For several decades Americans have agreed that we need a less expensive and more accessible healthcare system. In my experience working as a physician in a county hospital level-one trauma center, I would frequently see patients who delayed seeing a doctor due to financial limitations and thus only sought treatment when their condition reached emergent and sometimes critical levels of severity. These patients did not have access to preventative medicine and suffered from often-treatable illness.
Signed into law in 2010, the Affordable Care Act (ACA) attempts to fix our broken healthcare system, but has been fraught with controversy. After a fumbled launch in 2013 and multiple setbacks, the ACA succeeded in expanding health care to millions of previously uninsured Americans. While it does include provisions that are generally favored, such as coverage of preexisting conditions, it is also widely unpopular. Despite legal challenges, numerous failed attempts to repeal it, and Trump administration policies that weaken it, the ACA is still the law of the land in 2019. The reason the Affordable Care Act is so difficult to repeal is that Americans – and the lawmakers who represent them in Congress — cannot come to a consensus on a better alternative.
The best option is to improve it, not repeal or replace it.
There are reasons not to love the ACA. The law has struggled to live up to its “affordable” moniker because many Americans’ insurance premiums have increased substantially over the years. Enrollment is down, thanks in part to the elimination of the individual mandate, and due to cuts in funding for enrollment outreach and education. Working together to correct these problems should be our goal.
In order to make health care premiums more affordable, we must address the high cost of health care. If more effort were put into providing transparent healthcare pricing, overcharging by hospitals would be significantly reduced. Patients would be able to compare costs and find the best option. The Trump administration’s 2018 rule requiring hospitals to post procedure prices online is a step in the right direction, but doesn’t go far enough because it does not standardize the way hospitals report their data. So far the hospitals have been providing raw unprocessed data which is largely useless to the public. Consumers rarely have the time or medical coding knowledge to sift through massive information tables in order to find the savings hidden within. Comparing prices should be an easy exercise, not a treasure hunt in forbidding terrain.
The most obvious solution to more affordable health-care premiums is increasing the number of “under-utilizers” (young people in good health) in the insured pool. This could be accomplished by extending enrollment periods, increasing outreach to potential enrollees, reinstating the individual mandate that was repealed in 2018, and increasing the tax penalty that incentivizes more healthy people become insured. Relatively healthy people subsidize the health care costs of the indigent and infirm patients. Few of us relish the thought of volunteering to pay more in order for others to pay less, but that is how insurance has always worked. It’s the basis of how all insurance programs are structured.
Elections over the past few years have shown that people feel strongly about the health care issue. But polls show that repealing Obamacare is about as unpopular as the program itself. Overall, parts of the ACA have been — and continue to be — successful. It has resulted in a significant expansion of insurance coverage and is helping move our system from a financing model that pays for the volume or complexity of services and procedures to one that pays for higher-quality care and better long-term outcomes.
When changes to the health care system are proposed, including repealing the ACA, consumers and lawmakers on both sides of the aisle usually favor retaining some of the more popular elements of the law that Americans have come to rely on. This further illustrates the point that the focus should be on improving the ACA rather than again starting from scratch. Otherwise, we will forever continue to agonize and apologize for the sad state of our health care system.
Dr. Jeffery Hawkins is a Family Medicine and Sports Medicine physician in Texas who works in both in the urgent care and private practice settings. Dr. Hawkins’ wife is a dentist, and they have two daughters, ages 6 and 1-and-a-half years old.