Leviticus 19:9-10 “When you reap the harvest of your land, you shall not reap your field right up to its edge, neither shall you gather the gleanings after your harvest. And you shall not strip your vineyard bare, neither shall you gather the fallen grapes of your vineyard. You shall leave them for the poor and for the sojourner: I am the Lord your God (ESV).

There are many reason the Affordable Care Act (ACA) of 2010 will not be able to bring universal access to our country. Several are lack of federal government controls, shortages of healthcare providers, illegal immigration, lack of unification from state to state, and the overall effect on the U.S. economy (Shi & Singh, 2017).

The main objective of the ACA is to create a healthcare system that would allow everyone to participate. This is not a feasible goal when the government is a subsidiary to the private insurance sector. The research and development of new technologies and medicines is done in the private sector but is funded by government grants and subsidies (Shi & Singh, 2017).  In a true democracy one person equals one vote, but with the population of the U.S. this is not practicable so we elect a group of people to represent us in the House of Representatives and the Senate. Unfortunately, the elected do not make decisions based on what is best for those they represent but for what personal gain they can achieve.  Groups who wish to have their agendas passed send special interest groups to convince (buy/bribe) representatives to pass laws to benefit the special interest.

Another issue overlooked was the number of physicians that would be needed. According to the Association of American Medical Colleges (AAMC), it is estimated that by 2025 the shortfall of physicians will be 61,700 to 94,700. Primary care will be between 14,900 and 35,600, and surgeons between 23,100 and 31,600 (New Research Confirms Looming Physician Shortage,2016).

Under the ACA, there were policies put in place to expand Medicaid. This did help more uninsured gain insurance but it also created additional issues and costs at the federal and state level. Each state was given the option of expanding or not expanding. State funding for Medicaid is tied to the number of enrollees and the increased cost is paid for through increased taxes and cuts to Medicare (Davis, 2014). In June 2009, President Obama stated “If we don’t get control over costs, then it is going to be very difficult for us to expand coverage. These two things have to go hand in hand. Another way of putting it is, we can’t simply put more people into a broken system that doesn’t work”, it was still part of the ACA package.

An uninsured population that is not covered with the ACA is the illegal immigrant. This group has a tremendous impact on increasing health care costs. Since they are not eligible for most programs they rely on emergency room for care, which creates and increased cost to the community due to the amount of charity a hospital will have to absorb. There are programs that help hospitals defray the cost of charity but there are guidelines that must be strictly adhered to.

The ACA is a band-aid placed on one part of the health care system. Cost, quality and access must all be addressed concurrently not piece by piece. The system cannot be fixed if all the issues are not addressed simultaneously.

Word Count (578)

References

Davis, S. (2014, June 17). 12 Reasons Why Medicaid Expansion Is A Terrible Idea. Retrieved

August 22, 2017, from http://thefederalist.com/2014/06/12/12-reasons-why-medicaid-expansion-is-a-terrible-idea/.

New Research Confirms Looming Physician Shortage. (2016, April 5). Retrieved August 22,

2017, from https://www.aamc.org/newsroom/newsreleases/458074/2016_

workforce_projections_04052016.html.

Shi, L., & Singh, D.A. (2017).  Essentials of the U.S. health care system. Burlington, MA: Jones

& Bartlett Learning, LLC.

Discussion Question #2

The Health care Reform to Make America Great Again,” President Donald Trump stated, “On day one of the Trump administration, we will ask Congress to immediately deliver a full repeal of Obama care.” In fact, both houses of Congress had voted for a repeal before the inauguration had taken place. In the Senate, the vote was 51 to 48. The House of Representatives followed suit and voted 227-198 to instruct committees to draft legislation that would repeal the 2010 Affordable Care Act (ACA). With these actions and the nomination of orthopedist and Representative Tom Price (R, Georgia), an ardent opponent of the ACA, as the proposed Secretary of Health and Human Services, it is likely that the administration is on a path to dismantle President Obama’s signature health care plan–one that covers 20 million Americans. The health care community is deeply divided on the future of the ACA and what reforms will mean to patients. While no formal replacement plan has been proposed, an examination of Price’s legislative record, as well as some of the proposals that he and others have put forth, may provide a glimpse into the future(.Greif, Judi,2017)

Price’s alternative to the ACA, called the “Empowering Patient First Act,” states that there should not be “a government takeover of health care.” He vowed in his hearing that he would not “pull thout” from under those covered by the ACA. He favors returning control to individual states, such as providing them with block grants for medicaid  funding and creating state-run “high risk pools.”  It is likely that Price’s vision of health coverage would not continue to support women’s health services, as his plan does not guarantee prenatal care and he is opposed to abortion and funding for contraception. Although the American Medical Association has “strongly” supported Price, “for his service as a physician, state legislator, and member of the U.S. Congress” and has called him a “leader in … policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens,” this organization only represents approximately 25% of all physicians, and his nomination has spurred strong reaction among many clinicians. An online open letter entitled, “The AMA Does Not Speak for Us,” which gathered more than 5,500 signatures, stated, “Dr. Price’s proposed policies threaten to harm our most vulnerable patients and limit their access to health care.”(( Judi Greif,2017)

National Nurse United, representing 185,000 members, stated, “If confirmed, it is clear that Rep. Price will pursue policies that substantially erode our nation’s health and security … throwing our most sick and vulnerable fellow Americans at the mercy of the health care industry.”  Let us hope that President Trump’s desire to reform the ACA will retain its best components and improve on its shortcomings. As health care providers, we have an obligation to our patients–especially to those who are most vulnerable. A spokesperson for the Trump transition team told the New York Times that Price will “work to restore the patient-doctor relationship.” However, how can you have a patient-doctor relationship when the patient cannot afford to go to the doctor? (Judi Greif,2017)