Less than a month until online marketplaces are set to open, physicians find ourselves uniquely situated to act as advocates and repositories of basic information for our patients, family and friends, and sometimes colleagues, some of whom have only been following the ACA implementation on the op-ed pages of our local papers. And because of the way the politics of the Supreme Court decision have played out, for some of us the personal initiative we each take as individuals may make the difference for a patient between accessing quality, reasonably-priced health care and them falling through the administrative cracks, for many, yet again. Repeated polling has shown few Americans understand that the ACA remains the law of the land, and even fewer that it is rolling out across the nation in the next few months. HHS has undertaken some efforts to get the word out to targeted states and demographics, with the assistance of the states that are enthusiastically rolling out the law. Minnesota has Paul Bunyan and Babe the Blue Ox. Oregon has hipsters playing mandolins. Washington has ads at music festivals. Even states like Kentucky and West Virginia are setting up booths at summer fairs supporting their health exchanges. But the states that have remained reticent, if not outwardly hostile, to the imminent changes to the health care system aren’t giving any assistance to the over extended HHS- so what they have, is us.
Over the coming months, we will be fielding questions about what health care exchanges mean for our patients. Or, honestly, anyone we know. We can be equipped with coverage information, website referrals, and approximate costs. But what we can provide that a google search won’t- is our confidence and buy-in to the reforms. While complex and nuanced, the ACA puts us on a trajectory to narrowing the gaps in health outcomes which have opened up between the US and other countries, and within the US itself. We each have our opinions on where to go from here, and what changes could be made to make our healthcare system even more equitable and resilient- but by hearing the physicians in their lives express confidence in the path we are on, we provide a needed voice in the cacophony of conflicting reports our patients and personal circles have heard.
In the past week, I have engaged in a number of conversations I was pleasantly surprised to be approached with. As opening date nears, it seems a steady stream of information is beginning to reach a certain swath of the people I interact with, particularly those who the opportunities afforded by the ACA have something to offer. I was able to reassure someone that premiums on the exchange are going to be quite constrained in what criteria they can use to risk adjust- their age and pre-existing conditions no longer being a hindrance from receiving care. Another person who would certainly fall in the “young invincible” category was anxious about what happened when he turned 26 next year. Unlike the coverage we are inundated with, he is quite eager to sign up for affordable insurance on the exchange- and was asking for information to pass along to his friends in the same position. A third conversation centered on how the next stage of evolution of health care reform might take place- someone who had insurance through a university, but was startled to see the plans coming out on his state’s exchange, clocking in at a fraction of what he paid. The transparency on pricing that the exchanges mandate, as well as the compelled publication of prices at both public and private hospitals is already beginning to chip away at the edges of our perceptions of cost and quality in the larger system as a whole.
And my role as a physician gave me a particular role in these conversations- to be honest but encouraging. To show that I believe in the strides we are making towards making our health care system more efficient and more equitable. And that we are all- physicians, patients, and the public alike- on the same team in our efforts.