Health care policy is in maximum head-turning spin-cycle these days.
More than 60 times Donald Trump as a candidate for President promised to repeal the Affordable Care Act (ACA). But Republicans cannot coalesce around an effort to jettison the ACA. And finding a replacement plan acceptable to both the more conservative and moderate wings of the GOP is proving elusive.
Health insurance companies across the country are in a quandary, trying to determine how they will price plans for those who may or may not qualify for subsidies to purchase insurance. Many companies say they will “seriously consider” departing Obamacare if it is repealed.
In North Carolina, a new effort – lead by members of the majority GOP in the General Assembly – proposes to expand Medicaid by introducing work requirements and co-pays for participants.
All of these potential fundamental changes to how we provide health care are up in the air. Repeal the ACA? Replace it with…what? Will insurance companies keep offering affordable policies for those with the least in this era of tremendous uncertainty? And what about Medicaid expansion?
No one knows for certain which way these critical decisions will turn out.
What I do know, however, is that in the long-term, solutions to what ails our health care system will come from local communities.
Consider the North Carolina Care Share Health Alliance, a statewide healthcare network that coordinates care to those most in need across North Carolina. In business for just ten years, Care Share already reaches more than a third of North Carolina’s counties, supporting collaborative networks of care by integrating medical, social, and economic resources to help those in greatest need.
Care Share focuses on the broader “social determinants of health” – the factors impacting one’s health far beyond just clinical interventions. Long before the “social determinants” phrase caught fire, Care Share understood the power of connecting lower wealth patients not only to physicians and dentists and other providers willing to give health care services to those in need, but also to support patients in accessing additional human and social networks to get them on a path to wellness.
In Charlotte, Care Ring has been fortunate to partner with Care Share, advancing an innovative, volunteer-lead model to provide care to those with limited resources.
In just over a decade, our collaborative network in Charlotte has generated more than $130 million in donated care by our partners at Carolinas HealthCare System, Novant Health, OrthoCarolina and numerous independent practices.
More than 1500 physicians and dentists from across the region volunteer their clinical expertise to care for those with the least, and the results from the first 12 years of this innovative partnership are noteworthy.
From rates of emergency room utilization to access to life-saving specialty care, patients in our local Physicians Reach Out (PRO) network have access to excellent, affordable care. And the health outcomes for our patients are on par with what you would look for in the best provider models in the country.
Fortunately in Charlotte and in a number of communities across our state, we have collaborative models like PRO that have established trust across hospital systems and thousands of providers.
We have ample evidence at the local level that there are promising interventions already having a dramatic impact on the lives of those with limited resources.
Each day brings a new wrinkle to health care policy in the US. Will the ACA be repealed? If so, what kind of replacement is possible without a bipartisan path forward? Will North Carolina expand Medicaid? What will our insurance companies do in this cauldron of confusion?
My advice for health care leaders in Charlotte and for anyone trying to guess what the future holds for health care in the US?
Regardless of what happens with the ACA and Medicaid expansion, focus on the strength of existing partnerships and take advantage of all we have learned about how to provide care to those with the greatest needs. Innovative programs like PRO are firmly rooted and hold great promise for addressing any future health care challenge.
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