Why Repealing the Affordable Care Act Won’t Stop Healthcare Reform

So the election is over. The Republicans now control both houses. And several are promising that one of their first jobs is to repeal the Affordable Care Act (ACA). I’m sure there are lots of people jumping up and down with glee.

This reaction reminds me what one doctor told me a couple of weeks ago after I spoke to his group (abdominal surgeons) about healthcare reform (you can read more about the experience here). “This (the ACA) is going to go away and things will return to normal.”

Um, not quite.

Sure, if the ACA goes away we’ll return to more than 40 million uninsured Americans who can’t afford health care. States that have expanded Medicaid will have to pick up the full tab for those expansions (instead of 10% beginning in 2020). Young adults who are still covered on their parents’ policies will now have to buy their own — if they can afford them. Women will once again be discriminated against in terms of premiums and plan designs. People with preexisting conditions will be unable to find affordable health insurance on the individual market. We’ll have no guarantee of a basic set of benefits (for instance, some employers have been trying to remove inpatient hospital care from their benefits, something the Obama administration is disallowing based on requirements in the ACA).

But I digress.

What this doctor and his colleagues were most upset about wasn’t the gain of health insurance for millions of Americans; they were upset about the shift to a value-based healthcare system in which they will be judged on the cost and quality of their work rather than being paid a fee for everything they do.

I’ve got news for them. . . that horse has already left this barn and the barn has burned down.

No matter what happens with the ACA in the next couple of years, health care in the United States will continue to move from the fee-for-service, acute-care focused, wasteful, error-ridden, poor quality system that it is today to one that meets the Triple Aim: improving the patient experience; improving population health; reducing per-capita costs.

It has to. Costs to consumers, employers, and governments are simply unsustainable. If we don’t get a grip — and get it soon — then this country will be devastated in the next 20 years not by global warming (although that’s certainly an issue) but by aging Baby Boomers flooding into Medicare.

You think wars are expensive? Take a look at the federal government’s budget, in which health care is now the largest line item.

So repeal away. We’re still going forward with change.

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