RESTORING THE PARTNERSHIP FOR AMERICAN HEALTH COUNTIES IN A 21ST CENTURY HEALTH SYSTEM

Transcription

1 TESTIMONY OF DARLENE R. BURNS UINTAH COUNTY COMMISSIONER UINTAH COUNTY, UTAH BEFORE THE NATIONAL ASSOCIATION OF COUNTIES WORKING GROUP ON HEALTH SYSTEM REFORM DECEMBER 3, 2008 Darlene Burns, Uintah County, Utah, serves as one of three commissioners tasked with responsible oversight, growth and development of Uintah County. She is an innovative public official with several years experience working with State and Federal partners in the area of health. She serves as a member of the County Health Special Service District, TriCounty Health Advisory Board, Mental Health and Substance Abuse Local Authority Board and the Utah Behavioral Healthcare Network. Her strengths are in public policy, management and staff training and creative problem resolution. Introduction RESTORING THE PARTNERSHIP FOR AMERICAN HEALTH COUNTIES IN A 21ST CENTURY HEALTH SYSTEM FULL PARTNERS: County governments are integral to Americas current health system and will be crucial partners in achieving successful reform. At the most basic level, county officials are elected to protect the health and welfare of their constituents. County governments set the local ordinances and policies which govern the built environment, establishing the physical context for healthy, sustainable communities. County public health officials work to promote healthy lifestyles and to prevent the spread of disease. Counties provide the local health care safety net infrastructure, BY financing and operating hospitals, clinics and health centers. County governments also often serve as the payer of last resort for the medically indigent. County jails must offer their inmates health care as required by the U.S. Supreme Court. Counties operate nursing homes and provide services for seniors. County behavioral health authorities help people with serious mental health, developmental disability and substance abuse problems that would have nowhere else to turn. And as employers, county governments provide health benefits to the nearly three million county workers and retirees nationwide. Clearly, county tax payers contribute billions of dollars to the American health care system every year and their elected representatives must be at the table as full partners in order to achieve the goal of one hundred percent access and zero disparities. ***Added the word by to one sentence for better flow. Basically agree that county governments provide billions to the health care system and should be at the table as a full partner.

2 LOCAL DELIVERY SYSTEMS ACCESS FOR ALL: NACo believes that reform must focus not only on the financing but also the delivery of health services. Coverage is not enough. County officials, particularly in remote rural or large urban areas know that even those with insurance may have difficulty gaining access to the services of a health care provider. Local delivery systems should coordinate services to ensure efficient and cost-effective access to care, particularly primary and preventive care, for underserved populations. County governments are uniquely qualified to convene the appropriate public and private partners to build these local delivery systems. A restored federal commitment to such partnerships is necessary for equitys sake. It will ensure that the local system can provide access to basic care regardless of the resources that the local economy is able to generate. ***I agree that access to health care is expensive for all and difficult for many. Also agree that county government is uniquely positioned to assemble partners to coordinate an effective health care delivery system. Federal commitment to the cause is essential and should materialize in the form of increased funding for programs, not mandated managed health care. PUBLIC HEALTH AND WELLNESS: NACo believes that public health services for disease prevention and health promotion must be universally available. These critical services include: assessment of the health status of communities to identify the unique and most pressing health problems of each community; health education to provide individuals with the knowledge and skills to maintain or improve their own health; monitoring and action to prevent infectious and chronic diseases as well as the safety of air, water and food supplies; outreach, screening and referrals to ensure individuals with particular health care needs are identified and receive appropriate services; full integration of the public health response to emergencies into each countys emergency management plan and systematic integration of local public health considerations into land use planning and community design processes to help prevent chronic disease. ***I agree up to full integration of public health response to emergencies. Many local Health Departments do not have the resources, the assets, experience or training for full integration. Most on staff are nurses and secretaries and are not trained as first responders. Public Health staff should serve as back-up to first responders, but as a separate unit. First response is outside of their scope of expertise. Public Health roll is preventative and once the crisis has hit, it is out of the hands of the public health staff. Public Health has a perspective of the land and uses and has a definite role in that area. EXPANDING COVERAGE:

3 NACo supports universal health insurance coverage. County officials differ on the best way to achieve that goal, but in the meantime, existing public health insurance systems should be strengthened and expanded, including Medicare, Medicaid and the State Childrens Health Insurance Program (SCHIP). As states and counties attempt to develop their own plans to cover the uninsured, federal regulatory barriers should be removed to allow them to proceed. Furthermore, in the effort to expand coverage, reformers should not forget that the coverage must be meaningful the benefit package must be defined so as to provide the full range of services people need, including full parity for behavioral health, substance abuse and developmental disability services. ***Universal Health Insurance coverage does not seem to be the answer. Affordable health care is. Until there is control and/or removal of the influence of insurance coverage on health care costs there will be no forward progress. MAINTAINING A SAFETY NET: NACo believes that the intergovernmental partnership envisioned in the Medicaid statute should be restored and strengthened. Local safety nets constructed under Medicaid should not be dismantled to pay for universal coverage. County hospitals and health systems, in particular, will continue to need extra support to carry out their missions to reduce disparities and serve underserved populations. ***County hospitals and health systems should answer as to why health care costs are escalating and what they are doing to control the cost. Fiscal accountability must be a component of any successful solution. HEALTH WORKFORCE: NACo believes that the health professional and paraprofessional workforce must be supported and enhanced. Funding for existing education and training programs should be increased and also targeted towards initiatives to increase workforce in the health care industry. Partnerships between local economic developers and workforce development professionals should be encouraged to meet growing health care sector demand. Targeted incentives should be developed to encourage more providers to enter and remain in primary care. Primary care providers should be empowered to and rewarded for coordinating services to ensure costeffective, evidence-based, quality care. ***I agree. HEALTH IT:

4 The federal government should support the integration of health information technologies into the local health care delivery system. NACo supports efforts to promote the use of a range of information technologies to facilitate appropriate access to health records and improve the standard of care available to patients, while protecting privacy. This includes deployment of broadband technologies to the widest possible geographic footprint. Other tools facilitate evidence-based decision making and e-prescribing. Using broadband technologies, telemedicine applications enable real-time clinical care for geographically distant patients and providers. Remote monitoring can also facilitate post-operative care and chronic disease management without hospitalization or institutionalization. ***I agree. VALUE-DRIVEN HEALTH CARE: Individuals should have easy access to accurate information. NACo therefore supports greater transparency in both the quality and the cost of care. Broader availability of such information will serve as a tool to promote preventive health care measures, which will in turn reduce chronic illness. Counties also support plans that reward individuals who exercise choice based on high quality of care and competitive price for health care services. ***I agree. Individuals should, also, be rewarded for making healthy lifestyle choices which promote health and detract from the expense of providing health care. LONG TERM CARE: Federal policies should encourage the elderly and disabled to receive the services they need in the least restrictive environment. Since counties provide and otherwise support long term care and other community based services for the elderly and disabled, state and federal regulations and funding programs should give them the flexibility to support the full continuum of home, community-based or institutional care for persons needing assistance with activities of daily living. ***I agree. LIABILITY REFORM: NACo understands that medical liability reform is needed to help contain health care costs. To that end county officials support common-sense reforms that would reduce frivolous lawsuits without obstructing the rights of citizens to due process. Medical liability insurance carriers should be required to justify premium increases which exceed a certain rate. Instances of inadequate care should be subject to professional discipline and sanction. National medical liability reform should not preempt state and local policies. ***I agree.

5 JAIL HEALTH: Reforming Americas health care system must include reforms to its jail system. Counties are responsible for providing health care for incarcerated individuals as required by the U.S. Supreme Court in Estelle v. Gamble, 429 U.S. 97 (1976). This unfunded mandate constitutes a major portion of local jail operating costs and a huge burden on local property tax payers. The federal government should lift the unfunded mandate by sharing the costs of inmate health care. Furthermore, a true national partnership is needed to divert the non-violent mentally ill from jail and into appropriate evidence-based treatment. Finally, resources should be made available to counties to implement comprehensive reentry programs so that former inmates have access to all the health and social services that they need to avoid recidivism and to take a become fully integrated into the community. ***No comments, rather questions. Why do incarcerated persons receive the opportunity for better health care than the socially disadvantaged? Why aren t non-violent inmates on work-release and made to share in the cost of their own health care? One of the problems with Federal funding is how it filters down to the local government. It seems to go through so many departments that the majority of the money is spent before it ever reaches the local level.

6 Attachment 1 Darlene R. Burns, Uintah County Utah Comments on President-elect Obama Biden Health Care Proposal I agree that the two extremes are both incorrect principles: government run health care with higher taxes allowing insurance companies to run without rules Whichever healthcare plan is implemented must be based on correct principles. I also agree that it is important to continue to use facets which are currently working: building on existing health care systems using existing doctors, providers and plans Allowing people to continue with their own health care plans at a reduced rate and those who have no insurance to purchase at a low rate is desirable. Allowing people to use their own choice of doctors or facilities without government interference would also be desirable. Issues not working should be eliminated or replaced. However, requiring health insurance companies to accept every pre-existing condition may be such an immediate and excessive expense that the cost could be astronomical. Would this allow people with pre-existing conditions to be accepted by only one company, or would this allow people to hop from one company to the next expecting pre-existing conditions to be accepted over and over again? Some pre-existing conditions may be unavoidable, but some may be from bad habits or self inflicted, would that be taking into consideration? Some Mom and Pop businesses would have a hard time providing health care benefits to employees no matter what the tax credit may be. It is these small businesses, and the entrepreneurial attitude that gives America the competitive edge and makes America great. We would not want to hinder their ability to function. From what account would the government draw to lower costs for businesses by covering a portion of the catastrophic health costs they pay, in return for lower premiums for employees? How would that account be funded? How would the National Health Insurance Exchange be set up? It is often the case that layers and layers of bureaucrats are added and the initial focus is lost. That focus being the individual with health insurance coverage needs.

7 Consideration may be given for the IRS to change the law which allows a smaller percentage of income spent on health costs to be tax deductible. Concerning drugs, generic drugs do need to be more available, taking into consideration that dyes and fillers used in generic drugs do not always produce the same reaction as a name brand drug. Non FDA approved drugs can currently be purchased from foreign countries by use of the internet. There is no doubt that insurance companies need to be looked into, and changed, for their anticompetitive practices and the monopolies of ownership. Requiring preventive care to be covered by insurances does not mean that individuals would choose to participate in preventative care. Will subsequent health coverage be the same for those who participated in preventative care compared to those who choose not to participate? Preventative health care incentives should be built into any plan. I personally have a concern when I hear France, Germany and other countries that have long practiced a national health care coverage, are concerned that their pot of money has dwindled and they can no longer offer the same health benefits as they have in the past. Are the systems being abused? Should taxes from all citizens be raised to cover the needs? Do the systems need to be revamped? Are those administrating the systems too far removed from the recipients? I do not want to see those same problems with our country. It is my opinion and main concern with a nation-wide health insurance program that there will be great challenge of administration and monitoring. Would this program be better handled on a regional, state-wide, or even a county-wide basis where the administration better knows the needs of the constituents? Locals are closer to the problem and could determine whether abuses were occurring. On a federal-wide basis I don t want to see nine-tenths of the appropriation spent on administration and deliver of only one-tenth to the needy.

8 I don t want the government paying for people, some of whom had completely recovered from their ailments many years earlier, and having it said, It is cheaper to send out the checks than hire the monitors to check on the people! This could easily become a reality with such a huge system. There must be a careful examination of the current health care system identifying those factors causing inflated costs. The first job should be to rein in the existing costs, then examining how to make the system available to all.