BY DR. THOMAS T. LEE
In a 5-4 ruling, the Supreme Court of the United States recently upheld the majority of the Affordable Care Act (ACA). While we applaud the efforts to ensure all our citizens have access to quality, affordable health care, the methodology utilized under ACA to achieve universal coverage is unrealistic and unsustainable. Full implementation of the ACA as it is will harm patient access to quality care. The Westchester County Medical Society has been on record against this law because of its many flaws, which include
Ӣ Medicare cuts of $500 billion over 10 years. This will put pressure on a system that is currently underfunded.
Ӣ Failure to reform the Sustainable Growth Rate (SGR) formula for Medicare reimbursement, which cuts another $350 billion from providers of health care services.
Ӣ The formation of a health care infrastructure of more than 150 committees and boards to regulate and control health care from Washington, including the Independent Physician Advisory Board (IPAB), which will recommend coverage and payment rates to Congress without Congressional or public oversight or comment.
”¢ The unfair imposition of a 40 percent nondeductible excise tax on “Cadillac plans,” which adversely and disproportionately affect insurance plans in the Northeastern US ”“”“ including Westchester County ”“”“ which have higher costs than other parts of the country. If this policy is implemented in 2018, many people in Westchester will lose their current coverage.
”¢ The formation of state health care exchanges that subsidize insurance premiums for incomes up to 400 percent of the poverty level (about $96,000 per year). This, plus a relatively low penalty of $2,000 for failure to provide or purchase health insurance, will incentivize employers to drop their employee coverage and have people migrate from employer-based insurance to the exchanges. Many employers and benefit-consulting firms have stated that they are leaning toward dropping their health insurance benefits. It is estimated that 20 million Americans will lose their health insurance in this fashion. In reality, “You get to keep your insurance and doctors” is not something the current legislation will promote.
Ӣ A 2.3 percent excise tax on medical devices, which will put innovation and employment in this sector of the economy, which is vibrant and dominated by American companies, at risk.
Ӣ Failure at any serious malpractice litigation reform, since our current malpractice system drives up the tremendous cost of defensive medicine.
Ӣ $1 billion for the formation of an Evidence Based Medicine (EBM) infrastructure to conduct Comparative Effectiveness Research (CER), which in other countries is used to limit access to medical and surgical services.
There are provisions of the law which are popular, such as preventing insurance companies from denying benefits based on pre-existing conditions, a preclusion from instituting lifetime caps on coverage and allowing children up to age 26 coverage under a parent”™s policy. These are meaningful reforms that WCMS supports. The other portions of the law, however, will lead to serious diminutions in access to health care now and in the future. The President and Congress should act to improve the law so that the best health care system in the world is not seriously crippled in its ability to serve the American people and their health care needs.
Dr. Thomas T. Lee is president of the Westchester County Medical Society.
