Healthcare 2050 - Affordable Care Act

Healthcare 2050

Charles Gruer, Delydia Meadows, April Rogers, Andy Starkey

Pfeiffer University

Abstract

Even after full implementation of the Affordable Care Act (ACA), the CBO (2015) estimates by mid-century tens of millions of Americans will be uninsured or only partially insured, and costs will continue to rise faster than the background inflation rate. We must aggressively work to reduce healthcare costs, improve access to care, and better engage the public in managing their health.  We propose replacing ACA with a publicly sponsored healthcare program that would provide basic and advanced medical coverage for all Americans while lowering costs by streamlining coverage, leveraging technology, and eliminating the profit-driven private insurance industry with its enormous overhead.  AmeraCare Program (ACP) composed of two parts. BasiCare part 1, would provide free coverage for health screening, maintenance, prevention, and Urgent/Emergent Care.  AdvanCare part 2, would provide additional coverage for chronic illness available for purchase from non-profit insurance providers.  Dept of Health and Human Services will quote contracts with 3rd party insurance providers annually to ensure consumers are getting the most of every dollar spent on insurance premiums.  

Under our plan, healthcare funds would be streamlined into a single payer system with government oversight.  The government and individuals would share in the costs.  Hospitals, nursing homes, and other provider facilities would be nonprofit.  The government supported operating budgets would replace fees for each service. Physicians could elect to be paid on a fee-for-service basis, and fees would be adjusted to reward better primary care providers, or by salaries in facilities paid by annual operating budgets. The initial increase in costs would be offset by savings in premiums, better prevention/maintenance, and out-of-pocket costs.  The speed of medical expense increases would slow, releasing resources for other medical and public health needs.

Introduction: Healthcare Must Change

Thirty years from now, healthcare will be nearly unrecognizable as care moves to the outpatient setting and organizations integrate artificial intelligence, telemedicine, and other IT applications to care for patients outside the walls of their organization. Follow a meeting of 45 healthcare executives, Laura Dyrda (2017) reported that key trends arising in their responses consistently include:

• Reserving hospitals for truly acute care patients

• Monitoring patients at home with telemedicine applications

• Redesign process for enhanced patient experience

• Collaboration between all stakeholders to improve health

Susie Westrup (2017), Division Manager of Paladino and Company in Seattle, believes we will see more wellness campuses where research, education, healthcare, and community come together.

Today, access to medical insurance coverage remains out of reach for many, despite the passage of the Affordable Care Act (ACA).  According to Squires (2012), the US continues to spend extremely more on health care than other developed nations, while our health results under perform.  The CBO (2015) estimates that when ACA is fully implemented, an estimated twenty-seven million will remain uninsured, while many more face escalating copayments and deductibles that compromise access to care and leave them exposed to catastrophic medical bills.

We propose a single-payer government-sponsored program that will cover all Americans for all basic medical care and the option to purchase supplemental coverage for chronic illness through the AdvanCare program.

Health Care Reform

We propose a government-sponsored healthcare program covering all Americans for all medical care needs. The AmeraCare program is divided into two parts BasiCare and AdvanCare.  BasiCare is free to all US citizens and covers health screening, maintenance, prevention, and Urgent/Emergent Care.  AdvanCare provides additional coverage for chronic illness available for purchase from non-profit insurance providers.   The design of such a program has been previously described, in part, by Woolhandler, Himmelstein, Angell, and Young (2013).  We believe that deployment of a large integrated delivery systems will require modifications to current healthcare delivery mechanisms and norms.

ACP act can be theorized as an extension of Medicare to the entire US population, with improvement to the system’s deficiencies including high-cost sharing, restrictions on coverage, and subcontracting to inefficient for-profit private plans. By radically decreasing administrative costs and other wasteful spending, ACP could eradicate both uninsurance and underinsurance without any growth in healthcare expenses. It would separate the challenging relationship between employment and insurance, and reduce patients’ and physicians’ administrative liability. The system we visualize would have some public financing and would provide options to purchase insurance from non-profit insurance companies. ACP would depend on existing private hospitals, clinics and practitioners to provide care.  Following are the important features of the proposed system.

Coverage

We propose BC coverage be determined by a governing body of subject matter experts and patient activists. Cost sharing is discouraged since it has proven unsuccessful at containing overall costs due to administrative expenses in collecting and tracking co-payments and deductibles according to Sinnott, Buckley, O'Riordan, Bradley, and Whelton (2013).

The BC plan, like Medicare, would ban private insurance that duplicates the public coverage.

Payments

ACP would fund each hospital annually with a lump sum covering all BC operating expenses, eradicating per-patient billing.  These funds cannot be used for facility expansion or reconstruction, which will be separately funded through capital apportionments. Operating funds can not be used for advertising, profit, or bonuses.  This payment structure would provide a “cost-neutral” payment structure, decreasing hospitals’ motivations to evade (or pursue) certain patients or services, expand volumes, or upcode.  This payment structure would also remove hospital billing and release clinicians from the billing-related documentation. Himmelstein D, Jun M, and Busse R, (2014) reported that Scotland and Canada, which fund hospitals through global budgets, administration consumes about 12% of hospital spending vs. 25% in the U.S. – suggesting a potential savings of  $150 billion annually from hospital administration.