After the Congressional Budget Office released its assessment of the American Health Care Act predicting an increase of 24 million Americans without health insurance by 2026, there was an interesting response from Senate Republicans. They suggested certain changes to the bill which, they said, would increase the chances of it being approved by the Senate. First, they want to see lower insurance costs for the poorer, older Americans and second an increase in funding for states with higher populations of hard to insure people.
The Governors of most all of the states, including Republican Governors voiced their anxiety about dealing with the bill’s proposed roll back on Medicaid expansion which would leave the poor with fewer dollars.
Because the bill is being pushed towards votes so quickly, what is obviously missing is a reasoned, articulated and fulsome analyses of the various components of the law, explained in plain english and supported through real data as well as anecdotal examples. The reason this type of communication is so important is that Congress, healthcare and insurance communities and the public at large must come to know this law. This means that thoughtful modeling and clear explanations are key. It has not happened.
He is an example of the need for modeling what will happen: Assuming that 20 plus million Americans end up uninsured as anticipated. It is likely that a significant percentage of those individuals will seek out care at emergency rooms across the country, just as millions did before the passage of the Affordable Care Act. Those services are paid for jointly through Medicaid by the states and the federal government.. However, emergency rooms were not modeled to carry these kinds of loads and the results are heavily damaging to the healthcare system generally. First, the ER’s tend to lose money in the business model because the rates paid by Medicaid are extremely low and yet the services required can be quite complex and expensive. In addition, the patients lose because they do not receive the continuity of care and varied services offered by primary care physicians who frequently play a critical role in quarterbacking care when it is complex. The primary care physician for example makes recommendations for experts for chronic conditions or emergencies which require major diagnostics or surgery. This is not generally what ER physicians do because they do not have adequate information on the patients conditions over time in order to really know what is needed.
Add to this, the fact that the healthcare bill in its present form, contemplates reducing the present rate of increase in Medicaid funds to the states for the poor and disabled.
The secondary detriments to the healthcare system, which are long term and profound relates on the quality of life of the emergency room physicians, who simply get burnt out because of the sheer volume of patients coming through the door and who cannot be turned away. The medical community has lost legions of fine doctors who simply choose not the practice medicine under severe pressure in circumstances which do not allow them to do their job well and provide quality care to patients.
Given the complexity of creating this new law, designed to enable more Americans to receive health insurance and which will reduce healthcare costs, would it not be more reasonable to slow down a bit and think through what we are about to do? The fear it seems that if we slow down and consider the model, we will have Obama Care as it stood before the election. Surely there are significant deficiencies in that law but wouldn’t it be better to try to fix the more significant problems and take more time to create the alternative? What is at stake is a free-fall costing our economy billions and our care-givers their quality of their personal and professional lives. Why don’t we just change the name from Obama Care to interim care?
Jeffrey Newman represents whistleblowers in Medicare fraud cases