I was talking to a passenger on a plane recently. He is fully unsured but claims between very high deductibles and out of pocket, that his insurance doesn’t help much so he pays cash for medical services-says he even enjoys doing this. Claims to have negotiated a $200 MRI for all cash in a high volume center in Fl and then promptly turned the entire bill in to his insurance where it went against his high deductible. I think you can say, he has insurance but no benefits but he has access that he can afford. We opened a PT clinic in one of the most impoverished area codes in the country in West Louisville. It’s a population of over 25,000 without prior access to physical therapy. Many of these folks have #physicaltherapy needs and now have insurance but with copays and out of pocket costs, they cannot afford it. They are insured with no benefits and without affordable access.
Therein lies the heart of my major issues with ACA and general debate regarding healthcare reform. We are simply using the wrong metrics. The number of uninsured might be easy-like using a scale to calculate pounds but just like weight isn’t the proxy for fitness, either is somebody’s insurance card and active medical care. An insurance card doesn’t mean a person is under care anymore than a fitness club membership means somebody is in a fitness plan. While my genuine hope is that the 20+ Million uninsured are now under primary care services including disease management and prevention, there aren’t any real stats that support this. The benefits for this group at times are almost irrelevant as a significant number of providers don’t take medicaid or the exchange products which often like medicaid are far below provider cost.
While I think ACA is generally horrible given a larger perspective outside of number of insured, I don’t think it is an unmitigated disaster. I think repeal and replace was the wrong strategy at the wrong time and should have been “enhance and improve” deliberated by centrist democrats and republicans working together.
-we were taxed on ACA 2 years before implementation on a bill that was going to make healthcare more affordable and lower the number of uninsured. It succeeded on the later part of this only and I believe the measure is illusory and at a cost that is unsustainable as there will be no more 2 year ramp up and the shift of funding to states is unrealistic.
-Payors are running from the individual market making the individual mandate increasingly difficult to comply. On the healthcare exchanges, when you have one insurance company option, you have no option and even in those markets, many of the one option payors are departing. There are problems with ACA, everyone agrees with it and a wait and see attitude is a failed strategy.
-It’s funding is to shift to states already over burdened with obligations including underfunded pensions, rising educational costs, antiquated tax systems as well as a myriad of other complicated benefits and expenses. Given changes in administrations, how can they be expected to deal with a new mandated expense? For this reason, block grants and state flexibility should be fundamental to dealing with uninsured and that needs to occur sooner rather than later.
-What often goes unsaid is the folks that were insured during ACA implementation have seen their premiums soar, their copays and out of pocket grow significantly and their overall benefits decrease. Does one really have a #physicaltherapy benefit if almost 100% of the cost comes from out of pocket? Employer cost’s escalated exceeding salary costs in terms of percentage increase. This is not a good formula for maintaining an engaged, competitive workforce. Raising healthcare costs occurred during a time when providers reimbursement went down-where did all the money go? Just like higher education tuition increases, the rising cost went to administration not to teachers or medical providers.
-when ACA passed 7 years ago, not one Republican voted on it. Had TrumpCare won, not one democrat would have voted for it. A big criticism seven years ago, and one that I agree, is that it passed too fast without almost anybody reading the excessive pages and fine print of the bill. Isn’t America made great again by a more lengthy debate process using metrics, retrospective analysis, and consensus to drive improvements? I sure hope so. The logic of repeal and replace was as ill founded as the logic of passing the monumental ACA without consensus.
-the regulatory impact of healthcare has lead to increased process and paperwork demands that have created more burned out medical providers than at any time in our history. Any reform efforts must address this issue as the last thing we want is insured patients being treated by completely disengaged and disenfranchised medical providers.
One thing we know for sure, the debate of healthcare is not over, ACA’s current form is not sustainable and must be enhanced and improved for the benefit of America. We can do this.