ACA and the Nose-Face Problem

In 1807, in an effort to spite the British and French for shipping interference (and forced recruitment of American citizens into military service), the United States Congress passed an Embargo Act, effectively shutting down trade with these two countries. Britain and France quickly found other trading partners; the US, then limited in our capacity to sell products outside our borders, was left with a devastated economy and a gaping hole in our face. It took only weeks before Congress passed a loophole; they repealed the act within 15 months. 

Continuing the historical trend of ignoring unintended consequences, today’s Republican-controlled Congress seeks to replace an existing structure (let’s call it the ACA, for Affordable Care Act) with a FEMA trailer (let’s call it R&R, for Repeal and Replace). While people may not like the design of ACA, a quick consult with the healthcare counterparts of the Property Brothers or Chip and Joanna Gaines might have fixed it up a bit. But R&R was a promise and, being men of their word, scheduling ACA’s “tear-down day” was far more important that the quality of the blueprints for its replacement.

Front and center for demolition is ACA's most prominent feature: Essential Health Benefits. 

While Federal mandates may smell to some like limits on personal liberty, the ‘essentials” were far from arbitrary in their design; specifically chosen because of their broad social and economic value, eliminating them will place us all at risk.

More than 70% of American healthcare expenses are not paid by patients; 20% are subsidized by employers and 50%+ (more in the case of citizens over age 65, families with children at risk and adults with special needs) are paid out of Federal and State government coffers. This means we are paying for each other’s care right now, and will continue to do so in one way of another. In recognition, ACA attempted to create an economic safe harbor for public monies; R&R leaves us exposed to the elements.

Let’s look at two criticisms of “essential health benefits” to understand why this approach is valuable:

Why should I pay for maternity and newborn care if we’re done having children?

Your insurance premiums don’t really pay for your expenses; they are put into a pool that is used for all its “members”. Some pay more than they use, some pay less; others contribute so that there is a chunk of money available in case of disaster.

Here’s the thing: sick newborns, whether the result of nature or nurture, require extensive, expensive resources, special supports and services in school and can have lifelong disabilities. However, many of these problems are easily preventable through good prenatal and newborn care.  While the disabled baby may not be yours, it could be your neighbors, or drain resources from your grandchild’s school system budget. So, while being able to “opt-out’ of maternity and newborn care may result in a small reduction in your insurance premium, you are going to pay anyway, and far more than the additional cost in that premium.

Why should I pay for preventive and wellness services I don’t want?

Whether through Federal or state tax dollars, we all pay for late stage cancers, heart attacks and strokes, depression, anemia and vaccine-preventable infections such as the flu or pneumonia. “Essential health benefits” reduce those late-stage and catastrophic costs, freeing up money for law enforcement, community services and better roads. Eliminating essential health benefits may result in a short-term premium savings, but the economic consequences are substantial, especially as our society ages; between 2011-13, the ACA resulted in an increase of 8,400 diagnoses of early-stage colorectal cancer among US seniors, saving hundreds of millions of your tax dollars which would have been required for late stage treatment.

Since we’re already paying a share of the costs of our fellow citizen’s medical problems, I want to make sure that my money is being spent well, or at least not spent unnecessarily.  I can’t support the freedom to delay the diagnosis of colon cancer, acquire bacterial pneumonia, or go blind from diabetes or glaucoma; I can think of a few other things I would like my taxes spent on other than a completely preventable stroke and the subsequent physical and neurological consequences.  These conditions put limits on freedom that go well beyond anything imposed by the ACA.

Improving the health of Americans is not really about coverage, but about increasing the use of preventive, wellness and chronic disease management services that were part of the essential health benefits. This is where the real, big league, benefits lie; but first we need to make up for lost time (and care) for millions of people with under-managed chronic illness. Only then will the overall cost of maintaining our health will go down; and, even if they don’t, we will all just be healthier and live longer.

Essential health benefits are not an imposition, but a means to assure that our communities and our country have a better quality of health, which improves workforce productivity and economic vitality. Putting our lives at risk to defend our freedom is a fundamental aspect of American life, but this is not the same as letting people have the freedom to put their own lives at risk when the consequences, and their associated costs to us all, are completely preventable. 

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