MBA-E Students Get an Insider's Take on Healthcare Reform

Elizabeth Fowler has a unique perspective on the healthcare reform legislation that was signed by President Obama in 2010. She helped to write the bill as chief health counsel for the Senate Finance Committee; since 2010, she has worked for the Obama administration helping to implement it. She is currently the special assistant to the president for healthcare and economic policy.

Fowler spoke to students in the MBA for Executives: Leadership in Healthcare program on February 17, as part of the program's Visiting Scholars series. The series gives the healthcare professionals in the program the chance to engage directly with leaders from throughout the industry. Other speakers in 2011-2012 include Sam Nussbaum, chief medical officer of Wellpoint; Martin B. Silverstein, global leader of the healthcare practice at Boston Consulting Group; Michael Apkon '02, chief medical officer at Children's Hospital of Philadelphia; and Ian Smith, executive vice president and CFO of Vertex Pharmaceuticals.

In shaping healthcare reform, Fowler said, she and her colleagues tried to find a "middle course," building on the current employer-based system while "expanding good ideas across the healthcare system."

Fowler described the progress that has been made thus far in implementing reform, laid out the timeline for remaining measures, and answered questions from the audience of physicians and healthcare administrators, some of whom were already seeing effects of healthcare reform.

One system that is already in place is the Pre-Existing Condition Insurance Program (PCIP), which will provide insurance for those with pre-existing conditions until the law makes it illegal to discriminate again such people in 2014. "What we're finding is that the people enrolled in PCIP are really sick," Fowler said. "We're getting people who put off care for a long time" because they couldn't get insurance.

Other measures already in effect include the Early Retiree Reinsurance Program and new rules for insurance companies, including bans on lifetime benefit limits, restrictions on annual limits, and coverage for children under 26.

The insurance exchanges, one of the centerpieces of the reform, are scheduled to go into effect in 2014. They will allow individuals or small businesses to shop for a plan and get credits or subsidies for which they are eligible.

Other parts of the law that will take effect over the next several years will change the ways that doctors and hospitals are paid in order to help control costs and improve care. "This is the most exciting part of the law," Fowler said, "A lot of these measures are intended to start moving toward a system that rewards value and quality."

For example, if healthcare providers coordinate care through Accountable Care Organizations and lower costs, they keep some of the savings. "Providers are more excited about how to change the healthcare system than they have ever been," she said.