Editor’s note: This commentary is by Vy Cao, of Essex, who is a graduate student in the master of public health program at the University of Vermont.
[I]t is no surprise that after 100 years of health care reform, the United States still fails to give its people universal health care. In such a complex health care system, there are many stakeholders with competing priorities. As we spiral through the next four years of a new presidential administration, many changes to the health care system will follow. One of the major changes already seen is the repeal of the Affordable Care Act (ACA), to which the GOP offers no clear alternative. So, what will the repeal mean for our nation?
Without a practical replacement, cuts in Medicaid funding and higher health care costs are likely. Sens. Bill Cassidy, R-La., and Susan Collins, R-Maine, proposed the Patient Freedom Act of 2017 which offers three options that will cost our nation more than the ACA. By all means, the ACA is far from perfect, but it was a good attempt to offer quality, affordable and easily accessed health care. Overall, I would give it a grade of C, but the areas of access, cost and quality should be evaluated individually.
There has yet to be an administration that can provide us with a perfect answer but the ACA was a reasonable approach.
How did access expand with the ACA? Uninsured numbers dropped by 20 million, of which 13 million were due to the Medicaid expansion. New laws required insurance plans to cover essential health benefits for treatment of mental health, addiction and chronic diseases. People could not be denied coverage for pre-existing conditions. The age children could remain on their parents’ policy was increased to 26. Here in Vermont, former Gov. Peter Shumlin credits the ACA for the 50 percent decrease in the uninsured rate, making it the second lowest in the nation. Even with all these positive changes, health care was still unaffordable for many because of high premiums and deductibles. As Vermont Sen. Bernie Sanders stated, “Having access to does not mean they are guaranteed health care.” I would give the access expansion a B.
What did cost look like with the ACA? The financial burden was redistributed to other stakeholders in the system such as pharmacies, hospitals, higher income families, businesses and insurance companies. These groups opposed this because they would pay more but it would save our nation an enormous amount if everyone had health care. Is it not our obligation as humans, to help others in need, especially when lives are at stake? The ACA emphasized wellness and prevention which would save money overall. In 2015, service costs only rose by 0.5 percent, compared to the 4 percent from previous years. A downside to the ACA was that it did not address the unnecessary expenses, almost 25 percent of health expenditures gained little value. Much of the expenses were administrative since the ACA imposed 190 million additional hours of paperwork. I would give the effort on cost a C.
How has quality of care changed with the ACA? The health care coverage expansion came with a price. Patients lost their previous primary providers because insurance would only cover in-network physicians. The large influx of new patients overwhelmed the decreasing health care workforce, meaning more stress and instability for health professionals. Patient-provider time was shortened to accommodate for the amount of new patients. Many people did not apply because of the poor performance of health exchange systems and the complicated sign up portals. I would give the quality of care a D.
The ACA marked a monumental reform in our health care system, one that holds potential but still needs improvement. In a nation where profit margins trump people’s health, this proves to be a challenge. Policy makers will need to ensure that our money goes into health care and not to profit. They also need to account for everyone that the ACA did not such as people with hardships, refugees and permanent residents. There has yet to be an administration that can provide us with a perfect answer but the ACA was a reasonable approach. Reforms will always be a work in progress conforming to the political, social, and economical trends. Now is the time to voice your opinion to protect necessary components of the ACA while promoting solutions to fix the flaws. Your access to health care, something that should be a basic right, depends on it.
