The Affordable Care Act (ACA; Obamacare) was signed into law over 10 years ago. The ACA has done little to rein in healthcare costs, but has resulted in people losing access to their preferred providers. In addition, it has caused a flood of mergers and acquisitions among healthcare systems as individual providers and group practices find it difficult to meet the ACA's regulations and requirements. Appropriately, Republicans have attempted to dismantle ACA since it was enacted, but with no significant success. When President Trump took office in 2017, Republicans controlled both houses of Congress and the opportunity to repeal and replace the ACA presented itself. However, Republican leaders were unprepared, presented a poorly crafted and incomplete plan, and the bill was defeated in the Senate. Multiple Supreme Court challenges have similarly failed to overturn the ACA.
Ten years on, it is time for Republicans to move forward. The ACA is seriously flawed, but Americans have become used to it and many of the provisions are quite popular, such as protections for pre-existing conditions and allowing children to remain on a parent's insurance until the age of 26. Republicans should focus on solutions that can help control costs within the framework of the ACA. These include tort reform to end frivolous lawsuits that drive up liability insurance costs, investing in proven public health prevention methods that reduce illness and injuries, and increasing access to health savings accounts. In addition, it is a basic principle of health care that early detection of disease not only offers the greatest hope for recovery, but is also more cost effective. We should increase access to preventative screening, rely on healthcare providers who see patients on a regular basis and are in a position to identify disease early (for example, dentists), and increase utilization and reimbursement of telehealth technologies to deliver care in a more efficient manner to those in less accessible areas of the Commonwealth.
A personal issue for me relates to the current state of the mental health care system. Having worked in the system for over 20 years, I can state without hesitation that it is broken. Medicaid and Medicare spend billions of dollars every year on mental health treatment and much of it goes to pay for services with no demonstrable evidence that they are effective. Consider substance use treatment, for example. According to a 2020 report from the National Academy of Medicine, 60-70% of treatment facilities for those addicted to opioids do not offer evidence-based services. Highly effective treatments are available, thoroughly tested in rigorous clinical trials, but they are not widely implemented in the community. As a respected psychologist with experience in both the scientific and applied aspects of mental health care, I am in a prime position to write, propose, and usher through the Congress a mental health reform bill that will significantly improve the quality and effectiveness of mental health and substance use treatment services.