The House of Representatives is embarking on an ambitious effort to remake our healthcare system. The leadership wants to inject more competition, reduce costs and expand coverage. We share and applaud their goals.
The new administration and Congress are taking this action in response to unhappiness experienced by many Americans after the passage of the Affordable Care Act. Many Americans did not like the mandates. Some bristled at cost increases and changes to their health plans. People worry as insurers are leaving the marketplace. The American people have legitimate concerns. The ACA has issues that need to be fixed. In analyzing the means that the House intends to fix them, however, we believe that while improvements are needed to the ACA, the current version of the American Health Care Act unfortunately moves us in the wrong direction.
At Ascension, our mission is to provide compassionate, personalized care to all with special attention to those living in poverty and most vulnerable. We seek to transform our health system into one that is focused on delivering value and promoting health. Transformation is the long-term solution to costs and coverage, and any proposal to reshape our system must keep this long-term goal in mind.
Ascension has articulated four principles by which we will analyze any healthcare reform proposal. These principles flow from our faith-based roots.
The legislation:
- Must preserve a strong safety net.
- Should not reduce access or coverage; it should expand them.
- Must strengthen and stabilize the individual market to make insurance more accessible and affordable.
- Must push the pace of transformation to a system based on value, not volume.
As we study the American Health Care Act in its current form, we have concerns in three of the four areas above—preserving the safety net, reducing coverage and stewarding resources to achieve transformation. Ascension wants to work with congressional leadership to address each of these areas of concern.
Medicaid serves as a healthcare safety net for many of our nation's most vulnerable citizens. While we are certainly open to thoughtful efforts to restructure the program, expand flexibility for states on the delivery side, and pursue efforts to increase efficiency, no health reform legislation should reduce coverage significantly for the most vulnerable in our society.
The AHCA in its current form does just that. According to the Congressional Budget Office, the legislation will reduce insurance coverage for Medicaid beneficiaries by 5 million people in 2018 and by 14 million people in the year 2026. The administration and some members of Congress have questioned the accuracy of the CBO's numbers. Even positing that the CBO is wrong by half, an unlikely assumption, the loss of coverage for 7 million Medicaid beneficiaries is not taking us in the right direction, and no one is predicting that the proposed changes to Medicaid will actually increase coverage—which is our shared goal with the president and Congress. The Medicaid proposal fails to adequately preserve the safety net and reduces coverage for the most vulnerable.
According to the CBO, the AHCA also reduces taxes by $592 billion while cutting spending by $1.2 trillion over 10 years. Almost $900 billion of the net savings come from Medicaid—the program designed to provide a safety net for the poor and vulnerable. That is simply untenable. The legislation reduces taxes on wealthier Americans as well as on health plans and reduces federal support for the Medicaid program by 25%. States, especially those that expanded Medicaid, will not be able to maintain the coverage and access that they have achieved in the last six years with these kinds of reductions. Governors will be put in an impossible position.
We believe that Congress must strike a more effective balance between revenue and spending cuts as well as reinvest some of those valuable resources into hastening efforts to transform our health system from one that rewards volume to one that rewards value. A value-based system will stress population-based health and will reward value, with the marketplace competing on total value and higher quality. Moving to this system requires substantial upfront investments by providers, plans and government, but it will result in personalized care that engages consumers and ultimately bends the cost curve while increasing quality.
Healthcare transformation is the true bipartisan solution to producing a more efficient, less expensive health system that promotes health and covers more people. The move to value will not be easy, but in the long run, it will be the most effective solution to the legitimate frustration experienced by many Americans.
