HIT Think

Why healthcare is not out of the woods on reform

After weeks of high intrigue, the latest effort to repeal the Affordable Care Act has hit a congressional pothole.

Multiple efforts by the Senate to revamp health policy this week failed, culminating early this morning, with the inability of the Republican party to agree on a way forward to fulfill their threat to repeal Obamacare.

This is likely only a temporary reprieve for those that crave a return to some stability in the healthcare industry, particularly insurers and providers. In particular, healthcare organizations want such stability to make plans for the future, including making investments in information technology or pursuing other care initiatives, such as value-based care.

From here, much remains unknown about how healthcare policy will proceed. In fact, the immediate response by President Trump to the Senate’s failure suggests that health policy might be dictated by inaction that essentially undermines the existing approach, with the suggestion that everything will be fixed after “healthcare” implodes. So the lack of reform legislation thus becomes deconstruction that knocks the props needed to support existing policy and law.

Early Friday, the Senate’s effort to enact a scaled down plan to repeal parts of Obamacare fell short, as three Republican senators broke with their party and voted against the bill. The amendment was intended to be a vehicle to move the reform process along and continue the health reform effort in a conference committee with the House of Representatives.

It left many Republicans voting in favor of a bill while decrying that they would never want to see it become law.

“The skinny bill as policy is a disaster; the skinny bill as a replacement for Obamacare is a fraud,” said Sen. Lindsey Graham (R-SC) before the vote.

That was an honest assessment of the bill as a health reform effort. Kudos for Graham’s honesty in admitting that. We’ll grade that a Right Answer.

But Graham went on in his remarks. “Not only do we not replace Obamacare, we politically own the collapse of healthcare. I’d rather get out of the way and let it collapse than have a half-ass approach, where it is now our problem. I’m not going to tell people back in South Carolina that this product actually replaces Obamacare, because it does not; it is a fraud.”

Sorry, that’s a Wrong Answer. Just abdicating responsibility for healthcare, and letting the healthcare reimbursement system wander toward imminent failure is not responsible. The collapse of healthcare is not merely a political football or proof that one side is right over another—it impacts millions of people’s lives and the healthcare industry meant to protect those lives.

Graham’s response, of course, is a common one. One needs only look at President Trump’s immediate response to Friday morning’s vote, via Twitter. “Three Republicans and 48 Democrats let the American people down. As I said from the beginning, let Obamacare implode, then deal. Watch.”

Definite Wrong Answer. Declining to take steps to shore up and support insurance exchanges by not releasing the funds for subsidies that help insurers offset healthcare costs for low-income Americans, or by asking federal agencies not to enforce the individual mandate under Obamacare, are destructive actions. Now, it’s up to the executive branch to support the existing Affordable Care Act and not subvert the legislative process that put it in place.

The threat of congressional action on reform, as well as negative comments from the nation’s chief executive on the inevitable implosion of healthcare has done little to encourage stability in healthcare. Insurers are hesitant to commit to participating in insurance exchanges, jeopardizing healthcare coverage for millions. Providers also face increased uncertainty as any degradation of the ACA could result in swelling numbers of uninsured patients and rising amounts of unreimbursed care.

McCain explained his dramatic no vote Friday morning by saying he just could not back a bill that would be ineffective and only kick healthcare reform further down the road to hopefully be resolved by a conference committee.

“The amendment offered no replacement to actually reform our healthcare system and deliver affordable, quality healthcare to our citizens,” McCain said in a statement. Assurances by House leadership that the conference committee would greatly modify the “skinny” repeal, “does not ease my concern that this shell of a bill could be taken up and passed at any time,” he added.

“One of failures of Obamacare was that it was rammed through Congress by Democrats on a strict party line basis. We should not repeat the mistakes of the past that have led to Obamacare’s collapse,” McCain added.

The time for injecting needless uncertainty into healthcare should have long passed. There are new calls for bipartisan efforts to work on healthcare reform, with the hope that looking at issues more broadly could effectively achieve changes that are essential within healthcare to make it sustainable for our country for years to come.

No one doubts that healthcare is in crisis and needs a dispassionate revamp. However, a suggestion to wait for a cataclysmic implosion is not an option that is in anyone’s best interest.

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