The Changing Healthcare Environment

Posted on April 19th, 2013 by Denise | No Comments

The Changing Healthcare Environment


Denise Koonce OTR

Diane Gibson RN, Sue Muenks MOT, OTR, and additional members of the TAHC&H team along with Rep. Borris Miles on Capital Day.


There is much uncertainty in the realm of healthcare today and into the near future.  The uncertainties exist across the healthcare spectrum from recipients to providers.  We as humans, on average, do not like uncertainties and often become anxious while waiting for clear delineations and a defined product.    With the passing of the Patient Protection and Affordable Care Act (PPACA or ACA) we, as a nation, have this situation.  The PPACA was enacted by the 111th US Congress on March 23, 2010.  The act is a set of guidelines or an outline of what the end product needs to be but it does not provide all the details of how the end product will be achieved.  This is not uncommon when Federal Acts are created to provide sweeping changes in our Nation.  I remember when the Americans with Disabilities Act was passed and with it initially came the same uncertainties.  However, it has positively changed the lives of millions within the US because of its sweeping changes.  Not unlike the ADA, the PPACA was enacted to do the same but within healthcare.  The Patient Protection and Affordable Care Act’s outline is meant to reform aspects of the private and public health insurance industry by increasing insurance coverage to those with pre-existing conditions and expand the opportunity to access health insurance to over 30 million Americans.  The PPACA’s guidelines will provide this by short term subsidies from the federal government and overtime by the increased enrollment in federal health care programs.  The guidelines also require additional changes in the delivery of healthcare to decrease the overall long-term cost.     

As a part of the implementation of such a large federal Act it will also affect and require individual states to pass legislation in order to fulfill the purpose of the federal act.  Therefore, both our state and federal governments are writing, discussing, and voting on how to implement the details of the PPACA and simultaneous changes will occur both at a national and state level.  It is also important to remember that the implementation of the act, within both the federal government and the state government, has to be budgeted.    

In addition to the PPACA, the US Congress allowed a sequestration to occur starting on April 1, 2013 instead of passing a federally balanced budget.  This further complicates the understanding of and implementation of the PPACA.  Due to the lack of a balance budget, the sequestration now has required an additional, off the top cut, in our federal programs providing healthcare, such as Medicare and Medicaid in the amount of 2%.   

At our state level the Texas Legislature is in its 83rd Legislative Session and actively trying to work on how to implement the purpose of the PPACA and the announced budget cuts from the federal sequestration requirements.  The 83rd Legislative session began in January of 2013 and has already dealt with numerous bills in and out of committee addressing healthcare.  Some of the proposed bills would reduce all of the Medicaid rates for services down to Medicare service rates, all Medicaid children services would be provided by Managed Care Organizations and dissolve the Texas Medicaid and Healthcare Partnership (TMHP), and lastly a new program would be created to serve the pediatric population with disabilities.   

In order to try and stay informed and be an active participate in the changing healthcare process, Reach Healthcare Services, Inc., has employee volunteers serving on committees for the Texas Association for Home Care and Hospice (TAHC&H).  As a part of the TAHC&H Advocacy and Political Strategy, Diane Gibson RN and Sue Muenks MOT, OTR, traveled to Austin on Lobby Day and met with leaders in the capital on January 23, 2013.  Their role was to represent the client population we serve and how their services and needs would be affected by proposed changes.  Their goal was to inform and educate the congress members on how the proposed changes would impact the services they receive and therefore how these changes would ultimately affect their lives.  Fortunately, due to the concerted efforts of the Texas Association for Home Care and Hospice (TAHC&H), the Texas Occupational Therapy Association (TOTA), the Texas Physical Therapy Association (TPTA) along with their lobbyist, and numerous individual efforts some of the more adverse proposals were not passed in their initial phases.    

Speaking as a therapist, we are very fortunate to have such involved state supporting agencies such as TAHC&H, TOTA, and TPTA to present and voice concerns not only for us as professionals and companies but also for the individuals we serve.  With the changing healthcare environment it is even more important that you support your state professional organizations as they are fighting for the populations we serve, for you and the future of your profession in this political arena.  So I encourage you again to think about supporting your professional organization through membership as their role is vital.  If you are a member of a professional committee working towards the same goals listed here, please share any insight you may have regarding the current healthcare changes. 


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