Charles Baker, Jr., the leading Republican gubernatorial candidate and former CEO of Harvard Pilgrim Health Care, delivered the keynote address on Monday at a health care forum sponsored by the Graduate School of Social Work (GSSW).
The forum, titled, “From Policy to Practice: Health Care Reform,” sought to address the impact that the Affordable Care Act (ACA), commonly known as Obamacare, will have on the social work field.
“I am delighted that our school of social work takes a leadership role in the local and national conversation about health care reform,” said Alberto Gondenzi, dean of the GSSW, in his welcoming remarks. “We need to be at the table when the issues of quality, access, and cost control are discussed. We need to demonstrate that social workers play a crucial role in the design, implementation, and regulation of health care reform.”
The Obama administration’s landmark reform was signed into law in March 2010, but most major provisions of the law will be phased in over the next year. Full implementation of some provisions is not expected until 2020.
Among other things, the law allows young adults to stay on their parents’ heath plans until age 26; creates state-based health insurance exchange marketplaces where Americans can compare and shop for federally regulated health plans; and requires individuals to have health care or pay a penalty fee.
Baker accepted an invitation by Marylou Sudders, the former state commissioner of public health and now an associate professor within GSSW, to attend Monday’s forum before he had decided to run for governor for a second time after losing to Deval Patrick in 2009.
Baker, who served as the state secretary of health and human services from 1992 to 1994, made clear that his address was not a political one. “For those of you looking for some sort of political stump speech, you will be sadly disappointed,” he told the audience of mostly social workers.
Rather, his focus was on the implications that ACA will have for social workers in terms of coverage expansion, the creations of the state-based exchanges, and cuts in Medicare.
As coverage is expanded to more people, Baker said, it will affect social workers in three ways. Specifically, he said it will change how social workers are paid for their services.
Currently, state and local governments pay for some of the services for uninsured people. Under the new law, social workers will be paid for their services by a combination of state and federal funds through Medicaid, a current government-run health care program for low-income families and individuals. The ACA significantly expands the eligibility requirements and funding levels for the program.
“Because of the limitations in support for primary care that have taken place over the course of the past 15 years, a whole bunch of people are now going to be eligible for coverage,” he said. “In many cases they’re going to discover that their ability to access these services is going to be limited by the limitations we have within primary care currently.”
In a report released in early February, the Congressional Budget Office (CBO) reported that in 2024 there will still be 31 million Americans without health coverage, and that about 14 million of those Americans will choose not to purchase insurance.
The Kaiser Family Foundation, a non-partisan research foundation based in California, found that an estimated 17 percent of the non-elderly population nationwide would benefit from the expansion of Medicaid. At this point in the timeline of the law, there has been no definitive estimate as to how many more people will opt to purchase coverage.
According to research published in the December 2012 issue of the journal Annals of Family Medicine, however, the total number of office visits to primary care physicians will increase by 101 million between 2008 and 2025 due to population growth and aging.
Population growth alone will require nearly 33,000 more primary care physicians, according to the article, which was co-authored by Stephen Petterson, Winston Liaw, and four other medical doctors. As coverage is expanded under the ACA, the need for doctors will become more severe.
“I think one of the great challenges health care is going to face is figuring out-within the confines of what people are actually licensed to do, what people are actually going to be reimbursed to do, and what the rules of the games are going to require them to do-[who will] play to whatever their particular level of participation is in a team-based approach to care delivery,” Baker said.
He predicts that the coverage expansions and shortages of primary care physicians will require doctors, social workers, and other medical workers to play new roles in team-based approach. With that comes an inevitable movement away from one-on-one care.
With the creation of online health care marketplaces, Baker anticipates that more people will opt to purchase individual coverage, rather than insurance provided by an employer.