Healthcare Reform, Holzer and You

Category: Member News Created: Monday, 03 April 2017 15:08

Dr. Canady (533x800).jpg

Michael R. Canady, MD, MBA, CPE, FACS

Chief Executive Officer, Holzer Health System

            I have recently been asked questions from a variety of individuals about the effects of the Affordable Care Act on healthcare in our area and what the new reform efforts of the current administration might mean to us. I do believe that it is critically important to understand the impact of these concerns since Holzer provides significant employment opportunities to the residents of our area in addition to high quality healthcare. I will try to give you a bird’s eye view of the impact of ongoing healthcare reform, how it might impact all of us in southeastern Ohio, and what you can do as an individual or family in this regard.

            Healthcare is a very complicated business, maybe even the most complicated business due to the combination of market forces, individual needs and governmental oversight. The passage of the Affordable Care Act (Obamacare) in 2010 was a major paradigm shift in the evolution of healthcare delivery in the United States. The main focus was to provide health insurance to more Americans than ever before, primarily through Medicaid expansion and exchange plans. The large majority of those with new insurance coverage has come through Medicaid expansion, both in Ohio and the U.S. Regardless of your opinion about the ACA, it has not been as successful as its proponents claimed it would be.

            The real issue at hand is not insurance coverage, but access to appropriate health care at the right time. Medicaid coverage may have achieved a certain degree of success in this arena, but at the result of lower payment to hospitals and providers than is required for the budget to break even. The exchange plans have potentially worsened the problem of access. The increasing premiums and deductibles (average deductible for a bronze exchange plan in 2017 will be $6,000) are making the choice to seek care challenging for the average individual. In addition to the costs of monthly premiums, the first $6,000 comes out of pocket before the plan kicks in, causing many families to struggle financially.

            The impact to Holzer is hard to measure. We have very few exchange plans available in our area. Our percentage of patients covered by Medicaid has not changed dramatically since 2010. In fact, through a program managed by the Ohio Hospital Association, we do receive some funding in recognition of the amount of care that we provide for which we receive no compensation. Those patients under our care with exchange plans face the challenges noted above. It is too early to tell how the American Health Care Act will change the provision of care at Holzer, but rest assured that we are closely monitoring those developments and will strive to stay out in front of the changes as they are revealed.

            What do we know? The cost of healthcare in the U.S. is too high. As a percentage of GDP, we pay more for our care than anyone else in the world, close to twice as much as many other countries to which we would want to be compared. For those of you who would say that our care is better, you may be right if we are talking about advanced technology. However, in many other areas such as infant death rates and length of life, we trail many of those countries. In essence, we pay twice as much for care, yet have worse outcomes. Many would also say that the United States is the best place in the world to be sick. I believe that this is true, but it may not be the best place to be well.

            This brings me to my final point: wellness versus sickness. You may ask, “What can I do as an individual or family to make a positive impact?” There are many determinants of health that are under your direct control. If you can improve these determinants, we can begin to develop a culture of wellness and an epidemic of health. Those who improve these determinants live longer, are healthier and require less chronic care and medications. All of these things improve the long-term cost of care for the individual and the nation. What are these determinants? Eat healthy, exercise regularly and don’t smoke. Really simple, right? Unfortunately, the rate of obesity in the U.S. has increased from 10% in 1990 to 37% in 2015. Obesity is related to many chronic health problems. Although there are fewer smokers today than in the past, it is still a very serious concern.

In business, we rarely have certainty, but must always look for clarity. There are many aspects to the business of healthcare that are out of our control. Eat right, exercise and don’t smoke. Sounds too easy to be true, but attention to those three simple things can change your life and make a positive impact on the future of healthcare in the United States for everyone. Take control of what you can and live a long and healthy life.