June 28, 2017
As a political junkie and a healthcare public relations professional I have followed the healthcare debate with keen interest, and I have been anticipating the day when we would finally have a serious political discussion about how best to fix or replace the ACA. Sadly, even as we remained hopeful a decision would be made pre-Independence Day break, the Senate decided to delay the vote and now we are barely having that conversation.
So, I thought it might be useful to use the occasion of the new Senate Republican healthcare bill to bring-up a few relevant issues that seem to be getting left out of the conversation:
1 – We All Pay for Healthcare One Way or Another
Uninsured people get sick. If they cannot get cheaper preventive care at a doctor’s office, they go to the hospital-typically via the ER- for much more expensive care when they get really sick, and by law they must be treated. We all pay for that care, whether through DSH payments, 340B drug discounts, tax-exempt status (all of which cost us money) or by propping-up insolvent community hospitals as state and municipal taxpayers or as individual donors. Forcing people to use the healthcare system this way is inefficient at best and cruel at worst.
2 – The ACA is not DOA (Neither is CBO)
Contrary to what you might have heard, ACA exchanges are working well in many states. Also, one of the main reasons for lack of choice in some markets and rising premium costs is that ACA opponents blocked both the Medicaid expansion and the aspects of the law that would compensate payers serving exceptionally expensive populations.
There is an argument to make that the healthcare market should be far less government-subsidized and regulated. I don’t agree with it, but it’s a valid argument. Pretending that we have no choice but to replace a “failed” ACA or that its problems were not in large part created by its opponents, is just trying to trick the folks that don’t understand the policy and the history, and that’s just wrong.
By the same token, trying to discredit the CBO because of inaccurately predicting ACA enrollment numbers is another case of the arsonist shouting “Fire!” The CBO’s ACA enrollment projections were off largely because 19 states unexpectedly (and for primarily political reasons) declined to participate in Medicaid expansion. So why not try to rework the system already in place?
3 – Where is the Industry Input?
In a world where energy company executives make energy policy and agribusiness leaders write the Farm Bill, why is the healthcare industry so sidelined on this round of healthcare reform? The AMA, AHA and AHIP (to name just a few) have all opposed both the House and Senate’s healthcare bill, and I can’t help but think that maybe that wouldn’t be the case had these organizations been involved in the policy-making process. Where is the blue-ribbon panel of experts crafting the details and making the case for these bills?
For me, the true weirdness of the modern healthcare debate stems from the fact that although Obamacare/the ACA is reviled as a matter of orthodoxy on the right, the ACA was actually very conservative legislation in many ways:
- Strongly incenting individuals and employers to take responsibility for the healthcare resources they were inevitably using
- Marketplaces to shop for care
- Pricing transparency
- Accountable care
This makes replacing it difficult, because while many of the best ideas from the right are already in it, opponents have spent the last eight years talking about how the whole thing is terrible. You can’t keep it and fix it, but you also don’t have a good way to replace it.
I still hold out hope that a real and substantive discussion of what we really need to do to make the US healthcare system work better will happen eventually, but given the current political climate, that day seems pretty far away right now.
At Aria, we are always following the healthcare debate and related policies very closely, so be sure to check back to get our take on the latest and “greatest” soon. In the meantime, follow us on Twitter @ariamarketing to stay up-to-the-minute on all healthcare news.