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Health Policy and Health Services in the United States: Where Are We Headed?

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Suzanne Discenza

health-care-workerThe inauguration of a new President brings more questions than answers regarding the future of not only the Patient Protection and Affordable Care Act (PPACA) of 2010 (also known as the ACA or “Obamacare”), but also of many important public health policies and programs across the United States. Medicare, Medicaid and abortion policy have been threatened with privatization, decreases in eligibility or funding and even repeal at the federal level. Will Medicare “entitlements” be replaced by “vouchers,” with a fixed dollar amount being provided to each Medicare recipient regardless of the costs of their medical needs? Will elimination of Medicaid expansion or reduction in Medicaid services leave more of the country’s poorest citizens with no access to health care beyond high-cost emergency department use? What will happen to the 20 million people now insured through state health insurance exchanges if the ACA is repealed by Congress?

Entities funded either fully or partially by state and local governments are further bracing for barriers to health care funding and services for many of their most vulnerable citizens. The repeal of the ACA “threatens states’ public health funds,” wrote Jayne O’Donnell in the Jan. 17, 2017, issue of USA Today, noting that elimination of the ACA’s Prevention and Public Health Fund would remove programs “most needed to prevent and treat increasingly costly [chronic] diseases” such as diabetes. Complete defunding of Planned Parenthood related to the abortion policy controversy would severely restrict local access of low-income women to preventive and primary care services, the primary focus of most Planned Parenthood clinics. Will states and local communities be increasingly held accountable for provision of health services for their citizens? Will employers, philanthropies and nonprofits, or faith-based organizations step up to fill the void?

Purpose of the Current Health Policy Series

This series of six monthly columns proposes to explore the future of current government-sponsored health care policies and programs, highlighting arguments by both proponents and opponents to eliminate, replace, modify or preserve targeted policies and programs at the national, state and/or local levels.  Both intended and unintended consequences of these changes will be discussed, as well as potential financial, social and individual/population health outcomes and impacts. Finally, the reader will be invited to contemplate (perhaps again) the arguably most profound and problematic question in U.S. health policy circles: “Is health care a right, or is it a privilege?”

First Things First: All Eyes Are on the ACA

While it may seem almost inconceivable to many of us working in or supporting the public sector that many Americans do not understand that the ACA and “Obamacare” are the same entity, recent stories in the media seem to have “suddenly” discovered this to be the case.  A recent tongue-in-cheek expose by the Huffington Post on Jan. 17, 2017, titled “News Flash! Obamacare and the Affordable Care Act Are the Same Thing,” cited a 2013 CNBC poll showing that significantly more people opposed the ACA when the President’s named was associated with it than when it was referred to by its official name.  But it is for just this reason, involving public ire against the dreaded “Obamacare,” that the new President and the Republican majority in Congress purportedly feel compelled to overturn the ACA as its first order of business, despite the rising alarm among this same public that they or others may lose their health care coverage if the ACA is repealed.

Thus, it is only right to begin this series with an initial discussion on the ramifications of the repeal, replacement or severe modifications of the ACA. Whether a proponent or opponent of the most comprehensive piece of health policy legislation since passage of the Medicare and Medicaid programs in 1965, there is one point on which all individuals might agree: that repeal or major modifications of the policies implemented through the ACA will have a profound impact upon health care delivery in the United States. And although this discussion must necessarily be continued into the next month due to its breadth, for now the reader is asked to consider the consequences of elimination of a few of the ACA’s key provisions:

  • Health insurance coverage may not be denied an individual (starting with children) based on pre-existing conditions.
  • Young adults may be covered through their parents’ health insurance plans until they are 26 years of age.
  • Insurers must cover preventive care for children.
  • Medicare must provide annual wellness visits and free preventive screenings for seniors.
  • Expansion of Medicaid to include more low-income Americans.
  • Establishment of state health insurance exchanges to provide more affordable health insurance coverage for middle and low-income Americans.

Indeed, all eyes are on the ACA in the first month a new Presidential administration.  Part II of this series will highlight the progression of its yet-to-be-determined fate.

Suzanne Discenza currently serves as a lecturer in the School of Public Affairs at the University of Colorado Denver and as an adjunct professor in Public Administration and Healthcare Management at Park University.  Former Director of the MHA Program at Park, she also serves on the ASPA National Council and as Past Chair of the Health Policy Forum of AUPHA. Email: [email protected]

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