Evaluating Health Care Reform

There’s a great article in the Washington Post looking at the experiences of poor people in Kentucky who are newly insured by the Affordable Care Act. It’s worth reading in full to get a sense of how the law is affecting both people who were previously uninsured, as well as the medical professionals who are now treating them, but it frames the overall question of how to evaluate the coverage expansion in health care reform in a way I think is odd:

This is the world that many critics of the new health-care law have worried about, one in which the sick and the poor expand the ranks of Medicaid while other Americans see premiums rise, policies canceled or favorite doctors booted out of networks.

Supporters of the new law argue that another scenario will unfold in places such as eastern Kentucky, in which the sick and the poor get insurance, seek treatment for long-neglected illnesses and prevent other health problems down the line, ultimately saving the health-care system billions in emergency-room visits and other costs.

A week at the Breathitt County Family Health Center provides an early glimpse into how those theories are beginning to play out in a place where people have long worried about having no insurance at all.

“That’s the big question — does getting insurance bend the cost curve or the health outcomes curve?” said Karen Ditsch, the executive director of Juniper Health, which runs the nonprofit Breathitt clinic. “Is it going to make a difference?”

Controlling health care costs is important, and that’s the goal of many provisions of the Affordable Care Act. But I worry that if providing health insurance to low-income people is judged based on costs alone, it’s doomed to failure on that metric. Yes, uncompensated emergency room care is expensive and inefficient. But seeing doctors and specialists is also expensive. The Washington Post story is full of examples of people who can finally see specialists for the first time to address terrible chronic conditions that they had been leaving untreated before. All of that costs money, most of which is ultimately paid by the federal government under Kentucky’s expanded Medicaid program.

Looking at health care in a limited budget sense, it’s probably cheaper to ignore poor people suffering from chronic health problems, and just deal with an emergency room bill here and there when things get really bad. Of course, that’s disgusting, and only serves to point out that we shouldn’t look at health care in a limited budget sense.

The Congressional Budget Office estimates that Affordable Care Act will expand health insurance coverage to 14 million Americans who would otherwise be uninsured in 2014. By 2017, that doubles to 28 million Americans who will have health insurance because of the law. That’s not cheap. The CBO estimates that the coverage provisions of the Affordable Care Act will cost the government more than $1.1 trillion over the ten year period of 2012-2022.

Coverage expansion does not reduce budget deficits, but the Affordable Care Act does. That’s because the law also included spending cuts and cost containment efforts within other federal health programs like Medicare, and also new taxes that are mostly focused on the health care industry and the wealthy.

People can disagree about whether providing health insurance to tens of millions of Americans is worth paying for with new taxes and spending cuts elsewhere in the budget. I think it is. But don’t read the Washington Post story to learn about the Affordable Care Act and the federal budget (read this letter to Speaker Boehner from the CBO for that). Read the Washington Post story to see all of the suffering that the Affordable Care Act is already alleviating.

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