March 23, 2015

Today’s New York Times provides some compelling evidence of the impact of the Affordable Care Act (ACA) on health. Quest Laboratories, a major company that analyzes blood and other body fluid and tissue samples, compared test results by state and found that new diagnoses of diabetes among Medicaid recipients increased by 23% in states that have expanded Medicaid coverage under the terms of the ACA in the first 6 months of 2014.

 

By comparison, new cases rose only 0.4% in states that had not expanded Medicaid coverage. The study was published in Diabetes Care and is available online.

 

This finding comes as 11 million more people are covered under the ACA’s expansion of Medicaid and the Children’s Health Insurance Program (CHIP), another important safety net program. CHIP is to expire in September and, if it does, 5.8 million children currently enrolled in the program could lose coverage.

 

And all of the ACA could unravel if the Supreme Court rules in King v. Burwell that federal subsidies for people who sign up for health insurance under the federal health insurance exchange are ineligible for this subsidy because the ACA specifies subsidies for insurance purchased on the state insurance exchanges, not the federal exchange.

 

And all of this comes as as Congress is poised to act on the “Doc Fix” that would end routine cuts in physician payments (and payments to nurse practitioners and physician assistants). Often simply referred to as the “SGR”, the formula for paying physicians under Medicare was developed in 1997 as a way of containing costs by basing physician payments on economic growth.

 

Repeatedly, Congress has voted to delay scheduled cuts. It’s become an untenable situation, with wide coalitions and the Medicare Payment Advisory Commission even calling for its end. Too many physicians were refusing Medicare patients. We need more physicians, nurse practitioners and physician assistants to be available, particularly in primary care.

 

Although the expansion of insurance coverage under the ACA may help the uninsured, it could take a toll on Medicare beneficiaries’ ability to find health care providers who may conclude that their practices are more sustainable if they take patients with private insurance rather than Medicare. One of the potential show-stoppers for an SGR solution is an amendment that would extend CHIP coverage through 2019.

 

All of this leaves me wondering what those who oppose the ACA think about the impact of its demise on the lives of people who can’t afford care to diagnose and manage their diabetes and so develop costly complications–whether amputations, blindness, kidney failure, or other life-threatening conditions.

 

The ACA is saving lives–and money. Estimates of the costs of diabetes and its complications range from $132 billion in 2002 (more than half of which is related to complications and associated medical conditions) to a more recent estimate of $218 billion in 2008.  Time to move on with transforming our health care system into one that truly focuses on promoting health through primary prevention and early diagnosis and management of chronic illnesses.

 

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing and Co-Director, Center for Health, Media & Policy at Hunter College, City University of New York.