When the Supreme Court deemed the Affordable Care Act constitutional one year ago, it was a monumental moment in our nation’s history.
It meant that essential, historic reform of the American health care system would move forward. It meant guaranteed health care access for millions of Americans who hadn’t had access before.
It meant a re-energized focus on medical quality and the development of a more efficient health care delivery system.
Twelve months after the court’s decision, though, there are still more questions than answers.
Will insurance exchange programs be up and running by the due date? Will Americans understand these exchanges, what they will cover, and how to enroll? Will states expand Medicaid, as encouraged by the ACA? And what impact will the ACA have on hospitals, the economy and jobs?
One of the few certainties at this point is that reimbursement for medical services will decrease. health care providers will be paid less to deliver more care.
Our challenge is to find ways to work more efficiently and decrease costs, while continuing to deliver high quality care.
With implementation of the ACA, hospitals face some relief but also new pressures. Expanding health insurance to about 30 million more Americans will mean hospitals won’t have to shoulder as much of the cost of caring for the uninsured. However, all of those additional patients will need thousands more physicians than are working now.
The ACA does take some steps toward driving down health spending; for example, it will stop reimbursing hospitals for preventable re-admissions, creating a financial incentive for doctors to get treatment right the first time.
That’s certainly a start, but with a growing elderly population and a still-recovering economy, more needs to be done.
Specifically, four items should be at the top of the list – Medicaid expansion, hospital consolidation, salaried physicians and obesity. Here's more:
- Medicaid expansion was expected to cover 17 million uninsured Americans, but states can opt out.
In Ohio, the coverage of 275,000 low-income, uninsured Ohioans is at risk as politicians argue that Medicaid expansion would strain the state budget or expand the government’s role in health care.
That is simply wrong -- medically, economically and morally -- if we as a country believe that all Americans should have access to health insurance.
- Consolidation will be a growing trend in health care as providers look for ways to draw on each other’s resources and expertise.
Technological advances have become too expensive for all hospitals to be all things to all people. Instead, hospitals will come together to form networks of care, with certain hospitals acting as centers of excellence.
- Physicians should be salaried, not paid on a per-procedure or per-patient basis.
At Cleveland Clinic, all doctors are salaried employees of the hospital. They are paid the same, regardless of how many tests they order or how many surgeries they perform. The intent is not to get a bigger paycheck but to do what’s best for the patient.
- By 2020, half of all Americans are likely to suffer from one or more chronic diseases, a majority of them weight-related.
The ACA does not address this issue, but we simply cannot control health care spending without addressing Americans' weight.
We have to create incentives to keep people healthy, through programs that encourage wellness and prevention. When people are healthy, health care costs go down.
This is a time of unprecedented transformation in health care. We’ve truly entered a “new normal” in health care, and everyone is working quickly to adapt.
However, this isn’t a topic to be dealt with by health care providers alone. Collectively, we must all take responsibility for the cost of health care in this country by losing weight, eating healthier and quitting smoking. After all, the state of our nation is only as good as the state of our health.
Toby Cosgrove, M.D., is president and CEO of the Cleveland Clinic.