How bipartisan is health IT?
Earlier this year, a Washington think tank whose healthcare wing is led by two former Senate Majority Leaders, put its weight behind more widespread use of IT in healthcare organizations nationwide.
"To deliver high-quality, cost-effective care, a physician or hospital needs good information," said former Republican senator Bill Frist, MD, upon the release of a report, on Jan. 27, from the Bipartisan Policy Center's Task Force on Delivery System Reform and Health IT. "There is strong bipartisan support for health IT," added Frist's old senate colleague, Democrat Tom Daschle.
Healthcare reform is arguably the hot-button political issue of our time. And with the Supreme Court set to decide the fate of the Affordable Care Act this summer, it's a safe bet that controversial legislation will have a big impact on the 2012 election and beyond.
But what about health IT? If "Obamacare" has been a lightning rod, Washington's efforts to spur healthcare information technology might seem to enjoy much broader support, on both sides of the aisle.
But is that support really as bipartisan as so many in the industry say it is nowadays? Especially when adoption of EHRs and establishment of HIEs are being spurred in large part by money from the very federal stimulus program against which the Tea Party rose up to protest?
"When we're up on Capitol Hill, one of the big frustrations is this lack of bipartisanship in general," said Dave Roberts, vice president for government relations at HIMSS. "How do you create bipartisan conversations? Unfortunately, the system has broken down so much that they're not finding a lot of things they can talk about."
Strikingly, however, health information technology is "one of the extremely few areas where there still does appear to be consensus," he said. "I personally think one of the reasons is that you have people on both sides of the aisle who see its value."
Healthcare got just cursory mentions in President Obama's State of the Union address earlier this month. But in years past, both health reform and health IT, have taken much more central roles. In 2011, for example he touted a new era where "patients will be able to have face-to-face video chats with their doctors," and "Veterans can download their electronic medical records with a click of the mouse."
But Obama's predecessor has also given the rhetorical nod to health IT – in no fewer than three separate State of the Union addresses. "We will make wider use of electronic records and other health information technology to help control costs and reduce dangerous medical errors," exhorted George W. Bush in his 2006 speech. And these were more than just words: He had established the office of the National Coordinator for Health Information Technology by executive order in 2004.
Earlier this year, Healthcare IT News asked National Coordinator for Health IT Farzad Mostashari, MD, whether he believed that health IT had support on both sides of the aisle.
"Yes," he said.
Even, potentially, with a Republican president and a Republican-controlled House and Senate? And if that happened, did Mostashari think the meaningful use program would go forward as envisioned when enacted by a Democratic president, and Democratic majorities in both chambers?
"That is certainly my hope and belief," said Mostashari. "I don't have a crystal ball, but I see nothing to indicate that there's a real partisan or ideological drive to diminish" the HITECH Act, "or roll back the advances we have made on health IT," he said. "This has been for decades a bipartisan issue, and I think people recognize that we've made good progress and that we should keep pushing ahead."
"I've spoken with many members of Congress about the success we're having with healthcare IT," said Mostashari. "What ended up in HITECH was drafted in a bipartisan way. I have not seen anything to indicate there is any partisan rancor around HITECH.
"After all," he added, "this office [ONC] was founded by President Bush."
But President Bush founded ONC in 2004 – a full five years before the Tea Party sprung to life, united in righteous rage at the $787 billion American Recovery and Reinvestment Act, of which HITECH was a part, in 2009. Suddenly, thousands of people who didn't much care about President Bush's multi-trillion dollar deficits cared very deeply about President Obama's spending habits.
And the past three years have seen the Tea Party caucus wield a power – whether or not it's commensurate with their actual numbers – that's very real. Simply put: they don't like government spending – whatever benefits might come from those investments.
The Tea Party's attitudes are summed up best by Texas governor (and 2012 presidential also-ran) Rick Perry: "Washington's insatiable desire to spend our children's inheritance on failed stimulus plans and other misguided economic theories have given record debt and left us with far too many unemployed."
One year ago, Rep. Jim Jordan (R-Ohio) filed a bill, The Spending Reduction Act of 2011, that sought to lower federal spending by $2.5 trillion over the next 10 years. Among the host of federal programs targeted for elimination were "certain stimulus provisions" – including the Medicare and Medicaid EHR Incentive Programs set up under HITECH.
A Democratic president all but ensured that Jordan's bill would never become law. But as Dave Roberts, vice president of government relations for HIMSS, told Healthcare IT News at the time, the concern was less the legislation itself than the uncertainty it sowed in a still-fledgling healthcare IT industry.
"We've heard from some CIOs, asking us, 'What is this? We hear the House is going to rescind our money,'" said Roberts last year. "It adds to the confusion in the whole marketplace. And providers and hospitals who want to purchase this [technology] are wondering, 'Do I really want to start down this path?'"
Roberts assured those people that the meaningful use program was something to count on. But he worried, back then, that "We're leading up to the 2012 elections. The Senate's majority is very reduced right now. And if this is a new way of thinking, that could be concerning."
One year later, "it's very quiet on that front," said Roberts. "We have seen no legislation – absolutely nothing at all – perceived as trying to do anything" related to defunding HITECH.
In fact, "I don't think we've heard in over a year from anybody really complaining about using federal funding to prime this area" in the past year, he said. "Elected officials know how important the medical community is – and it is a good voting community. And I think they see this as a wise use" of federal money.