Friday, October 9, 2015         

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Stay the course on health care reform

The federal Affordable Care Act isn't perfect; but within it are solutions to problems that have plagued our health care system for decades

By Beth Giesting


In the aftermath of the landmark passage of health care reform last March, politicians and policy makers were whipped into a frenzy by the very contentious national midterm elections.

Many of these volatile discussions revolved around how Republicans planned to repeal the Affordable Care Act or, barring that, how they planned to defund reform line by line and program by program.

News that the U.S. House of Representatives plans to vote on repeal next week brings into question once again why our health care system -- broken for decades -- needs to keep moving down the path of reform.

Given the poor economy, it's easy to see how the public could look at any large-scale policy initiative that doesn't immediately improve the employment market as either too much government or bad policy. Indeed, for the first time since its passage, a sampling of public opinion polls now finds that a majority view health care reform unfavorably.

Interestingly, however, when people are asked about the many individual components of health care reform, nearly all of them are seen as necessary and essential to fixing our dysfunctional system:

» Millions of parents no longer have to worry about their children losing coverage due to their age.

» Millions of patients with pre-existing conditions can no longer be discriminated against by insurance companies or be terminated from their plans due to illness.

» Millions of small businesses are now eligible for tax credits to help pay for the cost of insuring their employees.

At a time when the system is suffering from an acute lack of providers, the Affordable Care Act also invests in rebuilding the nation's primary care workforce, supporting community health centers and strengthening rural workforce capacity.

These significant policy and infrastructure changes, all implemented in the nine months since its passage, clearly demonstrate the far-reaching benefits of reform.

These aren't simply abstract concepts. Rural areas throughout the state -- including all of the neighbor islands -- suffer from an acute shortage of primary and specialty care providers.

Far from being a "job killer," health care reform, through its various workforce development initiatives, would allow our island communities to train, attract and retain health care professionals where they're most needed.

In Hawaii, it's estimated that there are more than 100,000 people who are without health insurance. Many of these uninsured people, no doubt, hold multiple jobs but, due to the loopholes in our state Prepaid Health Care Act, aren't offered coverage by their employers; others are self-employed and can find no insurers willing to cover them at a price they can afford.

If the federal health care reform is repealed, our window of opportunity to provide coverage would be closed, leaving 100,000 Hawaii residents to seek care at emergency rooms (precisely where it costs the most).

Perhaps the most compelling motive for reform is the cost of health care.

Last year, the state's Medicaid program faced a budget shortfall of tens of millions of dollars, in part a result of surging enrollment brought on by the faltering economy. Repeal of health care reform would rob the state of sorely needed federal funds, creating an even larger budget deficit.

Those of us in Hawaii with employer-sponsored health care also need health care reform.

Basic health care costs have risen so dramatically over the last 30 years because the system has been focused principally on sickness, with little or no incentive for insurers, patients and providers to address the cause of those illnesses. The Affordable Care Act will address these root causes of spiraling health care costs by emphasizing preventive care and wellness, and spending our health care dollars more wisely.

For instance, the early detection and proper management of chronic diseases like diabetes, hypertension and asthma could save hundreds of billions of dollars, and innovative programs like the patient-centered medical home are intended to do just that. These cost-saving changes in care reduce what both you and your employer pay for insurance, making it possible to raise wages and invest in business innovation.

As our economy still struggles to recover, it's essential that the cost, quality and access improvements within health care reform remain in place.

Repeal of the Affordable Care Act won't improve the health care system for anyone except, perhaps, insurance companies, which would be able to go back to the good old days, when rate increases of 35 percent were not uncommon.

Complete repeal or partial defunding of the health care reform law will imperil millions of children, seniors and small businesses, to say nothing of uninsured families -- many of whom are also worried about their jobs and their homes -- who still stand to benefit from health care reform in the years to come.

And repeal would forever doom us to spending more for our health care and getting far less than we deserve.

The health care reform law isn't perfect; no complex and comprehensive legislation ever is. But within its many programs are the solutions to problems that have plagued our health care system for decades and nearly bankrupted us.

We need to look past our fear of change, muster the courage to stay the course and move our state and nation forward.

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