Latest / Becker’s Healthcare Podcast / Navigating ACA Uncertainty and Affordability From the Front Lines of Care

Transcript

Navigating ACA Uncertainty and Affordability From the Front Lines of Care · Becker’s Healthcare Podcast

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  This is where health care leadership comes together.
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  Becker's sixteenth annual meeting brings more than 3,500
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  hospital and health system executives and nearly 800
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  speakers to Chicago April.
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  This year's event includes keynote conversations with Dallas
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  Cowboys legend Troy Aikman and former president George
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  w Bush. For the agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  in Chicago.
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  Hello, and welcome to the Becker's Healthcare podcast.
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  My name is Chanel Banger. Today, I have
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  the pleasure of speaking with doctor Alexander Salerno,
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  founder and CEO of Nirvana Healthcare Management Services,
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  who joins the podcast today to discuss uncertainty
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  in DC when it comes to health care
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  policy and the Affordable Care Act and how
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  it's affecting providers and their patients. Doctor Salerno,
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  thank you so much for joining me. Thanks
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  for having me.
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  Perfect. Well, to get us started out, can
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  you please introduce yourself and tell us a
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  bit about an HMS?
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  So, my name is Alexander Salerno. I'm an
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  internal medicine
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  doctor,
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  second generation.
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  Nirvana HealthCare used to be Salerno,
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  Medical Associates.
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  It's evolved. It's been around for about eighty
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  years. We're in,
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  three counties in New Jersey,
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  and,
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  we're in urban areas for the most part
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  and, rural area and some suburban areas.
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  We're kind of a unicorn because we're family
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  owned, family run, so no strings attached with
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  private equity and no strings attached with, like,
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  hospital ink
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  medicine as I like to call it.
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  So we are a Jurassic dying breed. That
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  is for sure.
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  Thank you so much for the introduction and
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  getting into it. So the house on Thursday
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  passed a bill extending ACA tax credits for
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  three years, but has no path to enactment
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  given that this version has already been rejected
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  by the senate. And as I understand, a
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  bipartisan group of senators is working on a
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  compromise deal. What does this mean for you,
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  your patients, and the landscape of care?
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  So I'm in urban areas, so we're talking
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  about marginalized
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  populations.
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  And, you know, we're talking about health care
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  being more of a privilege than what it
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  should be, which is an inalienable
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  right in this country.
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  So
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  this means that we'll be dealing with more
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  underinsured and noninsured.
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  And, you know, there are lots of numbers
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  out there that are basically, you know, seven
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  digits in the millions range that they're forecasting
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  and predicting can lose their insurance.
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  And, you know, I I think
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  also
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  a lot of healthier, younger folks that initially
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  opted in and bought insurance might, once they
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  get their premiums, get that sticker shock.
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  So I think, you know, initially,
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  patients might not be signing up as they
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  did in years past, but I think even
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  those that did sign up, if your premiums
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  start coming in at a 100% an increase,
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  you're gonna see a lot of people dropping
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  out. And so it's gonna be kind of
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  like a trickle down effect over the next
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  several months.
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  So I I see this kinda snowballing.
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  Absolutely. And as it stands now, what works
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  with ACA and what doesn't?
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  Well,
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  you know, what was the theory of ACA?
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  It was about increasing,
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  affordability,
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  and that's the keyword, I think, today is
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  affordability
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  of health care
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  while also improving it. And, you know, ten
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  years later, you know, the premiums have doubled.
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  The subsidies that have been passed
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  are really, you know,
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  offsetting
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  escalating
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  costs, not offsetting
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  affordable costs.
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  So,
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  you know, we we didn't achieve its goal
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  of making health care affordable, and and we're
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  putting a Band Aid on a problem.
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  And, you know, we're treating a symptom. We're
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  not treating the disease.
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  You know, what else went wrong with it
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  is
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  it was kind of not a one size
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  fits all approach, even though we're a nation
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  of, you know,
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  50 plus states
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  because, you know, states could opt in and
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  opt out. And if you take, for example,
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  initially,
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  Texas opted out, Massachusetts
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  opted in.
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  Well, when you look at the number of
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  uninsured
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  in Texas, it's 17%.
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  And in Massachusetts, it's about 2%.
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  So again, you're not building a healthy nation
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  when
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  states are opting in or opting out. I
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  think the other thing that didn't work is
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  the ACA
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  was kinda like an onion. The more you
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  peeled it, the more you cried. It was
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  really complex when you look at the framework.
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  And that complexity,
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  unfortunately,
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  resulted in an introduction
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  to certain
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  groups in our society that,
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  you know, kind of
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  prey on complexity to their advantage, and private
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  equity is one of them.
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  Insurers are another one and large hospital systems.
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  So they were able to kinda manipulate the
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  ACA
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  and in in turn find a lot of,
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  ability
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  for profits and bottom line.
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  And, you know, they started cherry picking patients
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  and and, you know, bringing in more of
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  the healthy patients so they could maximize
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  profits by way of risk selection.
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  And with hospitals, you know, they made a,
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  took this opportunity to kinda do a lot
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  of mergers. And,
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  in doing that, it kind of changed the
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  landscape so health care wasn't competitive.
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  When you don't have competition,
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  you can't really have, you know, competitive pricing.
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  And so
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  a lot of collateral damage kind of came
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  from,
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  ways that people,
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  I guess, manipulated,
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  you know, the complexities
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  of the Affordable Care Act.
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  Absolutely. And now we all hear lawmakers and
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  the media talk about affordability all the time.
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  I'm curious to know in your day to
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  day life as a primary care doctor
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  in New Jersey specifically since, as you mentioned,
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  it does differ drastically state to state, what
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  does unaffordable care actually look like for the
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  patient sitting across from you?
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  It looks at
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  the idea of, okay.
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  Can I afford my
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  medications that manage my chronic disease when rent
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  is going up, food expenses are going up?
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  It's,
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  can I afford my new 2026
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  deductible,
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  which makes it look like I have more
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  catastrophic insurance rather than health insurance?
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  I mean, it's a dollar and cents game.
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  Right? So it's yet another
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  added,
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  increase
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  in expense in the cost of living,
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  that is making people need to make a
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  tough decision.
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  Do I have health insurance,
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  or do I just risk bad debt and
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  use an emergency room when I no longer
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  have access to a primary care doctor's office?
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  Got it. And with all of this said,
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  I'm curious. If you could have a seat
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  at the table, how would you like this
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  to be resolved?
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  So as I was saying, you know, unfortunately,
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  doctors don't sit at the table.
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  You know, we should be part of the
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  solution,
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  and we're not. And so if I really
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  wanna architect a solution,
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  it's a marathon approach, obviously,
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  and, you know, it's not a static solution.
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  It's a dynamic solution.
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  But I think, one, you know, we should
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  be able to put a cap on medical
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  debt. Number two, I do think, like, Medicare
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  should be able to negotiate prescription drug pricing
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  and better pricing, and that includes even the
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  pharmacy benefit managers, PBMs, which I think you
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  probably have heard recently in the news as
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  they've fallen under scrutiny
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  because drugs are a major cost of healthcare
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  and drugs.
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  Ironically,
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  we work in what's called value based medicine
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  contracts and certain
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  services are heavily weighted.
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  Medication adherence
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  is a triple weighted measure,
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  and it's about
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  medications treating chronic diseases
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  and being more proactive than reactive. But when
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  the medications are inherently unaffordable,
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  how are we supposed to get patients when
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  affordability is such a big issue to be
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  able to get their meds and take their
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  meds
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  and in turn,
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  satisfy
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  triple weighted measures, which are medication adherence?
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  So it's kind of like an oxymoron, if
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  you would.
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  I think we also need to look at,
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  like, elder care. I mean, you know, the
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  baby boomers are the fast growing generation,
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  and,
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  you know, I think, you know, the idea
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  of being able to
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  increase accountability
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  and of and affordability to get old and
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  get old in your home safely,
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  is something that really would be
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  part of a new, health care measure.
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  Protect and expand and stabilize Social Security
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  and and Medicare benefits.
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  I think right now, if you look at
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  it, I I read that if you take
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  just 10% of the of the real top
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  earners
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  and only the 10% of the top earners
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  in this country,
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  and you
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  apply,
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  you know, a greater Social Security payroll tax
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  on that
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  10% port, you know, part of the population,
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  you could probably expand Social Security benefits
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  annually,
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  and you could also,
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  extend the funding of Social Security
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  for
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  quite a bit longer than where we find
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  ourselves now. You know?
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  And I think if we can get, like,
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  clear messaging, I'd if anything,
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  unfortunately, maybe initially coming
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  into COVID,
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  there was a lot of mixed messaging and
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  and for good reason. Right? I mean, it
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  was a a a virus we knew little
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  about, and it was pivoting quite frequently.
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  But, you know, I think part of the
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  concern now with the dogging of a lot
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  of government agencies,
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  especially like the,
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  CDC,
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  we kind of now lost
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  our
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  scientific voice.
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  And so, you know, maybe, you know, tasking
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  the National Academy of Science, you know, to
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  really apply basic evidence
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  and clear messaging
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  and standardized
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  guidelines when it comes to health policy.
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  You know, medicine is a science, and and
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  science should be factual.
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  And,
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  I don't know right now if we have
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  truly,
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  you know, scientists
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  making clear,
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  consistent
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  standards.
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  Absolutely.
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  Well, doctor Slarno, I wanna thank you for
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  your time today. But before I let you
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  go, is there anything else you wanna leave
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  listeners with?
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  I think listeners should really
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  you know, when you go into a store,
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  when you go into some retail outlet, you
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  usually know the product. You know what you're
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  getting,
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  and you know who you're getting it from.
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  I think the doctor patient relationship is a
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  sacred relationship that, unfortunately,
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  has been watered down
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  by,
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  unfortunately,
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  you know, as I said earlier, private equity
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  and
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  monopolizing the marketplace.
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  And in turn, physicians have lost their voice,
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  and they've lost their identity.
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  I think, you know, you build a great
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  society on health and education,
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  and we're not there yet. You know? And
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  I heard our president say, you know, that
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  we're, you know, the most envious nation on
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  on Earth.
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  I don't know if that's the case when
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  it comes to health care,
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  certainly.
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  And what we spend on health care I
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  mean, we spend more on health care than
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  the gross domestic product of Japan.
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  So
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  more isn't better. Only better is better. And
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  better knowledge and an informed
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  consumer
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  that is a voting consumer at the election
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  time, it's time to elect on accountability,
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  and maybe accountability will lead to affordability,
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  transparency,
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  and humanity.
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  Well, doctor Salerno, I think that's a great
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  place to end on. I wanna thank you
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  once again for your time today, for shedding
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  light on all of these important issues in
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  health care, and for joining me on the
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  Becker's Health Care podcast. Thank you so much.
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  Thank you. Take care.