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The Affordable Care Act: If not this, then what?

February 22, 2011
by Ron Manderscheid, PhD, Executive Director, NACBHDD
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In whatever form it takes, reform is no longer an optional activity—it's mandatory

As I sit by my fireplace on a cold winter night and feel a warmth like the coming spring, I ask myself, “If not this, then what?” Of course, I am not referring to spring, but rather the Affordable Care Act.

The House vote to repeal this Act was overturned by the Senate, yet more than a score of state lawsuits are currently pending. The cases are likely to be argued before the U.S. Supreme Court. We need to take stock of this situation, and begin to plot our own course into the future.

Intuitively, most of us know already that reform of the healthcare system is not just a frivolous idea; it is essential, both for the economic wellbeing of the United States and for the personal wellbeing of each of us. Let me explore these notions a little further.

As we are reminded almost daily, the Great Recession of 2008 has necessitated a surge in Federal spending which has forced our annual national deficit to record levels—probably in excess of $1.5 trillion for the current year. What may be less obvious to us is that:

  • At the current level of spending, Medicare will move from a positive to a negative cash flow by 2017, just six years from now.
  • The elderly population will double from 36 million to 72 million by 2030, making it likely that Medicare expenditures will also double in the same period.
  • The Medicaid system, with 44 million already enrolled and massive current state budget deficits, is strained everywhere and in many states, already beyond its limits.

Yet, even with these very large expenditures today, we are left with nearly 50 million uninsured people, including about 8 million children, whose only care is provided through extremely expensive emergency rooms. And, we haven’t even talked about the 10 percent-plus rise in private health insurance premiums for 2011 or the financial strains being experienced by the military health system, the VA health system, or by Social Security. Not a rosy financial picture at all!

Now let me turn briefly to the personal level. We know today that:

  • Half the U.S. population, more than 155 million of us, already have at least one, and likely more than one, chronic condition.
  • This half of our population consumes more than three-fourths of the $2.7 trillion we spend each year on health care.
  • We have an exploding obesity problem that will only increase the number of people with chronic conditions in the future. (In many of our poorest urban communities, one simply cannot purchase healthy foods!)
  • Nationwide, virtually no providers offer health promotion services.

I could go on ... but you get the point. It’s not a healthy picture of our personal wellbeing! We know the behavioral health realities as well:

  • Persons with mental illness and substance use conditions are at epidemic levels in our communities.
  • An estimated 10.5 million adults and nearly 2 million children—all without health insurance—already have these conditions and do not receive appropriate care.
  • The fields of behavioral healthcare and addiction medicine are literally riddled with health and care disparities.

Again, not an optimistic picture at all! So, what are the consequences—what is the bottom line? Without a decisive change in direction, it's very difficult to see how any of the following can occur:

  1. The U.S. remaining economically viable. The financial load simply will be too great. To stay afloat, we will be very, very tempted simply to jettison the most vulnerable among us.
  2. The U.S. remaining economically competitive in the world. Being competitive really requires a healthy population.
  3. We, as individuals, having a good sense of our personal wellbeing when we are confronted with all of these dilemmas.

Hence, I return to my original question, “If not the Affordable Care Act, then what?” The Affordable Care Act is intended and is designed to address the issues I have described here. Many, including me, have written and spoken frequently about the features of the Act. If all or part of this Act is set aside, we will just need to reinvent it again in a new form. Health reform, in whatever form it ultimately takes, just is no longer an optional activity for us. It is mandatory!

Intuitively, I believe that most of us understand the scenario I have offered here, and most of us know that quick action is vital. Thus, I am very confident that we will eventually do what needs to be done, after we try various other avenues. This reality, like the warmth of the coming spring, is cause for much optimism.