Dive Brief:
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Providing care to high-cost patients is a central challenge to the healthcare system, Uwe Reinhardt wrote for Vox.
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In 2013, 10% of patients accounted for nearly two-thirds of healthcare spending and 1% accounted for more than one-fifth of spending.
- Whether Republicans repeal the ACA with or without a replacement, it will not solve a fundamental problem with healthcare, Reinhardt wrote, posing the questions: What treatments should high-cost patients receive and how should they be financed?
Dive Insight:
Most high-cost patients are chronically ill individuals with multiple conditions that can be treated, although at a high cost they cannot individually afford. If the goal of health reform is provide these patients with access to affordable healthcare services through a private health insurance system, it is inevitable that some people will have to pay more than is “fair,” Reinhardt wrote.
The ACA subsidizes care for high-cost patients through provisions like the individual mandate, community rating premiums, and guaranteed issue. These provisions essentially force healthier individuals to pay more than their fair share in premiums. Republicans have adopted an ideological argument against the ACA that targets rising premiums, but “the health insurance debate will be driven mostly by actuarial logic, not ideology,” Reinhardt wrote.
So far, Republican proposals for a replacement to the ACA, which generally include a combination of tax credits, health savings accounts, and interstate insurance sales, would not protect high-cost patients from extreme financial burden. It is possible that components of the ACA reappear in Republican healthcare plans.
“However, there is no getting around the actuarial mathematics on which health insurance everywhere in the world rests — public as well as private,” Reinhardt concluded. “Unless, that is, our government is content to leave millions of Americans without the benefits of health insurance, and the access to essential healthcare it provides.”