“I think of it as a critical first step in making a healthcare system that works for all Americans. It’s not the only thing. We’re still going to have adjustments made to further reduce costs…”

— President Barack Obama, in a televised interview with NBC’s Matt Lauer

Signing the healthcare bill (including the so-called fixes) into law only starts the process of making needed changes in the American health system. While I agree with the President that it’s a much-needed first step, that “we’re still going to have adjustments made to further reduce costs,” is an epic understatement.

The new law’s impact on health insurance reform should expand access and secure coverage for high-risk populations, but it does little to reduce the cost of healthcare. Long-term cost control is a must-have for this reform effort to be considered a success. The heavy lifting to achieve that objective really hasn’t begun yet. Congress and Obama’s first step does force everyone on both sides of the aisle into the game. Republicans need to avoid being seen as obstructionists and begin participating and influencing the change. There’s still a big split over how to reform healthcare, but the President’s approval rating jumped five percentage points since the bill was passed. Now that the law is on the books, Republicans run the risk of it being successful and the GOP being seen as watching history from the sidelines. Democrats need to make reform workable and affordable or risk being swept out of office. Both jobs seem sizable.

On a more practical level, the regulations that will implement the new law are already beginning to be developed. Secretary of Health and Human Services Kathleen Sebelius announced this week that the law’s regulations affecting insurance companies would be released “shortly.”

Anyone who pays attention to healthcare politics realizes that the rulemaking process defines how laws will be implemented. The American College of Radiology (ACR) is working to influence areas that affect the imaging community. The ACR Web site lists the following as key areas where healthcare reform affects medical imaging:

• Increase in the Medicare utilization assumption rate

• Increase in Contiguous Body Part Discount Rate

• Self-Referral Disclosure

• Appropriateness Criteria Study

• Exclusion of USPSTF Mammography Screening Guidelines as Basis for Coverage Decisions

• DXA Reimbursement Adjustment

• Sustainable Growth Rate Fix

Details on ACR’s lobbying efforts in these areas are available on the college’s Web site.

Thomas Scully, a former White House healthcare advisor to the first President Bush, told attendees at the Society of Interventional Radiology meeting in Tampa yesterday, that he expects the House of Representatives to pass the Senate version of healthcare reform, possibly by this coming Saturday.

Scully was part of the panel in the session, “The Evolution of the Economics of Modern Medicine—IRs Revolutionizing the Practice of Medicine,” He told the audience that he believes President Obama and Speaker of the House Nancy Pelosi will muster enough support to pass the bill by a very narrow margin. Scully said the Obama administration has so much invested in healthcare reform that it will get the Senate version passed by the House and signed into law.

Scully, who said he is an advocate for universal coverage, said the Senate’s reform bill is more moderate than the House version and the country and healthcare system will be marginally better off for it. His view is that there are both good and bad aspects of the Senate bill. Scully, who called himself a moderate republican, said the country probably would be better off if it had passed a bill similar to the Clinton administration healthcare plan in the 1990s. He noted that the actual core of the Clinton plan was similar to the changes to the insurance system included in the senate plan.

He said he would not be surprised if the House passes the Senate version but does not pursue with further changes using the controversial budget reconciliation process. Scully noted that the passing the bill could possibly cost Democrats control of the House of Representatives in the November elections, and will likely cut into its majority in the Senate. He surmised that by passing the bill and moving on to other initiatives, Congressional Democrats might think they can minimize voter anger at their inability to effect the promised change that swept them into power in November.