by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
Obamacare is now six years old. Its accomplishments include disrupting the health insurance market to the point where some of the most established carriers are considering exiting the Exchanges, throwing millions of Americans off their health plans, enticing states to expand a government-run health insurance program that harms the poor, and coercing people into purchasing expensive policies that come with annual double digit premium percentage increases. Despite the laundry list of party fouls, the White House will surely be raising their glasses. The Obama Administration will give a toast to the federal health law greatly reducing the number of uninsured – a paltry 2.7 percent.
And therein lies the problem. The administration and its supporters focus too much on its #GetCovered campaign, and not enough on how to make health care more accessible and affordable.
It’s really up to Congress to tackle the root causes of our distorted health care market – most of which predate Obamacare’s existence. John Goodman, one of the foremost experts in all things health policy, explains:
“Even if we abolished ObamaCare, we would not have a free market for health care. We would have a health care system shaped and molded by government policy and the worst of those policies are ones that encourage us all to have group insurance, rather than individual insurance. Those policies are tax law policies…If you’re not willing to take on the tax system and change those perverse incentives, I don’t think you’re really serious about health reform.”
Until Congress decides to get serious, there are ways in which states can act to mitigate the many flaws in our nation’s health care system. As North Carolina lawmakers gear up for short session in April, here are three key policy changes that ought to be considered as a means to improve access to care at a lower cost – with less government intervention.
Repeal Certificate of Need (CON)
North Carolina requires your doctor or hospital to request and receive a government permission slip before offering you new technology, better facilities, or more treatment options. In 1987 the federal government repealed its CON mandate and since then 16 states have ended state-based CON laws. However, North Carolina still allows bureaucrats to determine your health care options. The state’s CON program is one of the most stringent in the nation, regulating over 25 services that range from organ transplants to acute care hospital beds to ambulatory surgery centers (ASCs). It’s time to restore health care freedom to North Carolinians.
Grant mid-level providers full practice authority
To expand access to care in rural and underserved areas, it’s critical that nurse practitioners and other mid-level providers be granted full practice authority (FPA). In other words, the legislature should allow mid-level providers to practice to the extent they were trained when delivering patient care. Under the status quo, nurse practitioners must practice under direct physician oversight when prescribing medications and ordering diagnostic tests. Granting mid-level providers FPA will also help reduce primary care shortages in 145 areas across the state.
Promote Direct Primary Care
In exchange for an affordable monthly fee that covers a defined package of services, direct primary care (DPC) guarantees patients unlimited access to their physicians. More doctors are establishing DPC practices across North Carolina to bypass regulatory burdens that take time away from treating patients. While DPC faces minimal regulatory hurdles in North Carolina, it would be wise for policymakers to pass legislation that simply states that direct care providers do not act as ‘risk-bearing entities.’ This would ensure that patients’ monthly membership fees are not classified as insurance premiums. Legislation that clearly defines DPC as not being an insurance product will save this health care delivery method from being subject to regulations under the N.C. Department of Insurance in the future. Passing clarifying legislation would likely lead to a stronger DPC presence in North Carolina.