With a host of federal health programs on the line with the incoming Trump administration, some public health experts in the Baltimore region are both bracing for big changes and offering their take on how to better spend taxpayer funds to improve outcomes for millions of Americans.
It's not yet clear what will happen to Medicare, Medicaid, the Affordable Care Act and other programs, but the experts said the appointment of Georgia Republican Rep. Tom Price at secretary of the Department of Health and Human Services offers a clue. The physician-turned-lawmaker has long advocated for the repeal of the federal health law known as Obamacare.
A panel of policy experts largely supportive of the health programs gathered this week at the Johns Hopkins Bloomberg School of Public Health and said large groups of people could be affected in the new year as GOP lawmakers in charge of the Congress and the White House make use a budgetary process to alter programs.
Henry Waxman, who worked on healthcare issues during his 40 years as a Democratic congressman from California, told students, faculty and visitors at Hopkins that fixing problems, such as the increasing cost of premiums on the health exchanges, would be a far better course than reducing health insurance.
He said rhetoric has gotten more attention than facts this campaign season, but supporters of federal health programs would have opportunities to present evidence of the program's positive effects during hearings because there is not complete agreement, even among Republicans, on sweeping changes. They include moving Medicare to a voucher system where seniors buy private insurance, turning Medicaid to a block grant system for states and fully repealing Obamacare without a well-thought-out replacement.
He said there is also a case for lesser known programs, including one that supports innovation in health care delivery that has become integral in Maryland.
The federal innovation office, housed in the U.S. Centers for Medicare and Medicaid Services, oversees a unique experiment in Maryland aimed at cutting overall health care spending while improving care. It shifts the emphasis away from the traditional fee-for-service model in all of the state's hospitals to one that emphasizes health outcomes. The state is now working on a way to incorporate doctors into the plan.
"Republicans want to look at systems that are spending less money because they want to give out less money," said Waxman, a visiting lecturer at Hopkins.
There are signs the state effort is working as intended, but the system relies on extra funding from higher Medicare reimbursements, which Republicans might not want to spend, he said. It also is dependent on an expansion of Medicaid in Maryland, which means more patients pay their bills and the hospitals have less bad debt. The federal government also pays most of the bill for the extra Medicaid consumers.
There are other pilot programs supported by the innovation office, said Bill Corr, who served as deputy secretary of the U.S. Department of Health and Human Services until last year and helped implement the Affordable Care Act.
He said there is broad agreement that the United States should not be spending so much on health care only to have other countries report better outcomes.
"How do we get better outcomes without spending more money?" he said. "Innovation."
Separately others in public health, including Dr. Leana Wen, Baltimore City Health Commissioner, signed a letter along with 10 other public health officials to Vice President-elect Mike Pence and members of the presidential transition team urging investment in public health.
They argued that increased attention on the root causes of addiction, violence, mental health, infant mortality and public health emergencies would greatly reduce expenditures in the future.
The problem with the U.S. healthcare system, they wrote, "does not lie with the quality of this care; it is some of the world's best. It lies, instead, with the inadequacy of our commitment to public health – with our failure to pay for the early interventions that would reduce the need for direct care down the line."
The letter noted the long-running public discourse about controlling health costs. "This is the only way: with work that prevents health problems from arising in the first place," it states.. "A commitment to fiscal responsibility is a commitment to public health."