The following editorial appeared in the April 2016 print edition of Carolina Journal:
As Dan Way reported recently at CarolinaJournal.com, any celebrations for the sixth anniversary of the Affordable Care Act, aka Obamacare, were muted.
With health care spending growing at its fastest rate since 2007, Obamacare has made health insurance anything but affordable. And that’s not all. The law’s primary goal was making health coverage universal, ending the alleged “free rider” problem that allows healthy people to forgo insurance until they get sick and have to go to emergency rooms for treatment.
Obamacare failed that test as well. A recent report by the Center for Medicare and Medicaid Services found that the percentage of Americans who had no health insurance fell a mere 2.7 percentage points between 2010, when the president signed Obamacare into law (13.9 percent), and the end of 2014 — the most recent data available (11.2 percent).
Most of the problems with America’s health care system predated Obamacare — led by too much regulation and tax laws making employer-provided health insurance cheaper than individual policies — and they’re unlikely to vanish if the law were repealed under a new administration and Congress.
But there are things North Carolina legislators could do during the short legislative session to make health care more accessible and more affordable without involving Washington lawmakers or bureaucrats:
- Repeal Certificate of Need. North Carolina requires doctors and hospitals to get a Certificate of Need — a government permission slip — before offering new technology, better facilities, or more treatment options. North Carolina’s CON program is one of the most stringent in the nation, regulating more than two dozen services, ranging from organ transplants to acute-care hospital beds to ambulatory surgery centers. Repealing the law would let patients and practitioners rather than bureaucrats decide where new facilities go.
- Expand scope of practice. To expand access to care in rural and low-income areas, nurse practitioners and other midlevel providers should receive full practice authority — in other words, letting them prescribe medicines and order diagnostic tests without the direct supervision of a physician. This reform would help reduce primary care shortages in 145 areas across the state.
- Promote direct primary care. In exchange for an affordable monthly fee covering a defined package of services, direct primary care guarantees patients unlimited access to their physicians. More doctors are bypassing regulatory burdens that take time away from treating patients by establishing DPC practices. State policymakers should pass legislation ensuring that patients’ monthly membership fees are not classified as insurance premiums. That reform would protect this health care delivery method from regulations under the N.C. Department of Insurance in the future and likely lead to a stronger DPC presence in North Carolina.
These three changes would bring better medical services to more people in more locations at lower costs. And they would inject a healthy dose of freedom in North Carolina’s medical marketplace no matter who occupies the White House or controls Capitol Hill in 2017.