Don’t let the current hubbub and steady stream of misinformation from Washington distract you from reality. The Affordable Care Act, also known as Obama Care, is working and will not be done in by the recent tax bill.
Medicaid continues to expand, increasing the numbers insured. Tax credits will hold premiums steady for the majority of Americans. Young adults can continue to remain on their parents’ insurance until they turn 26. Those with pre-existing conditions cannot be denied coverage. Premiums will not depend on health status. There are also safeguards in place to penalize insurers who cherry pick and look to insure only those in good health. (Timothy Jost, Health Affairs Blog. “The Tax Bill and the Individual Mandate: What Happened and What Does it Mean?” Dec. 20, 2017 healthaffairs.org/do/10.1377/hblog20171220.323429/full/)
While expanded coverage, tax supports, and safeguards to avoid cherry-picking are all vital, they do nothing to address the true drivers of health care costs: unnecessary treatment and the underutilization of preventative care. Add overpriced drugs and these three problems make up more than a third of healthcare spending in the U.S.
Despite the mixed grade I give the ACA – let’s call it a C+ – Vermont, empowered by the flexibility that the ACA has afforded, is doing the right thing to move the needle on cost and quality forward. The state embarked on an ambitious plan to step away from fee-for-service to value based care.
After years of provider and system turbulence, Vermont has settled on a single accountable care organization, One Care Vermont that has been working to bring together providers in both the medical and community-based organizations to provide quality, integrated care.
Additionally, recent bills S.53 and H.248, propose a publicly funded health plan to provide primary care for all. These bills recognize we still have Vermonters who are underinsured and are discouraged from seeking necessary treatment due to financial barriers. Equal and better access, despite financial situation, means better preventative care and less reliance on costly emergency use visits.
VT Digger reported recently that both bills were received enthusiastically despite the known funding challenges (Mike Faher. VT Digger. “Advocates Press for Universal Primary Care,” Jan. 24, 2018).
Ten years ago when I owned a home-care company, I watched a doctor chastise my 87-year-old, agoraphobic client for not having had a mammogram in over a decade. Madeline struggled to leave her home due to age, infirmity and high anxiety. She was of the generation that her doctor’s word was equivalent to the word of God and she reluctantly agreed to a mammogram. The process was a nightmare for Madeline and when they discovered lumps, she was sucked into a miserable vortex of tests and uncertainty. In the end, Madeline died of a slow growing leukemia.
If only Madeline’s doctor had approached her care more holistically and had a conversation about advanced directives, discussing goals for maintaining independence, dignity and comfort, Madeline’s last year of life would have been vastly different. Today, Vermont’s push towards value-based care, allows for these crucial conversations.
Expanding primary care as basic necessity of life is critical as primary care doctors are often the entry point to diagnosing illness and disease.
I think about my mother who was running a food manufacturing business when she was diagnosed with breast cancer. She was 54 years old and had no relationship with a primary care doctor. As a result, she had no guidance connecting her to the care she would need. She was one of the underinsured. While her cancer was cured, the cost and effort crippled her business and finances. She lost everything, including the farmhouse that had been in our family for over 200 years.
Despite the current and chaotic political climate, the nation is on the right track with the ACA and Vermont is leading the pack. Moving away from fee-for-service to value-based and universal primary care will only work if we have strong leadership by the governor and the legislature to further ensure the success of the Affordable Care Act’s mission – expanded access, preventive care, and cost controls so the country will not be bankrupt for future generations.