative and other costs) has proved difficult. A plan to open temporary high-risk pools for people unable to obtain insurance because of pre-existing conditions appears to be running behind schedule.

On the employer front, the administration has notified nearly four million small businesses that they might be eligible for a tax credit to help defray the cost of insuring their workers. And it is accepting applications from employers for a separate program to help defray the costs of insuring early retirees.

President Obama was right to bypass Senate opponents and appoint Dr. Donald Berwick, a respected expert on health care quality and costs, to head the Centers for Medicare and Medicaid Services. With no chief to sign off on crucial decisions, the agency has been reluctant to create and staff a new innovation center, to provide guidance on a vast expansion of Medicaid, and to issue a slew of regulations to reshape Medicare.

State leaders also have a lot to do to get ready for reform and ensure that their citizens get the full benefits. They will need to set up new health insurance exchanges, more closely monitor and regulate insurers, and expand Medicaid. While some politicians have de"cided to keep battling reform, at least 21 states have officially designated a task force or committee to oversee implementation. That is responsible government.