This article first appeared in the St. Louis Beacon, Nov. 11, 2011 - Judy Baker, the regional director of the federal Department of Health and Human Services, spends part of her time visiting communities in Iowa, Kansas, Missouri and Nebraska to promote the Affordable Care Act. During a stop in St. Louis on Thursday, she recalled telling an audience elsewhere about the law's benefits and then having a man ask after her speech, "What will happen to all of those (benefits) when Obama's health-care law comes around?"
That was not the kind of comment Baker heard during what was billed as a listening session, hosted by the Missouri Foundation for Health and the St. Louis Regional Health Commission, at the Forest Park Visitors' Center. The audience, mainly informed health-care providers, spoke to Baker and other officials about the promise and challenges of health reform.
The issues they raised included medical homes for patients, mental health and women's health benefits, insurance exchanges to help make insurance more accessible and affordable, electronic health records to track patient conditions and needs, and a provider shortage.
That last issue was a recurring theme. The concern was that even if the law survives court challenges and takes effect in 2014, health-care needs won't necessarily be met because there probably won't be enough providers to care of these newly empowered patients.
"The short answer is we do not have enough health professionals -- doctors, nurses and nurse practitioners -- actually to serve the communities that are in the most need," said Thomas McAuliffe, policy analyst at the Missouri Foundation for Health. "It's a health disparities question. If you are elderly or low income, you are going to have a harder time accessing the health-care system. The (health-care law) doesn't do anything to address that."
McAuliffe was part of a panel offering a regional perspective on health issues. He echoed some audience comments about Missouri's restrictive policies governing nurse practitioners. The restrictions included requiring them to be within a 50 miles of a doctor and to consult with a physician every two weeks. Some say the policies, more restrictive than in some other states, need to be loosened to make it easier to use nurse practitioners to provide care in areas with a shortage of doctors.
Baker and another HHS official, Assistant Secretary E.J. Holland Jr., acknowledged the challenges. Still, Baker said the health-care law would do a lot of good in building a patient-centered system to reduce cost and provide effective care. Raising the safety net ceiling to reach people with incomes as high as 133 percent of the poverty rate will make a big difference, she says. She added that efforts were being made to iron out issues like those raised by the audience. She noted, for example, that the federal government had relaxed some rules to make it easier for hospitals to use nurse practitioners.
Holland stressed that a safety net would be needed with or without the new law. While the law would cover most people, insurance coverage still would be outside the reach of 27 million people.
"Way too many in my view," he says, adding that health providers would have to care for the uninsured or under-insured millions.
Another panelist offering a regional perspective was Dr. Dolores Gunn, director of the St. Louis County Department of Health. She suggested that the United States was known for extending its expertise in health to improve conditions in poor nations. She added that perhaps the United States could learn a few things from those nations. She noted that some impoverished countries have learned to use indigenous people with little technical training to deliver some health services and to reduce morbidity among women in particular. She suggested that some of those ideas might be put to work in medically underserved communities in the United States.
"Why can't we do it here?" she asks, then added that an American medical profession "so bent on regulation" would never allow it to happen.
At least one doctor in the audience suggested, however, that expanding the nation's nurse-practitioner system would address some of Gunn's concerns.
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.
