The Affordable Care Act represented a major overhaul to the ways this nation covered low-income Americans and helped others afford health insurance. It also ushered in many innovations in how hospitals and doctors were paid.
It succeeded in increasing the numbers of Americans who had health coverage to 90 percent. Arguably, it also played an important role in the multiyear moderation in health care spending increases.
Congress and President-elect Donald Trump will soon have the opportunity to overhaul Obamacare. A combination of the budget reconciliation process, executive orders and amendments represent the most likely scenario, as an outright repeal would require the approval of 60 senators.
To “replace” Obamacare will require a long and thoughtful process for our elected officials because we all pay in one way or another to treat the uninsured. Core provisions that should be seriously considered include:
▪ Pre-existing condition clauses and unaffordable “high risk” premiums based on an individual’s past or potential health status should be prohibited, although some revised levels of age band pricing should be allowed. If not, those with pre-existing conditions and those 55 or older would likely face large increases in their health insurance premiums. A corresponding expectation that all Americans carry at least catastrophic coverage might be necessary.
▪ Extending family coverage to young adults until age 26 should be retained.
▪ Tens of millions of Americans in lower-wage positions became able to afford health insurance through premium subsidies. Simple tax credits or deductions alone might not be enough to continue to cover the “working poor.”
▪ Standardized health insurance packages and regulated electronic marketplaces enabled the average consumer to shop for and compare plans. Retaining these provisions would avoid a return to the morass of confusing plans and loopholes.
▪ Requiring that health insurance companies spend most of the premium dollar on actual patient care versus overhead and shareholder profit helped hold down insurance rates.
▪ Obamacare’s Center for Medicare and Medicaid Innovation, its Accountable Care Organizations (ACO’s) and other innovations have allowed hospitals and physicians to provide more efficient and effective patient care.
▪ Medicaid expansion provided needed preventive care and medication coverage and reduced the need for hospitals to shift costs for more expensive care to the insured.
▪ Obamacare’s provisions and taxes extended the fiscal viability of Medicare by nearly a decade.
Studies indicate that only 7 percent of all health care spending is susceptible to routine price shopping behavior. Consumerism alone will not solve this nation’s health care ills because baby boomers are ramping up the demand for needed care while the supply of physicians and nurses is about to decline.
To help reduce spending, some things need to change. For example, drug manufacturers are currently not required to bid for the hugely profitable Medicare market.
We all have a stake in what happens next. Let’s hope our elected officials do not discard some of the positive aspects of the ACA as they craft a new vision for America’s health care.
Bill Bodnar owns The Leader’s Board, LLC, a health care executive roundtable education organization serving many of this nation’s largest health care systems.