Can We #RepealAndReplace #ObamaCare?

The Patient Protection and Affordable Care Act (PPACA, aka ACA, or more often as “ObamaCare”) might be analogized to an onion, insofar as:
1.) It has many layers, and;
2.) Peeling back the layers may cause tears.

Enacted in 2010, it has been decried primarily by Republicans, none of whom voted for the bill’s passage, either in the House, which approved it 219-212 with 34 Democrats voting “NO” – or in the Senate, which approved it 60-39 along party lines, with 1 Republican (Jim Bunning, KY) “Not Voting.”

The Patient Protection and Affordable Care Act contains nine titles, each addressing an essential component of reform:
1.) Quality, Affordable Health Care For All Americans
2.) The Role Of Public Programs
3.) Improving The Quality And Efficiency Of Health Care

4.) Prevention Of Chronic Disease And Improving Public Health
5.) Health Care Workforce
6.) Transparency And Program Integrity

7.) Improving Access To Innovative Medical Therapies
8.) Community Living Assistance Services And Supports
9.) Revenue Provisions

Immediate improvements through reform included:
• Eliminate lifetime and unreasonable annual limits on benefits
• Prohibit rescissions of health insurance policies
• Provide assistance for those who are uninsured because of a pre-existing condition

• Require coverage of preventive services and immunizations
• Extend dependent coverage up to age 26
• Develop uniform coverage documents so consumers can make apples to apples comparisons when shopping for health insurance

• Cap insurance company non-medical, administrative expenditures
• Ensure consumers have access to an effective appeals process and provide consumers a place to turn for assistance navigating the appeals process and accessing their coverage
• Create a temporary re-insurance program to support coverage for early retirees

• Establish an Internet portal to assist Americans in identifying coverage options
• Facilitate administrative simplification to lower health system costs

While no law is perfect – and the ACA is not perfect – there are provisions within it which many think worthy of keeping, notable among them, provisions for guaranteed coverage, prohibiting cancellation, extending dependent’s coverage, removing annual & lifetime limits, coverage uniformity, requiring insurance companies spend at least 80% of premiums on healthcare instead of executive compensation and overhead expenses, and other provisions including “sunshine” on payments to physicians & teaching hospitals, requiring costs of procedures to be made public, and increasing hospitals’ level of responsibility for successful outcomes in patient care, and more.

Some, however, have complained about increased costs of some insurance plans, and lack of competitors because some health insurance companies have “opted out” of participation in the National Marketplace.

Runaway healthcare costs have been a point of contention with many for quite some time, and over the years, Congress has endeavored to moderate them with little-to-no success. One such example was the ill-fated Certificate Of Need law which Congress repealed almost just as quickly as they wrote it.

The National Health Planning and Resources Development Act of 1974 (Public Law 93-641) – had a noble, three-pronged goal to:
1.) Restrain skyrocketing health care costs;
2.) Prevent the unnecessary duplication of health resources, and;
3.) Achieve equal access to quality health care at a reasonable cost.

As they’re accustomed to doing, Congress held out the proverbial “carrot on a stick” to states in the form of Federal Funds for states that enacted some type of CON legislation. Louisiana was the only state which refused.

The CON provision in the law required a governmental determination of need for hospitals, nursing homes, and other such organizations before construction or expansion. In essence, the law mandates a court fight first thing, and I have analogized thusly: It’s like forcing a grocer to go before a judge and plead, “Please, your honor, may I build a grocery store to feed these hungry people?” Those who would oppose the grocer’s prospective construction would be other grocery stores, who would ask the judge to deny a construction permit. Litigation is expensive, and the money spent on mandatory court fights could better be spent on patient care.

In a joint 2004 study, the United States Federal Trade Commission and United States Department of Justice denounced CON laws as “anti-competitive,” writing that they “pose serious anticompetitive risks that usually outweigh their purported economic benefits.” (“Improving Health Care: A Dose of Competition,” July 2004 – http://www.ftc.gov/reports/healthcare/040723healthcarerpt.pdf)

While in theory it sounded good, the Government Accounting Office (now known as the Government Accountability Office), which is the investigative arm of Congress, quickly repealed the law in 1986 when they found it did not accomplish what it had set out to do – lower healthcare costs. In response, many states changed (36), or completely abandoned (14) their CON laws. ALL Southeastern states have some form of CON law. Some states did neither – that is, the effect of change was negligible. Alabama is one such state. See: (Ala. Admin. Code r. 410-2-4-.03)

Here’s hoping this brief has been enlightening!