It’s a grim prediction, but healthcare organizations are headed for stormy days. The Affordable Care Act (ACA) was supposed to solve the problem of poor access to healthcare for most Americans. Signed into law in 2010, it was fully implemented in 2015.
What went wrong? In a nutshell, private insurance companies raised premiums, upfront deductibles, and copays. And big pharma raised drug prices up to 15,000% on some medications and refused to manufacture other, less-profitable ones. All of this was complicated further by local, state, and federal regulations and special taxes.
While the number of Americans without health insurance has fallen by about 15 million since 2013, health costs for the “average Joe” continue to escalate. This is in part because the ACA allowed insurers to increase deductibles and copayments with minimal oversight. Insurance companies have raised them—in some cases, dramatically. According to a New York Times poll and a Kaiser Foundation Report released a few months ago, an increasing percentage of Americans under age 65 with health insurance are having trouble paying their medical bills. The report is accompanied by heartbreaking anecdotal evidence of people losing their homes, taking second jobs, spending their savings, taking on excessive credit card debt, or seeking charity because of punishing medical bills.
The ACA ushered in a period of price manipulation by pharmaceutical and insurance companies that we’ve never experienced before. Many chief executive officers (CEOs) of these companies see their primary obligation as maximizing shareholder profits. The same can be said for CEOs at many publicly traded hospitals and other healthcare organizations.
Meanwhile, the middle class is hemorrhaging money. Health insurance premiums (even those subsidized by employers) have doubled or even tripled. Copays are increasing just as much. Some consumers are seeing a $12,000 upfront deductible renewed each year and copays that average about 40% of costs. So although most middle-class working Americans now have health insurance these days, many can’t afford to use it. Ultimately, the victims of profit-maximizing are the very ill patients and their families—and the nurses, physicians, hospitals, and pharmacies desperately trying to serve them.
Most Americans now support aggressive regulation to keep healthcare costs in check, including price caps on drugs, medical devices, and payments to doctors and hospitals, according to a November 2015 Health- Day/Harris Poll. Almost three-quarters want price controls on manufacturers of drugs and medical devices, the poll revealed—up from 64% who favored such controls in 2014. A majority also said they’d favor importing cheaper drugs from other countries and letting Medicare negotiate drug prices.
Fixing the ACA will require at least the following:
• government meddling with states’ rights over Medicaid
• government meddling with the Internal Revenue Service over the so-called “family glitch.” This happens when a worker is deemed ineligible for ACA subsidies if he or she is offered affordable health coverage by an employer. That ineligibility extends to all members of the family, even if affordable family coverage isn’t obtainable from the employer.
• government meddling with insurance companies over premiums, deductibles, and copays. In fact, caps on each of these all may be warranted.
All of this will take years of political wrangling. And healthcare professionals and organizations are— and will continue to be—caught in the middle. It will take bitter medicine to fix the ACA, and those in the healthcare field will be forced to swallow it one way or another.
If Congress simply restored the public option (creation of a government-run health insurance agency that would compete with private health insurance companies) and gave Medicare the ability to compete against private insurers for all Americans, that might be enough. Congress killed the original public option due to opposition from insurance companies, the pharmaceutical industry, medical device makers, and publicly held hospital corporations, all of which feared havingto negotiate prices with Medicare.
It’s time for political negotiations to take place with a healthcare agency that’s weighted in favor of patients and the middle class rather than fat cats and lobbyists. The most widely available and best understood agency is Medicare. And we wouldn’t have to create a whole new bureaucracy to implement it.
Leah Curtin, RN, ScD(h), FAAN
Executive Editor, Professional Outreach
American Nurse Today
Consultant to CGFNS International