By Joe Kennedy III
Every member of our society deserves quality, affordable health care – it is a moral priority and an economic necessity. Health care accounts for 18% of America’s Gross Domestic Product (GDP), but the reality is that our current health care system does not deliver the value it should. Up to 30% of U.S. health care spending, almost $1 trillion a year, is wasted on unnecessary care, high administrative costs, mistakes and errors, and fraud and abuse.
I strongly support the Patient Protection and Affordable Care Act (ACA), and believe that it takes important steps to expand access and lower costs. However, there is more work to be done. To fully guarantee access to meaningful care, government must partner with doctors, nurses, hospitals, insurance companies, and others, and focus on improving quality and value. We must accomplish this while protecting Medicaid and Medicare, which provide critical health care services to people who need them most.
Massachusetts has a unique voice to contribute to the national health care debate. The Commonwealth’s 2006 health care reform law was the most important model for the ACA, and was made possible because of the cooperation among providers, insurers, and other stakeholders. While caring for our sick, the Massachusetts health care industry also engages in innovation and research benefiting people around the world.
Though the solutions to our health care challenges are not easy, there are real ways that we can change our system to improve the efficiency, quality, and cost of health care for all of us.
The Affordable Care Act and Access
The ACA is one of the most important laws in a generation. I support the law and will vigorously fight any effort to have it repealed. Implementation of the law will improve access and quality of care for many millions, and will do so while reducing the federal debt. The ACA extends health insurance coverage to more than 32 million Americans, saves Medicare $716 billion, and extends the solvency of the program eight years, until 2024, all without cutting benefits.
In addition to these savings, health reform guarantees access for everyone – insurers will no longer be allowed to discriminate against women or those with pre-existing conditions – and adds new coverage for cost-effective prevention and wellness programs, without increasing copayments or deductibles.
The ACA builds on the private insurance system that has existed in this country for decades. While guaranteeing that at least 80% to 85% of every premium dollar goes to medical costs and not to an insurer’s administrative overhead and profits, it bans predatory practices that imposed dollar caps on policies, allows more than three million young people under age 26 to stay on their parents’ policies, offers tax credits to small businesses, and helps working-class families pay for health insurance with a sliding scale of assistance for those earning up to 400% of the federal poverty line ($92,200 in 2012 for a family of four).
The ACA’s limits on out-of-pocket expenses will reduce medical bankruptcies and medical debt. With guaranteed coverage, patients and families will no longer be vulnerable to unanticipated emergencies that threaten to wipe out savings and jeopardize livelihoods.
Benefits from the ACA will reach tens of thousands of people across the 4th District. For example, Beth and Brian from Wrentham no longer have to worry that their son, who has a serious heart condition, will exhaust coverage and be unable to afford life-saving treatments.
The ACA is also the greatest advancement in women’s health in decades. No longer will women pay more than men for the same health care policies. (For the first time, gender discrimination will be prohibited in all federally funded health care.) Essential services such as birth control, mammograms, and cervical cancer screenings are now guaranteed without copays or deductibles. Starting in 2014, 8.7 million more women who buy coverage in the individual market will gain maternity coverage.
The ACA is not perfect – no law ever is. Much more needs to be done to guarantee that everyone has access to affordable, quality coverage and to support businesses that are vital to health care delivery. For example, I support eliminating the ACA’s medical device excise tax, which will hinder innovation and harm an industry vital to the Massachusetts economy – I would pay for the elimination by reducing subsidies to agricultural commodities that too often make Americans less healthy. But overall, the ACA is a worthy law and its positive effects are already strengthening our health care system for all Americans.
Improving Quality and Containing Cost
With the ACA paving the way for near-universal health care coverage, we must focus our attention on increasing quality while decreasing costs. Consider the story of James Dichter, whose insurer paid a supplier $83 for a simple cloth arm sling that retails for $7 online. As Mr. Dichter rightly points out: “somewhere in our health care system, common sense has left the building.”
In Massachusetts and across the country, we need to make sure that our health care dollars are spent effectively and efficiently. The comprehensive cost containment bill passed in July by the Massachusetts legislature and signed into law by Governor Deval Patrick is an encouraging next step, and I support its goals. This law, along with the ACA, builds on market-based solutions to rein in costs by encouraging accountable care organizations and global-payment plans. These models will reshape our system to reward quality of care over the quantity of procedures administered.
Improving coordination of care means placing primary-care doctors in the center of patient care and elevating their role as leaders of comprehensive care initiatives. The supply of primary-care physicians continues to be a problem, with one in five adults in Massachusetts reporting problems finding a doctor. Although Massachusetts is making significant investments in expanding and transforming the primary care workforce, including allowing nurse practitioners and physician assistants to act in primary-care roles, we must do more to grow the pipeline and make sure that aspiring doctors can choose to go into family practice.
Community health centers also play a vital role in lowering costs and maintaining quality. They are pioneers in coordinated, integrated care, and serve as paradigms of cost-efficiency. The 50 community health centers in Massachusetts, including Family HealthCare Center at SSTAR in Fall River, are the state’s largest primary care network and serve over 800,000 Massachusetts residents annually. As demand on health centers increases, we must do all we can to guarantee that they have adequate resources to serve their patients and continue to innovate.
Coordinated care is already creating a positive impact on people in our district. Zoe, a 4th District resident who suffers from debilitating migraines, said, “I regularly see physicians in various networks across the state about my painful headaches. The new system has made a huge improvement in the coordination and quality of care I receive. I now receive more efficient care and better engagement from my doctors.”
The new Massachusetts law takes important steps to improve transparency and accountability in the marketplace. Every patient should know how much a procedure or drug costs – and how much it will cost them out of pocket. Equally important are provisions to ensure that businesses and individuals can obtain the most efficient coverage possible. Rising costs are a challenge for everyone, but perhaps the hardest hit are small business. We still aren’t doing enough to guarantee that small businesses can afford to insure their workers.
While administrative solutions will alleviate some issues, lasting change also requires harnessing the power of prevention. Prevention and wellness programs keep many of us out of our doctors’ offices and emergency rooms, and are cost-effective approaches to fixing health care. Preventable, lifestyle-related illnesses cause skyrocketing costs and millions of unnecessary deaths in the United States: smoking (465,000 deaths per year), obesity and physical inactivity (407,000 deaths per year), hypertension (395,000 deaths per year), and high blood glucose levels (190,000 deaths per year) are enormous drains. These problems represent an opportunity to promote strategies that can make an enormous difference in our lives. By encouraging physical activity and promoting good nutrition we can help citizens to live longer, healthier lives.
Medicare
Medicare is one of the most important programs run by the federal government. It is responsible for medical care of 49 million Americans, including more than 1.1 million in Massachusetts, a number expected to double by 2030. With so many Americans relying on Medicare, there is understandable concern about its future. We must preserve and strengthen Medicare, guarantee that Medicare recipients keep all their existing benefits, and not let the Republican voucher plan destroy benefits for today’s and tomorrow’s seniors.
The first goal should be ensuring that the ACA remains in place. The ACA guarantees Medicare’s solvency and extends the life of the Medicare Trust Fund until 2024. It does this by sensibly restructuring payments to providers and insurance companies so that reimbursement is based on quality – not quantity – of care. The ACA improves Medicare by closing the prescription drug donut hole, keeping all current benefits, and adding new benefits for all beneficiaries. These new benefits prioritize prevention by requiring coverage of wellness visits, colonoscopies, mammograms, immunizations, and other preventive treatments. This coverage will help create a healthier and less expensive Medicare population in the future. While saving billions, these reforms make Medicare more sustainable and ensure high quality health care starting today.
We must also call on patients and doctors to work together to use proven, evidence-based medicine to get safe and effective treatments. The Massachusetts 4th District has 11 hospitals. From Beth Israel Deaconess – Needham to Morton Hospital in Taunton, we have an increasingly informed patient population wanting to make good decisions about their health, but is forced to make difficult judgments with incomplete information. The government can do more to disseminate information about which treatments work – including helping everyone consider the costs and side effects of unnecessary treatments – so that every health care dollar is put to good use.
I will fight radical proposals – including those supported by Mitt Romney, Paul Ryan, and House Republicans – to “save” Medicare by replacing it with a voucher program. These plans force patients to pay thousands of dollars in out-of-pocket costs for their doctors and medicines or be forced to forego the medical attention they need. We cannot subject vulnerable people to the whims of the market and an experimental program. Medicare’s universal framework is valued by Americans. We must protect, preserve, and strengthen Medicare today and in the future.
Medicaid
Medicaid is now the nation’s largest health program, serving 56 million low-income and disabled Americans, our most vulnerable. In 2010, 77% of Medicaid enrollees were children and families, while 23% were elderly or disabled. About one-third of Medicaid payments go to nursing-home care for seniors. As a means-tested program jointly financed by the states and the federal government, Medicaid is administered by each state with minimum thresholds for eligibility and coverage set by the federal government. Massachusetts Medicaid, called MassHealth, is indispensable for 1.3 million people in the Commonwealth. More than half of children in low-income families, half of people with disabilities and one-third of all births in Massachusetts are covered by MassHealth.
The ACA strengthens and improves Medicaid by opening eligibility to all individuals between 19 and 64 years old with incomes up to 133% of the federal poverty level ($14,856 for individuals, $30,656 for a family of four). For the first time, low-income adults without children will be guaranteed coverage through Medicaid and parents will be eligible at uniform income levels across all states. This expansion will protect our neediest and keep them out of emergency rooms, an expense ultimately passed on to insured consumers. While the ACA’s Medicaid expansion is not mandatory, the federal government will pay 100% of the cost of expanding Medicaid for the first three years and at least 90% after that.
Some GOP voices refuse to see the dynamic effects of this program. They want to reverse the progress made by the ACA and convert Medicaid to a state block grant letting states abolish minimum eligibility and standards of care. While I agree we need to contain costs, I oppose turning Medicaid into a lump-sum payment for the states. This would give states less money with no accountability and allow conservative governors to balance their budgets by cutting health care coverage for the disadvantaged. With block grants, many of the neediest among us would be denied basic care – this is both irresponsible and uncompassionate.
Massachusetts as a National Leader in Innovation
In 2006, Massachusetts passed a first-of-its-kind health care law, a model for the ACA. The success of that law would have been impossible without collaboration involving insurers, businesses, community groups, and other stakeholders to work on a common goal. Thanks to these efforts, Massachusetts now has the highest percentage of insured residents in the nation (98%), including coverage for almost all Massachusetts children (99.8%).
Massachusetts is not only a leader in health care reform, but is also at the forefront in delivery of care, research and technology. One in six Massachusetts jobs is in health care, and we are home to the top five National Institutes of Health (NIH) funded hospitals in the country. Because the Massachusetts workforce is the most educated in the country, the hundreds of biotech companies and care centers who call our state home have a crucial edge in discovering, developing, and administering new products that cure disease every day.
This rich tradition of excellence is a point of pride for our district. From the life sciences and medical device companies who pioneer invention, to manufacturing companies such as Tegra Medical in Franklin who produce the technology, and to nationally recognized hospitals such as Newton-Wellesley and Milford Regional Medical Center who deliver excellent care, we are a community linked to health care. We must support the innovative spirit of these companies and institutions and ensure that they flourish, create jobs, and produce ideas to improve lives.
Conclusion
My great uncle, the late Senator Edward M. Kennedy, described health care as the cause of his life. He saw too many American families struggle to access care and fought for decades to eliminate inequalities in health care. As he explained, we must “guarantee that every American – North, South, East, West, young, old – will have decent, quality health care as a fundamental right and not just a privilege.” I couldn’t agree more.
I am proud to be a citizen of Massachusetts, a national model for a system where no family is one health crisis or bad accident away from financial ruin. We have much work to do to make health care more affordable, cost-effective, and transparent. But make no mistake: every American deserves access to high quality, affordable health care. Massachusetts residents can be assured that I will work every day to make sure that is what every American gets.
