2017-11-22 / Front Page

Queens College Business Breakfast Forum

By Thomas Cogan
Does the ACA Have a Future? was the question asked of the panel appearing at November’s Queens College Business  Breakfast Forum.  It’s apparent that a good half of our politicians hope the ACA, the Affordable Care Act, does not have a future, since they tried quite hard to repeal it a few weeks ago and almost did.  The panel consisted of four people active in health care or social services, whether with hospitals, in insurance or as a political voice from the other half of the health care dispute.  The forum was moderated by a veteran newswoman. 

It was preceded by a welcome from QC President Felix Matos Rodriguez, who congratulated Christina Jimenez, class of 2007, awarded a MacArthur Grant this year for founding and directing United We Dream, a group in aid of students without U.S. citizenship.  The forum opened as Sheryl McCarthy, whose journalistic experience includes reporting and column writing at the Boston Globe and the New York Daily News, introduced the panel. 

Lisa David is formerly of Planned Parenthood and in her travels has worked in many states, as she eventually revealed.  Cindy Goth is a vice president of Emblem Health, one of the leading non-profit health plans.  State Senator Gustavo Rivera represents the 33rd Senate District in the Bronx.  Kate Spaziano was a congressional aide when the ACA was evolving from bill to law and currently works at both New York Presbyterian Hospital and Weill Cornell Medical Center. 

“How’s the ACA doing?” was the opening question.  Lisa David said it’s not dead, citing large enrollments in one or another part of the country.   Sen. Rivera said President Donald Trump is plainly trying to kill it.  Cindy Goth hailed its strength in the state of New York but wondered if it could withstand the continuing Republican onslaught.  Spaziano said she was “very concerned” about its viability. 

David said two million persons are enrolled in the state of New York but reductions are just beginning and she fears for the health of the plan and its enrollees.  Nationwide polls have given the ACA a 63 percent favorable rating.  Of those polled, 60 percent have said they could not bear a medical bill of $1,000  while 40 percent say they could hardly pay a bill of $100.  Goth said that if the Individual Mandate is struck down as part of a successful Republican tax bill in the U.S, Senate, matters will be grave indeed.  Rivera said if $800 million is cut in New York as a result of the bill’s passage, Governor Andrew Cuomo is mandated to call another budget session to deal with the crisis. 

When McCarthy asked Lisa David if the bill by Senators Lamar Alexander and Patty Murray (which would allow subsidy funding to insurers for another two years,  temporarily reversing President Trump’s October cancellation of it)  would be helpful should it become law, David said it would, though earlier in the forum it had been described as “barebones.”  Rivera was asked if the Individual Mandate is killed in passage of the Senate’s tax bill, is the ACA dead?  He said yes, with that it would be “gutted.”  Goth agreed, saying that making the mandate optional would lead to desertion by those bothered by its enrollment-or-penalty-payment threat.  That would leave those remaining in the program to face soaring rates because of the consequent depletion of funds.

The question of block grants arose and Rivera said that at present, states and the federal government share costs but with block grants the feds would be able to fob off proportional payments to each state and be done with its duty.  He also said Gov.  Cuomo can adopt a single-payer system in New York if he can persuade a majority of the state’s 62 counties to register approval.  At the moment, the governor says he has the approval of 31, so only one more is needed.  He also said he’s had to tweak the plan a bit in the four years he has maintained it.

Goth said there are flaws in all this.  Federal authorities won’t willingly submit funds to New York.  She fears that the insurance industry could be destroyed by regulatory decline.  What’s more, the single payer system would not include employers who self-insure.  The New York state economy is quite dependent on the health industry as it is currently composed, and single payer would be highly disruptive.

Rivera said the expense of treating emergency room patients is huge.  Federal funds were needed to reduce the number of emergency room visits by creating better hospital systems, he said.  It took billions of dollars to construct that system, during the time Barack Obama was president.  It’s safe until 2020, Rivera said, but that’s not a long time from now.

McCarthy asked about what she called “weaknesses” in the ACA.  Goth said that it has always lacked commitment to dealing with costs.  It should move to a more risk/reward system.  Right now, no one can get beyond the critical core of the system to make a broader study of the social reasons for poor health.  She said one big accomplishment was accessibility for the ill, but without subsidies, few can take advantage of it. 

Spaziano said that when the ACA was being created, “we threw everything a t the wall” to see what would work but should have paid more attention to social services.  David suggested that there were numerous obstacles to developing a system, some of them absurd.  For instance, when she was working in Mississippi and Alabama for Planned Parenthood, she discovered  that many possible clients for Medicaid were bureaucratically judged unqualified because their income level was too low!  Rivera said that President Obama balked at creating a single payer system, believing it would be called too radical.  He settled for what we finally got, the state senator said, calling that decision understandable but wrongheaded.

McCarthy asked the panelists what they see as their policy priorities,  Rivera said his is to create health care for all in the state of New York.  He said it’s what he’s qualified to do.  David, who has been a Planned Parenthood activist,  said she is concentrating on women’s health care issues, which she called “at risk” under President Trump. Goth said   that if the goal is personal coverage, we’ll all be better off.  She is hopeful about New York’s statewide health care progress. 

Spaziano said deficits are a threat to the AC A, so we will have to work for it harder than ever in the face of further tax reduction measures. 

The next request was to describe a worst case scenario.  Everything, Rivera said, David said that the best case and the worst might not be too far apart; it’s hard to be optimistic.  Goth held to the bright side, saying she is hopeful about the growth of ACA sign-ups but at the same time hopes cooler heads will prevail.  Spaziano said only to pray for litigation, though she did add that the story’s not over yet.

The meeting ended with something of a lightning round.  Is health care a right? they were asked and all said yes, as all did when asked if firearms are a public health issue.  Spaziano answered the question about long term care, saying the ACA tried to address it, didn’t succeed and so must try again.  Who’s going to pay for all this?  We’re paying for it now, when the sick cannot be treated, Rivera said.  






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