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What about the rest of us?

August 25, 2017

By Scott Lyon, Senior Vice President, Small Business Association of Michigan

So much has been written about the efforts in Washington to Repeal, Repeal and Replace, Reform, etc., etc., of the Affordable Care Act—all that effort, and so far, exactly nothing to show for it.

When our elected officials get back from their summer break, the Senate Health Education Labor and Pension (Senate HELP) Committee has vowed to take up debate on ways to stabilize the individual health insurance market. That’s all well and good, the individual market has its challenges. However, for SBAM and our members who purchase their insurance in the small group market, it’s important to note that of the 285 million of us in the United States that have some form of health insurance coverage, only four percent are covered in the individual market. What about the rest of us?  For years we have been suffering from rate increase after rate increase to the point that many have dropped health insurance as an employee benefit and those small companies that still can afford to provide this benefit have no doubt made cuts elsewhere.

As the Senate and House of Representatives begin their fall schedules, here is what is on the SBAM wish list regarding the debate over health care and health insurance:

First, we wish our elected officials and those in the news media would understand that health care and health insurance are two separate and distinct things. Health care is the delivery of services in our hospitals, doctors’ offices, our prescriptions, physical therapy, etc. Health insurance is how what is delivered gets paid. Two completely different things and the words are not interchangeable.

  • We wish the debate was centered on what things costs, not how things get financed.  Health insurance premiums reflect the cost to deliver health care and the frequency that care is delivered. Payments to health care providers should continue to shift away from fee for service, which rewards action, and toward models that reward efficiency and favorable results/outcomes. 
  • We would like to see the debate include how to make things cost less. This can happen by delivering higher quality care, increasing administrative efficiency, wringing out waste and engaging the individual to take more responsibility (i.e., live a healthier lifestyle). The cheapest claim to pay is the claim that never happens because someone is healthy. The most expensive claims seem to come at the very beginning of life and the end of life. How do we make certain that end of life directives are completed and followed? 
  • We would like to see meaningful, easy to understand and use information made available on the quality of care being delivered. High cost does not always equal high quality and vice versa. With that said, how do we know who is doing a great job of delivering high quality care at an affordable price?  To know this requires transparency in care delivery, patient safety and pricing.  Wouldn’t it be nice if there was a resource that combined the information available on cost, quality and safety? Granted, no one will review this information in the back of an ambulance on the way to the hospital, but for the plethora of services that can be planned in advance, this information is critical. 
  • We wish there were enough primary care physicians willing to see patients on the patient’s terms (after hours, weekends, etc.), that the local emergency rooms returned to what they are designed for – emergencies. Getting to this point will require a hard look at our current laws and to expand the scope of practice for non-physician practitioners to practice at the full extent of their license. 
  • Medicare and Medicaid are very large components of our health care financing system. Are these programs demanding the absolute best of our providers?  The dollars that finance Medicare and Medicaid are tax dollars—are these dollars paying for the best results possible? Are the bureaucrats that administer these programs doing everything possible to wring out waste, fraud and abuse?

The effort of the Senate HELP Committee is important and some of what they will examine will certainly spill over to the small group market. We wish them much success. At the same time we hope the effort does not stop there.  

Lastly, despite its name, the Affordable Care Act was about expanding the number of people insured; and not about reducing costs. We hope the next efforts are about increasing transparency, reforming the way things get paid and reducing health care costs. If all that passes is a simple ACA Repeal or Replace and costs are not addressed, we have, to coin and old phrase, only rearranged the deck chairs, but we have not fixed the hole in our boat.

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