ABINGTON — Lowering prescription drug costs and deductibles and expanding coverage were among suggestions to improve the Affordable Care Act offered by health care providers at a June 14 roundtable.
“How do we let this important piece of legislation mature?” asked U.S. Rep. Madeleine Dean, PA-4, who hosted the discussion at Abington Hospital-Jefferson Health.
“It’s the No. 1 issue people talk to me about,” the representative serving most of Montgomery and a slice of Berks counties, said.
Referring to efforts to overturn or weaken the 9-year-old landmark legislation credited with providing health care access for millions previously uninsured, Dean said the House Democratic majority “want to build upon the model, not tear it down.”
“In my caucus, it’s probably our central set issue we’re working on,” she said. “Health care is a right for everybody, not for the privileged few.”
“The ACA was one of the most important pieces of legislation to make sure people get good health care,” Abington-Jefferson Health President Meg McGoldrick said.
Participants credited both the ACA and Medicaid for providing more access.
“We see far fewer without insurance due to the ACA,” said Mary Oleksiak, Asplundh Cancer Pavilion senior social worker.
“I’ve seen a major difference in the ability to get treatment placements for patients we weren’t able to get help for before,” Linda Youboty, an Abington Hospital-Jefferson Health behavioral health social worker, said.
“We can keep people healthy, not [just treat] at the end of the road with dire consequences,” said Dr. Susan Fidler, assistant director Abington Family Medicine Residency Program.
“The ACA has made a huge impact,” Hugh Lavery, senior vice president Jefferson Health, said. “I’d like to see it stabilized and strengthened.”
“People talk to me about prescription drugs and the cost of their deductibles,” Dean said. “We have an administration that wants to gut the central [ACA] benefits and companies that sell junk plans.
“What percentage are you able to see and connect to care?”
“Medicaid expansion has helped, especially for mental health care,” Dr. Kenneth Certa, Jefferson Hospitals, said. “Keeping people on their parents’ plan to [age] 26 has been huge.”
About 75 percent of patients now have insurance, compared to about 50 percent before, he said.
“The other piece is pre-existing conditions,” Abington Hospital-Jefferson Health Chief of Staff Dr. Gerald Cleary said.
Preventive care, wellness checks, prenatal care, “that’s what will limit costs,” he said. Without that, “people will get sicker.”
Eligibility for ACA exchanges beyond 400 percent of the federal poverty level should be expanded, Lavery said.
“There is a gap for those who don’t qualify for the exchanges and can’t afford insurance,” Dean agreed.
“Affordability is a huge piece,” Fidler said. “Every week we see patients forgo care because they can’t afford it. If we can get people to primary care and minimize that deductible, we can avoid catastrophic costs — keep them out of the hospital.”
“One challenge is to find a way to get around high deductible plans,” Cleary said. “When [care is] underutilized, people get sicker.”
Indemnity plans are also a problem, Oleksiak said. People come in with cancer and find out the insurer “wants to dictate how many chemo sessions; PET scans are not covered.”
“None of the short-term plans cover maternity,” Dr. Sarah Horvath, American College of Ob/Gyns, said. “
People must be taught how to use medications, grocery shop and spend their money, Tierra Pritchett, director of legislative and regulatory affairs for Health Partners, said.
“Everybody looks at health care as one big number; it’s a number of different components,” McGoldrick said. “Don’t forget dental care and podiatry.”
With people living longer, Medicare is consuming resources, she said. “It’s going to be very hard to control costs.
“By law, Medicare can’t negotiate prescription costs,” McGoldrick said. “It should be negotiating the price of medications. It would set the market price.”
“New cuts to Medicaid will add to the state budget,” said Bill Ryan, assistant vice president at Albert Einstein Healthcare Network. “It makes no sense to take away money from people who need it most.”
Plans providing additional resources to primary care offices and changing the fee structure from fee for service to value for care were also suggested.
The House passed five bills to reduce drug prices and address health care issues, Dean said.
“We’re trying to build on the ACA to reduce costs, negotiate pricing for medications.”
Dean also brought up gun violence and opioid addiction in terms of treatment.
“There are not enough beds for addiction treatment,” Cleary said.
The House passed two bills expanding background checks for gun ownership, but “the Senate has not done anything on it,” Dean said. Students on a district task force said “they are afraid in their schools.”
Guns are also “connected to suicide rates,” she said. “We have to attack it from different angles.”
“Anyone who uses a gun against someone, once you aggress, you are a terrorist and should be characterized as such,” McGoldrick said.
“My goal is to get everybody access to quality care,” Dean said. “The ACA changed the conversation. I know it’s not equitable, but there are ways we can get there with the exchange and Medicaid expansion, get more on the rolls.”
“There’s a consensus building in the country that the ACA does more to expand health care,” McGoldrick said. “We need to build upon it.
“If central services are free for people, it will bring them in,” she said. “Access to behavioral health services is essential. We need to have people in place and be able to deliver services that are not costly.”