Debate & Discussion Continues Of Replacing The Affordable Care Act

Congress is considering the American Health Care Act.


Frederick, Md (KM)  Citizens in and out of Congress are discussing and debating the merits of repealing the Affordable Care Act–often known as Obamacare–and replacing it with the American Health Care Act.

During Saturday’s “Success Happens” on WFMD, Dr. Mark Soberman, the Medical Director of Frederick Memorial Hospital’s Cancer Center, said there are problems with the Affordable Care Act which need to be addressed. “There are problems with the insurance exchanges. There are problems with the rate of rise of the premiums,” he says. “A lot of those premium rises have mitigated by subsidies, but then there’s a question of where the subsidies come from. So a lot of this come down to how to pay for the thing.”
The American Health Care Act was introduced by House Speaker Paul Ryan as a replacement for the Affordable Care Act. It has run into opposition from not only Democrats, but Conservative Republicans, many of whom campaigned on a promise to repeal Obamacare. Many are calling it “Obamacare lite.”

Dr. Mark Plaster, an emergency room physician and attorney, said coming up with any compromise on replacing the Affordable Care Act won’t be easy. “The country is just at each other’s throats, and we’re forgetting that we’re all in this together,” he said. “And in actual fact, we’re all trying to do the same thing which is trying to extend health insurance to the greatest number of people the best quality health insurance.”

The Congressional Budget Office say the American Health Care Act would reduce the federal deficit by $337-billion over the coming decade by cutting outlays for Medicaid and eliminating the Affordable Care Act’s subsidies for non-group health insurance. It would also do away with the Hospital Insurance payroll tax rate for high income taxpayers, a surtax on those taxpayers’ net investment income and the annual fee imposed on health insurers.

But the CBO says the American Health Care Act would mean that 14-million more people would be uninsured by 2018 due to the elimination of the penalties associated with the individual mandate to carry health insurance. That number would rise to 21-million in 2020,  and 24-million in 2026.

David Liddle, the CFO of Mission of Mercy, said since the Affordable Care Act went into affect, fewer patients have been coming to the agency’s mobile health clinic. Speaking by phone on “Success Happens,” Liddle hoped those patients have obtained insured, and developed relationships with physicians and other providers to serve their health care needs. But, he said, having health insurance doesn’t mean you’ll always get the care you need. “There were new additional groups that were coming to us, and oftentimes many patients who got insurance through Obamacare–if you want to call it that–and found that the insurance wasn’t  available for the actual care they needed,” says Liddle.

Dr. Plaster echoed similar comments. “We were anticipating with that with the extension of Medicaid that fewer people would go the emergency department. Exactly the opposite occurred,” he said. “More people had insurance, but the couldn’t get into a private office. So we actually saw  the number of Medicaid patients in the emergency department go up.”

During this debate on health care, Dr. Soberman says the issue of quality is often left out. “We currently are in a volume-based system. We get paid for the volume of service we do. So the incentive is the more you do, the more the hospital, the physician, whomever, get paid,” he said. “But there is no reward for quality. There’s no value, value being the quality being the benefit to the patient divided by the cost.”

He said there are a number of organizations which are working on this issue.

Dr. Plaster said insurance is part of the problem because it insulates patients from the actual cost of their procedures, such as surgeries and their medications.

“I think we have quality health care here. We have some of the best if not the best in the world. It’s just too expensive,” said Dr. Plaster.


By Kevin McManus