The ultimate moral test of any government is the way it treats three groups of its citizens. First, those in the dawn of life-our children. Second, those in the shadows of life-our needy, our sick, our handicapped. Third, those in the twilight of life-our elderly.1

Hubert H. Humphrey, 1976

Health care is political. Unfortunately, this is our reality. An awareness of this fact is essential in uncertain political times because much of our work may be directed by political will. This year, the US Senate may vote to pass a new health care bill, the American Health Care Act (AHCA) that would repeal and replace the Affordable Care Act (ACA). Supporters of the ACA are concerned that millions of Americans could become uninsured. Proponents of the AHCA feel that it will control insurance premiums. It is a complicated topic because many elements of the proposed bill are not yet known; however, reports indicate that the Senate bill may look very similar to the bill that passed earlier this year in Congress. It is clear that there is a sharp divide, perhaps another chasm in the US health care system between providing care and financing care.

It is important that providers understand the components of this debate and advocate for the best outcomes for patients. Although there are many uncertainties, information does exist to help us understand proposed changes to the existing health care law.

Professional organizations, led by health providers, have provided some key points to consider as they encourage all providers to become advocates for patients by communicating with political leaders.2 Providers may voice their opinions, recommendations, and concerns by writing or calling local and national leaders. Others will express opinions in white coat rally's and petitions. Democracy will support many forms of expression.

This is a critical moment for the future of health care. Informed providers may be in a unique position to advise patients and political leaders to join the conversation. Dr Mona Mangat appealed to Congress, suggesting that, just as we gather basic information and scientific data to best serve our patients, we must wait for more information and hold public hearings to hear from patients and health care professionals.3

Health care providers are acutely aware of the challenges many patients face. Changes in health care cost may affect equitable distribution of care. It is painfully clear that lower-income individuals are especially sensitive to cost sharing or other efforts to undermine consumer protections put in place by the ACA.

The details are a work in progress and fairly complex; however, Dr Don Berwick breaks it down in clear language and graphic detail. He explains that the ACA, passed in 2010, is really 2 laws in one, rolled out in many sections over time. The law has 2 arms: insurance reform and delivery reform. Each arm has many sections, each interacting toward 1 of the 2 major arms. Berwick explains terms such as guaranteed issue, an important concept, which ensures that persons with preexisting conditions are not excluded from insurance pools. He speaks about asking people to take individual responsibility as he describes community rating (pooling well and sick individuals) and individual mandates-logically necessary to cover all individuals, including children and our most vulnerable populations.4

Berwick explains little known details of the ACA on the delivery side-such as mandates for integrated care, quality focus, and innovation. A comparison chart explores how the AHCA may change the template of the ACA.

This short clip, delivered in plain language using logical flowcharts, provides a blueprint to help us interpret how these laws may be shaped and improved to better serve our patients and pass the moral test described by former Vice-President Hubert Humphrey.

References