Abolish or fix it?

ACA should be repaired, not repealed

ALTHOUGH he was young, the new patient I saw had suffered a heart attack in the past year. It was the first week of January, and now that he had health insurance, he came in to establish a primary care home and get a referral to see a cardiologist. He had not seen a heart doctor since his hospital admission.

We had so many things to discuss at this first clinic visit that I didn’t have the chance to ask him how he felt about his new health insurance. I hope he understands how lucky he is, just as I hope the many Americans now covered by insurance thanks to the Affordable Care Act appreciate their good fortune. Thanks to the Affordable Care Act (ACA), an insurance company cannot deny my patient coverage for his pre-existing condition. Before this legislation passed, an insurance company could have legally denied him coverage because he had a heart attack in his medical history.

The ACA has helped many. It has brought the percentage of uninsured people to historic lows. The ACA allows children to stay on their parents’ plans until they are 26 years old. It prevents insurers from imposing lifetime and annual benefit caps on health-care spending, which helps people who are diagnosed with conditions requiring frequent, expensive care.

Importantly for local taxpayers, having more people with health insurance lessens the stress on charity, usually tax-funded, hospitals, a trend seen in facilities in states that did expand Medicaid, according to the Kaiser Family Foundation. These often end up being the medical care of last resort for the uninsured because they do not have access to preventive care. Positive impact of the ACA would be greater here had Texas policymakers not continued to stubbornly refuse to expand Medicaid. For fiscal year 2016, for instance, Harris Health’s $697 million dollars in uncompensated care amount was just over half of the $1.3 billion total revenues that came into Harris Health, according to a report the nonprofit Center for Public Policy Priorities prepared last year for the Texas Senate Select Committee on Property Tax Reform.

Despite our nation’s health care gains, Republicans are working on repealing the ACA without any replacement plan in place. The majority of Americans do not support this. A number of conservative lawmakers are nervous about abolishing the ACA without an alternative, as well.

Could the ACA be better? Yes. For the sake of efficiency and better health care access for all, it needs to be. But making it better will take thoughtful, deliberate conversations, not the take-a-hacksaw-to-it, figure-it-out-later approach that the Republican majority is now steamrolling through Congress.

One way to continue reducing the number of uninsured Americans is obvious, especially in Texas:

Expand Medicaid in all states. Thiswould improve insurance coverage for the poorest in the population. People who are uninsured are less likely to get routine health screenings and delay needed care. When they do access the health care system, their conditions may be more advanced and require more expensive treatment. As I noted earlier, local and state governments currently pay those bills. Medicaid expansion could help states decrease uncompensated care.

Additionally, more healthy people need to sign up for insurance to cover the costs of care for sicker people. The penalty for skipping coverage should be raised. For many, the penalty is so small it is not a big enough stick to encourage them to pay for insurance.

Many may be surprised to learn that Medic are employs such amodel: People who sign up late for what’s knownas “Part B” pay a penalty. The longer an older American waits to enroll, the higher the penalties are. The ACA penalty would function similarly.

For some, affordability is still one of the challenges of the ACA. More tax credits could help families and young people buy insurance onthe marketplace. Raising the level of subsidies available for plans bought through the marketplace, raising the income limits at which the subsidies end, or doing both could lower costs for patients.

Finally, create a public option. Insurance companies have left some exchanges, leaving some counties with few choices. A government-run insurance plan could increase competition with private coverage. It also would impose price discipline on health systems and help keep premiums down.

Some parts of our state are dominated by a handful of healthcare systems. Because patients have limited choices, unless they drive anhour or longer for care, the health care systems have no incentive to lower the prices they charge insurance plans. A public option with larger market power could be in a better position to negotiate prices with these systems.

Congress is right towant to fix what’s wrong with the Affordable Care Act. But abolishing it— particularly without a plan in place with which to replace it— is incredibly shortsighted and willhurt more Americans than it will help. Americans do not want to lose their health care gains, nor should they.

BBB The patient with the heart attack did not return for his follow-up visit with me. I hope he does. We need to check that he is up to date with his routine screening tests and vaccines. Because of the ACA, those services are free. Nguyen is a family physician who works in Sugar Land. She is a member of the National Physicians Alliance, a Washington, D.C.-based nonprofit organization whose motto is “patients over profit, profession over privilege.”