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A Word From the President: Resolving to Improve Our Health Care System

AAMC Reporter: January 2014

The start of the new year is traditionally a time of hope and optimism. It provides each of us with an opportunity to prioritize what is most important to us, often taking the form of resolutions focused on individual health care choices—for instance, losing those last few pounds or adding more hours of exercise to the week. Clearly these are good personal goals to pursue, but on a broader level, all of us who work toward advancing the missions of medical schools and teaching hospitals could resolve to improve the nation’s health care system—not just our own personal health—to achieve better health care for all. With regard to this resolution, I see very real signs that the efforts we made in 2013 will move us forward in 2014.

The AAMC remains firmly committed to the belief that the Affordable Care Act, or ACA, gives us a potential start. This law will expand health care access to patients who desperately need it, and shows some signs of reducing overall costs. Despite the well-known and well-publicized imperfections, including problems with the ACA’s rollout and website, I am optimistic that the law will begin to benefit our communities. People are no longer going to be denied coverage on the basis of pre-existing conditions, and women and men now will pay the same premium for the same coverage. Most notably, the law expands coverage to millions of people.

According to the Obama administration, more than two million people are now enrolled in private health insurance plans through federal and state health care exchanges, while almost four million Americans are eligible for Medicaid or the Children’s Health Insurance Program. That translates to almost six million Americans signed up for coverage through the marketplaces in just a few months. In addition, 25 states plus Washington, D.C., are expanding Medicaid this year.

AAMC-member institutions are part of this story. Your institutions should feel proud of the leadership role you have played in helping to care for more Americans. As recently as December, the AAMC met with senior officials at the White House to help ensure your efforts will be as successful as possible. Many of your institutions acted early and proactively in 2013 to prepare and implement ACA outreach and enrollment activities. Several institutions have trained staff to work as certified application counselors (CACs), a special designation from the U.S. Department of Health and Human Services requiring several hours of online instruction. Still others have conducted specific outreach to patients who received charity care at these institutions, sharing with them the new coverage options available and helping them enroll.

Through your education and outreach efforts, we helped people better understand their health care options and aided them in getting enrolled through subsidies available under the ACA. In fact, our education and outreach work has been so successful that it now is being used as a model for what other groups can do to educate and enroll people in their communities.

I also am optimistic about hospitals embracing the opportunity the law provides to improve health care. According to a recent article in the Washington Post, 93 percent of hospital executives believe the law will help improve their health systems. A Reuters news article similarly pointed to many hospital systems welcoming the broadened coverage required by the ACA, standing ready to work with the new enrollees they expect to see.

I have another reason for optimism in the coming year: the recently passed budget bill in Congress. Last month, Congress voted for a budget that may restore funding for medical research and health professions training, a crucial component to improving the health of all. As you know, funding for the National Institutes of Health (NIH) has decreased in constant dollars since 2009. Lost funding can mean lost time for doing the basic research that eventually will find tomorrow’s cures. Restoring that funding can mean restoring hope for people who may face life-threatening illnesses down the road. While the Appropriations Committee has yet to set nondefense discretionary spending, the roughly 5 percent increase would restore most of the $1.5 billion in sequestration cuts to the NIH.

The recently passed budget bill also includes the Sustainable Growth Rate (SGR) Reform Act, which provides a three-month patch to prevent Medicare physician payments from decreasing by 20.1 percent. This gives Congress the time it needs to finish its work on the SGR Repeal and Medicare Beneficiary Access Improvement Act, bipartisan legislation that, among other things, would permanently repeal the SGR formula. This positive momentum to correct the SGR, however, may come at significant cost to our institutions because the patch and budget act are financed by cuts to hospital payments, including a two-year extension of the Medicare sequestration cuts (now effective through 2023). Clearly we still have important work to do, but at least we are moving in a more positive direction.

My sense of optimism regarding these ongoing improvements to our health care system in no way obscures the hard work I know remains before us. We likely will contend with unforeseen challenges along the way. But that same optimism potentially can provide the fuel for the journey ahead, giving us the resolve to achieve our ultimate mission: improving the health of all.