It was political theater week in health care. The Republican Congress listened to its grassroots and has presented the president with a bill repealing the Affordable Care Act (ACA). The Democratic president will veto it. Meanwhile, health care reform is still a work in progress.
On Thursday I spent the day attending the State of Reform Health Policy Conference in Seattle working on the shape of that progress. The State of Reform conference events and their companion website provide an open forum for discussions on health care reform. Their conferences strive to bring in speakers to bridge the divide between different players in the health care system and different points of view. Attendees were from all over the state, but definitely skewed to the Puget Sound region.
The morning keynote panel addressed lessons learned from the early years of ACA implementation. One panelist from a large business off-handedly remarked on the difficulties faced by small companies “with only a couple of hundred to a couple of thousand employees.” She would be surprised to learn that 99.7 percent of U.S. businesses have fewer than 100 employees and provide over half of the nation’s jobs.
Another panel discussed emerging health care delivery models. They included walk-in clinics in corner drugstores and a chain of smartphone-dependent primary care clinics located in urban hipster neighborhoods. A panelist mentioned how access to providers is good here in the Northwest, unlike more rural sections of the country. Apparently, Eastern Washington has been moved to elsewhere in the country; she needs to read Shawn Vestal’s Jan. 6 column on the provider shortage in the Inland Northwest.
A regular State of Reform feature is policy discussions by legislators serving on key committees. Rep. Joe Schmick, R-Colfax, serves on the Health Care and Wellness Committee chaired by Rep. Eileen Cody, D-Seattle. Presenting on the Republican Policy Panel, Rep. Schmick shared a long list of issues and trends that will drive future legislation, from mental health care and nursing home payments to drug pricing and unsustainable Medicaid funding.
Rep. Schmick also noted the impact of cost-shifting to consumers in the form of higher out-of-pocket costs. Being insured doesn’t mean being able to afford to use it. During the Q&A session, I asked about plans to address those who are dropping out of the insurance market because of high premiums combined with high deductibles. Rep. Schmick nodded with familiarity. He knows the problems created for the self-employed and small-businesses owners who make up the majority of his constituents.
He took the opportunity as a teachable moment for the largely urban crowd on the importance of Critical Access Hospitals. He described Garfield County, with a single town of 800 and a total population of 2,500. There was an audible gasp from several members of the audience, who apparently had a hard time grasping the concept of a town smaller than Olympia.
I asked the same question to the Democratic Policy Panel. Four puzzled looks. I described the typical profile, and how the Office of the Insurance Commissioner interpretation of the ACA impacted my association health plan and led me to drop insurance coverage. Rep. Cody jumped in with, “You won’t get any sympathy from me on association health plans.” Instead I got a lecture on their supposed evils and no sympathy for being forced out of the insurance market.
The last breakout session included a representative from the Office of the Insurance Commissioner. She first questioned my assertion that there were losers under the ACA. Then she commented there were winners and losers under the old system, and now there are different losers. No sympathy again.
One of those losers is a professional colleague whose premiums for a basic bronze plan tripled this year, even with a $12,000 deductible. He’s dropped health insurance as both unaffordable to purchase and unaffordable to use. Sympathy might be nice, but what we really need is a Legislature and an insurance commissioner who take the new losers seriously. Health care must be semper reformanda – reformed and always reforming.
(Disclaimer: The author is past chairman of the Empire Health Foundation Board of Trustees and attended as one of several participants from the foundation. Views expressed in this column are solely her own.)Contact Sue Lani Madsen at email@example.com
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