Tuesday, December 7, 2010

What happens if universal coverage is allowed to slip away?

One of the things about the health care reform debate that has bothered me the most is how little of it has been about the uninsured. The Republicans have not offered a plausible plan to cover the uninsured, and the Democrats have mostly emphasized the benefits for people who already have insurance (while assuring them that they can keep their doctor and their health plan). But the Affordable Care Act makes only modest improvements (like better coverage of preventive services) for people with insurance. Instead, most of its benefits will go to subsidize coverage for people who otherwise couldn’t afford health insurance.

This makes the law a harder sell for the 80% of U.S. residents with health insurance, and may help explain why support for the law seems stuck in the mid-to-high 40s in most polls. (Seniors, for instance, are the least supportive of the ACA. Could this be because they already have universal government-run health coverage – Medicare – and don’t see much to gain by extending coverage to others?)

But I think it is critically important that the debate over the future of the ACA focus on the uninsured – and the enormous consequences for our country if Congress turns its back on the promise of ensuring that nearly all Americans have access to coverage.

As I wrote in an article that appears today in the web version of the Annals of Internal Medicine, the United States is facing an unprecedented crisis in access to affordable health insurance coverage. Last year, a record 50.7 million residents had no health insurance and the percentage of Americans with private, employer-based coverage decreased for the ninth consecutive year. Many of them had chronic illnesses, and more were from middle-class families than in previous years.

A new study in Health Affairs finds that, “Throughout the past decade, even in good economic times, the number of Americans with employer-sponsored insurance has fallen, and the number of uninsured Americans has increased. . .”

This might not matter too much if the uninsured receive the same care and had as good of an outcome as the rest of us. But they don’t: the IOM found that each year, lack of health insurance leads to unnecessary suffering and premature, preventable death for tens of thousands of Americans.

The good news is that Affordable Care Act will “largely end the link between employment loss and insurance coverage”, meaning that Americans will have guaranteed access to affordable health insurance, not only in good times but especially in the bad times when millions can no longer count on a job, or if employed, can no longer count on their employer to provide them with affordable health insurance.

The Great Recession has taught us that being uninsured isn’t someone else’s problem, but a crisis that can touch each and everyone one of us. There are a lot of elements of the ACA that should be debated, and if there are ideas on how to improve it, all the better. But as I wrote in Annals, “providing all Americans with affordable health care coverage is a moral and medical imperative to prevent needless suffering and death, and must not be allowed to go ‘slip slidin' away.’”

Today’s Question: What is your reaction to my Annals article, and my premise that it is imperative that Congress not turn its back on providing all Americans with access to affordable coverage?

1 comment :

ryanjo said...

About rapidly evaporating support for the ACA, including (insert dramatic emphasis here) "Congress ... turn(ing) its back on providing all Americans with access to affordable coverage":
-- All Americans? Most estimates leave 20 million uninsured under ACA.
-- Details on coverage? It seems like our lower economic groups will be offered Medicaid, with limited providers and shaky funding.
-- The financing mechanism? 500 billion in savings to be recovered from Medicare, in the face of the largest incoming group of beneficiaries in the program's history, and enhanced preventive and prescription benefits being offered to Medicare members.
-- "end the link between employment ... and insurance coverage.” Ironically, this is proving to be true. Hundreds of companies and unions are applying for Obamacare waivers, claiming that their employer sponsored plans can't meet new requirements, so will no longer be available. So the ACA is potentially creating more uninsured!

These unintended consequences are exactly what many of us warned the ACP about, during its headlong rush to support ACA, overlooking our more central interests like payment reform, primary care recruitment, reducing bureaucratic burdens, and tort reform, which have token mention in the ACA.

Now the tune has changed in our Advocate's columns: "Good enough for now..."