On Monday, July 10, US Representative Dave Reichert reconvened his Healthcare Advisory Committee in Wenatchee to continue discussions about efforts in Congress to repeal and replace the Affordable Care Act. Rep. Reichert is one of four Representatives that represent sections of Pierce County. As a senior Republican on the House Ways and Means Committee, Rep. Reichert is influential in crafting health care policy on the majority side of the aisle in that chamber.
With the effort to repeal and replace ACA (Obamacare) currently facing uncertainty in the US Senate (a key test vote is expected next week), Rep. Reichert wanted to gather the committee to continue consideration of local health care priorities and get constituent feedback about scenarios that may unfold in the coming weeks. Earlier this year the committee had urged him to be cautious with any massive changes to ACA or Medicaid that might result in large numbers of patients losing access to care. Rep. Reichert was one of 20 Republicans who voted No on the repeal and replace bill that passed the House.
As he continues to consult with advisory committee members including PCMS Executive Director Bruce Ehrle, issues such as coverage and access to care remain central to deliberations.
During this latest meeting Bruce was able to make the following points and engage with Rep. Reichert on the following issues:
--Advising that as the discussion focuses so much on who gets coverage or who loses coverage, it’s easy to lose sight of the fact that behind that coverage are often incredibly high deductibles and co-pays that put up barriers to patient access to physicians and other providers so that attention needs to be paid to the overall affordability of coverage for the patient, not just whether they have it or not. Rep. Reichert strongly agreed and noted that he is concerned about overall affordability for both the patient and any entity offering coverage. He also stated that he agrees that having access to coverage does not necessarily mean having access to care.
--Given that a bi-partisan approach on much wider issues such as repairing ACA but also working on additional health care policy areas might be a scenario that plays out, there could be an opportunity in the coming weeks or months to consider a national push for health literacy improvement to educate patients about the importance of utilizing primary care as well as reimbursement rate improvements to some federal programs that have lagged behind in payment.
--Advising that there are two large issues currently in play—ensuring access to care and cutting costs—and that both issues may require separate but related sets of solutions. For example, Bruce noted that many people were surprised at the jump in expensive ED utilization by Medicaid patients after expansion occurred. These individuals had been extended access to care but it did not cut costs. In fact it increased them. With something like better health literacy about using their new coverage to establish a primary care relationship or utilizing Urgent Care, both increased access and reduced costs can be achieved. Rep. Reichert was highly interested in pursuing more discussion about the concept of improved health literacy on a large scale as well as on the local level such as Pierce County Medical Society and Pierce County Project Access are joining forces to address. He as well as his staff followed up with Bruce on this.
--Noting that new approaches to budgeting may be in order so that areas within the social determinants of health such as nutritious food and good housing that impact the majority of health outcomes are funded now, with savings in health expenditures realized later due to improved population health. Rep. Reichert said that he is very interested in pursuing innovative policy solutions that offer a holistic approach to overall health while also being able to address issues such as the homeless.
--Commenting that things are not fully functional for patients and providers in nearly every payer category—Medicaid, ACA, employer sponsored private plans, Tricare, VA Choice—and that much work remains to be done to provide access to quality care for all patients to physicians and other providers at payment rates that reflect robust reimbursement for the set of services offered.
--Pleading for more residency slot funding so that a giant backlog of medical school graduates doesn’t develop at a time when we need additional people in the physician workforce especially in the areas of primary care/family medicine as well as behavioral health—and encouraging the development of aggressive incentives for early career physicians to choose those areas of medicine to practice in such as loan repayment based on income and direct federal grants. Committee members strongly concurred with this suggestion by Bruce.
--Stressing the need for ongoing monitoring of the HIT situation in the US so that EHR systems achieve interoperability and fully integrated (physical and behavioral health data) medical records can be accessed by caregivers.
Rep. Reichert noted the incredibly high value of the ongoing committee meetings as did committee members including Bruce.
PCMS will continue to be heavily engaged with the Washington Congressional delegation about these issues of importance to physicians and other pending matters as well.