With the presidential election a few weeks away, health care providers are waiting to see how the results will affect them and their patients.
“One can’t even begin thinking about the future of health care until November 6 is over.… There’s tremendous potential for disruption no matter what happens,” said Donna Sweet, a professor and practitioner of internal medicine at the KU School of Medicine in Wichita.
Most of the rhetoric on the campaign trail has regarded the health care overhaul that became law in 2010. Most Democrats and President Obama support the law; most Republicans and presidential candidate Mitt Romney oppose it.
“I think most people agree the outcome of the presidential election will have an impact on whether or not the Affordable Care Act stays the way it is or gets repealed or possibly changed,” said Tom Bell, president of the Kansas Hospital Association. “That will have an impact on health care providers, patients and others when looked at not only for the individual mandate, but also things like pre-existing condition requirements.”
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The Supreme Court ruled 5-4 earlier this year that the Obama administration’s Affordable Care Act was mostly constitutional.
Romney has said he would issue an executive order on his first day in office to grant waivers to states that didn’t want to participate in the Affordable Care Act – then work to repeal the legislation completely.
Even if Romney wins, Bell speculates that the act in its entirety won’t be repealed – or that parts of it would be re-enacted, outside the individual mandate.
Sweet, whose work focuses on providing services for the poor and those with HIV/AIDS, said she favors universal access to health care coverage and said the Affordable Care Act helps in that regard.
“I look at this from the patients’ perspective,” Sweet said. “I truly believe as physician that, if we do what’s right for patients, we’ll do OK.”
But the future of health care won’t be shaped by the Affordable Care Act alone.
Health care professionals say there are also questions about Medicare reimbursements and the state’s new privatized Medicaid program. Medicare programs typically cover senior citizens and Medicaid covers the poor, including many elderly.
There also are unknowns about how state and federal roles will be filled regarding such programs as the state health care exchange.
Gov. Sam Brownback has said he will wait to make a determination on the state health care exchange until after the presidential election. But other state officials have said that, at that point, it likely would be too late to move ahead with a state exchange.
“All of those things are tied up in this,” Sweet said. “If the state opts out of forming insurance exchanges and goes forward dependent on a federal exchange, I’m not sure what that will look like. … We have the almost total transition of Medicaid into managed care Medicaid, and I think that’s a big black box.”
Kansas’ switch to managed care companies for Medicaid means the state is moving closer to privatizing the publicly funded health care program, said Tom Estep, a cardiovascular thoracic surgeon at Wichita Surgical Specialists and president of the Medical Society of Sedgwick County.
“It’s hard to say what’s going to happen until someone gets elected. … We’re in very turbulent and untested waters right now because we really don’t know,” Estep said.
Estep said many doctors are concerned about the costs of increased rules and regulations when “the bottom line is already pretty thin.”
He said many people don’t understand that the bulk of Medicare reimbursement dollars that individual doctors offices receive go toward maintaining staff and electronic systems.
“If you look at President Obama, he’s had some cuts to Medicare. Paul Ryan had some cuts to Medicare. Providers are looking at how we’re moving toward the reform system and are looking at ways to deal with a government that is looking very seriously at entitlement reform,” Bell said. “Those aren’t easy things to do.”
Bruce Witt, director of government relations for Via Christi Health System, says Via Christi does not have a particular plan or position that it supports, but they are aware that the current Medicare and Medicaid programs are fiscally unsustainable and need to be addressed.
“Depending on who’s successful, we know there’s going to be some changes,” Witt said. “With the Ryan-Romney plan, (they’ve indicated) moving toward premium support models looking at dealing more with private plans in addition to traditional Medicare plans. … Regardless of who wins at the state and national levels, we’re going to have more patient-centered models, but we’re not really making those plans contingent on who wins or loses,” Witt said.
“There’s lots of uncertainty,” Sweet said. “We’re waiting until the sixth (Nov. 6) and then we’ll move forward. We have to move forward for our patients’ sake and work with whatever we’re given.”