May 19, 2016

Candidates are talking about Obamacare—whether they know it or not



Health reform is about more than insurance, writes Dr. Eric B. Larson. It’s also changing racial, economic, and care disparities.

This election season, we’re hearing a lot from candidates—Democratic and Republican, local and national—about economics, equality, and immigration. Of course, the Affordable Care Act (ACA), or Obamacare, is still a hot topic. But the ACA also underlies political talk about poverty, opportunity, immigration, diversity, and American innovation.

I was pleased to read about the positive effects the ACA is having on care for low-wage workers, immigrants, and Hispanics. A New York Times analysis shows that health insurance coverage increased from 2013 to 2014 for all racial/ethnic groups, but especially for minorities and the most for Hispanics. A Boston Globe editorial lays out the direct connection between medical coverage and current discussions about income inequality, personal security, and individual freedom. Coverage has clear benefits for low-income Americans of all racial and ethnic backgrounds, as described by another New York Times article. These changes have the potential to reduce the disparities, inequalities, and gaps in prosperity that all the political candidates are talking about right now. To hear more about this topic, please join us when Dr. Leana Wen visits Seattle for this year’s Birnbaum lecture.

‘I’ve been waiting for this my entire career’

Less well-known reforms under Obamacare are particularly relevant to those of us who are part of Group Health and Group Health Research Institute (GHRI). Several programs from the ACA encourage exactly the type of practical research to improve clinical care that is our strength. Under funding originating from the ACA, the Healthy Hearts Northwest project from the GHRI MacColl Center for Health Care Innovation is part of a national initiative to help small primary care practices build their capacity for quality improvement. The initial focus is on preventing cardiovascular disease including heart attacks and strokes.

The ACA also created the Patient-Centered Outcomes Research Institute (PCORI) to develop, study, and promote health care improvements, guided by patients. This model of research and clinical improvement suits Group Health and GHRI so perfectly that we were early leaders in PCORI studies that are now yielding results with national impact. Our PCORI projects cover patient-priority issues such as back pain, cancer screening, and obesity.

The ACA also created the Center for Medicare & Medicaid Innovation to test ways to improve care and spread the most effective methods across the country. Support from the Innovation Center is helping GHRI’s Center for Community Health and Evaluation connect clinical systems and community resources in our state. The overall goal of this initiative, called Accountable Communities of Health, is health equity.

As a final example, I’m looking forward to a new program from the Innovation Center. Based on results from a successful earlier initiative, they are inviting clinical practices into the Comprehensive Primary Care Plus (CPC+) program. Instead of being paid for services and tests, participating practices will be rewarded for keeping their patients healthy. Group Health members already receive this type of care, but it has remained elusive for most Americans, who get their care in fee-for-service health care systems. My colleague, Dr. Michael Parchman, family physician and director of the MacColl Center, says about CPC+, “I’ve been waiting for this my entire career.” I have, too. We welcome the spread of this model to other practices.

November is approaching

As the election approaches, I will be watching the candidates and listening to their plans about health care. I hope they will be specific about their policies and realize that health care and coverage are fundamental to financial security, equality, and our capacity to move forward together as a nation.


Eric B. Larson, MD, MPH
Vice President for Research, Group Health
Executive Director, Group Health Research Institute

2016 Birnbaum Lecture


A shared vision: New perspectives on strengthening social determinants of health

Keynote speaker: Dr. Leana Wen, nationally acclaimed TED speaker and health commissioner for the city of Baltimore.