Replace ACA with Medicare for all Americans

By Richard A. Damon, M.D.
The Billings (Mont.) Gazette, Letters, Nov. 16, 2014

Now that both houses of Congress are controlled by the party that has tried to dismantle the Affordable Care Act by selective changes 54 times, what happens to the health care law?

The House has voted to repeal the Affordable Care Act in its entirety six times since enactment. Fifty-four House votes ranged from refunding to delaying measures and other fixing of the law. The 1099 tax reporting requirement was repealed and the CLASS Act (for long-term care) was dropped. Funding was reduced for the Prevention and Public Health Fund.

Does the ACA meet the affordability, accessibility and cost-control goals of health care reform? Objectively, we find it is a gallimaufry of millions of people struggling with insurance illiteracy. Patients find unexpected out-of-pocket charges. Prospective provider organization enrollees find they pay a percentage of the bill. Few patients understand cost-sharing, provider networks, unrecognized co-payments, deductibles and co-insurance.

The 2013 AIR Health Insurance Literacy Survey shows many Americans are unprepared to make informed choices. Patients want access, lower costs and better outcomes from reform. Unfortunately, the ACA misses all three.

The ACA leaves 10 to 30 million Americans under-insured, at risk of bankruptcy or death. Thirty million are left totally uninsured. Health care ends when income ends.

CBO estimates $100 billion annual decrease in government spending with $100 billion increase in total health care spending. That means patients and employers will annually pay $200 billion more than they pay now. Physicians want easy billing and prompt payment, which hasn't existed for decades. Employers want health care costs to be predicable and consistent.

Replacement should be simple; pass "Expanded and Improved Medicare for All," HR 676, Conyers' legislative bill.

Dr. Richard A. Damon resides in Bozeman.