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Dan Foster: Supreme Court should rule in favor of ACA

CHARLESTON, W.Va. -- The Affordable Care Act, or Obamacare as some call it, is long and complex. That doesn't mean it's a bad thing, but as we await a U.S. Supreme Court ruling, too many people just don't understand it.

I was convinced of that recently at a meeting of the Advisory Council of the Governor's Substance Abuse Task Force, when it became painfully obvious that none of the council members or DHHR agency employees were aware that substance abuse services would be an essential benefit of health insurance under the ACA.

Many opponents and even some supporters blindly believe what others say about the law. Most of them and others also aren't aware, or for political reasons don't want to acknowledge, that many people and businesses have already unquestionably benefited from the ACA.

For instance, in West Virginia alone, 16,000 young adults under 26 have gained health insurance on their parents' policies, 36,000 seniors on Medicare Part D have saved $23 million on prescription drug costs and nearly 600,000 individuals no longer have lifetime limits on their health insurance.

How many citizens and business people know that if all of the 15,000 eligible small businesses in the state had taken advantage of the tax credits in the law, they could have saved a total of $80 million last year? Also, is it common knowledge that individuals and companies covered by Mountain State Blue Cross saved $200 per beneficiary in 2011 because of the provision regulating administrative costs, or that over the last 18 months there have been enhanced opportunities for tuition support and loan forgiveness for certain doctors-in-training?

When and if the ACA is fully implemented in 2014, another little-known fact is that insurance coverage is projected to be expanded to nearly three-fourths of the 280,000 currently uninsured West Virginia residents, giving West Virginia the greatest benefit of any state. This means, perhaps surprisingly, that 150 West Virginia lives would be saved every year when this law becomes fully active, since the Institute of Medicine has estimated that more than 200 West Virginians die prematurely every year simply because they do not have health insurance. Sadly, within the last 10 months, a good friend of mine became one of those 200.

Since enactment of the 2006 Massachusetts universal-care law, the number of uninsured in that state dropped from 531,000 to 120,000, overall access to care has improved, and approval by both the public and physicians increased. What's disappointing is that few of our citizens truly recognize how all this relates to the potential impact of the ACA on the rest of the country.

On the positive side, when you look at the opinions of those who both have the most at stake in health reform and likely do understand the above statistics in addition to how the health-care delivery and reimbursement systems will change under the ACA -- medical students -- the results are striking. A recent study in the Journal of the American Medical Association from 10 diverse medical schools revealed that 59 percent support the ACA and only 15 percent wanted it repealed. The rest were undecided. Moreover, one-third of those advocating repeal did so solely because they feel the law did not go far enough.

On the other hand, the knowledge deficit among most other Americans causes us to spend too much time and energy discussing why this law won't work, rather than trying to figure out how to make it work. Yes, there are indeed flaws and also controversial provisions like the individual mandate and new taxes on certain citizens and industries. Unfortunately, though, instead of an enlightened discourse about the basic provisions of the law, it has become self-aggrandizing to discuss slick legal and constitutional arguments, economic concerns related to businesses, insurance companies, hospitals and physicians, ideology regarding the role of government, or who is going to gain political advantage.

Yet, despite all this, the data strongly suggest that the vast majority of young and future doctors realize that, after all is said and done, this should truly be about that most personal of issues: the quality and length of human lives.

So, just maybe, the next generation of physicians will be ready to help shape this bold, but imperfect, attempt to define the future of American health care. We can only hope that the Supreme Court will give them that opportunity.

Foster is a Charleston physician and state senator.


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