Sunday, January 29, 2012

More than one road to universal coverage

Published: Kalamazoo Gazette Tuesday, December 27, 2011
BY DR. KENNETH FISHER
Health insurance exchanges are a key provision in the new health care law, the Patient Protection and Affordable Care Act (PPACA). The law encourages each state to set up an exchange with federal funds and submit its plan no later than January 1, 2013.
The Secretary of Health and Human Services has sole final authority to determine adequacy and content. The law states that exchanges create a website to compare health insurance options, eligibility for Medicaid and federal premium assistance and maintain data on income, employment and residency. The exchanges would also participate in enforcing the law’s mandate.
If states do not initiate an exchange, a federal exchange would be substituted.
On Dec. 13, the Michigan House of Representatives, in a definitive statement in opposition to the PPACA, voted to strip $9.8 million in federal funds from an appropriation bill that would have funded the creation of a PPACA exchange. The governor and the Senate, originally in favor of accepting these funds, now have agreed with the House action. Because of a glitch in the law with many states refusing to initiate an exchange, premium support most likely will not be available, crippling the PPACA, regardless of what the Supreme Court rules this summer.
In response to this threat Secretary Sebelius on Dec. 16 issued a bulletin that states could choose an existing health plan as a model for essential health benefits. This gesture is problematic because this or any future HHS Secretary could change those requirements and has control over which physicians may participate in an exchange. Additionally, states assume financial support for exchanges January 2015.
Some have argued that the House’s action was the result of a far right wing tea party vote. We strongly disagree with this interpretation.
Docs4PatientCare, a non-partisan growing organization of physicians nationwide, stands for the preservation of the patient-doctor relationship which is threatened because of federal bureaucratic interference. We believe in universal coverage, but not this model, as it relies on central planning, price fixing and a bewildering array of regulations.
Unfortunately, while planning for universal coverage, our political leaders chose to emulate the Massachusetts model rather than the extremely successful plans in Indiana that uses patient-centered health care and financial responsibility through health savings accounts and high deductible catastrophic insurance. Rather, the PPACA is a federal adaptation of the Massachusetts plan which has experienced increased emergency room visits, exploding costs and perverse economic incentives.
Docs4PatientCare believes that through modest changes in tax policy and federal subsidies for those in need, we could provide health savings accounts with high deductible insurance for all Americans, along with care tailored to each individual devoid from bureaucratic interference. Starting at a young age and accumulating throughout a lifetime, each generation would then be able to provide for its health care when elderly, precluding the need for succeeding generations to subsidize their care.