Accessing care: 2010 Health Care Reform: SmartLink Breaks It Down

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As a donor, you may be wondering how health care reform will affect individuals and families served by nonprofit health care providers, as well its impact on nonprofit organizations themselves.

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act into law.  Seven days later, on March 30th, the president signed the Health Care and Education Reconciliation Act. Together, the acts comprise perhaps the most contentious and significant legislative effort to reform health care since Medicare.

More than 4,700 pages combined, the two acts' provisions provide coverage to 32 million more people, or more than 95% percent of Americans.  Aiming to lower health care costs over the long term, the bill is designed to reduce the deficit by $143 billion over the next ten years.  

Proponents of health care reform applaud its motivations, breadth and depth. Opponents question the constitutionality of its efforts to regulate the insurance industry. Regardless of perspective, most agree that the Patient Protection and Affordable Care Act will reduce disparities in prevention, access and treatment for low-income and minority populations --issues that have obvious implications for the health and wellness of low-income communities.  

“… the reform package emerged with a clear recognition of what is driving costs up: a system that pays for the quantity of care rather than the value of it.” Atul Gawande, The New Yorker, April 4, 2010

As a donor, you may be wondering how health care reform will affect individuals and families served by nonprofit health care providers, as well its impact on nonprofit organizations themselves.  

For individuals and families, the Acts:

• Require all insurance plans to provide coverage for essential, evidence-based preventive measures with no additional co-pays.  
• Require health care organizations to widely publicize their financial assistance policies and ways to apply for assistance. These policies must  also prevent discrimination against those eligible for financial assistance who seek emergency treatment.  
• Impose limitations on billing patients who qualify for financial assistance to no more than the amount generally billed to insured patients.  
• Impose limitation on taking extraordinary collection actions against patients without first making attempts to inform the patient about the health care organization's financial assistance policy.
• Provide the largest middle-class tax cut for health care-related costs in history, by expanding access to 95% of Americans.
• Eliminate discrimination based on health status and pre-existing conditions.   
• Eliminate “arbitrary” limits on annual and lifetime benefits, which includes the terminally ill. 
• Expand Medicaid to all non-Medicare eligible individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% federal poverty level.

For nonprofits and health care providers, the Acts:

• Offer a small employer tax credit, aimed at helping nonprofits control their health care costs.
• Impose no limitations on the tax deductibility of charitable gifts.
• Expand Medicaid payments to health care providers, increasing reimbursement to 100% of billable cost.
• Require nonprofit hospitals to perform a community needs assessment at least once every three years.  See this related story highlighted by Nonprofit Quarterly.
• Improve (potentially) the environment for attracting and retaining health care staff; opportunity for greater operational stabilityand more secure donor investments.

“Bottom line: the health reform bill may not be perfect, but it expands coverage to 32 million people, enacts significant insurance market reforms and lays a solid foundation upon which we can continue to build.” Rich Umbdenstock, president and CEO of the American Hospital Association  

Targeted giving becomes even more important

Achieving healthier communities will depend, in part, on the administrative, operational and financial health of local and regional health care providers.  

With greater access and affordability as its centerpiece, the Patient Protection and Affordable Care Act aims to lower costs, guarantee choices, and enhance quality health care for all Americans, with an emphasis on preventative care and early detection.

As a result, in the near term, nonprofit hospitals, medical centers and health clinics may become even busier places.  Increased numbers of patients and demands may overwhelm existing healthcare resources. Over time, the emphasis on and increased coverage of preventive care may help to reduce the burden on emergency care in hospitals serving low-income communities.

Where health care reform does not reach

For the remaining “un-covered” 5% of Americans, access to care and the costs associated with it will remain a critical need, especially in low-income communities.  The Cultural Wellness Center is an example of a community organization focused on such population-based strategies.

Health care remains an expensive and challenging enterprise.  Conditions that challenged the healthcare system, from aging populations to mental health treatment remain.  the creativity and flexibility of donors can make the difference in shrinking operating margins through a number of giving strategies: 

• By supporting equipment purchases, plant maintenance, capital improvements, and overll organizational capacity.
• By helping nonprofit hospitals and other grassroots health care providers consider and respond to an aging population and associated community health issues. 
• By considring the intersection of mental health issues, the arts and children's well-being.
• By helping to expand insurance coverage through enrollment assistance and other community-based efforts to help the "under-insured."
• By helping the industry incorporate technological advances that help to streamline, improve outreach and reduce costs in health care.  Rural hospitals and community-based health care programs have limited rsources but could potentially benefit greatly from technological advancements like “tele-health”-technology. 

“…far from being a government takeover, it counts on local communities and clinicians for success. We are the ones to determine whether costs are controlled and health care improves.” Atul Gawande, The New Yorker, April 5, 2010 

Ask good questions

Finally, with change, comes an opportunity to measure and evaluate the impact of health care reform, both for health care providers and communities – and for donors committed to healthy communities.  Donors can play a critical role in helping organizations assess and respond to significant changes in their operations and the quality of care.  You can begin by considering the role evaluation and measurement plays in your giving. 

Next steps

While it will take time for the full effects of the Patient Protection and Affordable Care Act to be seen, its very existence signals historic change and gives donors an opportunity to re-think and re-commit to their heath and wellness giving.

“Foundations can fill gaps and do things that government cannot do or chooses not to do because of political concerns. Foundation involvement….ensures that critical but sensitive issues, such as contraception and reproductive health, are not ignored.”  The Henry J. Kaiser Family Foundation

Content of quoted sources belongs to their publishers.

Sources:

The Association for Healthcare Philanthropy

“The Role Of Philanthropy In Health Care Reform,” D.F. Beatrice

The New Yorker, April 5, 2010 

Related Reading

Other Ways to Take Action in Accessing care

• A FEW WORDS WITH Atum Azzahir

• Advocating for change

• Developing new programs

• Organizing for change

• Strengthening community groups

• Tackling immediate needs