Congress has returned from its August recess with a full plate of must-pass legislation – hurricane disaster relief, the debt ceiling, annual appropriations to keep the government running. In the midst of these pressing issues, the reauthorization of the Children's Health Insurance Program may seem like an afterthought. Indeed, after the highly contentious debate this summer over whether to repeal and replace the Affordable Care Act, there may be a considerable amount of "healthcare fatigue" on Capitol Hill. Both sides made their arguments, fought for their positions, and then retired to their corners awaiting the next round.
However, before we return to the debate over healthcare, we should determine whether we are ready to elevate the discussion from name-calling to facts. I would argue it is a debate we're not yet ready to have. It's not for a lack of emotional maturity; it's because we don't yet have the facts.
As the CEO of the Association for Community Affiliated Plans, I spend my time advocating for 60 "safety net health plans" that deliver Medicaid managed care, CHIP, Medicare Advantage, and Marketplaces to more than 20 million Americans. I believe that the Right is truly concerned with patient outcomes. And there is work we can do, together, that falls outside of ideological lines.
Currently, there is no standard way to measure and report quality for Medicaid and CHIP. States and territories partner with the federal government to deliver healthcare through Medicaid and CHIP to more than 74 million Americans, but there is no comprehensive way to assess the quality of care in Medicaid and CHIP across all healthcare delivery systems. While most managed care plans routinely collect and report quality data, there is little such reporting in ‘fee-for-service' Medicaid.
This means that policymakers in Congress and the Administration have an incomplete picture of the quality of Medicaid and CHIP — and thus how effectively taxpayers' money is spent. That is why we need a standardized measure of healthcare data, so we can come up with an "apples to apples" comparison of healthcare outcomes across all of the U.S.
Congress has the ability to enact such a system by passing the Medicaid and CHIP Quality Improvement Act.
When it comes to policy making, Republicans have bolstered their ideas on federalism from an opinion of Justice Brandeis, " … a state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country." While Justice Brandeis was not an ideological conservative, the notion that states should be the home of policy innovation is central to modern Conservatism.
For Republicans who support federalism and believe states are the "laboratories of democracy" – we need consistent data with which to measure the success of their initiatives. How can lawmakers manage policy experiments without having standardized data? For Democrats who wish to improve the safety net, we need verifiable data to assure that Medicaid delivers the quality care that patients expect and deserve.
During the "Repeal and Replace" debate, Seema Verma, now Administrator of the Centers for Medicare and Medicaid Services, wrote in a Washington Post op-ed that there was an opportunity to "fundamentally transform Medicaid measurable improve lives for decades to come," but "[it] can only be achieved by tapping into the program's great potential and state-level innovation." As the intellectual progenitor of several Medicaid waivers through the Affordable Care Act, she is intimately acquainted with creating state-led innovation in Medicaid, but she also acknowledges the challenges.
In the same op-ed, she argued "Medicaid outcomes can be better for Medicaid recipients, and progress depends on having a much richer understanding of what's working and what isn't. Medicaid's current capacity for data collection and evaluation is weak, especially for a program of its size and importance." If the states are to be test labs, then we need to approach it methodically – collecting data, reporting that data, and using it to make evidence-based decisions on policy.
As I wrote earlier, we aren't ready to have a debate on the future of the safety net because we still lack a fundamental understanding of what works best for patients. If the goal for the Left and the Right is to strengthen the safety net while improving healthcare outcomes, then we should be able to compare Texas and New York, Arkansas and Kentucky.
This underscores the need for Congress to act on the Medicaid and CHIP Quality Improvement Act, so that our public debate is not about competing arguments, but comparing data. Let's compare apples to apples — and put patients first.
Meg Murray is CEO of the Association for Community Affiliated Plans.
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