LOSE OBAMACARE AND WE ALL SUFFER

Although Trump’s food policy agenda is unclear, his anti-regularity, anti-science leanings in general should be a major cause of concern to all of us.

If the Affordable Care Act (“Obamacare”) is repealed, not only could 22 million Americans face the devastating prospect of losing their health insurance, but all of us would lose several other health benefits as well.

First we would lose the opportunity to see how many calories are in thousands of foods, for, starting May 1st, 2017, we could lose the ACA rule that requires the listing of calories on menu boards of chain restaurants, movie theaters, supermarkets, delis, and convenience stores. The new administration could scrap the whole effort—as some in the food industry have urged. Moreover, the Federal Drug Administration (FDA) has told companies to disclose added sugars on Nutrition Facts labels by 2018. Since the new administration will likely sack the current physician FDA leader (Robert Califf, MD) in favor of a politically motivated layman, this regulation also could well be eliminated or delayed for years.

Second, the Obama administration proposed voluntary targets for cutting sodium (salt) in foods, which, as I have explained, would save tens of thousands of lives every year (http://www.mortontavel.com/2014/10/06/). Again, the present administration could scrap the whole effort—as some in the food industry have urged.

With regard to our children, two members of the Trump campaign’s agriculture advisory committee have worked to roll back the progress we’ve made in improving school lunches and removing junk foods from school vending machines. Can anyone doubt the potential damage of this measure?

The new administration may be inclined to grant the food industry’s request to continue to use heart-damaging trans fat (http://www.mortontavel.com/2014/) in many processed foods.

What about safe food protections? Who knows what to expect from a president whose campaign accused the “food police”—the FDA—of inspection “overkill.”

All these threats, as noted above, serve as a potential detriment—if not an outright danger—to the health of the general population. We should all follow these issues closely and become engaged, whenever possible, in the political process itself.

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AFFORDABLE CARE ACT (ACA): REPORT CARD

As the Affordable Care Act (ACA) enters its third active year, we’re taking a look at an interesting summary of its benefits and barriers to health care so far that was recently published in The New England Journal of Medicine.

In this paper, Dr. Benjamin Sommers, assistant professor of health policy and economics at the Harvard T.H. Chan School of Public Health, explains that the number of uninsured individuals in the United States has fallen from roughly 50 million in 2010 to between 30 and 34 million as of 2015.

This coverage expansion has resulted in modest improvements in access to primary care and medications, the affordability of care, and self-reported health.

Yet despite the successes so far, approximately 30 million Americans remain uninsured for a variety of reasons, including:

  • 3 to 4 million Americans live in states that have opted not to expand Medicaid
  • Approximately 5 million Americans do not qualify for ACA coverage options because they are undocumented.

In addition, many people who would qualify for subsidies through the exchanges have not signed up for coverage despite the mandate to do so, primarily because they are not aware of the options, or because it is still cheaper to take the tax penalties than to buy insurance.

For those who have received coverage through the ACA, two main barriers limit access to primary care. The first is the burden of cost sharing. For instance, Deductibles often range from $3,000 to $5,000. And according to a recent NY Times and Kaiser Family Foundation poll, about 20% of individuals who have insurance still struggle to pay their medical bills. Second, provider networks are narrow. Reports suggest that some plans even exclude certain specialties, particularly endocrinology, rheumatology, and psychiatry according to one recent analysis.

           Where does the ACA take us?

Although increasing numbers of people now have health insurance, it is far less than the 30 million many advocates had predicted.  And while health care costs have been growing more slowly than before the ACA, it isn’t clear if that’s been the result of the ACA itself or the general economic downturn. Even though the improvements in patient-reported access and overall health have been modest thus far, the ACA deserves a few more years before we can draw firm conclusions.

Unfortunately the ACA will likely prove little more than a temporary Band-Aid for our ailing health care system.  In my opinion, the most systematic and equitable approach to expanding coverage and access would be a comprehensive, national health care program, i.e., based upon a single payer (see http://www.mortontavel.com/2015/12/31).

But perhaps more important: regardless of how we expand coverage, we must keep our sights on the ultimate goals. Beyond increasing coverage or even access to primary care, we need to provide high-quality, comprehensive, accessible, and patient-centered care to everyone.