In wake of AHCA, public health professionals discuss bill

Chief legal officer at UPMC Sheryl Kashuba drew laughs from a full audience — including Chancellor Patrick Gallagher in the front row — as soon as she began her part of a discussion on health care Thursday afternoon.

“First let me say what weird times we’re living in when you’ve packed the room for talking about insurance,” she said.

About 150 students and faculty members gathered Thursday to discuss health care and the government’s role in providing resources in an event titled “The Affordable Care Act: Repeal, Repair, or Replace?” The panelists discussed the Affordable Care Act — also known as ACA, a 2010 bill intended to fill the gaps in health care coverage. The discussion focused on the possibility of replacing the ACA with a Republican bill that proposes ending Medicare expansion by 2020 and including age-based tax credits for those who earn less than $75,000 or $150,000.

During his campaign, President Donald Trump’s platform included repealing and replacing former President Barack Obama’s health care plan. His calls for a removal of “Obamacare,” were met with wide approval by Republicans — nearly all of whom had opposed the ACA.  

The Republicans released their replacement plan, called the American Health Care Act, earlier this month. The bill passed in the House Budget Committee Thursday.

The discussion Thursday did not attempt to answer which bill, the ACA or the AHCA, would be better for Americans’ futures. Instead, the panelists offered more dramatic approaches to solving the problem of health care, such as establishing an entirely new health care system.

The panel consisted of four health professionals who spoke one-by-one, each presenting their own lecture, focusing on the history and future of health care in the United States, and ending with a Q&A.

Everette James, associate vice chancellor for health policy and planning in the School of Health Sciences, opened the panel. He said since Sen. Paul Ryan and President Donald Trump ran on the ticket of “repeal and replace,” he expected that new health care legislation would be put in place. As the government was constructing a health care system in the early 1900s, he said, the United States missed the chance to move toward a system of social health insurance.

“We set up a system focused on the private sector with a goal of providing coverage for everybody but not actually guaranteeing it,” James said.

When the United States government realized that many people were not covered under the private system, he said, programs like Medicare, Medicaid and, more recently, “Obamacare” — a phrase which has become synonymous with ACA — were set up. James noted that only about 170 million out of 290 million American citizens were covered by private insurers in 2015.

If it were to pass today, the AHCA would leave 52 million people uninsured, compared to 28 million under the existing law, according to a report from the Congressional Budget Office.

UPMC’s Executive Vice President Steven Shapiro said the AHCA differs from the ACA in its use of government funding. The AHCA would reduce government spending by lessening the number of people covered by government-funded programs, which is the opposite of what the ACA does.

Both bills treaded a difficult course, Shapiro said.

“It’s really difficult to thread that needle, to give affordable health care for all and still lower the national spending on health care, which is a problem,” Shapiro said.

Associate Professor of Health Policy and Management Julie Donohue attempted to address this problem by proposing the use of a European-style single-payer system, where one public agency organizes financing health care. She said that the “patchwork” type system — a system that uses a variety of different programs to patch up the gaps in employee-sponsored insurance for those who are not insured under ACA — was failing.

“No one in their right mind would create this kind of patchwork system,” Donahue said, referring to both the ACA and AHCA.

When the panel opened up the room for questions, one person asked whether health care reform would ever go beyond the question ‘what is my personal problem?’

“I think it’s so personal that it’s difficult to have these global discussions,” Kashuba said. “There’s medications currently that can expand your life by two months, and these are costly. And if you’re that person that wants two more months, there is no money that is too much.”

Maureen Clark, a junior studying rehab science, said she was not excited about the possible implementation of the AHCA, but she has also been negatively affected by the ACA.

“My family’s premium went up astronomically when the ACA was passed,” Clark said. “We had to switch [health care] plans,” Clark said.

Angela Wateska, who works as a research associate with the Department of Medicine, also said she felt uneasy about the implementation of the AHCA because her research focused on improving health care delivery to the underprivileged.

“This new policy, I have a very low opinion of it,” she said. “I don’t want to see the rate for health insurance go up and 24 million people go uninsured.”

Shapiro said the solution to the health care crisis doesn’t have to be solved by a bill. Instead, he said, individuals have some responsibility in ensuring that everybody has a right to healthy living.

“Being at a premier academic institution, the real solution lies with us, in quality care,” Shapiro said.