My ACA Holiday

By  |  January 16, 2014 | 

I’m not sure if they were inspired by all of the commercials encouraging families to “talk about healthcare coverage” during holiday get-togethers, but clearly my family and friends were interested to find out what I thought about the Obamacare rollout and about the Affordable Care Act in general.  This is not surprising as there has been so much in recent news about healthcare and it had been quite awhile since we had all gotten together.  And of course they know that I have been involved in the healthcare policy world both through my work at Cogent and through SHM, spending the last several years steeped in both the practical and the more arcane features of the subject.

Hoping to avoid talking shop (and doing my best to avoid the always dangerous political discussions at holiday dinners) I tried to evade answering by describing the subject as complicated, multifaceted and not conducive to simple opinions. But it was no use. I was cornered, with nowhere to go but a kitchen full of dirty pots and pans.  And so I decided to do my best to simplify the subject enough to provide a few honest answers and still finish in time for dessert.

I started by saying that in my mind there are really three main areas covered by the bill.  These include insurance reform, expanding coverage to the uninsured and, the area of most interest to me, delivery system reform.  It is, after all, these reforms that are supposed to eliminate enough waste and save enough cost to pay for the other aspects of the bill.

Regarding the attempts to reform insurance coverage and to provide medical coverage for millions of currently uninsured, my take was hardly surprising to my guests. Between the website problems, tepid interest of the young to buy insurance, and the loss of current insurance plans by millions of well meaning citizens, even the most casual observer had to acknowledge that it had thus far been a mess. “The fixes will not be easy or quick and it will very likely get much worse before it gets better,” I concluded.

Realizing I was dampening the spirits in the room I quickly moved on to comment on delivery system reform knowing that I could speak more convincingly and optimistically about the progress made in this regard. Even I started to feel better as I described how physicians and hospitals are working together more to deliver safer and more patient-centered care and how my hospitalist colleagues are instrumental in these efforts.  I talked about my travels around the country where I have seen the innovative ways that creative provider groups are managing populations of patients often with dramatic results. I described how SHM staff and its Public Policy Committee are influencing Congress on emerging legislation to fix dysfunctional rules and incentives that have been preventing better care.  And how there is an increase chance of success on much of this legislation because of bipartisan support!  A sustained growth rate (SGR) fix in the near future?  Eliminating the acute stay provision for skilled nursing facility (SNF) eligibility? A simpler observation stay rule?  After all these years, could we actually be making some progress?

I was on a role but it was clear I was losing my audience as their eyes were glazing over. I think I may have heard my nephew mumble “uncle” under his breath.  I’m not sure whether he was trying to get my attention or muttering a surrender.

The good news was that I was able to stop talking and enjoy my pie.  And my guests learned a valuable lesson for future holiday dinners.  Don’t ask!

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