Reflections by Past Presidents of the ACOP
By Steven Snyder, DO, FACOP
Former ACOP President
Steven Snyder, DO, FACOP
Now that the election has passed and a new president has been sworn in – are we still anxious? Our country celebrated one of its leading tenets – the peaceful transition of power. Whether you are happy, anxious or scared, the country has weathered many storms. From a health perspective, the new administration has placed the Affordable Care Act (ACA) on the hospice service. Over the last eight years, there have been many pronouncements that “the country would go bankrupt”, “businesses would close” and “doctors could not stay in business.” The same headlines and pronouncements were made when Medicare started 50 years ago. Yes, some things will change and some will feel the pinch of whatever comes next. Both sides have squared off for a fight. The real question is who will feel the pain. Unfortunately, it is usually the patient.
So, who suffers? There are several things that could happen. President Trump’s executive order not to enforce the mandates will speed up the ACA’s death. Healthy people will no longer be fined if they aren’t enrolled and employers need not provide health insurance to workers. This means that if fewer healthy people are insured, it will cost more to insure them and therefore increased premiums or less coverage.
Without an actual plan, how can we measure whether there is better availability, affordability and adequate coverage? Providing tax credits that vary by age and not income, as proposed by Speaker Ryan and Tom Price doesn’t take the cost of actual affordable quality coverage into account. If affordable coverage is not available, people won’t get insured. How do we know? Go back eight years when 43 million were uninsured compared with 21 million today. Twenty-one million is still too many for the richest country in the world.
Expanding Health Savings Accounts (HSAs) are beneficial for those with higher incomes. Lower income families generally don’t have the extra to put away and can’t afford the cost of the high deductibles that HAS-eligible plans carry. Some proposals would also allow HAS-eligible plans to pay for premiums. Tax deductions and credits help those at the higher income levels. If we reduce the tax revenue, how do we pay for government services?
Eliminating the ACA may alter the substantial advances made in breastfeeding support. Currently, approximately 8 million dollars is allocated to the Centers for Disease Control and Prevention (CDC) for breastfeeding initiative like maternity care practice improvement. The ACA also requires health plans to cover breastfeeding services and supplies as a preventive service. Other provisions of the ACA require employers to provide break times and a private place for employees to express human milk in the workplace. If businesses didn’t have to do this prior to the ACA, will they continue to do this because it’s the right thing to do? If it was the right thing to do, they would have done it without the ACA?
This doesn’t even scratch the surface of parents insuring children until they are over 26 years old, pre-existing conditions or many of the other issues in the news.
We continue to provide care for America’s children. Whether we get paid to provide the care depends on whether they are insured. I never ask for insurance verification prior to intubating in the delivery room.