The reality of just how hard it will be to repeal and replace Obamacare is beginning to sink in, even among the law’s fiercest critics. At $3.2 trillion, the U.S. health care system is equivalent in size to the world’s fifth largest economy, according to World Bank data. Obamacare impacts almost every part of this mammoth enterprise. Let’s look at some telling numbers to understand how repealing the law without an effective replacement strategy could impact Western states.
- According to a December 2016 analysis by the Urban Institute, Montana would experience the most significant increase in the uninsured rate under a repeal of Obamacare, with 14% of the state’s population losing insurance.
- New Mexico has one of the highest rates of death by opioid overdose. Medicaid expansion required insurance to cover addiction treatment at the same level as other types of medical care.
- Of the eight states whose Medicaid enrollment increased by over 60% under Obamacare, five are in the West (CO, NV, NM, OR, WA).
Thursday morning U.S. House Republican leaders laid out elements of a replacement plan. Some of these concepts will help Western states improve access to care and contain costs. For example, high risk pools address the fact that the top 1% of health care spenders account for 23% of all spending, and the top 20% of spenders for 82% of the total. Even the libertarian think tank CATO institute agrees that high risk pools which require tax payer subsidies are a more transparent way to deal to care for the sickest patients while stabilizing the individual insurance market.
There are several other areas where a revised health care law could foster state innovation in improving access to care and addressing some of the most significant cost drivers.
- Increase access to behavior health care and addiction treatment. Much progress has been made in recent years in ensuring patients have insurance coverage for behavioral health and in integrating care for physical and behavioral health, yet every state still has a shortage of behavioral health providers. In some states, the percentage of need being met by current practitioners is troublingly low – 21% in Arizona, 25% in Montana. With heroin overdose rates having increased three-fold over the past five years, any new comprehensive health care law must prioritize the epidemic of opioid addiction and enable states to experiment with different approaches to this urgent problem.
- Remove barriers to training the next generation of health care workers. Hospital residency programs provide the final formal training that most doctors receive. Federal funding for residency programs has been capped since 1997, which puts high-growth cities like Phoenix and Las Vegas at a disadvantage. The situation in smaller communities is even more dire. Innovative programs such as the Family Medicine Residency Program at North Country Healthcare in Flagstaff should be encouraged. This program is unique not only in its teaching model but also in its ownership by a regional Area Health Education Center.
- Provide incentives for prevention and management of chronic diseases. Two-thirds of respondents to a January 2017 poll by Kaiser Family Foundation said lowering the amount individuals pay for health care should be a top priority for the new Congress and President. Two of the most cost effective ways to bring down systemic costs are to 1) prevent individuals from developing chronic conditions such as diabetes, high blood pressure and high cholesterol in the first place and 2) make sure patients are managing their conditions through correct usage of medication, smoking cessation, healthy nutrition and active lifestyles. Integrating Community Health Workers into the health care workforce is a proven strategy for lowering the usage of costly emergency room and hospital care and for keeping patients healthy. Community Health Workers can provide culturally appropriate care to vulnerable populations, thereby reducing the need for expensive medical interventions. Also, moving away from the traditional fee-for-service payment system to one that rewards effective disease management and care coordination across different types of providers can result in significant savings for individuals and tax payers.
Lawmakers are beginning to get the message that a plan must be in place before Obamacare is repealed. The Republican-led Congress would be well-served to create a system that maximizes state control while focusing resources on the areas of greatest pain. Keeping people healthy in the first place – both physically and mentally – will do the most to bring down costs across the spectrum and improve quality of life.