Congressional leaders have acknowledged a third defeat in attempting to repeal and replace the Affordable Care Act, but they can still make progress in three key areas of health care facing pressing deadlines.
Federal funding for teaching health centers and the Children’s Health Insurance Program needs to be approved this week, and premiums for the Affordable Care Act also need to be finalized.
The teaching centers, including the one on the campus of WSU-Spokane campus, were created by the Affordable Care Act to help alleviate the nationwide shortage of doctors that is expected to worsen over the next decade. The center on the Spokane campus has 18 residency slots.
Bills in the House and Senate would extend funding. The House bill is sponsored by Rep. Cathy McMorris Rodgers and it would renew funding for three years and would provide more residency slots. The medical school classes at WSU and UW-Gonzaga will need positions like this when those students graduate.
An estimated one-third of all physicians are projected to hit retirement age in the next decade, and the country is not prepared to replace them. According to a Rand Corp. study of Washington state, “The number of rural primary care physicians per capita will decrease by approximately 3.66 per 100,000 by 2025 – a 7 percent reduction from 2013 levels. Meanwhile, “urban areas … will experience a reduction of 4.14 primary care physicians per 100,000 – a 5 percent reduction from 2013 levels.”
A nationwide Association of American Medical Colleges study already pointed out: “If currently underserved populations utilized health care at the same rate as the rest of the population, an additional 40,100 to 96,200 physicians (5 percent to 12 percent) would be needed in 2014.”
So the shortage is already being felt, mostly in rural counties, which struggle to attract and retain physicians. The need for residency slots in Washington state and across the nation is obvious, and is most acute in congressional districts represented by Republicans. So Congress should be extra motivated to act quickly.
The state adopted Cover All Kids a decade ago and it is dependent on the reauthorization of CHIP, which Congress passed in 1997 with bipartisan support. As Frank Chopp, Lisa Brown and Chris Gregoire pointed out in a recent op-ed, “As of 2015, less than 2.6 percent of Washington’s children are uninsured. The law created a single coverage program known as Apple Health for Kids, providing comprehensive coverage, including medical, dental, vision and mental health. Apple Health provides this coverage for more than 840,000 Washington kids, including 66,891 kids in Spokane County.”
There is no planned replacement for CHIP, so Congress has no credible argument for failing to renew it.
As for ACA insurers, they need assurances that Congress will continue support that makes the individual marketplace viable. Without that, premiums could skyrocket or insurers could pull out of markets.
With the Graham-Cassidy distraction behind it, Congress can still resolve these crucial health-care issues. But it needs to hurry.
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