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Tuesday Mar 17, 2015

SGR Deadline Looms; ACA Faces SCOTUS Challenge

In my previous In the Trenches post, I implored (some might say begged) you to write a letter to your members of Congress urging the full repeal of the flawed sustainable growth rate formula. I want to thank those of you who took the time to communicate with your elected officials. For those who haven’t yet sent a communication, I continue to urge you to do so.  

A full repeal and replace bill(www.stltoday.com) is expected to be considered any day now, and your elected officials need to hear from family physicians who support this legislative proposal. This is not a test, this is real. And we need your help.  

I urge you to watch this passionate communication from AAFP President Robert Wergin, M.D., and then Speak Out

ACA Turns 5. Will It Turn 6?
On March 23, the Patient Protection and Affordable Care Act (ACA) will celebrate its fifth anniversary. This date is a cause for celebration for many in our country and a reminder of one of the darker days in our nation’s legislative history for others.

Regardless of political affiliation, there was a strong bipartisan consensus in early 2000s that our health care system was broken, wasteful and a drag on individual and business economic growth.  It is often difficult to recall the context in which policy decisions were made, especially in a society that consumes and disregards information at such an alarming rate. This is why I think it is important that we look back at the decade prior to the enactment of the ACA to remind ourselves of the challenges we faced as individuals and as a country.

In 2001, 39.8 million people, or 14.1 percent of the population, were uninsured. By 2006, the number of uninsured had increased to 47 million or 15.8 population of the population. In 2010, the year the ACA was enacted, there were 49.9 million people uninsured or 16.3 percent of the population. Ponder those numbers for a moment.  

According to the Kaiser Family Foundation, in 2000, a family of four paid an average of $6,438 for its health insurance. By 2010, this same family paid more than $13,000 for the same policy. Insurance costs for individuals also increased dramatically going from an average of $2,471 in 2010 to more than $5,000 in 2010. Between 2000 and 2010, health insurance costs increased 159 percent, and wages increased 42 percent. As a result, the number of uninsured and underinsured exploded.  

By 2008, both presidential candidates and a large swath of the U.S. Congress were calling for comprehensive health reforms. In 2010, Congress delivered a bill to President Obama, and he signed it – with cheers of jubilation from most corners of society (and over loud cries of opposition from others). In 2011, the law survived a Supreme Court challenge and implementation began. It didn’t go so well, but it began.

So where are we today? In the latest open enrollment period, 11.4 million people enrolled in an insurance product sold through a state or federal Health Insurance Marketplace. Medicaid expansion, in those states where it has been implemented, has expanded health care coverage to more than 7 million people.


Although it would seem that a fifth anniversary would signal stability, the ACA is far from stable. On March 4, the Supreme Court heard oral arguments in King versus Burwell, which seeks to establish that the tax subsidies created by the ACA and aimed at assisting low-income individuals in the purchase of health insurance, are not applicable to individuals purchasing an insurance policy in the federal Health Insurance Marketplace. The plaintiffs in the case argue that the law only allows such tax subsidies for individuals who purchase a health insurance policy through a state-established Health Insurance Marketplace.

The immediate and real-world implication of a ruling in favor of King is that 13.4 million people would become uninsured immediately. Now, there are pathways for those individuals to retain their health coverage, but those pathways require action by Congress, but I wouldn’t look for white horses to come galloping to the rescue. It also would send the insurance market in many, if not all, state into chaos. Neither of these events is good for our health care system.

The AAFP has advocated for universal health care coverage since 1989 when the Congress of Delegates approved a resolution entitled “Health Care for All: A Framework for Moving to a Primary Care-Based Health Care System in the United States.” With few modifications, this policy has stood the test of time. At the core of this policy is the following statement, “Ensuring that all people in the United States have health care coverage is essential to moving toward a healthier and more productive society.” This policy is central to the AAFP’s advocacy efforts and, in my opinion, to family medicine.  

Each of you understands the importance of health care coverage because you see it every day in your practices.  Of course, people with health insurance sometimes still face challenges accessing health care services because insurance companies aren’t always the most helpful partners. But despite some administrative burdens, individuals with health care coverage have better opportunities to be healthy than the uninsured.  

Decades of research shows that there are two leading drivers of a quality health care system: health care coverage and a continuous relationship with a physician, most often a primary care physician. These two indicators, when combined, have demonstrated the ability to improve the health of individuals and do so in an economically efficient manner. Regardless of your political stripes, 13.4 million uninsured is an undesirable outcome.

Posted at 08:00AM Mar 17, 2015 by Shawn Martin

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ABOUT THE AUTHOR



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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