Dear Mr. Alexander:
Thank you for shining the spotlight on the Affordable Care Act in your recent Veiwpoint column (Not so affordable health care, March 1). I love the Valley News and always find your columns amusing if not informative and thought provoking. Your column on the ACA however really does a disservice to your readers and misses an opportunity to encourage individuals on the fence about signing up for health insurance to do so. (Later in this piece I will provide the information on how to do just that.) Your perception about the efficacy of the new health care reform law appears to be more informed by FOX News than by the facts on the ground. Let’s review some of your questions and assertions and compare them to reality.
We’ll start with your question: “Looking back, one has to wonder how could we ever justify making such a major change to the American health care system, clearly seen as the best in the world.” The American health care system by most measures is nowhere near the “best in the world”, although it is clearly the most expensive. According to the World Health Organization the U.S. ranks only 37th among countries with advanced economies for overall population health. Research published in the New England Journal of Medicine in 2010 found that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy. Bloomberg.com last year found that the US healthcare system in terms of efficiency ranked 46th out of 48 advanced economy nations. We can do better than this and the Affordable Care Act puts in place powerful incentives for our health system to improve. There are many other factors that fueled the long over-due reform of our health system, to include:
•Health spending climbing at twice the rate of inflation;
•Health insurance policies that could be cancelled when you got sick;
•Health insurance denied due to a preexisting condition;
•Health insurance policies that lacked coverage for mental health and substance abuse services;
•An estimated 57 percent of personal bankruptcies attributed to medical expenses; and,
•47.3 million Americans between the ages of 0 and 64 without any health insurance coverage at all.
These facts are the symptoms of a very sick health care system…not one that is the envy of the world.
Now that we have reminded readers why we needed health reform let’s address a few of your other assertions about the ACA. The ACA is “destroying the economy and millions of American families have lost their health insurance coverage and many more will be unable to afford coverage under the plan”.
Where on earth are you finding data that the ACA is destroying the economy? On the contrary since the ACA was signed into law the economy has been in a slow recovery. Recovery in my book is the opposite of “destroy”. (Mr. Alexander, such hyperbole risks undercutting your credibility with thoughtful readers.) You are correct that over 3 million Americans have lost their previous policies. This has generally been attributed to the insurance companies changing the terms of the policy and thus voiding the grandfather status granted in the ACA. This was the act of the insurance companies and not the President. Research commissioned by the Associated Press found that most of the individuals who lost policies purchased plans directly from insurers, rather than through a workplace. The reason for the cancellations: their plans changed since the signing of the new healthcare law. On the other hand as of the end of February over 4 million Americans have enrolled in health insurance plans either through the exchange or through the expansion of Medicaid eligibility. In New York State alone over 500,000 individuals and families are now enrolled using the exchange. Yes there were terrible problems with the roll out of the Federal website but they have been fixed for the most part and the sites are working. New York State’s site has been running smoothly since December 1st.
What about the increase in cost to of policies since the ACA went into effect? You mentioned Excellus, an insurer that my company also uses. You mentioned that you are anticipating a double digit increase in premiums this year. You failed to mention what the increases have been over the past 5 to 10 years. I will share that since 2005 our small community rated non-profit company experienced increases of 12 to 17 percent every year. This year is the first where we could shop on the exchange compare apples to apples in available policies, and find a comparable policy at a 9 percent increase. We think that is progress and we anticipate further reductions in percentage increase next year. That being said, if you really want to assign blame for your company’s Excellus premium increases start with Excellus. According to the Syracuse Post Standard’s Syracuse.com website, as a not for profit organization, Excellus posted a $106 million profit in 2012 and paid their former chief executive officer a tidy $3-plus million pay check (and over $5 million in 2011). The new CEO is making $1.6 million and sixty-eight Excellus employees earn more than $200,000 annually. This is a hefty payroll that needs to be supported by hefty premiums.
You seemed to take exception to the first lady’s characterization of individuals who do not sign up for health insurance as “knuckleheads”. Let’s drill down a bit and perhaps we can understand her frustration with these folks (knuckleheads may be too mild). As a fiscal conservative I think that people should be accountable for their own actions and choices. On the other hand as a humanitarian and a registered nurse I support the social contract where in when someone is sick or injured they are able to receive care when they show up at the emergency room. The problem arises when an uninsured person (who we will call Max) shows up sick or injured and either cannot pay because he is broke, or refuses to pay. So who does pay?
•Who pays when Max calls for an ambulance and the rescue squad cannot bill insurance?
•Who pays when Max is delivered to the Emergency Room?
•Who pays when Max is admitted to the hospital and needs life saving surgery?
•Who pays when Max is then admitted to a skilled nursing facility because he has no insurance for homecare services and no family to help out?
•Who pays when Max misses work for an extended period?
Who Pays? You and I both know who pays…you and me. We pay through higher taxes, we pay through higher health insurance premiums, and as an economy we pay in lost productivity. This is how our broken system has worked for decades. The Affordable Care Act fundamentally changes this equation… and fiscal conservatives should be doing everything in their power to encourage even knuckleheads to sign up for coverage.
Here’s how: Health insurance navigators can assist with enrollment through the exchange and can be contacted: in Hamilton, Warren and Washington Counties by calling 866 708 2912. In Clinton, Essex and Franklin Counties call 866 872 3740. Or Visit NYState of Health at nystateofhealth.ny.gov
Finally what about those huge deficits attributed to the ACA? Again the actual facts seem to contradict the predictions. 2012 and 2013 data (2 1/2 years into the ACA) indicates that medical prices are rising at their slowest pace in a half century with overall spending on healthcare rising less than 4 percent in 2012, less than half the rate of a decade ago, independent economists at the U.S. Centers for Medicare and Medicaid Services recently concluded. The prices paid for medical care in July 2013 rose just 1 percent from a year earlier, the slowest annual rate of growth since the early 1960s, according to Commerce Department data. Health-care increases now trail overall inflation, which itself has been historically slow in recent years. The trend, if continued, has big implications for the government’s finances because health-care costs are the biggest long-term driver of the federal deficit.
As I mentioned earlier the ACA places strong incentives for health care providers to reduce cost while increasing access to, and quality of, care. New York State under the leadership of Governor Cuomo and Health Commissioner Shah are using the incentives in the ACA to create and environment which strengthens rural health care here in the North Country. The recently established North Country Health System Redesign Commission will soon make recommendations which will improve access to primary care services, integrate behavioral health and sure up the system of acute and long term care services we need. Forward thinking organizations such as the Adirondack Health Institute have already demonstrated better care at lower cost through the all payer Patient Centered Medical Home pilot project and the Medicaid Health Home program.
As we look to the future, will changes need be made to our current way of delivering health care services? Yes of course…they need to be. Will the system look like it does now? No it must change to be sustainable. Will we all be asked to be more accountable for our own well being and health? Yes, we will all have some level of financial risk (skin in the game) and we will be more aware of the lifestyle choices we all make and how they affect our health and well being.
Barry B. Brogan, RN, MAPP
Mr. Brogan is the Executive Director of one of the NYS Department of Health’s 35 Rural Health Networks, he is a former EMT and serves as a hospital trustee in Saranac Lake.