Brown convenes first NACo hearing on health reform
By Paul Beddoe
ASSOCIATE LEGISLATIVE DIRECTOR
NACo President-elect Valerie Brown called the first hearing of NACo’s Health System Reform Working Group to order in the Maricopa County, Arizona’s Supervisors Auditorium in downtown Phoenix Dec. 3. Brown welcomed Robert Smoldt, the executive director of the Mayo Clinic Health Policy Center in Scottsdale, Ariz. to offer remarks about the current national debate over the future of the health system.
President Don Stapley, a Maricopa County supervisor, welcomed the working group and witnesses to his county and offered a full endorsement of Brown’s effort to restore the partnership between state and county governments in the health arena, and to develop a well-honed Health Reform agenda for NACo to pursue with the Obama-Biden administration and the 111th Congress.
 Working group members and witnesses were invited to offer their views on a draft NACo white paper, Restoring the Partnership for American Health: Counties in a 21st Century Health System, and to highlight specific successes and challenges they have had in providing for the health and welfare of the people in their counties.
Working group members Ilene Lieberman, Leon Evans and Carol Moehrle made formal statements for the record. County officials from the southwest region were also invited to participate.
Commissioner Lieberman, from Broward County, Fla., made the case that federal policy should be changed to encourage living organ donation and that incentives should be implemented to encourage health care professionals to work in underserved areas.
Evans, the CEO of the Center for Health Care Services in Bexar County, Texas, highlighted the special needs of individuals with severe behavioral health problems, mental illness, developmental disabilities and substance abuse.
He warned of the problems of warehousing these populations in the nation’s jails rather than in appropriate treatment and called for reforms that would enable everyone to access the services that they need.
Moehrle, who directs a five-county Public Health District in North Central Idaho that serves Clearwater, Idaho, Latah, Lewis and Nez Perce counties, explained the importance of investing in public health in order to improve health outcomes for entire populations.
Santa Fe County, N.M. Commissioner Harry Montoya testified on behalf of NACo’s Labor and Employment Steering Committee, which he chairs. He described the worsening shortage of qualified health professionals, paraprofessionals and other health workers, particularly in underserved rural and urban areas as well as some model programs adopted by local Workforce Investment Boards to train workers for the health sector.
Commissioner Darlene Burns of Uintah County, Utah, serves on the NACo Health Steering Committee. In her testimony before the working group, she cautioned against adopting national reforms that would increase burdensome government bureaucracy at the expense of the personal needs of individuals.
Montoya and Burns were followed by a panel of three witnesses who serve as county professional staff: Chester Pintarelli, the administrator of the county nursing home in Iron County, Mich.; Elizabeth Akley, the indigent health care administrator in San Juan County, N.M.; and Mike Schaiberger, the director of Employee Health Initiatives for Maricopa County, Ariz.
Pintarelli described how long-term care is currently undergoing major cultural changes in order to respond to the needs of the elderly frail population. He urged wholesale reforms to the survey and certification procedures required by the federal government and the states. He argued that the current process is too often punitive and petty and should be replaced with a collaborative system built around best practices, which produces improved quality-of-life outcomes for residents.
Akley described recent legislative efforts in New Mexico to provide health care coverage for all and observed that the indigent health care directors in New Mexico are leaning towards an incremental approach in providing universal coverage that builds on existing systems and revenue streams.
She concluded that too often health care reform advocates go home if their exact plan or top choice is not adopted. “But that leaves the status quo in place as the second choice,” she said. “We need to make a virtue out of our second choices — choices that can transcend partisanship and ideology and move us forward.”
Schaiberger spoke on behalf of Maricopa County as a large employer and purchaser of health care for county employees. He stressed, among other things, the success the county has had controlling health care costs through effective incentives and urged that reformers allow flexibility in benefit design in order for that to continue.
The next hearing is scheduled for the southeastern region, in Wake County (Raleigh), N.C. on Feb. 19, 2009.
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