Members of Congress are looking over their shoulders. The Democratic caucus is worrying aloud that an uneven implementation of the Affordable Care Act will cost them seats during next year's mid-term elections--instead of using that nervous energy to roll up their sleeves and make sure it's deployed correctly.
I'm also not surprised that Republicans, having lost every legal battle to defeat the ACA, have gone guerrilla. They're now focused on defunding the program's implementation--the ACA has received about half the money that the GOP-backed Medicare Part D fiasco did a decade ago--and setting up the policy equivalent of nails in the road and sugar in the gas tank to make sure it fails.
And there are lots of potential failure points in the ACA, particularly if enrollment in the exchanges and Medicaid is lukewarm to start. If the former attracts a lot of unhealthy people and few other enrollees, premiums for everyone are expected to skyrocket due to adverse selection.
In the rest of the industrialized world, healthcare access has been a long-settled issue. It makes me wonder what those countries think when approximately half of the citizenry of the richest nation in history thinks it's entirely proper to use any means necessary to deprive the other half of access to healthcare, while those on the other side demonstrate a decidedly Yeatsian lack of conviction about the law they championed to change that.
I also sometimes wonder if I can move, but that isn't going to happen just yet.
What can and should happen is that those who support the ACA should make sure it gets implemented smoothly. Since hospitals overwhelmingly fall into this category, they need to be involved to a level their lawmakers are avoiding.
So, rather than spend all their marketing money on those ads that show their campuses and vacuous stock photos of smiling models in lab coats, here are four things they can do instead:
1. Set up programs to enroll every single uninsured patient who comes into an emergency room in Medicaid, the exchanges and any other relevant state programs. The Sharp Healthcare hospital system in Southern California launched such a project in 2010, and found that 80 percent of the patients that came through its ED qualified for some form of coverage. Once the ACA kicks in, that will be virtually 100 percent. There is absolutely no reason why other hospitals cannot capitalize. Moreover, if they do a little research, they'll find a bunch of companies willing to do the enrollment work for them. They should also offer the service to any family member or friend of a patient who shows up in the ER as well.
2. Use those now-enrolled patients, friends and family members for public service announcements. There is an enormous amount of confusion regarding what the ACA actually is; a recent Kaiser Family Foundation poll said that 42 percent of respondents weren't even aware that the ACA was a law that is still in effect. The testimonial of a visibly relieved patient or their loved one saying the hospital got them coverage instead of sending them a huge bill will go a long way in prodding others to obtain coverage. And if there's money in the community benefits budget to set up an enrollment office on campus or elsewhere in town, it should be spent.
3. Work with your state's health plans to tout the exchange. Many of the exchanges are getting short shrift on marketing budgets because their states have chosen to sit on their hands. Health plans want the business, and hospitals want the insured patients. A joint marketing campaign will get more bang for everyone's buck.
4. For those hospitals in states that are against expanding Medicaid or that are not marketing the exchanges, consider a "bankruptcy clock" billboard somewhere in the community. This would be much like the "deficit clock," which a lot of conservative organizations like to tout to back their claims that spending is out of control. Instead, hospitals can show how many of the state's residents have filed for personal bankruptcy in the past year because they couldn't apply for expanded Medicaid and couldn't afford the exchanges. The first facility that puts something like that up in the community will do more to open up the debate on ACA in their state than hiring a battalion of crack lobbyists.
Expect more suggestions as we get closer to 2014. - Ron (@FierceHealth)