Today’s battles over “repeal and replace” of the Affordable Care Act are the latest chapters in a saga that began with the creation of Medicare and Medicaid in 1965.
University of Nevada Reno Professor Jeanne Wendel, who teaches health care economics, said that larger trends can get lost amid the breaking news coverage.
She said that while the current Republican health care proposal significantly scales back Medicaid and the ACA, it is still a concession by the GOP of a major federal role in the healthcare sector.
“The idea that people can just buy their own health care has become less and less realistic,” Wendel told KNPR's State of Nevada.
She said there used to be disagreements about whether the federal government should be involved in the healthcare industry at all, but those disagreements are gone. She said the discussion now is how to get everyone health insurance.
The biggest reason for the growing consensus is the rising cost of care that Wendel attributes to the research and development of new procedures, drugs, and treatments. While those breakthroughs have proven to be effective, they're also expensive.
“You’re going to have to make health care delivery more efficient," to pay for those breakthroughs, Wendel said.
Last week Nevada Sen. Dean Heller, a Republican, announced he could not support his party's legislation in its current form because of cuts in Medicaid, a federal-state insurance program that benefits low- and moderate-income individuals.
“I imagine that Heller’s concern probably mostly focuses on the fact that it’s one of the biggest components of our state budget… so a reduction in federal dollars coming in for Medicaid would pose some really tough choices for state budgets,” Wendel said.
The concern is the Medicaid expansion, which was part of the ACA. Before the expansion, Medicaid provided health care insurance for the very poor, children and the disabled. The expansion allowed more people, especially adults, to get coverage.
“If you want to keep them insured, that would have a serious state budget impact,” Wendel said.
She said to keep the expansion without federal dollars would probably mean cuts in education budgets.
Amy Vilela became an activist for Medicare for everyone, which would be a system like Canada's universal health care, after her daughter died. Her daughter was between health care coverage because of job change when she got a blood clot in her brain. Because she didn't have insurance, she didn't get treatment.
Now Vilela has been attending a weekly protest of Senator Heller's office. She wants to make sure that he doesn't vote for the Senate's reform bill, even though the senator has stated he's not for the bill in its current form.
“We are continuing efforts to make sure that Senator Heller hears our concerns and will do what’s right for Nevadans," she said.
Professor Jeanne Wendel, teaches health care economics at the University of Nevada Reno; Amy Vilela, Las Vegas health care activist