University Times

As details emerge about the impact of the sweeping health care reform approved last week, Pitt faculty and staff are pondering its impact on the University and its employees.

Health economics professor Judith R. Lave, chair of the Department of Health Policy and Management, said she believes the health care reform legislation will have more impact on Pitt’s medical side than on individual faculty and staff, noting that the benefits provided to faculty and staff under the University’s insurance plans largely are consistent with the aims of the legislation.

One impact on individuals, she said, is that some high-income employees eventually will see their payroll taxes rise. The legislation calls for Medicare payroll taxes to increase in 2013 from the current 1.45 percent to 2.35 percent of wages for individuals who earn more than $200,000 in wages or couples who make more than $250,000.

Closer on the horizon are a number of other changes. According to a statement from the White House Office of Health Reform, these are among the key provisions of the legislation that take effect this year:

• Children with pre-existing conditions no longer may be denied coverage.

• Young people may remain on their parents’ insurance policy until they turn 26.

• Insurance companies will be banned from dropping people who become ill and may not implement lifetime caps on coverage.

• New private plans will be required to provide free preventive care with no co-payments or deductibles.

(Links to the 2,074-page Senate bill and the House changes are available at www.whitehouse.gov/health-care-meeting/proposal.)

Pitt director of Benefits John Kozar said his department is examining the potential longer-term impacts of the legislation, but he expects no changes now for Pitt employees covered by University health insurance plans.

“The immediate issues have been addressed long ago,” he said, noting that Pitt employee health plans do not exclude people with pre-existing conditions nor is there a lifetime maximum benefit or cap.

In addition, the University offers health plans that include preventive care and Pitt already extends health insurance benefits to qualifying adult children. A state law that took effect last June allows employers to provide coverage to employees’qualifying single adult children up to age 30, at the parent’s expense. (See Nov. 12, 2009, University Times.)

Details on Pitt health insurance benefits are available at www.hr.pitt.edu/benefits/medical.htm.

Lave said the bigger impact here will be on the hospitals: “It will have an impact on the number of insured people who will come to the medical center.” On the other hand, the bill also decreases payments to health care providers, “but don’t blame this bill for that,” Lave said. “If they hadn’t put it in this bill they would have done it anyway in another bill.”

Jacqueline Dunbar-Jacob, dean of the School of Nursing, praised the provisions of the bill that expand health care access.

“This legislation seemed to be about availability,” she said, but added there still is room to improve the quality and efficiency of the nation’s health care delivery system.

Citing the U.S.’s ranking behind 27 other industrialized nations in health care outcomes, Dunbar-Jacob said, “We need to be looking not only at people having access; providers need to look at ways to improve the quality of outcomes. There’s considerable room for improvement.

“This legislation gives us a real chance to help reduce the differences in populations in health care outcomes.”

Dunbar-Jacob noted the current shortage of primary care providers and said that the legislation increases the potential for nurse practitioners to become primary care providers.

“We are anticipating some increase in dollars for nurse-managed clinics,” of which some 250 currently operate in the United States. Dunbar-Jacob also foresees additional financial support for nurses interested in advanced practice education.

“We and other programs in the region would be pleased to see increases in enrollment and would love to accommodate that,” she said. “It is the area where we have the capacity to grow.”

Commenting more broadly on the legislation, Lave said, “I like the basic structure of the bill,” adding, “I’m concerned that it may blow the budget even more, but I think we need to bite the bullet and engage in the kind of decision making we should have been engaged in a long time ago.”

Having the legislation in place is primary; making changes and corrections can come later, she said.

Questions about the value of services Americans receive from the health care system remain, she said. “Getting rid of waste is not the same as rationing care.”

Lave said she is concerned about state taxes rising, foreseeing the need for state tax increases in order to cover the increased state costs that will stem from higher Medicaid eligibility limits. It’s a tradeoff necessary in order to give poor people access to health care, she said.

“I am a believer in the social good, that we all ought to be contributing if we are going to receive.”

Lave said she understands concerns about the fact that the bill requires people to purchase health insurance, but finds the provision necessary. “I don’t see how we can implement the kind of insurance reforms that we think are desirable without mandating coverage,” she said. For instance, forbidding insurers to exclude people who have pre-existing conditions without requiring people to buy coverage, she said, could result in individuals deciding not to buy coverage until they get sick and need care.

“What is going to be very interesting is to figure out what it was about this bill that had everybody so totally infuriated about it,” Lave said, adding she doesn’t understand what in the bill’s language had opponents in such a tizzy.

“It’s not clear the bill warrants it.”

—Kimberly K. Barlow