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Will the new health-care law lead to a healthier Missouri?

This article first appeared in the St. Louis Beacon, April 29, 2010 - The federal health-insurance law could transform care in Missouri in the long run, a public-health expert in Missouri said Wednesday. But Edward E. Lawlor, head of the Institute for Public Health at Washington University and dean of the Brown School of Social Work, cautioned that the outlook for health care in the state looks cloudy in the short term.

Lawlor cited reduced state spending on health programs between now and 2014, the year most provisions of the new federal law take effect. 

The federal legislation offers a "tremendous level of regional and state opportunities to improve health care," Lawlor said. But he added that Missouri's short-term challenge is to make sure its public-health centers and other health-related safety net programs "have the resources to continue to covered uninsured people during this period. We have to keep our eye on that prize" until most changes in the law take effect in about three years.

A drop in state revenue has prompted state lawmakers and agencies to propose cuts in social services, ranging from programs that serve children to those that assist the mentally ill.

Concerns about the state's health funding picture was part of Lawlor's discussion of the federal health law Wednesday night at a forum held at Washington University. Joining him were Susan Levy of Ascension Health System; Dr. William Peck, head of the university's Center for Health Policy; and Timothy McBride, the university's associate dean for public health.

McBride, the session's moderator, says some might liken the new health law to a starter home with "foundation and walls." He says the public shouldn't lose sight of the way the law holds insurance companies accountable and puts health insurance within reach of most Missourians.

Levy, the Ascension executive, added that the public shouldn't "expect one piece of legislation to fix everything." She pointed to many benefits in the law, including insurance reforms.

"The idea is that you won't be afraid of the fine print anymore," she says. "There are some guardrails that make insurance (benefits) a lot more transparent."

Peck expressed reservations about portions of the law, including its emphasis on evidence-based medicine. He isn't sure it will be easy to reach consensus on what constitutes evidence. As an example, he says, one pill might be 70 percent effective in addressing an illness, but if it has troubling side effects, a pill that is only 45 percent effective may be better medicine. Still, Peck says the public should applaud the legislation for its potential to address medical needs, particularly those in underserved rural communities.

The session marked the second time in weeks that an area university has held a forum to sort out the complexities of the new health law. Last month, Sidney Watson, a St. Louis University law professor, moderated a similar session at Saint Louis University. Participants included Dr. James R. Kimmey, CEO of the Missouri Foundation for Health, and Dr. Johnetta M. Craig, chief medical officer of Family Care Health Centers.

Craig praised the law for giving medical students more financial incentives to pursue careers as primary-care physicians. The extra money, she says, will prevent students from "being forced into some specialties simply because the pay rates are better" and will make it easier for them to pay off students loans.

In addition, Craig says the legislation might help to boost the number of primary-care providers by allowing health centers to partner with a university to train them. The program will give medical students "hands on experience with underserved populations. This will encourage people to go into a primary care specialty."

One of the biggest question marks about the new health law involves $11 billion earmarked for public health. Part of the money will be set aside to expand the reach of community health centers, says Joe Pierle, head of the Missouri Primary Care Association. Beginning with the next federal fiscal year in October, Pierle says $1 billion in new funding will be available.

Over the next five years, he says about $3.6 billion will be available for expanding or opening new health center sites. In addition to allowing centers to open satellite offices or develop new health centers, the funds will be used to allow centers to add services, such as dental health and pharmacies; or to expand their medical capacity, such as adding more doctors or nurse practitioners.

"I think you will see a significant expansion of the number of health centers" under the federal law, he says. But he says that isn't necessarily good news for Missouri.

"There is no guarantee that a dime of it will come to Missouri," he says. "I say that because of the last round of funding of $500 million, when 13 of our 21 health centers submitted applications, and Missouri got nothing. I don't think the money was fairly distributed. Most of it went to Massachusetts and California."

Martin Kramer, a spokesperson for the Health Resources and Services Administration, says his agency "is still exploring how these grants will be awarded."

While community health centers in Missouri may not have received funding from the latest distribution of public health grant monies, Kramer noted that they did receive $26.6 million in federal stimulus money. The amounts included $2.3 million for Grace Hill Neighborhood Health Centers; $2.2 million for People's Community Health Center; $1.9 million for the Myrtle Davis Comprehensive Health Center; and $1.2 million for Family Care Health Centers.

Kramer also says the stimulus grants helped Missouri create or retain 111 health-center jobs, and serve 47,000 new patients, including about 25,000 who lacked health insurance.

Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.