This week, the Republican majority in the House of Representatives fulfilled a campaign promise to repeal the Affordable Care Act, the landmark health care reform legislation signed into law by President Obama last March. This action was largely symbolic, as the Senate, which is controlled by the Democrats, will not take up the measure.
Going forward, however, there may be attempts to chip away at funding that supports the implementation of the Act. These efforts will not be symbolic, and they may very well have real consequences for the healthcare received by each and every American.
There are four reasons why the United States Congress should not repeal or defund the Affordable Care Act.
- All of the underlying dynamics that propelled passage of health reform have only gotten worse. 50.7 million Americans are now uninsured, the highest level since before the adoption of Medicare and Medicaid. Health care costs continue to rise well beyond the cost of living. And in light of how much money we spend as a nation, our health outcomes remain disappointing, to put it mildly. The October edition of Health Affairs noted that over the last decade, the United States slipped from 25th to 49th in the world in the life expectancy of its citizens. With these dynamics unabated, the case for reforming our health care system is stronger today than it was a year ago.
- The Affordable Care Act remains the most logical and achievable approach to reforming the American health care system. A single-payer option or “Medicare for all” never had sufficient political support, particularly given the fiscal challenges confronting the federal government. And consumer driven options lack the systemic impact required to bring health care costs under control, and they may discourage patients from obtaining precisely the kind of preventive attention which reduces long-term demands for care. The Affordable Care Act strikes just the right balance. It preserves and buttresses Medicare, expands Medicaid, creates an individual commercial insurance market, and obligates insurers to play by a fair set of rules. As importantly, the Act encourages a host of changes to the ways in which health care is delivered and for which it is paid, incentivizing gradual transitions away from fee-for-service medicine to payment modalities that reward high quality, low cost care.
- The Affordable Care Act is already helping the American people. Children can no longer be denied coverage due to pre-existing conditions. Young adults up to 26 years old can be covered under their parents’ insurance. High risk pools have been created to offer the uninsured a coverage option until the health insurance exchanges are activated in 2014. Wellness visits are now free for Medicare recipients. Seniors are getting more assistance with their prescription drug costs. Primary care physicians are now entitled to enhanced payments. With each passing month, more and more of the Affordable Care Act is being implemented, and the elements of the Act that are going into effect are popular.
- The passage of the Affordable Care Act has already dramatically changed the dialogue occurring amongst providers, physicians, plans, and policy makers. At all levels, the discussion is centered around how to transition away from a system in which fee-for-service payments were predominant to one where providers and physicians will drive, and be compensated for, reductions in unnecessary procedures and improvements in outcomes delivered by our health care system. This dialogue is an essential first step in the nation’s effort to reign in our healthcare expenditures and, in the words of the President, “bend the cost curve.”
Former Republican Senate Majority Leader Bill Frist, a physician, recently said: “The Affordable Care Act, not just for me but for most of the American people, is not the bill they would’ve written. It’s not the bill I would’ve drafted but it is the law of the land and it is the fundamental platform upon which all future efforts to make this system better . . . will be based.” He continued: “[The Act] has many strong elements, and those elements, whatever happens, need to be preserved, need to be cuddled, need to be snuggled, and need to be implemented.’’
He’s right. Neither symbolic votes nor syphoning funding away from the Affordable Care Act will reduce the number of uninsured Americans, control health care costs, or improve health outcomes in the United States. Let’s focus instead on implementing and – yes – improving the Act. It’s our best hope to ensure access by everyone to high quality care, and to do so in a way that, in the long term, will be affordable for the American people.
Arthur A. Gianelli, MA, MBA, MPH
President and Chief Executive Officer
The NuHealth System
East Meadow, NY