KMS statement on health system reform
The Kansas Medical Society did not support H.R.3590, the so-called “Affordable Care Act” (P.L. 111-152), the health reform legislation enacted in March 2010. However, opposition to that specific legislation does not mean that KMS opposed reform of the health system. Physicians understand better than many others that the problems of the health system, particularly around the issues of cost and access to care, were simply not sustainable without systemic reform.
Positive aspects of the Affordable Care Act
Though there were several positive provisions in the Affordable Care Act, such as insurance reforms (elimination of lifetime caps and increased coverage of preventive services, for example), enhancements for primary care, graduate medical education, administrative simplification, and subsidies so lower income employed individuals and families can obtain insurance. However, in our view the positive provisions were outweighed by the many deficiencies and negative aspects of the bill.
Deficiencies of the Affordable Care Act
Among the deficiencies in the legislation were a lack of a permanent Medicare SGR fix, a lack of meaningful medical liability reform, an aggressive expansion of the role of the federal bureaucracy (principally the Department of Health and Human Services) over the delivery of medical care, and vesting a new “Independent Payment Advisory Board” with the power to make program and funding cuts that are more properly the responsibility of the elected Congress. In addition, the ACA did not include a provision to allow private contracting in Medicare, nor did it provide any real antitrust relief to physicians to encourage collaboration.
The legislation also includes provisions which restricts physician ownership of hospitals (KMS supports responsible physician investment in health care facilities, technology and equipment, along with appropriate disclosure to patients so they can make informed care decisions), and includes penalties for physicians who fail to report quality data under PQRS, and includes the implementation of an unproven cost/quality index modifier. We were also skeptical of claims that the bill won’t add to federal and state budget deficits, and we see little in the legislation that will slow the growth of health care spending, short of claim denials and provider pay cuts.
Unfortunately, the bill does nothing to promote a greater degree of individual responsibility in controlling one’s own health care choices and costs. Taken as a whole, the legislation provides for a troubling and unprecedented degree of control by the federal government over the resources, financing and delivery of health care.
Amendments to the bill
KMS supports Congress’ efforts to revisit and significantly revise deficiencies in the law that adversely impact physicians’ ability to deliver quality medical care to their patients free of unreasonable government interference. While KMS believes that everyone should have health insurance coverage, our preference for achieving that goal favors financial subsidies and tax incentives to purchase insurance, instead of the individual mandate in the ACA. That issue, a key feature of the ACA, is now in the hands of the federal appellate courts, who will determine whether the individual mandate, and possibly the entire law, is constitutionally sound.
Principles of reform
KMS has long-standing policy which supports reform of the health care system that is fiscally responsible, promotes quality care, encourages individual responsibility, promotes pluralism, promotes transparency, reduces administrative burdens, and preserves the ability of patients and their physicians to make health care decisions that meet their individual needs and circumstances, free of undue influence from government or insurance companies.
KMS supports health system reform that builds on the strengths of the current system. Reform should promote quality as determined by health professionals–not the government. It should preserve patient choice of physician and facility, and it should harness the power of individual responsibility and market forces as a superior approach to a government-controlled delivery system.
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