Health Care Reform Should Avoid Short-Sighted Cuts

As federal policymakers consider changing the nation's health care system by repealing or changing the Affordable Care Act, they need to realize that taking away people's health care benefits does not remove those persons' need for health care. Some might see repeal of the ACA as a way to cut health care expenses, but in fact, it could instead increase health care expenses. To understand why that is so, it is important to understand the cost shift that occurs when uninsured people's health care costs are passed on to others in society.

At West Virginia Health Right Inc. in Charleston, we know firsthand how that cost shift occurs and how it can affect people. WV Health Right is a nonprofit free and charitable clinic serving more than 19,000 patients with medical, dental, pharmaceutical, vision, behavioral health, health education and mobile dental services. We rely on physicians and other health care providers who volunteer their time and talents to provide care and treatment to our vulnerable neighbors. For decades, we have served people who either have no health care insurance or are underinsured. Many of our patients work one or more low-wage jobs and have incomes at or slightly above the federal poverty level.

One of the important changes brought by the ACA was the expansion of Medicaid to cover more people, and WV Health Right responded by treating Medicaid recipients. Prior to Medicaid expansion under the ACA, the income eligibility for Medicaid in West Virginia was about 33 percent of the federal poverty level. That meant that adults in a household of four with an income of about $10,000 did not qualify for Medicaid coverage. Since Medicaid expansion, the same family of four could have income up to 138 percent of the federal poverty level and be eligible for Medicaid coverage for all family members.

Thus, Medicaid expansion has improved health care access for such persons, allowing them to receive care in a more organized, clinically appropriate and efficient way. When such individuals do not have access to affordable care, they tend forgo primary and preventive care. Consequently, they ignore medical issues until those issues become so problematic they end up in hospital emergency departments, where care is especially expensive. In 2013, the average cost for an emergency department visit was $1,223, according to The Washington Post. Because those individuals still have no way to pay for their care, it becomes uncompensated care for the hospitals, which must then pay for their expenses by shifting costs to the rest of society. That effectively becomes a hidden tax on everyone.

Studies have shown that medical costs can be reduced and outcomes can be improved by providing people with primary and preventive care, such as through patient-centered medical homes. WV Health Right is accredited by the National Committee for Quality Assurance (NCQA) as a Level 3 patient-centered medical home. NCQA studies have found that recognized patient-centered medical homes are associated with lower average annual health care spending, lower acute care hospital spending and fewer hospital emergency department visits. Since the expansion of Medicaid under the ACA, many West Virginians are now able to access health care in a more consistent and timely manner, which both improves health care outcomes and reduces the cost shift.

That is why there is a dollars-andcents reason not to go backward by making it more difficult for people to connect to affordable health care. Again, legislating away health care benefits does not make health care needs disappear.

We hope that, as West Virginia Senators Shelley Moore Capito and Joe Manchin review health care reform legislation, they consider the positive effects of providing people with organized care, as the ACA has done. The current system is not perfect, but any change should lead to improving the system, not an elimination of Medicaid expansion, which has proven to be good for the health of West Virginians and good for cutting health care costs.