NEW YORK, November 14, 2011—Nearly nine of 10 leaders in health and health care policy recently surveyed (89%) said it is important for federal and state policymakers to continue to move forward in implementing the Affordable Care Act. The latest and final Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey asked experts in the field about health spending and implementation of the health reform law.
Health reform and health care spending remain critical topics for Congress, as it struggles to lower the federal budget deficit and improve the nation's return on its investment in health. According to published projections, between 2010 and 2020, national health spending per capita will increase 5.1 percent annually—from $8,327 per person in 2010 to $13,709 per person in 2020. At the same time, the gross domestic product per capita is projected to grow 3.9 percent annually. Survey respondents strongly support bringing annual increases in health care spending more in line with economic growth—a central goal of the Affordable Care Act and the President's recent deficit reduction framework. Nearly three-quarters of opinion leaders believe the growth in national health spending per capita can be lowered without harming access to or quality of care.
When asked about specific coverage provisions in the reform law, a large majority of leaders said it was important to move forward with major elements, including insurance market rules (86%), Medicaid expansion (79%), and premium tax credits (68%). The individual insurance mandate—while remaining a controversial component of the law and the basis for several legal challenges—also received strong support. Eighty-four percent of respondents believe the mandate is an important strategy for reducing the number of uninsured, making coverage more available and affordable, and improving the health of the country overall.
The Affordable Care Act also introduces new, state-based exchanges—or marketplaces—for individuals and small businesses to buy health insurance. As of November, 13 states had passed legislation to establish insurance exchanges, with several governors issuing executive orders to create one. More than two-thirds (68%) of leaders think it is important for states to develop and operate their own insurance exchanges.
"Despite continued debate over aspects of the law, health care leaders remain steadfast in their support of the Affordable Care Act," said Commonwealth Fund president Karen Davis. "Moving forward in implementing reform provisions such as the coverage expansion and the development of insurance exchanges will be critical in lowering health care spending and providing high-quality, accessible, and affordable care for all."
Other findings from the survey include:
- More than three of four respondents think strategies included in the Affordable Care Act are important for slowing the growth of health spending, including moving toward more efficient models of care delivery (95%), shifting from fee-for-service reimbursement to bundled forms of payment (84%), and improving health care quality and outcomes (79%).
- Leaders believe it is important to implement several payment and delivery system initiatives included in the Affordable Care Act, including the Center for Medicare and Medicaid Innovation (83%), Patient-Centered Outcomes Research Institute (64%), and Independent Payment Advisory Board (64%).
- Large majorities support key strategies in President Obama's recent deficit reduction framework, including reducing waste, fraud, and abuse in Medicare and Medicaid (90%); adjusting payments to encourage efficient post-acute care (87%); and aligning Medicaid and Medicaid drug payment policies (79%) to lower federal health spending.
Commentaries by Kathleen Sebelius, the Secretary of Health and Human Services, and John Colmers, the former secretary of the Maryland Department of Health and Mental Hygiene and a vice president for health care transformation and strategic planning at Johns Hopkins Medicine, appear in the November 14th issue of Modern Healthcare. The commentaries are also posted on The Commonwealth Fund's Web site, along with a Commission data brief discussing the survey findings.
The survey is the 27th and final installment in the Health Care Opinion Leaders series, which the Commonwealth Fund launched in 2005. As implementation of the Affordable Care Act gains momentum, the Fund's attention will shift toward reporting on important trends and milestones in the reform of the U.S. Health care system. "Modern Healthcare and Harris Interactive were the perfect partners for this project, which contributed critical information to the public debate leading up to, and subsequent to, passage of the reform law," said Barry Scholl, senior vice president for communications and publishing at the Commonwealth Fund. "We extend our sincere gratitude to both organizations, to the hundreds of health care leaders who participated in the surveys, and to those who contributed their insights to the accompanying commentaries."
Methodology: The Commonwealth Fund/Modern HealthCare Health Care Opinion Leaders Survey was conducted online within the United States by Harris Interactive on behalf of The Commonwealth Fund between September 28, 2011, and October 25, 2011, among 1,302 opinion leaders in health policy and innovators in health care delivery and finance. The final sample included 185 respondents from four sectors: academic/research institutions, health care delivery, business/insurance/other health care industry, and government/labor/consumer advocacy, for a response rate of 14.2 percent. The complete methodology is available on The Commonwealth Fund Web site.