First Medicare, Then the HMO Act, Now the ACA

Vernon Pertelle

The deadline for enrollment under the new healthcare law has come and gone; well for most it has but for a few [that experienced technical issues], they will have a couple of weeks to sign up for health insurance under the Affordable Care Act (ACA).  The target for total enrolled was initially 7 million; then the Congressional Budget Office (CBO) scaled back the number to 6 million. The final numbers based on preliminary results will be close to the original estimates of the CBO.

So, what does it all mean? There has been a lot of chatter surrounding the need to repeal or replace the law because it will kill jobs, create higher premiums for most and simply not work.  Well, it might not be perfect to begin with - - but we have to begin somewhere if we're going to improve access to care for the uninsured and reduce expenditures as a percentage of the Gross Domestic Product (GDP). The Affordable Care Act (ACA) essentially empowers patients with rights and ensures access to quality and affordable healthcare.  While it’s not clear if the law will be successful, we'll soon find out.   

Travel back in time for a moment: In 1965 under the Social Security Act, Medicare was enacted to ensure seniors received health insurance that was paid for by the federal government.  The measure received significant resistance from the American Medical Association (AMA) for fear of socialized medicine.  However if you try to change reimbursement nowadays there is significant uproar.  Just think: if the pressures against the provision of care for seniors would have resulted in the elimination of the services; the elderly would be hard pressed with paying for health care.  Medicaid soon followed to provide coverage for the poor and has proven to be a safety net for young adults and children. 

Now let’s reflect for a moment on the HMO Act, which changed the organizational structure of providers and hospitals and the way care was delivered.  It formed the basis for managed care, disease management, case management and other important mechanisms of care for a population of patients to improve health outcomes.  

While none of the early efforts were perfect in the beginning; through a series of amendments and changes that followed, the laws have transformed the way we care for patients and has improved over time. The challenges with caring for the uninsured, unemployed or under-insured; or adversely selected patients due to pre-existing conditions has resulted in increased costs with poor outcomes. The goals of the ACA are to give more Americans access to affordable, quality health insurance, and to reduce the growth in health care spending in the U.S.; which ultimately will help to reduce costs and improve health outcomes.  

There are many opponents of the ACA that creates many myths that cloud the facts but we have to start, if we are to improve as a nation in providing basic health insurance for everyone.  Unless there is a viable alternative, we have to support the goals and be mindful of the need for valid change when required.