After a strong long drawn out battle to change the healthcare system in America, the Affordable Care Act (ACA/Obamacare) seems to have stalled out. The White House has abruptly halted its efforts to implement perhaps the most extensive and controversial law into effect .Initially it was set to become effective on January 1, 2014. It appears that it will be delayed for another year to 2015.
The bill is over 3000 pages long and intends to overhaul the American healthcare system with its most controversial measure, the individual mandate being the centerpiece . The measure calls for every American citizen to "sign up" by law or pay a penalty to opt out. This single item was greatly debated by the U.S. Supreme Court as to the constitutionality of it. Justice Roberts considered healthcare constitutionally backed. Many other critics have argued that nowhere in the constitution is there a provision for healthcare.
Justice Roberts,however was able to successfully interpret the provision as a tax . This made it even more controversial as critics began to ask since when does a trade (healthcare) become a constitutional mandate. This "tax" provision now puts ACA under the jurisdiction of the IRS as well. But, this was only the beginning of the great debate as more than 26 states Attorneys Generals took legal action (lawsuits) against the constitutionality of the mandate and even the entire act itself. These states also plan not to accept the exchanges that will convert most of the private insurers policies into the new system.
If that wasn't enough many large corporations appear to be exempt from the exchanges which has made small business owners question the fairness of this even further.
Other law makers are looking at issues that are potentially delaying the bill into taking effect including its largess, the complexity of the language, states not in agreement with the exchanges and general the dislike by private medical doctors having to purchase very expensive computers to update all medical records to the IT system. Privacy advocates also have concerns about the accessibility of one's private medical data becoming readily available online to not only medical doctors, laboratories, third party payers and providers hospitals, government health groups (Medicare/Medicaid/HIPAA), state medical and privately owned medically related groups , but concerns grow about information potentially being "hacked" or sold for by improper use. Questions arise if a patient's medical information could be traded as a stock , bought or sold to other retail health corporations such as pharmacies if they want to know what type of medicine or biomedical product they may wish to sell such as a pacemaker or prosthetic device your physician is searching to place. These concerns are far reaching and perhaps need to be revisited by legal scholars , bio-medical ethicist, constitutional academics, actuarial experts, tax and accountant officials as well as clinicians alike.
But, perhaps the biggest road block that potentially could stifle ACA is the mid-term elections of 2014. The number of both Democrats who are straddling the fence as well as Republicans who promise to block or change the bills language may gain momentum by 2014 , just in time to make a reversal .
Clinicians , who have been kept out of the debate by far need to have their opinions heard about this matter also have a side not heard enough about this issue. Clinicians who are on the front lines of the battle treat disease daily and will be the ones who have to deal with the effects of these changes. In their minds the system should not be designed as a system that "punishes" sick or ill patients by penalizing those who are viewed as "over-utilizing" healthcare service with higher deductibles. Instead, clinicians would prefer to see a system that utilizes prevention, wellness , nutrition, fitness, and personal responsibility in a "rewards" effort that could act as incentives to help reduce disease , benefit users and reduce the financial burden.
Seventeen states have decided to opt out of the Federal Health Exchanges of ACA/Obamacare and now two medical health insurance companies in the state of Georgia have decided also to opt out of the new system. Both Cigna and UnitedHealthcare have officially opted out as to date.
A health savings and preventive incentive health system could tie wellness behavior(weight loss, better nutrition, behavior modification, regular exercise) with a system of 3rd party payers, insurance companies, and CPT codes. Many large corporations already allow wellness programs and health promotions on property or even have facilities for employers to improve fitness. Studies have proven a healthier worker is a more effective worker and can also improve the bottom line for a company. Japanese studies showed these results even earlier. Putting physical education and nutrition courses in primary and high schools to educate students about health and prevent obesity is a part of this concept. Communities need to have access to improving fitness that can be promoted by the healthcare system. By rewarding consumers who take the time to improve their BMI(body mass index ),glucose, cholesterol, or weight could have a major impact on health improvement and cost savings.
The new healthcare system will have to become a "rewards" system to modify behavior and get the consumer to accept it universally.
Dr. Wells, MD, MPH is the author of the book Fit Family . Fit Family is currently available at Barnes and Noble's website:
www.b&n.com
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