By Brian Nolan
Prominent in your freezer you may very well have something called “Half Baked.” What I am thinking of is a treat from our famous ice cream maker. There is also something else we all have in our lives that is “half-baked,” and that is our current health care system under the Affordable Care Act (ACA).
The recipe and the ingredients started out in 2009 in the Washington, DC, test kitchen and were churned up by Congress and chef Obama. The label on this package promised that inside we would find many things that we would like, or are good for us – gobs of preventive care, access for the uninsured, a reduction in the federal deficit over 10 years and no longer a lifetime cap on our health care claims. There were a lot of great treats in the ACA when it was rolled out, but several major ingredients were missed, which has caused our current health care reform to be too much of a plain vanilla.
Seven years later, this recipe still isn’t quite right. What is right is that 31 million more Americans have health insurance, mostly through Medicaid expansions in participating states. The ACA requires that our health insurance plans have gobs more preventive care for children and adults, including no-cost preventive services and tests, such as routine physicals, testing and vaccinations. Coverage for children is extended until age 26.
The ACA provides for standardized levels of health coverage through the exchanges – platinum, gold, silver and bronze (like half gallon, quart, pint and scoop), guaranteed issue, standard out-of-pocket caps, premium subsidies and advance premium tax credits to help citizens based on a factor of the federal poverty limit. A few elements of the ACA have soured some folks, including the business mandate for employers with more than 50 employees, individual mandates and extensive reporting requirements.
So, a lot of good things have been mixed into our health care system to help our citizens to have coverage through Medicaid or to choose and purchase a standardized health insurance coverage option through an exchange, or with subsidies, and this coverage has no limit.
But, although a great deal of good has come from it, the ACA “as is,” is half baked.
Now it looks like we’re having a recall on the ACA, because some things aren’t as tasty in our bowls as they were in the test kitchen. This may include a repeal and replacement of the coverage mandates, tax credits and subsidies, the Medicaid expansion and the Cadillac tax. The Patient Freedom Act was introduced January 23, which also provides latitude to states to choose among a reinstatement of the ACA, adopting a state market-based alternative or a more flexible state-based option.
So, although the ACA is half-baked right now, our president and Congress have the opportunity to develop a new recipe. Experts say that some of the ACA will stick, like the ban on underwriting restrictions, the removal of the benefits caps, preventive care services and extended coverage of children until age 26.
Our new chef is looking at testing out an expansion of health savings accounts, Medicaid block grants to states, going back to high risk pools and, in fact, just about “everything but the kitchen sink.”
We are not yet hearing about a replacement recipe that will aim to improve the quality of care, nor a recipe of plans to provide quality care at a lower cost. The most successful health care models in the U.S. and other countries have a demonstrated integration of services and collaboration among all of our health care providers.
Most commercial services or products have a strong integration in order to produce an excellent product, such as coordination of milking, tank truck deliveries, mixing, freezing, packaging and shipping to a grocery store. Yet, our country is lacking in coordination of care and collaboration of providers. We need to see these goals and standards of integration and collaboration in our health care delivery system if our country is to achieve a super-premium health care system for our citizens. This will make a “swirled of difference.”
We have been reading every few days about the repeal of the ACA. A great deal of good has come from the ACA, including preventive care and health care access for 31 million of our citizens. We need to recognize what’s good about the ACA and where it falls short. Now that access has increased, our political leaders must bring forth new options to ensure higher quality and lower cost care.
We are all in this together, as we work toward realizing the American dream of solid health care for our country.
Brian Nolan lives Fayston.