Tuesday Mar 05, 2019
Under Pressure: Health Care Needs Reform, Stable Markets
"You had your time, you had the power. You've yet to have your finest hour."
-- Queen, Radio Ga Ga
I have hesitated to write about comprehensive health care reform proposals such as Medicare for All, primarily because the idea is wrapped inside some fairly strong emotional packaging at the moment. However, given recent activity in Washington, D.C., I have decided that it is time to offer an opening salvo in what is likely to be a long and contentious debate about the future of our health care system.
Today, from a policy perspective, we find ourselves caught between two major forces: the need to stabilize our insurance markets and the need to identify the next generation of health care reforms. Both objectives are necessary, and both are important.
In public speeches, I remind audiences, "We think about health care as a human issue, but we legislate on health care as an economic issue." This clarification is important because it allows us to focus our attention on the economic drivers that motivate our legislative process. Despite the coverage gains and insurance reforms secured by the Patient Protection and Affordable Care Act (ACA), the cost of health care has continued to increase at an alarming rate, placing tremendous economic pressure on individuals, families, businesses and government programs.
In the past two months, a number of studies and reports have been published that point toward the economic trajectory and realities of our current health care system.
• A CMS report(www.cms.gov) projected increases in health care costs of 5.5 percent per year, with overall spending on health care reaching 19.4 percent of GDP by 2027.
• A report from the Health Care Cost Institute(www.healthcostinstitute.org) found that per-person spending reached $5,641 in 2017, and individual out-of-pocket spending continues to rise at greater than 2 percent per year.
• A CDC report(www.cdc.gov) found that the number of uninsured people is increasing and that an astonishing 45 percent of people who are insured now have a high-deductible health plan (HDHP).
These findings aren't surprising, which is sad, but they illustrate what is motivating a new push for major health care reform.
And so it begins. Last week, the much-discussed and highly anticipated Medicare for All legislation(www.congress.gov) was introduced in the House with more than 100 co-sponsors -- an eye-opening display of support. M4A, as it is often called, is the most discussed proposal that has been introduced to date, but it certainly is not the only one. In recent weeks, other bills have been introduced that would expand access to the two primary public insurance programs -- Medicare and Medicaid -- to Americans who are not currently eligible to participate.
These others are
- the Medicare at 50 Act (S. 470(www.congress.gov) and H.R. 1346(www.congress.gov)),
- the State Public Option Act(www.congress.gov) and
- the States Achieve Medicaid Expansion (SAME) Act.(www.scribd.com)
The Medicare at 50 Act is an interesting proposal that would allow individuals between 50 and 64 years of age to buy into the Medicare program. It is viewed as a compromise position between the current system and the M4A proposal. The bill has strong support among Democratic senators who are seeking an alternative to M4A.
The SAME Act would allow states that expanded or plan to expand Medicaid after 2014 to access 100 percent matching federal dollars for the first three years of their expansion. More simply, it allows states that expand Medicaid to benefit from the funding structure established in the ACA regardless of when they implement expansion.
Health reform activities are not limited to Democrats. There are a number of bills being introduced by Republicans that would promote more "market-based" solutions. Primarily, these proposals focus on expanding access to health savings accounts and health reimbursement arrangements. Also, remember that the administration has taken significant steps to broaden access to association health plans and short-term limited duration insurance plans. Although the AAFP has concerns about these models because of their nonadherence to the consumer protections and insurance reforms included in the ACA, they are products that make health care coverage more broadly available.
The AAFP is excited that Reps. Brad Schneider, D-Ill., and Elise Stefanik, R-N.Y., will soon reintroduce the Primary Care Patient Protection Act,(www.congress.gov) which would incentivize those 45 percent of individuals with HDHPs to access primary care more frequently.
The AAFP been diligently working for more than two years to build an understanding and policy basis for this debate, and I am comfortable with our current position. The Academy has produced two documents in recent years that have been adopted by the AAFP Congress of Delegates (COD). The first document, "Discussion Paper on Health Care Coverage and Financing Models,"(37 page PDF) (see Appendix A, which begins on page 195 of the link) was approved by the COD in 2017. The second is our policy Health Care for All: A Framework for Moving to a Primary Care-Based Health Care System in the United States, which was approved by the COD in 2018. The AAFP first adopted a policy for health care for all in 1989, and the new framework builds on our 30-year commitment to this goal.
Additionally, the AAFP is scheduled to host panel discussions on health care reform and financing at the Annual Chapter Leader Forum, the National Conference of Family Medicine Residents and Medical Students and the Family Medicine Experience. These panel discussions aim to inform family physicians about the current system and proposals under consideration in Washington. If you plan to attend one of these meetings, I would encourage you to come to these sessions.
I was honored to join several state chapters in Dallas recently for the MultiState Forum to discuss health care policy and advocacy issues that impact family medicine. I always enjoy engaging with our state chapter leaders and family physicians from across the nation. Nothing sharpens your focus like hearing directly from family physicians on the frontlines of our health care system.
On the flight home, I had the opportunity to watch Bohemian Rhapsody. Although the movie was panned by many critics, I found it to be a wonderful trip through my youth and a celebration of the incomparable talents of Freddie Mercury. After watching the movie, I was left with one thought: There are two types of people in the world, those who believe Queen is the greatest rock band of the 1970s and '80s, and those who are wrong. Don't tweet me, just go with it!
Posted at 07:35AM Mar 05, 2019 by Shawn Martin