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Dr. Fred. Kniffin: Put health and well-being ahead of politics

This week’s Community Forum is by Dr. Fred Kniffin, president of the UVM Health Network’s Porter Medical Center
If you have been following the news about health care reform coming out of Washington, you may be both confused and concerned. The issue is complex. Emotions run high and there is a good deal of fatigue around the national debate, because it is an enormously important economic and human issue that touches each of our lives and it has become highly politicized and partisan.
We have had an ongoing national debate about health care reform for as long as any of us can remember, but the challenges of ensuring access, quality and affordability in our healthcare system have been eluding us for decades. We can all agree that there is much more work to do. The current environment in Washington of partisan posturing and rhetoric makes a complex issue even more difficult to understand, and progress is not being made because the focus is not squarely on the most pressing issues of access — quality and affordability. Frankly, I think most of us would agree that at the moment, it’s a mess.
At UVM Health Network-Porter Medical Center, we have been following this issue closely on behalf of the patients we serve. Our interest is not political, and our positions are not partisan. What we want from our government — state and federal — is leadership, collaboration and legislation that aligns with our mission to improve the health of our community. Our concerns are about caring for this community and about the patients we serve every day.
A formative experience on this issue for me occurred last winter. The drive to repeal the ACA (“Obama Care”) was just beginning and I attended a meeting of the presidents of the 14 Vermont hospitals with Congressman Peter Welch. I have come to know my colleagues from our state hospitals well enough to say I am confident not everyone in the room shares the same politics. I suspect the composition of the group mirrors the composition of our state — a solid mix of the political spectrum.
But everybody in that room, regardless of party affiliation or personal politics, was horrified by the prospect of the repeal of the ACA without anything specific to replace it that would allow us to preserve the health insurance coverage gains for our fellow Vermonters. No legislation is perfect, but we have made real strides in Vermont in recent years to increase access, improve quality and slow the growth of hospital expenses, and we just cannot go backwards in any of these areas.
Fast forward five months. We now have seen proposed replacements for the ACA, and health care leaders across the state remain deeply concerned. And the reason is simple, it is not partisan or financial — it’s about serving our communities and our patients.
The replacement bill proposed by the House of Representatives was estimated to eliminate health insurance coverage for 23 million people nationwide by the Congressional Budget Office. In Vermont, this would translate to 30,000 people losing coverage by 2026 according to the Vermont Association of Hospitals and Health Systems, many of them children, disabled or elderly citizens who depend on Medicaid for medically necessary care. Regardless of your politics, I hope we can all agree that this is just not acceptable.
Patients without insurance coverage understandably avoid seeking care until there is an emergent need, avoid preventative care, and struggle to afford treatments for serious conditions. Their health suffers and in the end costs the system more. I am not an expert on the ACA, and I am sure it is not perfect legislation, but literally thousands of Vermonters who enrolled in Medicaid under the ACA’s Medicaid expansion stand to lose coverage if any legislation passes that eliminates the Medicaid expansion, according to a January study released by the U.S. House of Representatives.
Additionally, the ACA has created pathways for hospitals like Porter to participate in payment reform models that reward primary care, preventative care, and wellness. In essence, many of the principles of the ACA support Porter‘s mission of improving the health of our community. As a member of the UVM Health Network, we are already involved in innovative projects seeking to meet the triple aim of providing quality care, improving patient satisfaction and addressing the issue of affordability.
Healthcare reform is a complex issue. We are all confused and exhausted, but we also all agree that we have to reform the current system and find a way to protect the most vulnerable and reduce healthcare expenses at the same time. What are we to do?
Here is my perspective: we should ask our elected officials to be thoughtful and deliberative. To support legislation that improves, not diminishes coverage for necessary health care for our citizens and that supports the type of healthcare reform initiatives that are now well underway here in Vermont.
In short, put our health and well-being ahead of politics.  

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