Ken’s Take on the World

Among a string of poor public policy positions advocated by members of the Republican Party, the recent decision to attach an amendment to a Continuing Resolution (CR) that would fund the government but withdraw all funding for various components of the Affordable Care Act (ACA) is among the dumbest.  There are several reasons for arriving at this conclusion.  The most dangerous is that it will potentially lead to a partial shutdown of government which affects every single American.

First, the amendment that was attached to the Continuing Resolution striking funding for the ACA is purely a political gimmick designed to appease a small, extremely regressive, faction of the Republican base.  It is highly unlikely this amendment will be attached to a Senate resolution for a floor vote.  If it is offered as an amendment, it will likely not be approved.  This means the Bill goes into a Conference Committee.  This will put the House of Representatives into a showdown with the Senate and pushes us closer to a deadline which will result in the stoppage of essential government services.  Think Social Security checks, Military paychecks, the Centers for Disease Control and Prevention (CDC) which is gearing up for flu season!

For the sake of argument, let us say that the amendment does become a part of the final Bill that is presented to the President.  It is extremely likely the President the President would return the Bill to Congress with a bright VETO stamp across the top.  Republicans do not have the votes to overturn a veto and would be left holding the bag on a smelly collection of dog excrement when the deadline for government operational funding passes.  American citizens do not like when there is no one answering the telephone at the Social Security Office!  I personally would be quite pissed off if I found that our Military service members were not getting paid!!

Let’s enter the world of a Republican wet dream for a moment.  The amendment that defunds the ACA is passed through both chambers of Congress and the President accidentally signs this wrong-headed piece of legislative bovine-manure.  The Republican Party collectively orgasms all over themselves and claims they have achieved a monumental victory!  Orthopedic surgeons in the Beltway will be extremely happy for with all of the folks patting themselves on the back there are sure to be a few Rotator Cuff tears to deal with.

What happens next?

This amendment does not repeal the Affordable Care Act.  It does not block the implementation of any of the rules and regulations promulgated by the ACA.  It only does one thing.  It eliminates funding for any of the provisions of the Affordable Care Act.  So, what?

Hospitals have begun to implement Electronic Health Records (EHR’s) using money provided under the ACA.  Study after study has demonstrated that EHR’s reduce medical errors and have the potential to reduce costs.  The ACA requires that hospitals and physicians adopt the EHR as part of a goal to improve patient safety.  Doctors and hospitals are now left solely on the hook for the expense of this technology.  Failure to comply will result in a loss of eligibility for Medicare and Medicaid reimbursement.  The hospital I work at receives more than 40% of its reimbursement from these two programs.  Fortunately, we have already completed adoption of an EHR system.  I do not know about all of our affiliate physician groups and individual practice physicians, however.  If our surgeons cannot operate on Medicare patients, a huge piece of our revenue stream disappears.  Hospitals generally operate on extremely thin operating margins (gross revenue over expenses), typically 1 to 3%.  Many hospitals have a much higher percentage of Medicare and/or Medicaid patients and would be impacted even more by a loss of access to these revenue streams.  Loss of Medicare funding will mean the demise of a number of independent hospitals and loss of funding for EHR technology will mean that most independent practice physicians and many physician groups will cease to exist.

States are required to begin enrolling individuals in Health Insurance Exchanges (HIE’s) beginning on October 1.  Funding to set up these exchanges was allocated through provisions of the Affordable Care Act.  In a number of Republican-led states, the legislature and executive refused to participate in an HIE.  In these states, the Federal government is operating the exchange.  The money to administer these programs is eliminated as a result of the defunding amendment.  Insurance companies are participating in these exchanges anticipating a new influx of customers seeking health insurance.  From a business standpoint, health insurance companies know that having a broad base of customers allows them to spread risk among a broad base of payers.  This means that insurance rates can be maintained at an affordable rate for all consumers.  In a number of states that have already started operating these exchanges, insurance rates, including premiums and deductibles have been lower than suggested by certain folks on the right of the political spectrum.  Many of the folks enrolling are doing so in anticipation of subsidies available as part of the ACA.  Those subsidies are gone as a result of the amendment.

Under the Affordable Care Act, which, by the way, remains the law, insurance companies cannot deny coverage or charge exaggerated rates to individuals based on health status.  With the defunding amendment, Health Insurance Exchanges have been hobbled and not able to reach out to customers.  Since they will not be able to obtain, potentially 30 million additional customers, insurance companies will be forced to drastically raise the cost of premiums for all of their customers.  Except for the wealthiest among us, individuals will find they are unable to afford monthly premiums and will be forced to drop their coverage.  Businesses will find it increasingly difficult to afford the cost of health insurance for their employees and will begin to drop insurance coverage.  Instead of stable, affordable premiums, I would anticipate much more expensive premiums.  The result, millions more uninsured Americans!

This wrong-headed amendment to defund the Affordable Care Act would be dangerous for patient safety, health insurance companies, hospitals, doctors, taxpayers, and businesses.  The proponents of this legislation have failed to grasp the tremendous negative consequences of such a thing happening.

I am absolutely certain the Republican leadership in Congress is fully aware that they are playing political gimmickry with this amendment to defund the Affordable Care Act.  They know, completely, that this amendment will not make it to the President’s desk.  Speaker-of-the-House John Boehner knows this as does every member of the US Senate.  The absolute worst possible outcome for Speaker Boehner, and every Republican member of Congress would be for this to land on the President’s desk as part of a Continuing Resolution and actually be approved by President Obama.  The resulting collapse of the Affordable Care Act will lead to a collapse of the health insurance industry, hospitals and physician practices, and culminate in the establishment of a universal, single-payer healthcare system in the United States.  Speaker Boehner would be credited, single-handedly, with bringing Socialized medicine to the United States of America!