Monday's Town Hall session on health system reform drew a crowd of NMA members.

Writer shares story of reforming the system

Amy Goldstein wrote the book on health care reform. Actually, she and other staff reporters from The Washington Post co-wrote Landmark: The Inside Story of America's New Health Care Law and What It Means for All of Us.

She shared her story of piecing together the thorough narrative, which she said was written and edited in just three weeks, during Monday's Town Hall.

The Post notes that the book "pierces through the confusion, examining the new law's likely impact" and "reveals just how close the law came to defeat, as well as the compromises and deals that President Obama and his Democratic majority in Congress made in achieving what has eluded their predecessors for the past 75 years: A legislative package that expands and transforms American health care coverage."

Goldstein, who joined The Post in 1987, said her reporting career has afforded her the opportunity to "listen to a lot of people," whom she called upon to help her understand the bill.

Even legislators in the thick of the bill's writing were unsure of some of its ramifications. She shared a story of her attempt to understand one section on Medicaid mental health benefits. Not one to name names, Goldstein said even those who had been heavily involved in the law's writing had different interpretations of its meaning.

"The law does not blow up the insurance industry, and it does not aspire to be the Holy Grail of universal coverage," she said. "If it works, about 32 million more people, according to the Congressional Budget Office, will get coverage."

In particular, she said, the law provides for those living below the poverty level. Single people making less than $14,000 a year and families of four with a yearly income of less $30,000 will be eligible for Medicaid no matter where they live, she said.

In addition, a much broader set of health benefits will be included under Medicaid, Goldstein added.

Those who don't qualify for Medicaid can purchase insurance coverage by taking advantage of state-run "health exchanges." These new marketplaces are aimed at people who do not have access to insurance through their employers. For example, small businesses often see offering insurance coverage as cost-prohibitive.

It's estimated that 24 million people will buy their insurance through these exchanges, Goldstein said. "In addition, the federal government will do something else big and important. For the first time, it will subsidize private insurance in a big way. The predictions are that 19 million of the 24 million people will get the federal subsidy," said Goldstein.

For the first time, the law requires that every American purchase insurance, and monetary penalties for noncompliance will begin in 2014.

The law attempts to curtail the possible shortage of family physicians. It's estimated that the number will reduce by between 30,000 to 40,000 physicians within the next 15 years. According to Goldstein, the law will provide for higher reimbursements and additional training programs for primary care over the next decade.

The law also seeks to expand access to health care for people who live in areas with less access — those living in urban and rural communities. Over five years, $11 billion will make its way to community health centers, and the National Health Service Corps will get more money, Goldstein noted.

Beginning in 2011, primary care physicians who work in underserved rural or urban areas will be eligible for bonuses as well, she added.

Noting that her talk was not the "half of it," Goldstein said one known remains.

"Will it work? No one knows," she said. "How things turn out depends on an awful lot of variables. There's no way to predict [if it will work], but time will tell."