For ACA to work best, we must tackle other barriers to health care

Problems are especially acute in rural areas

A FIX IS IN for the Affordable Care Act. But it’s just a start.

The Biden administration’s new stimulus package includes consequential repairs to the Affordable Care Act: wider income eligibility, increased subsidies to support more affordable premium costs, and other improvements that will help more people access health insurance and health care.

Clearly, the stimulus bill’s ACA improvements leave many affordability issues unresolved, and they are set to expire in two years. But recent repairs do provide a toehold for a better ACA and longer-term health care for millions of Americans. Still, regardless of greater affordability for many, the ACA won’t reach its highest potential without repairs to other persistent systemic barriers to health care: geographical isolation, broadband service gaps, transportation challenges, and reimbursement issues.

For instance, COVID-19 caused a rapid pivot to telehealth as the front-line staple of patient care. All signs indicate that broader use of telehealth is here to stay, but an online doctor’s visit is only as good as a patient’s internet access, which is poor or non-existent in the most rural communities. For many, internet access is simply unaffordable, regardless of zip code.

Just as electricity and phone service reach the most far-flung customers, broadband service expansion is critical to ensuring equitable health care for more isolated Americans. Better internet access also means that doctors and other clinicians can have a wider geographical reach for many aspects of patient care.

A related challenge, especially in rural areas, is the transportation gap for people who need help getting to a medical office. Creative solutions and federal action are key to connecting patients with safe and reliable round-trip ride services. At the same time, enhanced support for community-based mobile health services (which are ramping up to deliver COVID vaccinations) means that clinicians can go to the patients where they are, to provide routine care.

Another stark inequity: people with mental health and substance abuse disorders also face serious gaps in access to care. Although mental health and physical health are equally critical for overall wellness, federal law does not require parity in reimbursement for behavioral health treatment.

Especially in isolated areas, there are simply not enough insurance-friendly behavioral health professionals to meet the pressing need. Where private pay options are available, costs can be prohibitive.

This long-standing lack of parity in reimbursement for behavioral health services translates to staffing shortages, poor pay, and long waits for patients who need both emergency support and ongoing care. Improved reimbursement for these services would plug a financial leak in community-based mental health centers, where so many patients rely on ACA and Medicaid. It’s noteworthy that in states that did not implement Medicaid expansion as part of the original ACA, the shortage of mental health providers is most severe.

Equally concerning is poor reimbursement for psychiatric care, which many patients depend upon for medications. As a result, many private practice psychiatrists and psychiatric nurse practitioners have shifted to a private-pay model: patients must pay out of pocket or forego this expertise entirely. They may wind up relying on primary care providers for medications that are better managed by psychiatric professionals.

Our year of COVID-19 has underscored persistent inequities facing our more vulnerable and underserved Americans – those most likely to depend upon the ACA and Medicaid. Whether or not the stimulus bill’s ACA measures are renewed beyond two years, these other systemic blocks to health care demand attention and investment.

Meet the Author

A health care system that strives to serve all Americans requires a solid, supportive framework of technology, transportation, and equitable reimbursement. Only with these improvements in place will all ACA participants receive the full benefit of their more affordable health plans.

Lia Spiliotes is the CEO of Community Health Programs, a federally qualified health center network serving 35,0000 patients based in Great Barrington.