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Up or Down, We have work to do

By Dr. Andrew Loehrer
. 1 Comment(s)

Since the passage of the Affordable Care Act, healthcare advocacy across the country has been seemingly incapacitated in anticipation of the SCOTUS decision. Proponents and opponents are dug into ideological trenches, predicting apocalyptic consequences should the decision go one way or another.  Yet regardless of the ultimate legal result, there remains much in place both because and independent of the legislation about which patients, providers, and advocates should be encouraged. 


A multitude of key provisions within the ACA have already gone into effect with tremendous success.  Millions of young adults have gained access through parental plans.  Discrimination based on pre-existing conditions is no longer in place and over 14 million seniors have access to free preventative health services.  This week, private insurers Aetna, Humana, and UnitedHealthcare announced that they will continue to honor these provisions regardless of the SCOTUS decision.  Similarly, health systems across the country have initiated and begun scaling care redesign models that are unlikely to be turned back should parts of the ACA be struck down.


Beyond isolated responses to the ACA, payers and providers have continued to move forward on novel initiatives to improve access to and delivery of healthcare.  New contracts between private insurers and hospitals are shifting away from fee-for-service and toward quality or outcomes based reimbursement.  The Commonwealth of Massachusetts tackling rising cost of healthcare through such models and will likely have another major piece of major policy reform before the year is out.  Both private and public payers are tackling the problem of inefficient care delivery for high-utilization patients with remarkable results that not only improve health care outcomes but also reduce costs along the way.


After decades of an inefficient and perversely incentivized system, significant progress will require much more than a single piece of legislation.  Disparities in access to and outcomes of health care by socioeconomic status and patient race persist across the country.  Rising healthcare costs continue to stress patients, communities, and our national economy (a trend not unique to the United States).  Often backing away from contentious topics, our country has yet to fruitfully engage very critical discussions about appropriateness of many medical and surgical treatments as well as end-of-life care for elderly and terminally ill patients. 


The ACA brought many key healthcare issues to the forefront of the national discussion but it is but a first step in a much larger solution.  As delivery and payment models continue to evolve, advocates too must be willing to work beyond ideological strongholds and remain open to impactful solutions that will likely vary greatly by geography, practice setting, or patient populations.  The healthcare community should therefore remain poised to collaborate across disciplines, industries, and political lines with the common purpose of creating more accessible, affordable and quality care for all Americans. 

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  1. Maggie Kozel, MD

    Well said! Thank you.

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