Changes needed in our health­care sys­tem, but we can’t re­vert to life be­fore the ACA

Modern Healthcare - - COMMENT - By An­nette Walker

Ev­ery­thing changed for health­care in 2010 with the sign­ing of the Af­ford­able Care Act. While ad­mit­tedly flawed and laden with com­plex­i­ties, the ACA elim­i­nated some of the worst prac­tices in the in­sur­ance in­dus­try.

These in­cluded pol­icy re­fusals for those with pre-ex­ist­ing con­di­tions, pol­icy can­cel­la­tions on tech­ni­cal­i­ties when ill­ness ap­peared im­mi­nent, an­nual and life­time cov­er­age caps and no sup­port for young adults just start­ing out in their ca­reers. But we can­not for­get the big­gest ben­e­fit—in­sur­ing 20 mil­lion peo­ple who could not pre­vi­ously af­ford cov­er­age.

At St. Joseph Health, the im­pact was pal­pa­ble. Our emer­gency rooms ini­tially burst at the seams as peo­ple who had never en­joyed cov­er­age sought im­me­di­ate med­i­cal care. This in­tense de­mand came be­cause so many had gone with­out care for so long. But we learned from this and be­gan guid­ing many of these pa­tients to pri­ma­rycare physi­cians and to­ward more pre­ven­tive health mea­sures. It wasn’t per­fect and there were chal­lenges, but we saw fewer in­di­vid­u­als hav­ing to pay out of pocket, and it was clear many were be­ing helped.

Our health sys­tem also re­sponded by con­tin­u­ing to pro­vide char­ity care. None of that stopped with the ACA—in fact, we ac­tu­ally ac­cel­er­ated and ex­panded our ef­forts. Guided by our founders, the Sis­ters of St. Joseph of Or­ange, St. Joseph Health still sup­ports many as­pects of com­mu­nity need.

Through­out the era of the ACA, we have re­mained a na­tional leader in com­mu­nity ben­e­fit, and in 2016, we came to­gether with an­other faith­based sys­tem known for its char­ity care—Prov­i­dence Health & Ser­vices. To­gether, as Prov­i­dence St. Joseph Health, we are fo­cus­ing on more op­por­tu­ni­ties to pro­vide for our com­mu­ni­ties, es­pe­cially the poor and vul­ner­a­ble

How­ever, as lead­ers in char­ity fund­ing, we can un­equiv­o­cally state that we can­not pro­vide for all our com­mu­ni­ties’ health­care needs on our own. We can­not—and Amer­ica can­not—go back again to life be­fore ev­ery­thing changed in 2010. Yes, Oba­macare isn’t per­fect, but it can­not be re­pealed with­out an ad­e­quate re­place­ment plan.

While we are heart­ened that cer­tain el­e­ments of Oba­macare are re­tained in the re­place­ment plan in­tro­duced in the House, there are still many con­cerns. Un­der the Amer­i­can Health Care Act, mil­lions of peo­ple would trag­i­cally lose ac­cess to cov­er­age and much needed health­care. A re­cent anal­y­sis by Stan­dard & Poor’s found about 6 mil­lion to 10 mil­lion peo­ple will lose health in­sur­ance un­der this re­place­ment leg­is­la­tion, in­clud­ing 2 mil­lion to 4 mil­lion cur­rently en­rolled in the in­di­vid­ual health in­sur­ance mar­ket, and 4 mil­lion to 6 mil­lion cur­rently en­rolled in Med­i­caid. Pro­jected cov­er­age losses are even higher ac­cord­ing to an anal­y­sis by the non­par­ti­san Con­gres­sional Bud­get Of­fice.

We must also con­sider the im­por­tance of men­tal health­care. Be­gin­ning in 2020, the pro­posed re­place­ment plan not only phases out Oba­macare’s Med­i­caid ex­pan­sion, it does away with base­line men­tal health cov­er­age re­quire­ments. This change would mean cer­tain Med­i­caid re­cip­i­ents would no longer get men­tal health and sub­stance-abuse cov­er­age pro­vided un­der the ACA, or it would give states the abil­ity to make cov­er­age de­ci­sions.

Con­sid­er­ing the strides that have been made in rec­og­niz­ing the im­por­tance of ad­dress­ing men­tal health dis­or­ders in our coun­try, this is a ma­jor con­cern, es­pe­cially for the most vul­ner­a­ble among us who are al­ready lack­ing ac­cess to men­tal health care.

Prov­i­dence St. Joseph Health’s faith-based val­ues guide us to take care of our com­mu­nity se­ri­ously. We join our col­leagues around the na­tion to em­pha­size car­ing for those most in need. But you can’t ex­pect us to do it all with­out val­ue­sori­ented pol­i­cy­mak­ers who will part­ner with us.

To­gether, we can fix what was wrong with health­care and we can make things bet­ter. To any part­ner who wants to work with us and other health­care sys­tems across the coun­try, we are ready and will­ing to roll up our sleeves with you. A health­ier na­tion must be our goal and pro­vid­ing eas­ier ac­cess to care is im­per­a­tive.

In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed?

modernhealth­care.com/op-ed. View guide­lines at Send drafts to As­sis­tant Man­ag­ing Ed­i­tor David May

dmay@modernhealth­care.com. at

An­nette Walker is pres­i­dent of strat­egy for Prov­i­dence St. Joseph Health based in Ren­ton, Wash. and chief ex­ec­u­tive of St. Joseph Health in Irvine, Calif.

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