United States Representative Dave Reichert convened a meeting of his Healthcare Advisory Committee in Seattle on Tuesday, February 21 while he is home from the nation’s capital for the Presidents Day Recess. The purpose of the meeting was to explore health insurance reform options at a time when he is helping to draft legislation to repeal, repair, and/or replace the Affordable Care Act as one of the senior Republican majority members of the US House Ways and Means Committee that oversees health and tax policy. As a member of the advisory committee, PCMS Executive Director Bruce Ehrle attended and participated in the deliberative session during which he stressed the following points:
--Access to providers for all patients in the nation at affordable insurance rates that reimburse such providers at meaningful rates for their expert services is of paramount importance when examining the status of ACA or any other insurance options.
--Having insurance does not equal having access if the deductibles are so high that using the insurance for anything over than catastrophic events is too expensive or reimbursement rates are so low that they don’t allow for the economic viability of the provider. This denies citizens access to physicians for the care they need and deserve.
--Without considering co-pays and deductibles and focusing solely on premiums, health insurance will continue to often be too expensive for many to consider obtaining, denying access for patients to providers and instead placing them in EDs as uninsured patients--and this applies not just to those currently covered under ACA but those on employer sponsored plans where such costs are also increasing, causing many to decline such coverage even when employers offer it as a benefit.
--Consideration of insurance issues should be tied to consideration of other issues that are causing stress to the health care system including shortages of primary care physicians, behavioral health professionals, and even specialists in such fields as gastroenterology where there are frequently long waits to see such physicians--and where there are corresponding pressures on such physicians due to the overload of patient volume—which again causes such patients to seek care in EDs.
--Incentives should be provided to new physicians to go in to primary care and behavioral health including through new mechanisms of loan forgiveness or loan payment reduction based on income level so that early career physicians don’t experience an ever-increasing financial burden that causes many to feel they must go in to the highest paying specialties, exacerbating the shortages and further increasing stress on the system. More residency slots are also desperately needed to accommodate those successfully completing medical school in record numbers.
--Working on these related issues in an effort to provide insurance coverage to as many Americans as possible through whatever mechanisms there are (ACA, Medicaid, or a new program), will increase the chances that they have access to quality physician care in settings other than the expensive ED. It will also help a physician community that in many ways is more stressed now than ever before.
--Health literacy needs to be increased in the United States so that citizens understand how to navigate insurance systems, tax incentives or subsidies, and the importance of developing patient relationships with physicians so that prevention can be focused on before acute and expensive problems develop, especially in the ED setting.
--Coupled with this, an effort needs to be made to change the culture of young people in the nation regarding their lack of belief in the need to obtain health insurance to match widespread understandings of the need to obtain car insurance to solve the problem of smaller high-risk health insurance pools.
--At all points in the care delivery and payment reform process, physicians, whether they be independent or employed by health systems, need to be viewed as valued partners in that evolution who are experts about the reality of front line care of patients.
All these points were well received by Rep. Reichert and many of them were further discussed by the advisory committee with him.
The advisory committee largely stressed that Congress should be extremely careful in its timing and sequencing of health insurance changes. The committee also largely recommended that Medicaid expansion for states like Washington be maintained. Rep. Reichert indicated that they are hearing from a wide cross-section of individuals and entities about trying to find a way to allow the Medicaid expansion under ACA to not be repealed including from Republican governors whose states have embarked on the expansion. Additionally, the advisory committee stressed the importance of federally qualified community health centers as key safety net providers that help reduce ED usage and provide primary care. Rep. Reichert immediately agreed with those points about the FQHCs. The committee noted the increasingly important linkages between social determinants of health, population health, and care coordination to achieve the Triple Aim. Finally, the advisory committee stressed the ongoing need to be mindful of administrative, regulatory, and technological burdens on physicians and all providers as national goals are pursued.
Rep. Reichert stated that he expects a committee markup of legislation on insurance reform to take place sometime in March with floor action in the spring.
PCMS will continue to alert members about developments on federal health policy and continue to advocate for the role of physicians in the process as well as the importance of continued patient access to physicians in all care settings.