I was in a meeting yesterday and overheard this statement regarding the need to plan for changes in the care delivery system. It got me to thinking about how much we don’t know about the implementation. It turns out the once a law is passed, the devil is in the details and the Patient Protection and Affordability Act is no different.

I figured a good place to look is a textbook entitled “Government in America” and what they say is that

Once Congress, the president, or the Supreme Court makes a policy decision, it is most likely that bureaucrats must step in to implement those decisions. Since bureaucrats are typically less visible and are not elected to their positions, their actions and power are often subjects of considerable debate.

They also point out that

Much depends on whether bureaucracies are effectively controlled by the policymakers that citizens do elect-the president and Congress.

So how does the president exert control?

  • Appointing the right people to head the agency.
  • Issuing executive orders.
  • Tinkering with an agency’s budget.
  • Reorganizing an agency.

In the case of health care reform, here is what those agency heads are saying:

Quote from Anthony Rodgers, M.S.P.H., deputy administrator for the Center for Strategic Planning and Initiatives at CMS:
“The basic medical home model offers better coordination of care and patient care management,” said Rodgers. “But we quickly have to move to more advanced medical homes that have the ability to manage acute and chronic care across the continuum of care.”
Quote from  Mary Wakefield, R.N., Ph.D., administrator of the Health Resources and Services Administration:
Access to health care “is very much about access to health insurance coverage,” said Wakefield. However, she added, access to health care also depends on the availability of a team of highly qualified health care professionals.

She called for a primary care workforce that is “adequate in number, adequate in distribution and adequate in competencies in order to deliver on this (medical home) care model.”

“I want to be clear that President (Obama) going forward and everyone at HRSA understands the importance of addressing this deferred issue — that is a focus on primary care and a focus on building a platform of health care providers,” she said.”