THE CONTROVERSY OVER THE AFFORDABLE CARE ACT CONTINUES

Health Care Reform will give everyone
access to healthcare.
Photo courtesy Parent Guide News

For those of us responsible for stewarding resources to ensure high quality care for people with serious illness and to maintain the health of the population, the controversy over the Affordable Care Act is a huge distraction and an environment of uncertainty for management. The New York Times on Sunday (July 8, 2012)  ran a story about whether the Act authorizes subsidies to individuals who purchase services through the federal exchange in states that do not establish their own exchange. This is just one more example of using people’s access to healthcare as a political football. As most of you know, the Act provides support to states to establish “Health Insurance Exchanges.” Modeled after the system in Massachusetts, the Exchanges are designed to pool the purchasing power of individuals and small employers to make available affordable insurance. The Exchanges will also determine eligibility for subsidized premiums for individuals who are not eligible for Medicaid. In addition to making health insurance affordable, the Exchange is supposed to make selecting a plan more understandable for the average consumer, no small task in itself. Rhode Island is pretty far along in establishing an Exchange and recently hired a health policy expert, Christie Ferguson, to head it up. Sitting on one of the advisory committees for the RI Exchange, I can say there are some very smart people trying their best to implement it. I can also say that it is complicated stuff. The core of the Act is an effort to extend insurance coverage to the 40 million uninsured by expanding Medicaid and by using the Exchanges to create competition for the purchasers of insurance.

Can’t we just get on with it already? I guess not. People on the right have criticized the Act as big government interference in the private marketplace and a drain on the federal budget. I heard a spokesperson for Mr. Romney criticize the Act because it doesn’t give the states the freedom to experiment with different options to meet the needs of the uninsured. I assume she believes the Massachusetts’ program that Mr. Romney supported reflects the creativity of that state’s leaders. The left has always been suspicious of the Act’s reliance on private insurers, who they feel have bloated administrative costs (compared to Medicare) and have failed to get costs under control. The left, and some people on the right, also criticize the Act as not promoting necessary changes in the delivery system (the way care is actually provided) and not promoting a movement away from the fee-for-service payment system. The latter two changes are considered essential if we are going to bend the healthcare cost curve.

As the CEO of the local health system, people frequently ask me what I think of the Affordable Care Act. I always say the same thing—it’s a step in the right direction. If nothing else, it has focused our attention on a system that doesn’t work. We spend too much and don’t get the same results as most western countries that have universal coverage. The Act is flawed and will need changing, but it is a beginning. It gives states a fair amount of freedom to experiment through the Exchanges, including using their purchasing power to alter the reimbursement system and the way care is delivered. I say let’s get on with tackling the problem and stop using healthcare as a political football.

Thanks for visiting. —Lou Giancola