OP-ED

The Republican Landslide and the Affordable Care Act

After their resounding triumph in yesterday’s midterm elections, House Republicans will likely act on their promise to repeal the Affordable Care Act, the health reform bill President Obama signed into law last March.

Their efforts could be blocked by the Democratically controlled Senate or, if necessary, by a veto from the Big O himself. But the Boehners might still get the final say, since they have the power to halt appropriations funding for large swaths of the law.

These realities have health-industry groups, some of whom vigorously supported Democratic efforts to pass the law, cozying-up to the GOP like a Snuggie on a cold winter night.

Private insurers want Congress to nix that $70 billion tax that will be levied against them beginning in 2014. They’d also like lawmakers to permit them to widen the rating bands which cap the amount of money they can charge older enrollees.

Insurers and providers want Congress to add a tort reform rider to the law, preferably one that protects physicians against malpractice lawsuits if they adhere to best practice guidelines. Drug companies want to kill the proposed Independent Payment Advisory Board, whose job it is supposed to be to control the rate of growth in Medicare spending. The Board’s recommendations would, after all, likely include reduced federal spending on prescription drugs which is very bad for their business.

Yet these same groups are worried sick that Republicans might go too far in their zeal to repeal the deal. The baby in the bathwater for these trade groups is the individual mandate: a provision in the law that requires most Americans to carry health insurance.

Many House Republicans detest the mandate, believing it to be an affront to personal liberties or whatever. Of course when providers and insurers look at it, they see an unprecedented revenue bonanza! So they are busy as bees conjuring up alternatives that appease the Boehners and let them cash-in at the same time.

The alternatives they’ve come up with so far include levying higher rates on people that choose not to purchase insurance in the first years after the law goes into effect, and auto-enrolling folks into coverage subsidy programs for which they are eligible. Those woebegone Dems will remind anybody who cares to listen that they considered automatic enrollment before bagging it on account of implementation difficulties and other snafus, but nobody is listening to them right now anyway.

“We’re open to lots of different ideas” for assuring access to affordable coverage, Wes Metheny told the Wall Street Journal recently. An SVP at the Pharmaceutical Research and Manufacturers of America, Metheny added, “we were very supportive of health-care reform last year and there are some good things we think need to stay in place.”

Meanwhile, the folks who penned the Affordable Care Act in the first place are more worried about misguided Republican smart-bomb attacks on selected portions of the law than they are about a full-on repeal.

Those “smart” bombs could destroy the financial underpinnings of their insurance exchanges, for example.

Worse yet would be a situation in which the Feds are left to enforce provisions requiring insurers to cover folks with pre-existing medical conditions even after a “smart” bomb has destroyed the individual mandate. In this nightmare scenario, insurers including Medicare end up with a very sick customer base and no way to spread the costs.

Then again, if past history is any indication, we can rest assured that cooler heads will prevail and our newly elected officials will do the right thing. Riiiight.

Glenn Laffel, MD, PhD, was formerly Senior Vice President for Clinical Affairs at Practice Fusion and is now CEO, HealthResults.

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Raymon MittlerNateJ. RichardsAnitaMargalit Gur-Arie Recent comment authors
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Raymon Mittler
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Thanks, I’ve recently been looking for facts about this topic for ages and yours is the best I have located so far.

DeterminedMD
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DeterminedMD

Thanks for the validation in your last comment, J Richards, and I don’t need Jesus Christ to save me, nor your prayers. It is exactly your comments that condemn Christianity for the failure it has come to be across this planet, that your interpretation of a higher being is just your religion’s only correct point of view. Dismissing the beliefs of billions of other people is the depths of arrogance that soils the image of this country to others. And, I truly do not expect you to understand nor respect my opinion. After all, I don’t embrace your point of… Read more »

J. Richards
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J. Richards

Nate, Care to share whether or not you are a Christian? I suppose I could make some assumptions as you have done. For example, I’m betting you’re probably not a Christian by your tone and the fact that you completely side-stepped any discussion at all of the biblical verses that support the position of helping one another and working together as Jesus commanded. If that is the case, you have my prayers to come to know Christ for only Christ can offer you eternal life. As I said I have paid health insurance premiums for the last 22 years and… Read more »

J. Richards
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J. Richards

Determined MD, Why is that a Christian who merely professes his beliefs is automatically labeled as being “holier than thou”? I merely professed what I believe. I can’t help it if what I believe offends you or if you don’t believe as I do. I realize there are indeed many cultural Christians who go to church every Sunday, but who are draped in hypocrisy and could care less about helping others outside of themselves. They claim to be “saved” but they don’t act like it. I apologize for them, but I sincerely don’t believe I am one of them and… Read more »

DeterminedMD
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DeterminedMD

You know what I do not get about christianity and this Holier than thou attitude being applied to this issue per above commenter: if religion was a simple answer to this issue, we wouldn’t be dealing with it today. But, religions do not solve community issues in the end, as just like politics, they just become extremism and inflexibility, and if you don’t fit their peg, you are discarded, plain enough. This is an issue that has to account for choice and responsibility, and expecting the community to care for all who are infirmed and indigent does not teach independence… Read more »

Nate
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Nate

J Richards, Care to share what you think a resonable premium would be for your family and how much in claims your family has averaged over the last six years? I’ll give you the benefit of the doubt till you answer but fully expect you want to pay less then what you cost the system, that is how most people view insurance. “Republicans and Blue Dog Dems, was it worth it? Were all your creature comforts and wads off payoff money for re-election worth your soul?” Anita, your obviously not capable of thinking for yourself, so ask someone why insurance… Read more »

Nate
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Nate

“I somehow cannot agree with that simply because the evidence based standards are not there for complex cases and even if they are, they are never 100%.”
If a group of experts with the benefit of hindsight and time can’t establish a correct course of treatment how can a single physician with time constraints and possibly a budget be expected to. These are the exact cases providers need protection from. There should be a safe harbor for a provider that does what was prudent regardless of the outcome

J. Richards
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J. Richards

I am neither a Democrat nor a Republican. I’m just a man with certain beliefs. It’s man’s tendency to try to put people and things into categories (black or white, Republican or Democrat, liberal wuss or right wing nut job, Gator or Bulldog, dog-lover or cat-lover) so that man can make sense of the world around him and create a false sense of belonging and control. I am just an average Christian American guy who does the best he can to take care of my wife and kids and who believes these things regarding health care because I am a… Read more »

Anita
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Anita

A November 5th Newsweek article I read this morning “Why Healthcare Reform Will Survive” is the best assessment of the Republican plan for health care reform that I have seen yet. The article was written by Wendell Potter, the former insurance insider and head of PR for CIGNA health insurance for 20 years. Potter basically says that the health insurance industry has been working behind the scenes with the GOP and Blue Dog Dems and actually LOVES multiple parts of the “Obamacare” plan that passed the house and the senate, even going so far as to write several portions of… Read more »

Barry Carol
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Barry Carol

Paolo – It was always my understanding that health courts, if they come to pass, would be implemented at the state level in place of the state level jury based malpractice system that exists today. I think the feds could be helpful in providing seed money, especially in a tough economy, to help cover start-up costs. As part of the new process, states could also individually pass safe harbor protection from lawsuits if evidence based standards were followed where they exist. Juries should not be deciding these cases if there is a more sensible alternative.

Paolo
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Paolo

“I’m not a lawyer but, to sue in federal court, I thought there has to be a federal issue involved for the federal court to have jurisdiction. Aren’t most malpractice cases filed in STATE courts and governed by state law?” Barry – That’s my point. Medical malpractice is a state issue that can and should be resolved at the state level. If it is resolved at the federal level(by making it a federal offense and setting up federal health courts) you would now be giving people the right to trial by jury (as per the 7th amendment). Peter and Margalit… Read more »

Barry Carol
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Barry Carol

Margalit – I don’t think the level of malpractice premiums or whether or not caps on economic damages are in effect have much to do with how much defensive medicine is practiced when the jury based dispute resolution system is so inherently unpredictable from one case to the next even when the issues are similar and the jurisdiction is the same. In Europe, doctors generally perceive (correctly) that their probability of being sued for malpractice is essentially zero which makes it much easier for them to practice cost-effective medicine even when they are being paid on a fee for service… Read more »

Margalit Gur-Arie
Guest

The September issue of Health Affairs had some interesting articles on the subject, notably this one:
http://content.healthaffairs.org/cgi/content/full/29/9/1578
(not sure I understand the methodology, though)

Barry Carol
Guest
Barry Carol

Margalit and Peter – While the numerous doctors who comment here can speak for themselves and it would be nice to hear their perspective, my perception is that the current system of dispute resolution is viewed as arbitrary and highly unpredictable from one jurisdiction to another and sometimes even within the same jurisdiction depending on who the lawyer is and the composition of the jury in each particular case. Health court judges could hire experts who have no financial stake in the outcome of the case and are not viewed as either a plaintiff witness or a defense witness. Judges… Read more »

Margalit Gur-Arie
Guest

Barry, I am not certain that things can be as cut and dry as you are suggesting. For example: “If a woman of a certain age and risk profile should not get a mammogram according to the evidence because it has more associated risks than benefits and she later develops breast cancer, I don’t think it’s malpractice despite the bad outcome.” Did the doctor inform the woman of the risks and benefits? Did she understand? Did the doctor actually evaluate her risk profile, or did the patient or nurse filled the questionnaire, but the doctor never read it? If a… Read more »