Government programs have laudable goals, adverse impacts
Affordable health care for all Americans. A free and appropriate education for American children. Both are laudable goals. But what do these initiatives imply and how do they impact northern Nevada businesses and residents?
The Affordable Care Act was designed to require that each American is covered by health insurance. With this legislation, individuals are required to obtain coverage or pay a penalty, and large employers are required to offer affordable health plans that offer certain minimal coverage or face penalties. Further, insurance companies are required to provide coverage regardless of preexisting conditions, and parents are allowed to insure their children as dependents to age 26.
Some have said the employer mandate has caused some employers to rely more heavily on part-time employees, for whom insurance coverage is not required, and others claim the insurance mandate has resulted in higher premiums. To my knowledge, no one has said the goal of trying to provide affordable care for more Americans is not a worthwhile goal. Rather, the challenge is in the approach.
The Affordable Care Act has resulted in new and greater impacts on hospitals and health care providers. Reimbursements are being reduced, and expectations are growing. Expectations of both consumers and payers, including the federal government are taking the form of payment and withholding of payment. At the same time that providers are facing growing volumes due to the growing number of insured parties, their reimbursements are being reduced, and they are being required to assume greater risk. For example, hospital reimbursements are reduced for readmissions, and they are being asked to accept a single payment for an “episode of care” that will include a single payment to be shared with physicians, therapists, and others for care provided over an extended period of time.
In addition, the law offers rewards and penalties for patient satisfaction. Thus, in a world of transparency, “hospital compare” and “health grades” websites are the Yelp for doctors and hospitals. Is this good? Is this right? Time will tell.
Compare this with what is happening in education. The Every Student Succeeds Act has replaced No Child Left Behind. The goal is to prepare all students for college and careers through a program of grants and supports. The law provides for more assessment (testing), seeks to hold educators (teachers) accountable, and includes support for pre-kindergarten education.
However, most public schools rely on state and local support, so the federal law is in addition to the requirements of state law. In Nevada, this means that educators will be facing evaluations that include a component based upon the “success” of their students. The Nevada State Department of Education and local school districts have been wrestling with the components of what those measurements will include for months. Not all students and classrooms are equal in terms of ability and skills, and how that fact will relate to educator evaluations, and how those evaluations will relate to the educators’ success or failure has yet to unfold. Likely, however, is that those results will be available to the public, and may form the basis for choices.
Nevadans have seen the next generation of change in education with the educational savings accounts approved by the last session of the Nevada legislature. Their future currently is in the hands of the Nevada Supreme Court, which heard arguments on the constitutionality of the law last week.
What do these two Acts have in common? Both have laudable goals: the availability of affordable care for all Americans, and the availability of a public education which prepares every child for the world of work and/or college education. Both seek to do so through federal government incentives and penalties designed to influence behavior. Both have significant economic impacts upon the public. Both have major impacts upon the institutions and the people who provide the service of healthcare or education.
The ultimate benefit of these programs is yet to be seen.
However, from what we see in northern Nevada, our institutions and those involved with them, continuously strive to provide exceptional health care to area residents. Our local hospitals, with the various affiliated and non-affiliated providers, make available to us the best quality of healthcare through providers and modalities ranging from dermatology, to cancer care, to open heart surgery. Regional care centers have been recognized for their exceptional quality heart care by the American Heart Association, and Carson Tahoe just announced its grand opening for the new Breast Exam Center.
Governor Sandoval has made education a top priority for the Silver State. The University of Nevada, Reno is responding to this call and is currently in the process of creating a new Master of Physician Assistant Program to aid not only the education and work force development but also to assist in the ever increasing demand for medical care providers. Additionally, new emphasis in STEM (Science, Technology, Engineering, and Math Education) has been placed in area school districts such as the STEM Academy at Galena High School, and Carson High School’s Career and Technical Education center is expanding to include curriculum in manufacturing. These efforts are a testament to our local institutions and will continue to aid job force development, graduation rates and education levels of Nevadans.
Northern Nevada’s dedication to both affordable quality healthcare and education and work force development shows that despite the pressures of increased governmental regulation, our institutions are thriving. Further, with this continued commitment and enthusiasm, more people are relocating to the area and our economy will continue on its road to recovery.
Mike Pavlakis is a shareholder in Allison MacKenzie Law Firm with primary practice in Business, Healthcare, and Education Law. He can be reached at 775-687-0202 or mpavlakis@AllisonMacKenzie.com.
Reno-based design firm MBA Architecture and Design is assisting on the $47 million Caesars Entertainment project in downtown Reno.