“Trustworthy leaders move through uncertainty to pursue opportunity.” – Leadership expert Amy Lyman, PhD
“Uncertainty” has been a word often associated with the Affordable Care Act (ACA) in recent months, from individual patients uncertain about the status of a health plan to national uncertainty about whether enrollment targets will be achieved. Serving as the chair of the AMA Board of Trustees last year, I strove not to be pulled into that maelstrom of uncertainty. Instead, I focused on moving through it to pursue the opportunity that the ACA represents: Extending lives and improving the health of millions of Americans while also addressing aspects of our health care system that frustrate and even outrage physicians.
The AMA’s constructive engagement with the law stems in large part from the fact that people who lack health insurance live sicker and die younger. The Institute of Medicine has reported that as many as 18,000 deaths annually are attributable to a lack of coverage. The ACA expands coverage by ending denials due to pre-existing conditions and lifetime payment limits, and has enabled 3.1 million adults age 26 and younger to gain coverage through their parents’ plans.
Expanding Medicaid eligibility also extends health coverage on an optional state-by-state basis—an opportunity our state of Kentucky has embraced. Research shows this expansion will increase access to care and decrease mortality rates for our state’s low-income citizens.
Increasing Medicaid coverage makes fiscal sense, and not simply because the federal government will pay the lion’s share: 100 percent for three years, scaling back to 90 percent by 2020. States bear significant costs in caring for the uninsured, and the status quo has already created significant stresses on the health care system. As a practicing emergency medicine physician, I see firsthand how the uninsured suffer without access to necessary preventive, maintenance, and follow-up care, and I am hopeful this will be mitigated as ACA implementation moves forward. Certainly, there is much we seek to improve in the Medicaid program, but even with its shortcomings patients with Medicaid have better outcomes than those without health insurance.
It is important to remember, however, that expanding health coverage is not the purview of the government alone and that the ACA retains our country’s mix of public and private health insurers. Consumers can now use the online insurance marketplaces to find comprehensive, affordable private plans—and many people will qualify for subsidies that lower premium or out-of-pocket costs.
Just as Kentucky is a leader in expanding Medicaid, its online insurance marketplace has been touted as a model. More than 481,700 Kentuckians were screened for Medicaid eligibility or subsidized insurance coverage as of Dec. 13, and more than 84,400 had enrolled in new coverage, according to the governor’s office.
Although Kentucky has embraced opportunities under the ACA, the implementation at times has been frustrating and confusing, here and around the country. Physicians have been on the front lines, fielding questions from patients while registering their own concerns about elements of the law. The AMA is dedicated to advocating on physicians’ behalf to improve the law and provides information physicians can share with patients.
Writing in The Washington Postrecently, Kentucky Governor Steve Beshear noted that the ACA has been a success in the Bluegrass State because “political and community leaders grasped the importance of expanding health care coverage and have avoided the temptation to use health care reform as a political football.”
Physician practices will continue to change along with the evolving health care system. Further uncertainties and frustrations will surely arise. Yet physicians have been—and I have no doubt will continue to be—among those leaders Beshear described. The nation simply cannot afford to see the ACA treated as a matter of political gamesmanship. Rather, our nation and we as physicians must pursue the opportunity to better serve patients in need of care.
The American Medical Association has several information sheets available to advise consumers about the Affordable Care Act. To download them, go to:
By Steven J. Stack, MD, Immediate Past Chair, Board of Trustees American Medical Association