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The Affordable Care Act (ACA) signed into law by President Barack Obama was the subject of a recent forum at Columbia Presbyterian Medical Center.
If Mitt Romney were elected, he has said he would repeal the Affordable Care Act.
But what would happen to the provisions relating to pre-existing conditions?
That was a question raised at the health care forum hosted by the Columbia University Medical Center this past Tues., Oct. 23rd.
For Colleen Lanier-Christensen, a first year student at the Mailman School of Public Health, it wasn’t an abstract issue.
She asked the question because she has a pre-existing condition.
Thomas Barker, Esq., partner at Foley Hoag LLP, said that a Romney administration would retain those positions.
At the forum, there was some agreement on the merits of the Affordable Care Act, often called Obamacare. The health care forum was an opportunity for the medical community to learn more about the details of ACA.
Barker said companies deny coverage of pre-existing conditions because insurance becomes expensive. “If we move away from that model,” said Barker, “then there wouldn’t be a problem with pre-existing conditions.”
Very few people are protected by the pre-existing condition exclusion, he said.
“You don’t remake 99 percent of the health care market to deal with that problem,” he said. “You fix the one percent.”
Lanier-Christensen, who has Type I diabetes, remained unconvinced that repealing the ACA was a good idea. Repealing the act is a leap into uncertainty, she said, especially since it’s unclear what will take its place.
“And what about people who lose their insurance?” she said after the event. “We are not one percent of the population,” she said.
According to a 2011 Health and Human Services report, an estimated 50 to 129 million people have a pre-existing condition—and 25 million of them don’t have insurance.
Dr. Vivek Murthy, Harvard Medical School instructor and attending physician at Brigham and Women’s Hospital, said having insurance coverage was key to having a therapeutic doctor-patient relationship. Doctors need to be able to catch ailments early, before it can manifest in a painful and expensive illness.
“That’s very hard to do when they don’t have health insurance,” he said.
Barker said the current Medicare program is unsustainable. Medicare is deep in the red with a 75-year unfunded liability of $39 trillion dollars.
If projections in the 2012 Medicare Trustee report are accurate, the program runs out of funds by the year 2024.
But Barker said the report’s statistics were optimistic and it’s likely to happen much sooner.
The Obama administration is hoping that savings from the ACA will kick in and cut costs. “That’s not going to happen,” Barker said.
He endorsed Romney’s position that ACA should be repealed and lawmakers should start the process over. “We really should start from scratch,” he said.
Murthy didn’t dispute the Medicare assumptions.
Instead, he said most physicians support ACA. “No one is saying it’s a perfect solution, but it moves us a step forward,” he said.
Murthy, who was appointed by President Obama to develop the National Prevention Strategy, said repealing ACA and starting over is a step backward.
“It’s very difficult to get Congress and political parties to come together over one big solution,” he said. “But we did it. The prudent thing to do is actually improve on the law.”
Even Berger conceded that ACA does a few things right. He said Centers for Medicare and Medicaid Services (CMS), which administers ACA, was a well-run agency.
ACA has also implemented significant delivery system improvements – particularly for patients receiving kidney dialysis – by improving patient care and lowering costs. “Delivery system reform has the most promise,” said Barker. “It’s moving the payment model away from paying providers more and more money without any accountability for quality outcomes or better performance.”
Murthy said that there is a lot of agreement behind closed doors, particularly in the area of investments in public health and preventative care. This allows health care providers to prevent illness instead of react to it, he said. “These are things we should have invested in decades ago.”
It wasn’t clear that the forum changed anyone’s mind about the candidates.
Dr. Angus Sampath said Romney doesn’t care about social issues. “He doesn’t believe in family planning or a women’s right to choose.”
Dr. Sampath works at Harlem Hospital, which he says gives him another perspective on healthcare.
“Romney wants to put more money in the military and take it away from Medicare,” said Dr. Sampah. “That doesn’t make any sense to me.”
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