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The following op-ed appeared this morning (06/28/2015) in the Hartford Courant.

On Thursday, the Supreme Court upheld Affordable Care Act subsidies for all Americans regardless of what health insurance exchange they use.

The issue was whether qualified citizens who purchased health care insurance through the federal healthcare.gov website are entitled to a subsidy. Opponents claimed the legislation specified the subsidy was only for those who used a state-run health insurance exchange. Only 16 states, including Connecticut, built an exchange. The others use the federal exchange. Connecticut citizens were in no jeopardy, but the real issue is that health care is not affordable for large numbers of state residents.

The number of Americans insured with a large deductible has grown to almost 40 percent. A high-deductible plan enables young families to have well-baby coverage for their children, but the high deductible makes the majority of their health care expenditures out of pocket and unaffordable.

The situation for a man and wife in their late 30s with children in Connecticut puts this point in perspective. The children may be covered by Connecticut’s HUSKY program. The parents may be healthy, but feel the need to have coverage for themselves, “just in case.” If they visited Access Health CT, the Connecticut health exchange, they would find 38 policy choices from four health insurers. The monthly premiums would range from under $500 per month to just over $1,000. The couple might chose a plan with a premium of $468 and qualify for a subsidy of $112. This would make their monthly payment $356, an amount they may consider affordable.

The policy for $356 per month sounds affordable until you consider the family deductible, a whopping $12,000. There is no co-pay for a doctor visit, but not until the man and woman have each spent $6,000. The deductible is a two-edged sword. A larger deductible results in a more affordable premium, but on the other hand it creates the potential for needing to spend far more than is in the family budget. The good news about large deductibles over the long term is they will cause consumers to question the need for recommended tests and procedures. In cases where they are convinced they need to follow the recommendations, they will be motivated to comparison shop. Consumers will demand transparency to pricing of health care services. Providers will have to justify what they charge. These factors will lead to lower health care costs.

Some politicians react to frustrations over the high cost of health care by urging Congress to repeal the Affordable Care Act. The legislation relating to the exchanges and subsidies has room for improvement. But, repealing all 10 parts of the Affordable Care Act would be throwing out the baby with the bath water. The other parts of the Affordable Care Act address patient safety, quality and the methods for determining reimbursements for providers. The Affordable Care Act provides a shift from a fee for every service provided to a fee for the value provided. The new Accountable Care Organizations being formed by health care systems across Connecticut will provide incentives to keep us healthy, not just an incentive to treat us when we are sick. Providers will receive fixed reimbursements per patient in the population they are caring for. More tests and procedures will no longer mean more revenue.

Another part of the Affordable Care Act provides incentives for health care providers to implement electronic health care records. Connecticut has taken a leadership approach with the implementation of health care information exchanges to allow providers across the state to share patient electronic health care records when authorized by patients. The improved information sharing will reduce duplicate tests and unnecessary visits. It will improve collaboration among primary care physicians and specialists on patients’ behalf.

The No. 1 issue with health care in Connecticut and throughout America is the high cost. It is double that of other countries and takes a disproportionate amount of money from the economy. The result is less money available for the growth of other sectors of the economy. The high cost makes health care unaffordable for too many Connecticut citizens. Many of the provisions in the Affordable Care Act focus on cost reduction and they are beginning to work. We should give the changes a chance to have a larger effect. The result will be more affordable health care.

John R. Patrick of Danbury has a doctorate in health administration and is a former board member at Danbury Hospital, now part of Western Connecticut Health Network. He can be reached at [email protected].