Challenges to Health Care Reform in 2017

• Publication year: 2017

Challenges to Health Care Reform in 2017

Paul J. Zwier
Emory University School of Law

CHALLENGES TO HEALTH CARE REFORM IN 2017

Paul J. Zwier^*

Why has health care in the US been such a challenge to fix? Perhaps it is because there is a religious, even anti-secular reasoning to those who are resisting its reform. This article will briefly examine the problems the Affordable Care Act was trying to address. Next, it will describe the recent arguments in Congress against reform and what the nomination of Tom Price as head of the U.S. Department of Health and Human Services (DHHS) might portend for what is behind the Affordable Care Act's (ACA) repeal. Lastly, I will propose some potential policies that might be part of the reform that could help overcome this resistance.

After all, before the enactment of ACA, it was clear to the U.S. health care community that a crisis was brewing:¹

• Health outcomes in the U.S. compared to Europe and Canada didn't justify higher U.S. costs, (e.g. higher infant mortality rates, lower or equal life expectancy, rise of obesity and diabetes, higher rates of heart attacks and cancers).
• Year-to-year rises in the cost of health insurance in the years preceding the enactment of the ACA were running at 10%, and consuming an ever-increasing portion of the U.S. GDP.²
• More employers were ending lifelong health care coverage for their employees, compelling the need for changes in Medicare and Medicaid coverage.
• Medicare and Medicaid were not providing a sufficient safety net for children, the elderly, and the lower middle class.

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• 29 million Americans lacked any health insurance and heartbreaking stories of those with pre-existing conditions not able to obtain coverage cried out for something to be done.³

The fix seemed sensible to many. The ACA was drawn from Republican plans that had been put forward during an early attempt at a more comprehensive reform during the Clinton administration. It was to use a model that rejected a single payer national health insurance plan (like Canada) in favor of a combination of employer plans provided by private insurers and Medicare and Medicaid. Of course, private employer insurance plans would continue to provide coverage and subsidized insurance exchanges by private insurers at the state level for individuals were supposed to be the final piece of the coverage puzzle. This model (a version of which is used by Germany) intended to use competitive market forces to help bring quality and service through contracting with private insurers and thereby avoid some of the perceived pitfalls of national single payer systems. However, the U.S. model (though still in the process of rolling out each of its provisions) has yet to uniformly deliver the savings in health care costs, at least as a percentage of GDP, that either the German or the Canadian systems have delivered. Despite its apparent success in states like Arkansas and Kentucky, general political sentiment seems to favor its repeal.

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While costs initially appeared to have leveled off,⁴ the overall cost reductions have yet to materialize. In some markets, costs have continued to rise. The new Republican leadership, when advocating for its repeal, frames the ACA as a wasteful and expensive imposition by the federal government into private choices of individuals. But if repealed, the country would be back to where it started, caught between the need to increase coverage and also control costs while still providing adequate patient choice.

Lacking access to data that would help individuals and employers understand the pricing forces behind the various coverage plans, the body politic continues to show skepticism about whether the ACA can control costs. News reports continue to emphasize its high costs (forgetting earlier cost increases) and it is difficult to measure the impact of the ACA's various successes, such as improving coverage for young adults⁵ , preventive care services⁶ , higher access⁷ , or the increased availability of care outside a traditional hospital setting (e.g. community clinics, home care). There simply is not enough information yet to judge the net cost increases after tax credits for small businesses, or discounts for prescriptions for seniors, or the ability of the system to protect against fraud, or savings from the efficiencies required by better coding procedures...