Delivery System Day: Sara Rosenbaum
Sara Rosenbaum is chairman of the Department of Health Policy at George Washington University. She also led the team that drafted Bill Clinton's 1993 Health Security Act. And she brings up a piece of this that's not betting much attention, but should: community health centers.
Both the House Tri-Committee bill and the Senate Finance Committee proposal assume modest efficiency reforms. The House bill also assumes an investment in community health centers, which furnish comprehensive primary health care access to millions of residents of medically underserved communities. This investment turns out to have an important impact on costs, even as it expands access. A recently completed GW study that considered the economic effects of this investment found that the $38.8 billion expenditure assumed in the House bill would result in overall health care savings of $212 billion over the 2010 to 2019 time period, including federal Medicaid savings of $59 billion.
The dollar value of these expected savings would significantly exceed the cost of the investment. Savings are the result of the highly efficient way in which health centers operate, as well as their documented impact on reducing avoidable hospital and emergency department use. Were the reach of health centers to be further extended by assuring that exchange health plans pay health centers at the special Medicaid rate, Medicaid savings would climb to $70 billion as health centers' reach grows. This is a case in which doing good for medically underserved communities also turns out to be the smart investment.
You can download the full report here. (pdf)
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