Health care is likely to top the agenda of state and federal lawmakers in the coming weeks, as New York's new governor aims to reform the Medicaid system and Congress considers a measure to repeal last year's health care reform legislation.
In New York, Governor Andrew Cuomo has pledged to reduce the costs of the state's Medicaid program while increasing quality and efficiency.
Meanwhile, in Washington, the new Republican majority in the U.S. House of Representatives has already taken steps to repeal President Barack Obama's massive health care reform bill.
Here in Saranac Lake, the head of one of the region's largest hospitals says taxpayers and politicians need to take a measured approach to reforming health care on both the state and federal levels.
Chandler Ralph is president and CEO of the Adirondack Medical Center. She says hospital officials are encouraged by the new administration in Albany.
Last week, Cuomo called for government consolidation during his State of the State address. He said bloated state agencies are responsible in part for a budget deficit nearing $11 billion. The state Department of Health, for example, consists of 46 councils, six committees, 17 boards, six institutes, two task forces, and five facilities. That's a lot of red tape for New York hospitals, Ralph says.
"Cuomo really wants to streamline and consolidate government around efficiencies," she said. "We're 100 percent in favor of that - we deal with many of those groups."
Cuomo also wants lawmakers to tackle Medicaid reform. Earlier this week, he used an executive order to establish the Medicaid Redesign Team, tasked with making the state's Medicaid program cheaper, better, and more efficient.
The state currently spends more than $53 billion a year on its Medicaid program, which provides health care to approximately 4.7 million New Yorkers.
The program is funded by the state, as well as through county and federal taxes. It's also one of the largest strains on the state's budget year-in and year-out. A majority of county governments statewide spend at least half of the tax levy on Medicaid.
Ralph says the system needs to be fundamentally reengineered.
"Not just continuing to take monies away from providers who service the Medicaid population," she said. "We really applaud this task force going forward and it looks like we could have some movement going forward."
Ralph is also applauding Cuomo's efforts to give the North Country a louder voice in Albany. The governor recently appointed a trio of North Country officials to high-level posts in his administration - Dede Scozzafava, Joe Martens, and Darrell Aubertine.
But Ralph adds she's still not certain that Cuomo grasps the importance of hospitals to the North Country's overall economic health. Last year, the Healthcare Association of New York State released a report showing that hospitals are often the largest employers in their communities.
That point needs to be driven home with Cuomo, Ralph says.
"I think if he has people close to him that understand those issues, that's helpful," she said. "And of course we have our three elected representatives who have his ear - particularly state Senator Betty Little. She will be very powerful in getting our message across."
On the federal front, Ralph says she doesn't want to see lawmakers overturn last year's health care reform bill.
North Country Congressman Bill Owens said recently that he had spoken with hospital CEOs from across the 23rd district - including Ralph - and he learned that repeal was not a preference.
Ralph agrees, noting that having 32 million Americans uninsured is - quote - "unconscionable." But she adds that the bill isn't perfect.
"I think there are some things in it that are very bad and some things that are very good," Ralph said. "It'd be really nice - and maybe this is wishful thinking - if both sides could get together and say this is a very good piece, or this will be very difficult, or this has unintended consequences."
Specifically, Ralph says the health care bill is right to push for more evidence-based medicine. She also says measures to increase the practice of bundling are a good thing - in other words, encouraging all-inclusive hospital trips where, for example, a patient gets a hip replacement and remains there for inpatient rehabilitation.
And while Congressman Owens is calling for outcome-based reimbursement, Ralph says that aspect of the health care bill is onerous for hospitals.
"One of the tough parts of the bill is the readmission penalties," she said. "If people are readmitted to the hospital, regardless if it had anything to do with their original visit, they're not going to pay you. So if you come in for a hip replacement and then go out and get hit by a car and you have to come back to the hospital - we don't get paid for that."
If someone is readmitted because of doctor error - Ralph says the hospital should take the hit financially. But she says hospitals shouldn't be penalized for readmission not related to the original admission.
Ralph says the intent behind the health care bill was good - but some of the regulations can't be put into practice without raising costs for providers.
In any event, Ralph doesn't see the legislation being repealed, as that would require support from the Senate and the president's signature - both of which are highly unlikely.
What Ralph does foresee is a serious discussion among state and federal officials about how to increase the quality of health care at a more economical cost.