The great health care reform debate - insights from Capitol Hill

A glimpse into the future of America’s health care system

There’s been a lot of news lately about health care and ongoing debates in Congress. Today we’ll take a look behind the media coverage to see what is at stake and why it’s important. The controversial bill the Senate is considering will affect the future of America’s health care.

We took our questions to an expert on D.C. policies and politics: Ali Santore, vice president of government and public affairs for Providence St. Joseph Health, the parent organization of Providence Health & Services.

Help us understand what is happening in Congress right now in regard to health care

Congressional leaders have made it clear they plan to repeal and replace the Affordable Care Act. Many, including Providence St. Joseph Health, have said that the ACA is far from perfect and that more can be done to improve how people get care. Still, it created ways for about 24 million people across our country to get health coverage and regular care, many for the first time. That is big step forward. The proposals to replace the ACA that we’ve seen to date are very troubling because they will remove coverage for millions of people or make care so expensive that lower-income people will not be able to afford insurance.

It might help if I explain the jargon. The Affordable Care Act is the bill often known as “Obamacare,” which has increased insurance coverage by about 24 million people across the country. I am calling that bill the ACA. Congress is debating about replacing that law right now. The House passed the American Health Care Act, and the Senate has proposed the Better Care Reconcilation Act. It’s the Senate bill that is in the news right now. I’m just going to refer to them as the Senate bill and the House bill. Also, it’s important to know that the ACA is still in place until Congress passes one replacement bill.

Why is this political debate important to our average reader?

Almost everyone needs health care at some point. Families have babies, kids get sick, accidents happen, or our beloved grandparents need some extra help staying well. Having health insurance matters. For all these reasons and many more, it’s important to walk into a doctor’s office and not be worried about insurance. The more people who don’t have insurance, the more it affects us all. Without coverage, we have seen that people tend to delay care due to affordability, leading to poorer health, especially for those who are chronically ill. Ultimately, if large numbers of people in an area lose their coverage and access to care, that will affect entire communities, both their economies and their overall health and well-being.

Why is Medicaid important in this debate?

About 20 million people got new coverage because they became eligible for Medicaid thanks to the ACA. Many of them are working, but their employers might not offer health insurance or it is not affordable because their income is quite low. If they lose their coverage, they won’t be able to replace it. The right thing to do is to keep these millions of people covered. Also, the Senate and House bills make the biggest changes to Medicaid since it began in the 1960s. If either of those bills pass, far fewer people will have Medicaid to count on. These are some of the most fragile and vulnerable people in our communities. In fact, in the U.S. today, about 74 million people depend on Medicaid for care and services. With Medicaid supporting 65 percent of all seniors in nursing facilities and 50 percent of all births in our country, most of us know someone whose care comes from this program. It is a safety net and a lifeline.

The mood in Congress seems divisive. What could be done to move this health care debate in a positive direction?

It is very tense—more than I’ve seen in all of my years working in health care. While many on Capitol Hill are dedicated to their policy positions, I believe immediate progress could be made by keeping Medicaid coverage and focusing instead on smaller proposals that stabilize the insurance market. This is important because many people don’t have employer-sponsored coverage and have to buy what is called an “individual policy.” The ACA made individual coverage accessible for several million people with lower incomes.

Additionally, the especially-national debate should shift the focus toward outcomes rather than quantity of services delivered. In other words, by making care more patient-centered and creating payment systems that reward good care results rather than how many patients were seen. Many stakeholders, including Providence St. Joseph Health, tried to include more aggressive delivery system reforms into the drafting of the ACA. I would like to see those types of discussions continue. That is one area we know the federal government can do more. There is so much potential with new technologies and big data to streamline and improve the delivery of care.

Assuming the Affordable Care Act is replaced, how will patients with pre-existing conditions be affected?

The concern is for people who are currently buying their own individual coverage on the insurance marketplace. Without protections for those with pre-existing conditions, there is a chance that they could be charged such high premiums that coverage becomes unaffordable. The Senate bill actually protects pre-existing conditions, while the House bill does not.

Besides those with pre-existing conditions, who will be most negatively affected should the Affordable Care Act be replaced by a bill with less coverage?

The group of people who would be most adversely affected would be those on Medicaid. The new proposal includes over $700 billion in spending cuts, much of it to Medicaid. Disabled individuals, children and the elderly will be at a great disadvantage. As I mentioned, about 74 million people in the U.S. depend on Medicaid. Those who have Medicaid coverage thans to broader eligibility from the ACA, including low-income workers and those with disabilities, will also be affected.

People come to this country from all over the world to get health care. But so many Americans slip through the cracks. What can be done to close the gap?

We need to maintain the current health care coverage levels. Moving forward with the Senate or House bills could mean even more people falling through the cracks. As providers, it is important to understand the health needs of the community, identify gaps in patient engagement and focus on those at risk. This includes investing in both behavioral and physical health care.

What is the effect of the Senate and House legislation on the number of uninsured?

The ACA is currently enabling coverage for 24 million Americans, through the insurance marketplaces for individuals and through broader eligibility in Medicaid coverage. However, both the House and Senate proposals will essentially dismantle all of this coverage, with up to 22 million people no longer able to get health care when they need it.

What role should the government play in providing Americans with health care? What role should the marketplace play?

It is important to have a balance, although the government can be the model for the market. We can’t continue to pay more for health care that delivers less value. With its scale, government can set the tone for the private sector and be a responsible, effective steward of taxpayers’ money. If the government focused its efforts on where it could complement the market, working in partnership with health care providers and insurers, there is potential for some real progress.

What would you say to our readers who want to be more involved but don’t know how or don’t think they can make a difference?

The health care debate affects all of us. Some of the biggest changes in American health care since 1965 are being debated right now. These changes will affect moms and babies, grandparents and other relative and friends who may be disabled. The best way to be involved is to become more knowledgeable about what is going on in the debate. Look up the latest information on current affairs and debates from reliable sources. You can also reach out to your House and Senate members by writing letters, calling and sharing your perspective. Members of Congress do listen to their constituents.

These days everyone has a voice on social media—Providence St. Joseph Health and our family of organizations are posting often. Do everything and anything you can to be involved; these changes will affect you in more ways than you think.

Now that you have a little more insight into what is going on with the debate, what are your thoughts? How are you getting involved? Share in the comments below!