Ev­ery­one agrees the ACA isn’t per­fect, but let’s ‘fix and in­no­vate,’ not ‘re­peal and re­place’

Modern Healthcare - - COMMENT - By Dr. Bruce Siegel In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at mod­ern­health­care.com/op-ed. Send drafts to As­sis­tant Man­ag­ing Edi­tor David May at dmay@mod­ern­health­care.com.

The House Repub­li­cans’ cam­paign to re­peal the Af­ford­able Care Act and shrink Med­i­caid fund­ing has pro­duced a lot of drama—and an un­ex­pected re­al­iza­tion for re­peal pro­po­nents: Peo­ple like the ACA. And they’re pretty fond of Med­i­caid, too.

A re­cent Gallup sur­vey found a ma­jor­ity of Amer­i­cans—55%—sup­port the ACA, and 41% op­pose it. Those num­bers were flipped just two months ago, sug­gest­ing Amer­i­cans in­creas­ingly un­der­stand the law’s ben­e­fits and what’s at stake un­der the GOP’s plan, the Amer­i­can Health Care Act, which the House lead­er­ship has placed on hold. By con­trast, only 17% of Amer­i­cans sup­port the AHCA.

Mean­while, even pol­i­cy­mak­ers rarely in Med­i­caid’s cor­ner have found new love for it af­ter see­ing Repub­li­cans tar­get the pro­gram with $900 bil­lion in cuts over 10 years. Kansas law­mak­ers, for ex­am­ple, moved quickly to ap­prove Med­i­caid ex­pan­sion for that red state af­ter the AHCA sput­tered to a halt (the gov­er­nor later ve­toed the bill). Other con­ser­va­tive law­mak­ers have ex­pressed alarm over the AHCA’s with­er­ing Med­i­caid cuts.

This emerg­ing na­tional recog­ni­tion that, as Joni Mitchell sang, “You don't know what you've got till it’s gone,” should come as a warn­ing to even the most ar­dent ACA de­trac­tors that “fix and in­no­vate” might be prefer­able to “re­peal and re­place.”

In Wash­ing­ton, where ACA par­ti­sans dis­agree on nearly ev­ery­thing, an of­ten-over­looked truth is that both sides agree on one thing: The ACA isn’t per­fect. Even Se­nate Mi­nor­ity Leader Chuck Schumer has pledged to work with Repub­li­cans to fix the 2010 law if they take re­peal off the table. Most ob­servers also agree on needed re­pairs, with sta­bi­liz­ing the in­sur­ance mar­ket­places and stop­ping dis­pro­por­tion­ate-share hospi­tal cuts high on the list.

Law­mak­ers should set aside pol­i­tics and seize on these points of con­sen­sus to move our na­tion and health­care for­ward. This means not only fix­ing the ACA, but also cap­i­tal­iz­ing on Med­i­caid’s flex­i­bil­ity as a pow­er­ful lever for in­no­va­tion. Be­yond pro­vid­ing health­care for vul­ner­a­ble Amer­i­cans, Med­i­caid serves as a lab­o­ra­tory for novel ad­vances in care through var­i­ous mech­a­nisms for flex­i­ble pro­gram de­sign.

Es­sen­tial hospi­tals— those that fill a safety-net role—have led the march for in­no­va­tion us­ing the lat­i­tude Med­i­caid pro­vides, and ex­am­ples are nu­mer­ous among our mem­bers.

Un­der the Texas Health­care Trans­for­ma­tion Waiver, UTMB Health in Galve­ston pro­vides preg­nancy test­ing, pre­na­tal care, cer­vi­cal can­cer screen­ings and other ser­vices at 13 Re­gional Ma­ter­nal and Child Health Pro­gram clin­ics across the state—in­clud­ing in the Rio Grande Val­ley, which has some of the state’s high­est cer­vi­cal can­cer death rates.

Jer­sey City (N.J.) Med­i­cal Cen­ter uses fund­ing un­der the state’s de­liv­ery sys­tem re­form in­cen­tive pay­ment waiver for pe­di­atric asthma case man­age­ment, work- ing out­side the hospi­tal’s walls through school-based in­ter­ven­tions and “en­vi­ron­men­tal house calls” to as­sess and re­me­di­ate air qual­ity and al­ler­gen is­sues.

A great tragedy of the re­peal plan’s dra­co­nian cuts to Med­i­caid would be an al­most cer­tain end to the mo­men­tum to­ward in­no­va­tions like these. This is an un­ac­cept­able fu­ture for a pro­gram that has im­proved and evolved for more than 50 years to keep af­ford­able health­care avail­able to sin­gle moth­ers, chil­dren, the dis­abled, low-in­come se­niors and many oth­ers.

Seema Verma, the new CMS ad­min­is­tra­tor, could prove an ally in pro­tect­ing the progress we’ve made through Med­i­caid flex­i­bil­ity. Her ex­pe­ri­ence de­sign­ing the Healthy In­di­ana Plan and help­ing other states sim­i­larly use waivers as a path to Med­i­caid ex­pan­sion gives her a per­spec­tive we hope trans­lates into on­go­ing CMS sup­port. En­cour­ag­ing, too, is her ex­pe­ri­ence at an es­sen­tial hospi­tal, Eske­nazi Health in In­di­anapo­lis. We look for­ward to part­ner­ing with her to lever­age our mem­bers’ ex­pe­ri­ence.

It’s not too late to step back from the edge. Rather than re­sume the push for­ward with a plan that would leave 24 mil­lion more Amer­i­cans unin­sured and rip a hole in the safety net, law­mak­ers must find com­mon ground to fix what’s bro­ken, build on what works, and put the health and pros­per­ity of pa­tients and com­mu­ni­ties first.

Dr. Bruce Siegel is pres­i­dent and CEO of Amer­ica’s Es­sen­tial Hospi­tals, which rep­re­sents about 300 hospi­tals na­tion­wide.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.