Apr
6

The Pitfalls of Reversing the Affordable Care Act

This week spearheaded the Supreme Court debate over the constitutionality of the Affordable Care Act -the Obama Administration’s landmark legislation on healthcare reform. Specifically, the courts are examining the government’s right to mandate health insurance for everyone.
 
It is mind boggling to me that we have a system of mandated car insurance, but we take an issue with mandated health insurance when we are living with severe consequences of everyone’s need for care, and there are millions of people with no means to provide for that care.
 
This law, and the court decision that could end it, will mean different things to many depending on one’s agenda. But those who are the recipients of services, as a result of healthcare reform, stand to bear the greatest negative effects of the loss of this law. Those who stand to be negatively affected are:
  • those with preexisting conditions,
  • the uninsured,
  • the underinsured,
  • those in need of preventive care,
  • and those in need of extended coverage to age 26.
In addition, this law eliminates the insurance company’s practice of charging women 50% more for insurance and allows seniors to receive the preventive care needed to remain healthy and viable.
 
There are many aspects of the Affordable Care Act that govern what individual states will do to meet the requirements of the law. As a result of this law, hundreds of thousands more people will now be eligible for health care services who were not covered previously. This change primarily affects each state’s Medicaid system. This is a major challenge considering there are so many states currently experiencing dilemmas in addressing the high cost of care to this population.
 
In the state of Illinois, we are experiencing extreme financial challenges to support care for those on Medicaid, as are many other states. As a result of the Affordable Care Act, it is estimated that approximately 700,000 more people will be added to the Medicaid program. The State is also mandating that 50% of all Medicaid recipients be placed in managed care systems by 2014.
 
To the State’s credit, it has decided to allow providers to participate in the development of healthcare models that provide quality healthcare while containing costs. Through the State’s Innovations Project, they are looking for comprehensive models that address the medical and the psychosocial needs of this population.
 
The state recognizes that the current methods of providing services to the Medicaid population have not produced the kind of quality, or cost savings, necessary to sustain our system over the long haul. The state is virtually "broke” and our healthcare system is "broken.” Our current system requires an individual to be sick in order to receive services.” A model of care that includes prevention will identify problems before they occur or worsen.
 
The call for proposals indicates the State’s recognition that continuing to operate in silos that treats symptoms only addresses one aspect of a person’s health or life. The ideal model will take a comprehensive look at a patient and his environment and will treat current problems, while addressing the potential for future medical, as well as, psycho-social issues.
 
This system of care coordination amongst all providers that focuses on prevention, community management, medical and psycho-social issues will produce the quality and cost outcomes necessary to build and sustain a viable Medicaid system in the State of Illinois, and could very well become the model of our country in finally developing what can be considered a true healthcare system.
 

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