Cover: Back in the spotlight - How will federal health care reform work for Colorado?

Monday, May 01, 2017 12:00 PM
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by Katie Lozano, MD, FACR, President, Colorado Medical Society

Have we reached a tipping point in this long, contentious debate on federal health care policy? Is there an opening for productive problem-solving in Congress? Since its enactment in 2008, the Affordable Care Act has been defined in sharply partisan terms, and the country split down the middle notwithstanding well-documented confusion as to content, design and purpose. We’ve all seen the paradoxical street interviews where respondents proclaim their disdain for Obamacare but their support for the Affordable Care Act, and voter belief that after each U.S. House vote to “repeal” (upwards of 70 times) the law was, in fact, repealed.

After the Republicans’ effort to “repeal and replace” in March, has ownership changed hands? A recent Kaiser poll found voters, once confronted with losing coverage only recently acquired and held, opposed to disrupting that coverage. Are the visuals of crowded auditoriums shouting down Republican members of Congress symptomatic manifestations of the “you break it, you own it” rule, or are they orchestrated turnout by the Democratic party, or somewhere in between? Or does it matter? In politics, perception is reality.

That irony is not lost on those among us who also understand that the ACA is not without structural flaws. This is not a case of “ain’t broke, don’t fix it.” In the same Kaiser poll, three-quarters of the respondents said the administration “should do what they can to make the current health law work.”

The fix-what’s-broken position in our multi-payer, public/private system mirrors the findings of our CMS member survey prior to the statewide rejection of Amendment 69. Our long-time pollster, Benjamin Kupersmit, provides a more detailed review of what Colorado physicians think about the range of state and federal health system “fixes,” and the dissatisfaction with the current multi-payer system and specific complaints to target (see the summary here). Since the election, we have brought those collective views to our congressional delegation. We have also taken a suite of market-based insurance reforms pulled from those physician insights to the Colorado General Assembly. Most of those bills are making their way through the process to the governor’s desk, despite the determined resistance of the commercial health plans. Those advocacy efforts will most certainly carry over into the interim and into the 2018 session.

Is this finally a teaching moment where our ideas, coming from the grassroots views in the exam room, can move congressional hearts and minds? Judging from what I hear from my colleagues, and measured by our regular polling of Colorado physicians, there is an understandable level of frustration with a debate that seems more partisan than informed. In the world of politics and public policy it is hard for physicians to see the end game. After all, we have been methodically building a physician consensus and pressing our case for two decades (as explained in the infographic here). I strongly share the core commitment of the medical profession to persistently and consistently advocate for a rational system that aligns the incentives and delivery paths that move closer to the bedrock of getting our patients – all of them – the right care at the right time, place and value.

Progress is Sisyphean, but we continue to work hard to advance our ideas into public policy. I believe our advocacy rises from a commitment to our patients and our profession. Who better understands the needs of our patients and our colleagues? Given the shift in public awareness that appears to border on militancy, and perceived political perception that there could be consequences for not finding a “fix,” don’t we have an opening to help break through this impasse? We are all-in to remain engaged and committed, regardless of mixed signals, setbacks and the long-term nature of this debate.

Posted in: Colorado Medicine | Cover Story | Health System Reform


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