More than almost anything else, our health has a tremendous impact on our day-to-day activities, state of mind, and overall wellbeing. Good health is foundational to everything else we do – our ability to take care of our families, be productive at work, and pursue our passions and hobbies. We’ve made significant progress in improving our nation’s health over the past few years – but when two-thirds of American adults are overweight and the diabetes epidemic continues to grow, we need to be diligent in our efforts to improve healthcare. That fact is particularly resonant when we take a look at how our healthcare spending compares to our health outcomes. We spend about 2.5 times the average of other developed countries on healthcare, and those expenditures consumed 17.6% of our GDP in 2012. Yet our life expectancy of 78.7 years is under the average 79.8 years for developed countries, and we have fewer practicing physicians and hospital beds per person.
The Affordable Care Act – commonly known as Obamacare – must be properly implemented to improve the status of healthcare in our country. While the ACA is a good start for better healthcare in this country, it is in our hands to oversee its successful implementation and to continue strengthening American healthcare over time – especially as some members of Congress repeatedly attempt to repeal the law and others seek to strip its preventive measures and other core provisions. That said, we must to be open with American people and ensure that those who have been surprised by policy cancelations as a result of Obamacare are able to keep their plans for the next year. We need to honor the commitment that people get to keep plans they want, and I am encouraged that the Obama Administration is working on this important fix. We also need to take measures to lower the cost of health care so that working families and the middle class do not face rising premiums.
Now and in the future, healthcare and technology will become increasingly intertwined, and Silicon Valley has an opportunity to make the delivery of American healthcare more efficient and user friendly. To avoid more instances like the bumpy rollout of Healthcare.gov, it is imperative for government officials and technological innovators to come to the same table to ensure that government operates at the forefront of technology. We need to be more open with our software development process, willing to draw upon the talents of up and coming tech companies instead of defaulting to our same old government contractors, and more competent when it comes to stress testing and troubleshooting projects before introducing them to mass markets.
Keeping Costs Down with 21st Century Preventive Care
- Expand primary care. I support the ACA’s expansion of coverage for primary care and preventive health measures such as cancer screenings and smoking cessation programs. Better preventive care will improve health outcomes, decrease the length of hospital stays, and ultimately make health insurance more affordable – creating a more sustainable and cost effective system. Unfortunately, some of the funds originally allocated for preventive care in the ACA’s $15 billion Prevention and Public Health Fund have eroded and been used for other purposes. As a member of Congress, I will prioritize committing the funds to preventive measures so American healthcare can be the best it can possibly be.
An essential component of preventive care also includes teaching our children healthy, lifelong habits – many of which they learn in school. Unfortunately, districts across the nation are cutting physical education courses, recess, and break periods. In addition to keeping our students physically fit, these programs are necessary for helping children maintain focus. In the long run, they contribute to healthier Americans who will have lower lifetime healthcare costs.
- Leverage technology to improve healthcare. In 2009, the U.S. government set aside $27 billion to pay doctors and hospitals to switch from paper archives to electronic health records. That increased digitalization has made medicine more productive by streamlining record keeping and cutting the time doctors spend charting. Electronic record keeping should be just the first step we take toward integrating technology and medicine.
For the ACA to thrive, states need to develop information technology (IT) systems that provide consumers with answers about their eligibility for public health insurance benefits and tax subsidies, and help them enroll in health insurance. Part of that process includes seeking out the advice of technology experts – like those here in Silicon Valley – to ensure that the software is up to date and works efficiently for consumers. Additionally, it is essential to provide enough federal funding to hire qualified computer programmers. Instead of letting our technology be defined by outdated contractors, government should be employing programmers and companies at the forefront of innovation.
New technologies can also complement the ACA’s goal of lower cost healthcare. Mobile phones are giving rise to a new class of clip-on diagnostic devices that could change the way doctors detect disease. A new device that measures the refractive error of the eye using a smartphone screen and an inexpensive pair of plastic binoculars, for example, has the capacity to do the same job as an autorefractor – which costs $5,000. Although technology cannot displace healthcare professionals, it has the potential to decrease costs. It allows people with routine healthcare complaints like the need for reading glasses to make less frequent visits to the doctor – doctors’ fees currently account for over 20% of U.S. healthcare spending and three percent of the country’s GDP. Such technology could also cut costs for healthcare providers, like the optometrist who may eventually find that an iPhone will work just as well as a pricier autorefractor.
- Adopt a local focus to healthy living. When it comes to preventive care and healthy living, national policies can only take us so far. Good habits originate in communities when we encourage family members and friends to lead healthier lives.
Here in the 17th District, we should petition local officials to prominently display MyPlate guidelines in municipal and county venues where food is served. We need to ensure children and adults know what a balanced plate looks like, and have the resources they need to make healthy choices.
We should also increase our communities’ participation in school food programs. Many kids consume the majority of their daily food intake at school. That food needs to be nutritious, helping kids focus, feel better, and succeed academically. I encourage local elected officials to increase our communities’ participation in the School Breakfast Program (SBP) and the National School Lunch Program (NSLP).
Improving Access to Quality Healthcare as the ACA is Implemented
- Address healthcare disparities. Patients from racial and ethnic minorities often have worse health outcomes than their white counterparts on health indicators including life expectancy, infant mortality, prevalence of chronic diseases, and insurance coverage. The ACA includes provisions to address these gaps. As it is implemented, we must ensure we are meeting our goals to reduce disparities.
Provisions in the ACA will help Americans infected with hepatitis B and tuberculosis, diseases disproportionately affecting Asian Americans and Pacific Islanders. The provision barring insurance companies from discriminating based on pre-existing conditions, the expansion of Medicaid eligibility, greater investment in community health centers, funding to broaden the healthcare workforce, and the establishment of the Prevention and Public Health (PPH) Fund will help individuals with hepatitis B and tuberculosis receive the care they deserve. Those patients will be able to see their healthcare professionals earlier, rather than having to wait for treatment until they are sicker and care is more expensive. But there’s more we can do – we should expand funding for research to explore differences in patient outcomes among racial and ethnic minorities and to address disparities in preventive care.
Language is another barrier to equitable care. Working one’s way through the process of obtaining insurance on the online marketplace or understanding the benefits included in coverage purchased by an employer assumes competency in English. In reality, one out of four individuals seeking coverage on exchanges speaks a language other than English at home. Although the ACA requires marketplaces to hire individuals and organizations to help people who do not speak English navigate the system, there are indications that supply won’t meet demand. We need to expand the funding to employ interpreters. Additionally, it is necessary that the application used to determine what type of coverage a person qualifies for be translated into languages other than English. The federal government should also develop language glossaries that include standard translations of commonly used healthcare terms.
- Ensure small businesses benefit from the ACA. The small business community has expressed some misgivings to the ACA due to the fact that it requires those employing more than 50 individuals full time to provide insurance or face a penalty. That requirement has led some small businesses to reduce their full time staff, increase hiring through contracting agencies, leave certain employees to find their own insurance through Medicaid, or begin self-insurance with stop-loss coverage.
Despite apprehensions, the ACA’s negative impact on small business is actually minimal, and the law includes provisions to compensate for detriments where they exist. Ninety-six percent of small businesses with over 50 employees already offer coverage to employees, and will not be negatively impacted by the law. And because small businesses pay 18% more on average per worker for health insurance than large groups buying insurance plans, the ACA creates SHOP exchanges specifically designed for small businesses to compare insurance plan prices. The ACA also gives small businesses tax credits to help offset greater costs.
Those protections will help increase small business leverage in the market. But we must do a better job of making sure those benefits are publicized and ensuring that small business owners have the resources they need to understand and take advantage of them. Additionally, Congress needs to come up with a solution to end the senseless sequester, which caused an 8.7% reduction to tax credits to small businesses in the ACA.
- Reduce the projected physician shortage. The rise in health insurance access due to the ACA and the imminent retirement of 79 million baby boomers is projected to create a shortage of at least 50,000 physicians by 2025. We need to begin training more doctors now to avoid a serious future crisis.
Medicare is the single largest funder of hospital residencies in the country, and almost every medical residency in the country relies on funds from Medicare or Medicaid. However, the number of Medicare-funded residences has been frozen at 94,000 since 1997. As a consequence, there are too few doctors to meet demand, and a huge number of medical graduates each year fail to be matched to a medical residency program – 1,100 MDs last year. It is essential that we expand Medicare funding for medical residency positions, which will help our economy by employing more doctors.
- End the ACA coverage glitch. Congress defines “affordable coverage” as 9.5% of an individual’s income, but includes no language defining what constitutes affordable coverage for a family. As a consequence, families that contribute to their own health insurance through an employer may be paying for unaffordable coverage but are unable to receive subsidies in their state’s health exchange – an estimated 3.9 million non-working dependents will be affected by this coverage glitch.
Congress should clarify the language of the law and define “affordable care” for a family, allowing families to qualify for subsidies to buy insurance on the exchanges offered in their states. Lawmakers have admitted that this coverage glitch was not intended in the original law, but partisan gridlock has made it difficult to remedy the glitch.
- Introduce greater post-market surveillance of medical technologies. Although the FDA works intensively with manufacturers to analyze and review scientific and technical data on drugs and devices, not everything can be known about a product before it enters the marketplace. Unfortunately, the FDA currently lacks the resources to effectively track drugs and medical devices after they are marketed. There is potential to improve post-market surveillance and make healthcare safer and more efficient for patients and providers.
The FDA has already proposed new rules to strengthen post-market surveillance, and it’s time for Congress to examine the effectiveness of those measures and propose its own complementary reforms. That legislation should take advantage of 21st century technology, and could include rolling out mobile applications that allow medical device users to report suspected or known problems about the medical products they use from their smartphone or tablet, establishing a unique device identification system, and promoting expanded use of registries for surveillance and post-approval studies.