In­stead of im­prov­ing health­care cov­er­age, Se­nate bill would take us back to square one

Modern Healthcare - - COMMENT - By Dr. Rod Hochman

Ial­ways con­sid­ered the Af­ford­able Care Act to be more about health in­sur­ance re­form than health­care de­liv­ery re­form. While far from per­fect, it has ex­panded cov­er­age to mil­lions of Amer­i­cans who were pre­vi­ously un­able to af­ford health in­sur­ance.

It also pro­tects in­di­vid­u­als with pre-ex­ist­ing con­di­tions and en­sures that ev­ery health plan of­fers con­sis­tent es­sen­tial ben­e­fits.

Seven years later, I thought the na­tional de­bate would fi­nally shift from how we pay for health­care to how we de­liver it. By now, I thought the con­ver­sa­tion would be about mak­ing Amer­i­cans the health­i­est peo­ple in the world and de­vel­op­ing a health­care sys­tem that’s af­ford­able, high qual­ity and con­ve­nient for ev­ery­one.

In­stead, we’re back to square one.

Rather than talk­ing about how to ad­vance the U.S. health­care sys­tem, our na­tion’s po­lit­i­cal lead­ers are talk­ing about tak­ing it back­wards. The Se­nate Repub­li­cans’ Bet­ter Care and Rec­on­cil­i­a­tion Act is es­sen­tially a tax plan, not a health­care plan. It proposes cut­ting taxes for the wealth­i­est Amer­i­cans by tak­ing $772 bil­lion out of Med­i­caid over 10 years. This means 22 mil­lion in­di­vid­u­als would lose health cov­er­age, ac­cord­ing to an anal­y­sis by the Con­gres­sional Bud­get Of­fice.

The pro­posal does not just roll back the ACA, it takes us all the way back to pre-1965 when Med­i­caid first be­gan. In other words, the bill would evis­cer­ate Med­i­caid.

As a na­tion, de­mo­graph­ics in­di­cate our pop­u­la­tion is get­ting older and poorer. We need to pro­tect the health of th­ese in­di­vid­u­als, and Med­i­caid is a vi­tal safety net that plays that role. Nearly all of us have loved ones or know some­one who de­pends on Med­i­caid for their health­care.

Med­i­caid sup­ports 65% of all se­niors in nurs­ing homes. Th­ese are our par­ents and grand­par­ents. The pro­posed “caps” don’t ad­just for ag­ing pop­u­la­tions, which means the old­est, most-vul­ner­a­ble mem­bers of so­ci­ety would be hard­est hit.

In ad­di­tion, 50% of all births are cov­ered by Med­i­caid. Imag­ine if th­ese new­borns didn’t have ac­cess to care. That would have a pro­found ef­fect on their long-term health. If chil­dren don’t have good care from the get-go, their cost of care be­comes more ex­pen­sive over time, and their abil­ity to func­tion fully in so­ci­ety could be com­pro­mised.

Med­i­caid is also a life­line for other vul­ner­a­ble pop­u­la­tions, in­clud­ing work­ing peo­ple who don’t have the op­tion of em­ployer-spon­sored health ben­e­fits and don’t make enough money to af­ford pri­vate in­sur­ance. Pulling the rug out from un­der mil­lions of in­di­vid­u­als—many who now have cov­er­age and care for the first time—is not the an­swer.

Rolling back Med­i­caid also means a sig­nif­i­cant loss of cov­er­age for men­tal health and sub­stance abuse treat­ment. The opi­oid cri­sis alone is sweep­ing the na­tion, war­rant­ing a state of emer­gency. We are at a point where 23 vet­er­ans a day are com­mit­ting sui­cide, and 39% of all dis­ease burden is re­lated to some form of men­tal ill­ness. Med­i­caid is our na­tion’s largest payer of men­tal health ser­vices. It’s a trav­esty to con­sider cut­ting back cov­er­age for men­tal health at a time when it is more ur­gent than ever.

Med­i­caid cer­tainly has its flaws,

and there is more that we can do on the provider side to im­prove the way we care for this pop­u­la­tion. For ex­am­ple, ex­pand­ing ac­cess to pri­mary care for Med­i­caid en­rollees is one way we can iden­tify health is­sues early and avoid more se­ri­ous, costly care down the road. Like­wise, of­fer­ing bet­ter, more-co­or­di­nated men­tal health re­sources is also crit­i­cal to cre­at­ing healthier com­mu­ni­ties while low­er­ing over­all costs in the long run.

I would much rather be talk­ing about in­no­va­tive so­lu­tions for im­prov­ing Med­i­caid in­stead of dis­man­tling it. If the lead­ers of our Congress would work to­gether on a bill that aimed to make our health sys­tem bet­ter, I be­lieve many Amer­i­cans would wel­come the col­lab­o­ra­tion and find it re­fresh­ing. It’s time to change the con­ver­sa­tion and work to­ward real so­lu­tions, to­gether.

In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at mod­ern­health­ Send drafts to As­sis­tant Man­ag­ing Edi­tor David May at dmay@mod­ern­health­

Dr. Rod Hochman is pres­i­dent and CEO of Prov­i­dence St. Joseph Health.

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