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