President Shalala’s Grand Rounds Dissects Health Care Reform
In the months before President Barack Obama signed the historic health care bill that is expected to bring insurance coverage to 32 million more Americans, UM President Donna E. Shalala had been telling audiences she was “pretty certain” some manner of reform legislation would pass.
Shalala, who after two terms in the Clinton Cabinet is the nation’s longest-serving Secretary of Health and Human Services, gave an insider’s view of that legislation on Wednesday as she presented her much-anticipated Grand Rounds: “The Challenges of Health Care Reform for Public Health” for the Department of Epidemiology and Public Health.
The Patient Protection and Affordable Care Act will, she said, bring many people face-to-face with doctors for the first time in non-emergency situations, as well as improve gaps in Medicare, cover children on their guardian’s insurance policies through age 26 and provide coverage options for people who have pre-existing conditions. Importantly, she added, it will bolster prevention efforts and set the stage for adequately managing the chronic diseases that plague the nation’s health.
“We are going to see some patients who have pre-existing conditions who are going to be able to get health insurance for the first time … and there are some elements that are going to bring major help on the prevention side, something very important to all of us,” Shalala told the students, faculty, staff and others who packed the Lois Pope LIFE Center auditorium or watched on closed-circuit TVs set up for the overflow crowd. Miami-Dade County Commissioner Katy Sorenson and Health Department Administrator Lillian Rivera and State Senator Durrell Peaden, J.D., M.D. also attended.
José Szapocznik, Ph.D., professor and chair of the department and associate dean for community development, introduced Shalala, who answered a series of questions at the conclusion of her lively presentation.
The former Secretary, who interjected her talk with reflections on her time in Washington, noted how difficult it is, even with good friends on politically opposing side, to get bipartisan buy-in and pass a bill with such far-reaching effects. Now, she said, it is important to have, as she did, a diverse staff who understands the cultural and social dynamics that dictate how different communities across America live, earn and spend.
“One of the things I worry about at these exchanges we’re about to go out to, is that they won’t understand the population we’re trying to cover,” Shalala said. “The Obama health care coverage is all about working-class Americans. They don’t have health insurance, or they have lousy insurance that they don’t pay very much for.”
The people devising the plans, she urged, “must understand that out-of-pocket costs are very important if you’re only making $30,000 a year. I don’t care how many subsidies you put in.”
At the same time, Shalala said, the reform will bring some challenges for physicians, especially with the dearth of primary care doctors, and for hospitals that will now have to compete for the newly insured patients. There is opportunity, too, she remarked, in that teaching hospitals can attract more residents into primary care and health systems can make plans to absorb millions of the newly insured.
“The world is going to change under our feet and we have three years to get ready,” she said. “Suddenly, we’ll have to compete for patients [but] we can compete because we have world-class physicians at University of Miami Hospital
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