Access to quality care, impact of ACA lead list of physician challenges

Sight Lines By J.C. Noreika, MD, MBA

Editor’s Note: Welcome to the latest installment of “Sight Lines,” a feature in which J.C. Noreika, MD, MBA, an ophthalmologist in Medina, OH, discusses trends in ophthalmology, medicine, and health care with key leaders in their fields. In this issue, Dr. Noreika talks with U.S. Sen. Sherrod Brown (D-OH).

Dr. Noreika: It is an honor to speak to you today. You represent more than 11 million people in Washington, DC, and you’ve been a long-time friend of medicine and ophthalmology. I would like to talk about the changes that are going on in medicine-especially in regard to accessibility to quality health care and the Affordable Care Act (ACA). Can you share your thoughts relative to these changes?

SEN. BROWN:

Early in my congressional career, you invited me to your office and I watched you and learned about your practice. My dad was a general practice physician, as you know, and so I was open to these discussions. As the ACA is implemented, it is important that doctors have their say and that members of Congress understand the challenges physicians face and the interplay between the law and a physician’s practice.

There are a number of very positive things in the ACA. A lot more people have insurance. In Ohio, about a half million more people have insurance today than (several) months ago. Having children with pre-existing conditions no longer disqualifies a family from getting insurance. We have seen thousands of cases already in Ohio, for instance, where a family previously denied (coverage by insurance companies) for years can no longer be denied. On the other end, when someone gets sick and becomes very expensive to care for, the insurance companies can no longer cut them off.

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Also, the ACA requires that 80% to 85% of premium dollars go to actual health care. That means it goes to medicine, doctors, and hospitals, not to advertising, marketing, executive salaries, or profits.

The law also has some very important provisions for seniors in terms of preventive care. Things such as eye checkups, physicals, or screenings for osteoporosis or diabetes are covered with no co-payment and no deductible. This is particularly important for ophthalmologists, since so many of their patients are seniors.

On the other end of the age spectrum, people under 27 can be covered on their parents’ health-care plan.

There have been problems, of course, but I think the ACA is a big advance for patients in general.

NEXT: Continued + Podcast

Listen to the complete audio interview with J.C. Noreika, MD, MBA, and Sen. Sherrod Brown (D-OH) to hear what Sen. Brown says about medical malpractice liability and the role of ophthalmologists and pediatricians with regard to examining for retinopathy of prematurity. 

Dr. Noreika: Is there anything about it you would have done differently?

SEN. BROWN:

Yes. For instance, I had a provision in the bill that would have allowed people to buy into Medicare at age 55. This would have let people who lose their jobs at age 58 and can’t get insurance because of their health to be in a program like Medicare, which works most of the time for most people. It needed 60 votes to pass, but it only got 59.

Certainly, I would have done the rollout differently, too. I don’t really care to second-guess though. When Medicare passed in 1965, there was a lot of opposition from doctors and insurance companies. But shortly after it passed, Vice President Hubert Humphrey began to call mayors and governors in the South and told them that if they wanted Medicare, they had to integrate their hospitals. That was the same timeframe in which voting rights and civil rights laws passed, so it was very controversial.

Social Security was controversial at the beginning. Medicare was controversial at the beginning, and the ACA is, too. But I think over 2 or 3 years, as doctors adapt and realize that their practices can prosper and we are not taking choices away from them, they will generally be satisfied with this.

Dr. Noreika: Medicare is a great segue to the next theme. Can the sustainable growth rate (SGR)-which is important to ophthalmologists because we see so many Medicare patients-be fixed?

SEN. BROWN:

It absolutely can be fixed. You and I worked together on the first SGR fix when I was in the House of Representatives. I co-sponsored it with the Republican Chairman of the Committee. It was temporary, unfortunately, and has been temporary ever since because of the cost. That’s the bad news, but at least we have extended it every year.

The good news is that the Senate Finance Committee passed a repeal in December. It didn’t move forward in the Senate, but I think a permanent solution is in sight. The new chairman on the Senate Finance Committee and the ranking Republican have great interest in making this permanent. As health-care reform takes hold and we see more of a plateau in health-care costs, the cost to fix the SGR will probably go down. That is not certain, but it is making it easier for Congress to fix it.

There is great interest in finding a permanent fix. It makes no sense to make doctors lobby us to fix the SGR over and over again instead of pursuing a long-term fix. We need to free up doctors to practice medicine, and let the ones who are activists lobby Congress about tobacco or other public health issues.