Commentary: What firefighters know works because of the ACA

By Greg Markley

For The Herald

Every day firefighters go to work not knowing what the day will bring, but they do know that the majority of calls they respond to will be for emergency medical events.

That firsthand experience offers firefighters unique insight into how health care policy affects the people we serve. We’ve been witness to the progress we’ve made with implementation of the Affordable Care Act, but we know there is more to do to ensure every American has access to affordable coverage and high-quality care.

The Affordable Care Act, as well as expansions of the Medicare and Medicaid programs, have allowed many more people to be covered. In 2012, Washington state had an uninsured rate of 14.5 percent. Thanks to the ACA and the state of Washington’s effective implementation of the law, that rate dropped to 6.1 percent in 2017. Still, we have more to do to provide more Americans the affordable choices in health care they deserve.

People without insurance rely heavily on emergency response. As a result, many fire departments strain under the demand for emergency services from high-frequency callers who use the system as their primary care provider.

By opening the door for “Community Paramedicine” pilot programs, the ACA is helping us confront these challenges. The program allows first responders to team up with social service providers to address the care needs of uninsured patients with chronic conditions.

A great example is in the city of Kent with the Puget Sound Regional Fire Authority where the fire department is pairing firefighters with nurses in non-emergency response vehicles to attend low acuity 911 calls. The team shows up, assesses whether a patient needs clinical care or social services, and connects them to the resources they need. In some instances, patients just need help installing a hand rail to prevent recurring falls, or assistance keeping track of the medications they take.

As our health care system becomes more focused on outcomes-based models of care, innovations like this should continue to be prioritized and funded. At Puget Sound Fire we’re giving people the care they need while reducing calls from previously high-frequency users of the system. This means lower emergency response times for everybody, and a better chance of a good outcome when a call does occur.

Unfortunately, some politicians want to scrap the progress made under the ACA by repealing the law. This would cut resources for innovations like Community Paramedicine. Repealing the ACA would also compromise the basic health care coverage of hundreds of thousands of Washingtonians. As bad as that is on the face of it, removing coverage would also result in more 911 calls and add pressure to an emergency response system already under stress by a high volume of need.

Some politicians think a single payer system is the answer. While Medicare and Medicaid are great programs, many hospitals and clinics, especially in rural areas, struggle financially and rely on higher reimbursement private payers to offset the cost of providing services under lower Medicare and Medicaid reimbursement rates. How would an all government system ensure that these marginal facilities stay solvent?

Even in Canada, where they have a single-payer system, 2 in 3 people buy supplemental insurance to cover services the government doesn’t provide, with the result that approximately one third of all Canadian health care is financed through the private sector. The state of Vermont already tried to implement a single-payer system, but ended the experiment in 2014 when a new study predicted only 1.6 percent savings over five years and that implementation would require new taxes of 11.5 percent for employers and up to 9.5 percent for individuals.

For our union members, maintaining access to comprehensive plan options is important given the unique and dangerous nature of the job. And while not everybody needs plan options as extensive as what we need, we should make sure that those plans are not out of reach for those who need them.

Upending the whole system could result in unintended consequences that results in less coverage or increased financial burdens. As we consider the next steps to getting more Americans access to high quality care, let’s start with what we know works — protecting and strengthening the ACA, Medicaid and Medicare would be a good start — and fix what’s not.

Greg Markley is secretary/treasurer for the Washington State Council of Fire Fighters.