How does the 2010 Patient Protection and Affordable Care Act affect access to health care coverage, the quality of care, the pricing of services and market innovations?
These questions, among others, were the focus of a debate at the offices of The Denver Post on September 20. Moderated by Michael Booth, a Denver Post health care reporter and former Colorado Governor Richard Lamm, the debate pitted Ezekiel Emanuel, a chief architect of the Affordable Care Act, against Linda Gorman, who represents a Denver-based free market think tank.
In his opening statement, Emanuel identified three problems with the current U.S. healthcare systems that PPACA seeks to rectify: (1) access to healthcare; (2) uneven quality of health care; and (3) unacceptably high costs.
Emanuel said that 50 million Americans are currently without healthcare because they lack insurance and therefore are prone to adverse health outcomes.
“In 2012, the U.S. will spend $2.8 trillion on health care,” said Emanuel, chair of the Dept. of Medical Ethics and Health Policy at the University of Pennsylvania and formerly a special advisor for health policy to Office of Management and Budget Director in the White House. “To put this into context, France is the fifth largest economy in the world. With 66 million people, they cover everything with $2.7 trillion.
“In other words, our health care system is the 5th largest economy in the world, and growing at 2% above our gross domestic product,” he added. “For these three reasons–limited access, uneven quality and run-away costs, the president committed himself on taking office to reforming the system.”
And, thus passage of the Patient Protection and Affordable Care Act, which was enacted in March of 2010. This “world historical event,” said Emanuel, will yield a far superior healthcare system by the time the time the law’s final provisions are phased in by 2020.
“With the U.S. Supreme Court upholding the mandate, everyone in America will have access to health coverage, whether through Medicaid, for those below poverty line; or through subsidized health exchanges for those above the poverty line.”
Emmanuel said that PPACA is already producing benefits. He pointed, for example, to provisions that permit adult children to remain on their parents’ health care policies until age 26 unless they can secure health care coverage through an employer; and to the 4 million $250 rebate checks the federal government is sending to seniors who occupy the Medicare Part D “doughnut hole.”
Emanuel touted other PPACA provisions. Among them: incentives that encourage the adoption of electronic medical records by doctors; a reduction in medical errors at hospitals; a lowering of readmission rates for discharged patients (which now average 20% nationwide); and the implementation of metrics to help patients assess the quality of service of health care providers
Turning to the most controversial aspect of the Affordable Care Act, the individual mandate to buy health insurance, Emanuel said that coverage of pre-existing conditions–a popular aspect of the law–would not be possible without the mandate.
“Most Americans don’t want health insurance companies preventing people who have an illness from getting insurance or paying too much because of pre-existing conditions,” he said. “You cannot have that prohibition on insurance companies without an individual mandate. It won’t work.
“There’s no way–economically or policy-wise–to cover preexisting conditions without the mandate,” he added. “What’s the Republican Party alternative? The GOP has never issued a [viable] alternative plan that addresses the key issues of access, quality and cost.”
Linda Gorman, director of the Health Care Policy Institute at the Independence Institute, a state-based free market think tank in Denver, Colo., replied that the Affordable Act is badly designed and therefore should be jettisoned.