Nev's Health Law

Neville M. Bilimoria

Neville M. Bilimoria is a partner in the health law practice group in the Chicago office of Duane Morris LLP.

March 2017

The biggest question mark in the field of health law right now is President Donald Trump’s outlook for American health care.

Before I can comment on President Trump’s decision to repeal or — depending on what you read — partially repeal “Obamacare,” I think it would be helpful to understand exactly what Obamacare is, was, and what it hoped to accomplish.

Obamacare, health care for the masses

First and foremost, the Patient Protection and Affordable Care Act (PPACA) was designed to provide access to the more than 47 million uninsured or underinsured Americans to the U.S. health care system. Certainly prior to PPACA, the U.S. health care system suffered from a lack of coverage for all individuals, and that lack of coverage was growing and adding to skyrocketing health care costs.

President Obama set out on a course to rectify that situation, but also at the same time to reel in health care costs and to maximize quality. PPACA set out to take on a daunting task in health care: increase access while increasing quality. Historically, access and quality in the U.S. health care system sat diametrically opposed atop a fulcrum. If access goes up, quality necessarily goes down.

But PPACA set out to change all of that and remove the fulcrum, with the idea of raising both access to and the quality of health care in the United States. One key part of PPACA is a focus on wellness, keeping people healthier now so they wouldn’t need more costly health care later.

Was Obamacare a success?

This is a huge question that cannot be answered here. But with certainty, PPACA succeeded in providing more access for individuals. Some would say that was the main goal of PPACA, and, therefore, that PPACA succeeded in solving much of the U.S. health system’s woes. However, others criticize PPACA — namely Republicans and President Trump — given that as a result of PPACA, most people’s health insurance costs skyrocketed to the point where it became popular during the 2016 campaign to call for a repeal of PPACA in the name of higher insurance premiums suffered by many Americans.

But what about health care costs? Have health care costs been reduced under Obamacare? Some people’s premiums did not get reduced in the name of increased access, but was overall health care spending reduced? The answer to that seems to be a bit murky.

According to a recent study done by Cascade Partners, total health care expenditures in the U.S. for 2015 reached $3.2 trillion and are forecasted to grow to $4.5 trillion by 2020. While Obamacare promised to keep costs down, the administration claimed this benefit would surface over time, with the idea that after an increase in wellness and preventative care, eventually costs will decrease because of early detection.

Remember, PPACA is based on promoting wellness and keeping people out of expensive and time-intensive health care services, such as extended hospital stays, expensive treatments, and expensive surgeries. By promoting wellness, PPACA created an incentive for providers to look after the overall health of their population within an accountable care organization, or ACO. Some would say that health care expenditures have gone down in 2016 somewhat, but that still remains to be seen long term. Whether that is truly the legacy of PPACA remains to be seen, but all in all, it does not seem that the PPACA succeeded … yet … in reducing overall health care expenditures by much. But some could also argue that any repeal of PPACA now may not allow PPACA’s reduced health care cost long term plan to come to fruition.

And what about quality? Has PPACA improved the quality of care in the U.S. health care system? More study is needed on this as well.

The new president’s solution to solve

Amidst all of this, President Trump now wishes to perhaps focus on revamping the health care system, all the way from reports of Health and Human Services Secretary Tom Price wanting to revamp the Medicare system to repealing the entire PPACA. Purely from an objective perspective, it seems that the most important consideration now for health care is a true, concerted analysis of whether PPACA failed, and if it failed, those failures need to be identified.

Once the failures are adequately researched and identified, if any, then logically, only then can a reasoned repeal or solution be made to our U.S. health care system. But repealing PPACA merely because premiums went up or based on partisanship does not seem to be the logical answer.

President Trump will need a meaningful solution for the nation’s health care problems. If we repeal with no path to a solution, we may be doomed to returning to a system where there are millions of growing insured or underinsured, and skyrocketing health care costs that will not only limit access and quality, but also go back to the ways in which health care in the U.S. has been criticized.