Friday, Jun 22, 2018
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Mend, don’t end

The Affordable Care Act is working largely as advertised; the law needs to be improved, not repealed

The Affordable Care Act, known affectionately (or otherwise) as Obamacare, is doing precisely what it is designed to do: extend health-care coverage to millions of lower-income Americans. Republican Govs. John Kasich of Ohio and Rick Snyder of Michigan are sensibly expanding their states’ Medicaid programs to take advantage of the federal law’s subsidies.

Yet the law’s die-hard opponents maintain their futile quest to overturn it, either in Congress or in the courts. A better course would be to work with the Obama Administration to strengthen the program, such as preparing for potential physician shortages. But Obamacare’s partisan and ideological detractors have shown no interest in that.

In a special report this week in The Blade, staff writer Marlene Harris-Taylor described how Toledo-area medical providers and their patients are adjusting to Obamacare. Local doctors and hospital executives agree that the Affordable Care Act is likely to accelerate a move away from the obsolete fee-for-service model, which encourages costly, after-the-fact, and often unnecessary tests, treatments, and procedures.

The new model emphasizes preventive health care and wellness, a more-central role for primary-care doctors and nurses, post-treatment follow-up, and improved coordination among family physicians, specialists, and hospitals. Obamacare offers meaningful financial incentives to focus on these priorities, which will cut costs, enhance provider accountability, and improve the quality of care while broadening access.

The Affordable Care Act also links Medicare and Medicaid reimbursements to improved medical outcomes, shared savings, and clearer up-front estimates of the cost of procedures and treatments. It encourages providers to develop specialized care-management “navigation” plans for high-risk patients with chronic illnesses, who account for a disproportionate share of medical spending.

Obamacare also promotes better coordination of multiple prescriptions, to control costs and prevent potentially dangerous drug interactions. It rewards providers for making the transition to electronic medical records, which are more efficient and allow for better care than do old-style paper files.

Some doctors in private practice complain that expanded access to medical services under Obamacare is placing greater demands on them and increasing their office costs, while federal and private-insurer payments for some services are getting cut. Other critics warn of greater centralization of America’s health-care industry, with fewer and larger providers that they fear could corner local medical markets.

The answer to such objections is not to scrap the law, but rather to launch a crash program to train many more new doctors nationwide. That is where the emphasis needs to be in Washington, rather than protracted squabbles over Obamacare.

Overall, the Affordable Care Act is making health insurance available to more Americans while maintaining the quality of care and limiting its cost growth. As other provisions of the law kick in, these advantages will become even more pronounced.

The goal now should be to fix Obamacare’s acknowledged remaining problems. This is less, not more, likely to happen while its assailants continue to fight a rear-guard action against a law that isn’t going away, and shouldn’t.

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