How to Make Providing Care  More Difficult by the 115th Congress


By William Mintz, MBA, MHA - Co-Founder, Care3. Last week Congressional Republicans made public their plan to repeal and replace the Patient Protection and Accountable Care Act (ACA).  While the positive impacts of the ACA are well documented and undisputed by most policy experts, the legislation has its challenges.  Broadly speaking, people living in states that chose not participate in the ACA did not benefit as much as those in states that did participate.  To address the perceived failing of the ACA, the repeal and replace legislation titled the American Health Care Act, focuses mainly on health insurance coverage.  As it currently stands the AHCA would remove 14 million people from the insurance rosters next year and 24 million total by 2026.  While the Congressional Budget Office has determined that the AHCA will have a positive impact on the federal budget, leading industry groups have stated that the AHCA would do more harm than good.  

Sicker loved ones

The impact of the AHCA to caregivers will be significant.  Without access to health insurance people will become sicker placing a greater burden on their caregivers.  In the March 2017 issue of Health Affairs a study was released that concludes having health insurance would not only help people identify their chronic conditions, but it would help them bring the diseases under control.  While the research into the effect of health insurance on health is not 100% conclusive across all conditions, it is widely accepted that the best means to a healthier population is through increasing access to health insurance.

Less professional support

All early analyses of the AHCA indicate that it will have a negative effect on providers.  One of the landmark achievements of the ACA was to decrease the level of uncompensated care provided by doctors and hospitals.  Prior to the ACA, the estimates for uncompensated care were over $62 billion annually and growing.  With the additional revenue resulting from lower levels of uninsured and underinsured patients, providers have been able to increase service offerings and invest in population health management.  The ACA directly incentivises doctors and hospitals to provide more holistic care.  These incentives are being used to invest in population health management tools and services ranging from technology to home and community based services.  Of the hundreds of cottage industries created by the ACA some of the most helpful to caregivers are home and community-based services.  Without the ACA, access to these services would be much sparser making caregiving much more difficult.

Higher out of pocket expenses

The American Health Care Act does one thing well, it shifts the responsibility to pay for healthcare square on the shoulders of the consumer.  The mantra of personal accountability is embodied by this proposed legislation.  The AHCA emphasizes the use of health care savings accounts and tax credits.  These financing mechanisms along with the changes to health insurance regulations will make health insurance out of reach for most Americans.  Under the AHCA caregivers will have a catastrophic increase in out of pocket health expenditures.  Not only will insurance premiums rise, but so will copays.  Providers will increase initiatives to balance-bill patients as their revenue declines in step with the increase in uninsured and underinsured patients.  Caregivers already spend nearly $7,000 annually on out of pocket costs associated with caregiving.  Being a caregiver is already financially burdensome, and under the AHCA being a caregiver could be worse.  

The ACA was not perfect out of the gate, and that was very much by design.  Progress must not be halted because elected officials act like bickering siblings and seek only to undermine the opposition. Healthcare is expensive, and merely shifting the financial responsibility around does not help.  To make a lasting change providers and consumers must continue to adopt behaviors and technologies that can help them better manage their care. Remember that, at one time or another, we will all be caregivers or in need of one.


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