Before and After

The Vanderbilt Health Care Conference and Career Fair hosted more than 500 participants and 35 companies at a one-day session in Nashville this past fall. It was the fourth year for the student-organized conference, which is designed for anyone interested in the intersection of business and health care.

Headlining the October event was Nancy-Ann DeParle, Deputy Chief of Staff to President Barack Obama. Drawing on her experience as Director of the White House Office of Health Reform, DeParle outlined the contrast in the national health care system prior to passage of the 2009 Patient Protection and Affordable Care Act and what it will look like once the plan is fully implemented.

Where We Were

• Health insurance premiums doubled: Family premiums for employer coverage rose from nearly $6,000 to more than $13,000 between 1999 and 2000.
• Insured Americans and businesses paid a hidden tax: Up to $1,000 of uncompensated care was shifted from the uninsured to already-insured families. In 2008 we spent $43 billion on uncompensated care.
• Millions lacked quality, affordable health care: 50 million Americans were uninsured in 2009, and millions more lacked access to quality care, preventive services and catastrophic protection when ill or injured.
• People with pre-existing conditions were locked out: As many as 129 million Americans have a pre-existing condition that could limit access to insurance.

“Even after spending almost twice as much per capita on health care as every other industrialized country in the world, we continue to rank near the bottom when it comes to health care outcomes,” DeParle said. “Those of you working in health care understand that this is bad for business. Imagine you’re selling cars. If cars become more expensive, but the quality stays the same, or even gets worse, you don’t need an MBA … to realize that you’re in trouble.

“Health care isn’t like most other industries. If people can’t afford insurance, they don’t stop coming to the hospital. They just stop paying for the care they receive. So to tweak the analogy that I just used, not only are customers not buying cars, but you have to hand them out for free. That’s not sustainable.”

What the Law Does

• Allows young adults to stay on their parents’ policies: More than 1 million 18- to 26-year-olds have benefited.
• Gives uninsured with pre-existing conditions affordable insurance: The Pre-existing Condition Insurance Plan has covered more than 30,000 people and is a bridge to 2014 when discriminating against anyone with a pre-existing condition will be illegal.
• Protects retiree coverage: $5 billion is provided to keep coverage affordable for early retirees in more than 6,600 plans.
• Expands community health centers and workforce: Clinics can serve nearly 20 million more Americans, adding 16,000 primary-care providers during the next five years.
• Holds health insurers accountable: The law implements a patient’s bill of rights, eliminates double-digit rate hikes without review, guarantees that overhead expenses are held in check, and promotes pricing transparency among health plans on healthcare.gov.
• Creates a competitive and affordable insurance marketplace: Starting in 2014, consumers will be offered the same health plan choices as members of Congress. Tax credits and Medicare coverage will be made available to ensure that coverage is affordable for families and small businesses. The law also protects existing employer-based coverage while ensuring that all Americans who can afford it get health insurance, increasing the insurance purchasing pool, ending pre-existing condition exclusions, and eliminating the “hidden tax” of cost shifting.
• Lowers cost and improves quality: Health care fraud persecutions are up 85 percent, and billions have already been saved. The law promotes prevention and offers incentives to reduce hospital readmissions and conditions acquired in health care facilities. It also provides tax credits to small businesses and relief for seniors. There was record low growth in national health spending in 2009 and 2010.

“I’m not saying it’s going to be easy for us to make all of these changes,” DeParle said. “But what I’m saying is the framework is there and the incentives are there in this new law.

“Do we embrace this new law, this new world of health reform, as a first step and work together to make it better? Or do we fight to restore an unsustainable status quo that left millions of our neighbors on their own in their time of need?”

A version of this article originally appeared in VB Intelligence on Nov. 17, 2011.