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In his much-anticipated remarks last night, President Obama offered a comprehensive proposal for health care reform. However, most of the plan's impact on state and local health care operations would come through the initiatives he announced for Medicare/Medicaid, which are intended to pay for the heart of the $900 billion reform effort. His primary agenda items were as follow: (I)t will be against the law for insurance companies to deny you coverage because of a preexisting condition. - The most likely area of impact at the state and local levels would be with state insurance commissioners and attorneys general, who are either elected or appointed depending on the state in question and would be charged with consumer protection in these cases. Tracking compliance would require some expanded capacity in terms of regulation and enforcement tracking systems. (I)f you...don't currently have health insurance...you'll be able to get coverage (through) a new insurance exchange -- a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices...This exchange will take effect in four years, which will give us time to do it right. - All indications are that this exchange would be created as some sort of non-governmental entity (NGO), which would most likely be a federal government-sponsored enterprise (GSE) along the lines of Massachusetts' Health Connector. The Federal Employees Health Benefits Program (FEHB) is likely the nation's most significant exchange and the one in which members of Congress participate. (I)ndividuals will be required to carry basic health insurance -- just as most states require you to carry auto insurance. - As is well known, the Commonwealth of Massachusetts passed a health insurance mandate several years ago as part of its statewide health care reform effort. The Commonwealth requires proof of health insurance in order for tax filers to take advantage of the annual standard income-tax deduction (along with other penalties). It seems likely that the federal government will adopt this approach at the national level given that tax filling is the only regular and universal touch point for enforcement. Those are the three major elements of the Obama reform proposal. However, it is the Medicare/Medicaid reforms that will be of most interest to state and local technology vendors. (T)his plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies -- subsidies that do everything to pad their profits but don't improve the care of seniors. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead. (B)ecause Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody. We have long known that some places -- like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania -- offer high-quality care at costs below average. So the commission can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system -- everything from reducing hospital infection rates to encouraging better coordination between teams of doctors. Efforts to reduce or eliminate waste, fraud, and abuse (WFA) have long been part of the discussion around Medicare and Medicaid. And, you can be sure that whenever someone at the federal level announces a new initiative for Medicare, they also mean to include state-operated Medicaid programs. The programs are inextricably tied together by the same long-standing programmatic and technological architecture operated by the Centers for Medicare and Medicaid Services (CMS). However, the inclusion of best practices into Medicare and Medicaid formalizes an assumption that INPUT made several years ago when we asserted that quality-of-care incentives for Medicaid recipients represented the single most effective place for driving health IT adoption at the state and local levels. To acheive the highly ambitious savings and include metrics such as those generated by Intermountain or Geisinger will require a massive architectural overhaul of state Medicaid Management Information Systems (MMIS), which to this point have been little more than big, dumb processing engines, conducting billions of routine health care transactions across the entire health care marketplace each year. To date, CMS has only dabbled in quality-of-care reforms. The use of quality metrics for Medicare/Medicaid will further drive the adoption of electronic medical record (EMR) systems by state and local health care facilities as covered in INPUT's recent report Health IT Transformation: FY2009-FY2014 State and Local Market Forecast (Aug 2009). Make sure you stay tuned to the heath care feed of INPUT's B2G Breaking Views blog to catch up on all the latest in this area as well as breaking events going forward.