One year after the passage of the Patient Protection and Affordable Care Act, the United States continues to find our health care system in greater peril than ever before.
I continue to wonder how President Barack Obama, then-Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nev.) did not recognize that this legislation — that is now law — would not benefit American medicine, but instead, inflict damage beyond what we could have imagined.
The Democrats’ decision to make such drastic changes in such a short period of time rendered it virtually impossible to debate the real issues necessary for true reform. There would be no health care without physicians. One year ago, when Congress passed the largest health care law to date, physicians should have been at the forefront of every discussion. The haphazard approach that Democrats took when passing the PPACA has cost physicians dearly, and in doing so has cost patients monumentally.
Limiting physicians’ involvement throughout the entire process of drafting the PPACA was just another example of the government’s continued low regard for the medical profession. Last year was the worst ever for physicians, particularly those who are reimbursed under Medicare. Because the Sustainable Growth Rate extension was repeatedly postponed, Medicare reimbursement checks were held three different times.
This affected physicians and their practices dramatically. They have staff to pay, electricity bills, building leases, medical equipment and numerous other costs associated with running a practice. Any other business that provided a service and was not paid would refer the customer to a collection agency. These doctors, however, still provided care while putting their personal finances on hold. Even now, after most of the $200 million in claims have been processed, physicians are continuing to wait on checks because of the backlog. This battle is not over, as the new health care law did not fix the SGR — it only prolonged the insanity.
Nothing is more detrimental to the doctor-patient relationship than the looming possibility that doctors may have to shut their doors. Fear is the greatest barrier to trust, and maintaining patient trust is essential in everything from determining medical history to making a diagnosis. Patients should have the right to choose and keep their physicians without the constant threat of being forced to find new ones when the money runs out.
The PPACA has also made significant changes to Medicaid. What was intended to be a safety-net program has morphed into a one-size-fits-all program. The Congressional Budget Office predicts that by 2021, 17 million additional Americans will enter Medicaid, and many believe this is the low number. If you make less than 133 percent of the federal poverty level (just under $30,000 in 2011 for a family of four) and are uninsured, you will be required to enter into Medicaid or pay the tax penalty of greater than $695 a year per person, up to a maximum of $2,085 per family, or 2.5 percent of household income. Being forced to enter Medicaid or pay additional taxes becomes no real choice at all and is an affront to personal liberty. When patients do not have choices, the doctor-patient relationship is jeopardized, which limits the physician’s ability to provide the care needed.
The medical community will see a surge of new patients as a result of the PPACA, and physicians will have to ensure that every patient receives the care needed. Unfortunately, this might result in the misuse of nurse practitioners and physician’s assistants in a doctor’s role. When a couple of doctor’s appointments pass by without one word from the actual physician, patients will become disenchanted. Too many people wait until it is too late before going to the doctor with an ailment, and this would increase that number exponentially. Doctors and patients must maintain an open line of communication; otherwise, yearly checkups will become a thing of the past, and preventive medicine will take a backseat to late-night emergency room visits.
The PPACA has succeeded in its goal to provide health insurance to America. However, what it has gained in surface area, it has lost in depth and substance. Democrats were so eager to pass health care legislation — any health care legislation — that they settled for a rushed and ineffective law. Had they taken the time to look down the line at the repercussions of the PPACA, they would have seen that the United States’ current number of physicians could never adequately serve the needs of so many. This lack of foresight has severely thwarted the doctor-patient relationship, and it is American citizens and their health that will feel the effects.
Rep. Michael Burgess (R-Texas) is the vice chairman of the House Energy and Commerce Subcommittee on Health and chairman of the Congressional Health Care Caucus.
Senate Minority Leader Mitch McConnell, R-Ky., carries a musket on stage as he speaks during the American Conservative Union's Conservative Political Action Conference (CPAC) at National Harbor, Md., on Thursday March 6, 2014.