Replacing or Improving ACA Likely Will Be Major Challenge
The ACA isn’t perfect, but it’s possible that repealing it could create even more issues for patients and providers.
“The ACA was funded on the backs of the wealthy with a new Medicare tax, as well as a tax on the device manufacturing and pharmaceutical companies,” says Keith S. Naunheim, MD, professor of surgery at Saint Louis University School of Medicine in St. Louis.
“In effect, it was an income redistribution plan,” he explains. “It was not necessarily a bad thing, but the whole idea was to get a significant amount of the uninsured on some sort of insurance plan, whether it’s Medicaid or a government-subsidized plan, and somebody had to pay for that.”
It remains unclear what will happen to the taxes that subsidize the ACA, although some suggest these will be cut, Naunheim notes. It’s clear the ACA ran into some problems in meeting its ambitious goals.
“I think the Obama administration really could not appreciate the complexity of the care needed for those who previously had been uninsured,” says Frank Opelka, MD, FACS, medical director of quality and health policy for the American College of Surgeons.
“By insuring that population without any real actuarial data, we took on a liability that, I think, surprised everyone,” he explains. “Number two, we did so in such a way that we dispersed the risk on many healthy young people who had no real means to absorb that kind of expense.”
Providing healthcare to low-income people is a good idea and the right thing to do, but the ACA’s methodology to do so uncovered problems that needed to be addressed, he adds.
Now, the GOP, faced with fulfilling its repeal-and-replace promise, realizes there are no easy solutions.
“They have the same population to consider and the same extraordinary expenses to deliver,” Opelka says. “And we need to reduce the burden on providers because they can’t carry this burden, and we have to reduce the burden on the population in general, and some of this probably will shift to the states.”
If the financial burden of the ACA replacement shifts to the states, there likely will be some states that are fiscally strong enough to absorb the burden and others that cannot, Opelka says.
“Our concern is about all of these patients who need surgical care and whether they have appropriate coverage and access to care,” Opelka says. “Will they have the necessary pre- and post-op care to get the best outcomes? Will our surgeons be able to create sustainable business models to care for these patients without it being an undue burden on the healthcare delivery system?”
These are some of the challenges HHS Secretary Tom Price, MD, and Speaker of the House Paul Ryan face as they construct a solution, he says.
The American College of Surgeons is ready to provide information and education to everyone in government who is working on this issue. “We will be both proactive and reactive, depending on where the Congress goes with the Affordable Care Act and how and where they go with MACRA,” Opelka says. “We’re not taking a position on whether or not to repeal the ACA. We’re letting Congress determine what it wants to do, but if that happens, and they have concerns about a replacement, we will approach that by offering any opportunities to assist them with developing care models that optimally provide for the surgeon and care of the surgical patient.”
Once Congress and President Trump are ready for a dialogue, the American College of Surgeons will be ready, too.
“Our primary focus is on optimal care for the surgical patient and to stabilize the business environment for the surgeon,” Opelka says. “There has been a lot of transformation in the last eight years, and now there is a new administration.”
Surgeons and other physicians have not been immune to the stress and burnout that comes with so much instability and change, including the new regulations and the transition to electronic health records.
“Surgeons love what they do; what burns them out is the level of uncertainty and constant change of regulations, the inability to get into a stable environment,” Opelka says. “They want to get to where they’re not worried about rules and regulations and fraud and can, instead, be focused on providing the best care.”
The ACA isn’t perfect, but it’s possible that repealing it could create even more issues for patients and providers.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.