Since the Affordable Care Act was signed into law on March 23, 2010, one thing has remained constant: change.
To make sense of it all, a panel took up the issue of health care reform at the most recent Health Forum of West Michigan, where community conversations are held the first Friday of every month at Grand Valley State University. Blue Cross Blue Shield of Michigan and Blue Care Network sponsor the events.
Panelists agreed that while more people have access to health care than before the legislation was enacted, there needs to be a concentrated, multi-pronged effort to improve the quality of care received and to lower costs.
As far as access goes, more than 691,000 people in Michigan are now covered by the state’s Healthy Michigan Plan, which expanded Medicaid coverage to adults with incomes at 133 percent of the federal poverty level as part of the ACA. Subsidies for lower-income individuals in the ACA exchanges have also helped more people access insurance.
Still, there wasn’t a lot in the original ACA that targeted cost, said Laura Appel, senior vice president and chief innovation officer for the Michigan Health and Hospital Association. She said self-awareness on the part of providers and health care systems is necessary to begin to reign it in.
“We do a lot of stuff that we probably don’t need to do,” Appel said.
Stabilizing the individual insurance market needs to be a top priority, said Todd Anderson, director of public policy and regulatory affairs for Blue Cross Blue Shield of Michigan.
“The ACA exchanges began with high enrollment, but the number of folks enrolled has steadily dropped since then,” Anderson said. “More needs to be done to reduce premium costs and bring healthy individuals back into the marketplace.”
As rates have risen, fewer young, healthy people choose to purchase insurance, which causes rates to increase even more for those remaining in the marketplace, he explained.
Steps that government could take to improve affordability include providing funding for high-risk individuals and allowing more flexibility in benefit design and rating. This could encourage younger and healthier individuals to purchase insurance and strengthen the overall risk pool, reducing premium costs for all.
Anderson said other areas that can move the needle on quality and cost include a continued focus on value-based payments over fee for service reimbursements to providers and a dedicated effort to reduce prescription drug costs. Currently, prescriptions account for 26 percent of BCBSM’s health expenditures, more than hospital stays or doctor visits.
A silver lining to consumers bearing more of the brunt of health care costs than they have in the past is the choices they’re making, said Frank Belsito, chief physician executive, System Integration & Alignment and chief population health officer at Metro Health – University of Michigan Health.
The family physician said he sees patients taking better care of their health and becoming more invested in the types and kinds of care they receive because it’s directly affecting their wallets.
“We all make value judgments about what we spend our money on,” Belsito said.
He also said that health care is only a 10 percent factor in determining a person’s health, based on research from the Kaiser Family Foundation. Individual behavior accounts for 40 percent, genetics makes up 30 percent and social determinants of health account for the remaining 20 percent. To make inroads on cost, Belsito sees addressing the social determinants – things like socioeconomic status, education, employment and social supports – as something that needs to happen.
There are “no easy answers” when it comes to reform, Anderson concluded, but all parties involved need to continue to work together to find solutions to ensure all Michiganders have access to affordable, high-quality care.
Also speaking on the panel was Marti Lolli, chief marketing officer and senior vice president of consumer markets at Priority Health.
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Photo credit: Kathea Pinto