NASW’s Betsy Clark Answers ACA Decision Questions

Elizabeth J. Clark, PhD, ACSW, MPH is CEO of the National Association of Social Workers

Q: The ACA was upheld, but experts predict an avalanche of new enrollees in 2014, which will overwhelm our health care system. What should be done?

Dr. Clark: Between 30-40 million new enrollees means that, among other issues, we need to think about using health care providers in such a way that everyone practices at the top of their license.  Some of the ACA demonstration projects are already showing greater cost efficiencies when we stretch staff into new areas, such as using social workers to help people coordinate their care in the community after being discharged from the hospital.  Medical homes and Accountable Care Organizations—promoted heavily in the ACA—will also be critical in our efforts to expand care to more people and keep costs down.

Q: The Court has ruled against the provision for withholding Medicaid funds from states that refuse to expand their Medicaid programs. Without the Federal penalty, how will we have uniformity in the Medicaid expansion, so that all individuals under 133% of the Federal Poverty Line are covered?

Dr. Clark: Unfortunately the ruling makes it harder to achieve a national Medicaid floor – a key aim of the ACA.  But leaving those at the very bottom uninsured is not acceptable social policy. NASW and its members will work with reluctant states to get them to do what is right – and expand their Medicaid programs to the level set by the ACA.

Q: Is a mandate to purchase health insurance really the best way to address the health insurance crisis in the United States?

Dr. Clark: Policymakers have been wrestling with the issue of un-insurance and under-insurance for well over 20 years—and the problem is only getting worse.  Every hour of every day, a social worker somewhere in the U.S. is dealing with the effect of our government’s inability to address the health insurance crisis—families going into bankruptcy because they can’t pay their medical bills; people with chronic illness rationing their medication because they can’t afford to pay for all their prescriptions; hospital ERs bursting at the seams because people have no coverage to allow them to seek regular care at a doctor’s office.  The individual mandate is a reasonable solution.  It expands the risk pool and makes insurance more affordable for everyone.  It is also an avenue for more affordable, more appropriate care.

Q: How can we implement a law that will only add to our astronomical federal debt?

Dr. Clark: The ACA is one of the few pieces of legislation in recent history that expands health insurance access while also addressing our county’s out-of-control health care costs.   The law includes many promising health care payment innovations such as Accountable Care Organizations, Medicare bundled payment programs and penalties for hospitals that experience excessive re-admissions and hospital-acquired infections.  The law may not be perfect – but it’s a foundation that we should keep building on.

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  1. 30-40 million new enrollees means more problems for to many people.

  2. While Dr. Clark (whom I personally admire and adore) gives great answers to questions, I am NOT happy with the decision to uphold the personal mandate.

    First, the promise the POTUS made to incur no new taxes on the middle class (we who earn less than $250,000 annually) has been broken. Those who cannot or will not purchase health insurance will now be levied an additional tax (penalty).

    Second, while increasing the health care risk pools will help decrease some costs, the other ACA requirements in combination with lack of legal inter-state insurance commerce, will limit those savings.

    Third, approximately 50% of the American people do not pay income tax. How will we monitor their compliance with the Individual Mandate? Will health care providers become the “police” for this issue? How does that work to promote client-centered practice?

    We need to continue to focus on health care quality, moving away from a fee-for-service payment system. We need inter-state commerce for health insurance to increase risk pools. We need tort reform and evidence-based practices to increase.

    Ultimately, we need to rid ourselves of a third-party payer health care system. THAT will drive costs WAY down.

  3. Vince Coraci, LMSW

    Thank you, Dr. Clark, for addressing these integral questions regarding the intersection of social work, healthcare, and the ACA. Your leadership and guidance for NASW is much appreciated!

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