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MESSAGE FROM THE OUTGOING SCCMA PRESIDENT

william s. lewis, MD Past President, SCCMA

Health Reform and Reflections By William S. Lewis, MD Past President, Santa Clara County Medical Association While the Supreme Court’s recent ruling on the Patient Protection and Affordable Care Act (ACA) will undoubtedly affect all Americans, the impact of this historic decision is particularly significant on physicians across the nation. Throughout the health care debate, the SCCMA and the CMA advocated for an expansion of insurance coverage and improved access to care for uninsured Californians. To this effect, physicians should applaud the court’s decision to uphold the law’s individual mandate provision, which recognizes the responsibility we share for universal affordable health care. Preservation of the mandate also protects two key insurance reforms in the law: the elimination of bans on patients with preexisting conditions and coverage rescissions. Without the mandate, the insurance industry insists these reforms are unachievable. But there is a catch. As beneficial as the ACA is, we know it is flawed. Two flaws are particularly objectionable. First, it is built upon the broken foundation of Medicare and Medicaid. Second, it creates a powerful, unaccountable Independent Medicare Payment Advisory Board. Until the ACA addresses inadequate funding for Medicare and Medi-Cal, it will fail to provide timely access to quality health care. California physicians have called upon Congress for years to eliminate the flawed Medicare Sustainable Growth Rate (SGR) payment formula and adopt a long-term path to an alternative payment system that recognizes the real drivers of cost in health care. Despite these efforts, this issue was not addressed in the ACA, and physicians face a 32% Medicare reduction at the end of this year. Unless the SGR is fixed, Medicare will be the new MediCal. Despite the CMA’s successful fight against cuts to Medi-Cal, current Medi-Cal payments are still so low that most physicians cannot afford to see Medi-Cal patients in their offices. This forces Medi-Cal patients disproportion-

ately into congested and expensive emergency rooms. Expansion of Medi-Cal, without improving physician payments, will only aggravate the problem, and paying primary care doctors Medicare rates will not matter if they are cut to Medi-Cal levels. The Independent Medicare Payment Advisory Board (IPAB) will be appointed by the President and has the power to mandate spending cuts. The IPAB can, and predictably will, reduce physician reimbursement without any accountability or practical reversibility. Eliminating IPAB, at least as it’s currently structured, is imperative. That’s why physician advocacy by the SCCMA and CMA is more relevant now than ever, and I implore you to get involved and stay involved. In that regard, I am happy to leave you with a county medical association in good health. The SCCMA has the largest membership in the state. We enjoy the lowest annual dues of any medium- or large-size county. We

send the largest delegation to the CMA’s annual meeting, giving us the most powerful voting bloc in the state. We have the best staff in the state, and our CEO has invaluable connections county and statewide. It’s been an honor and an education to serve as SCCMA president, for which I am grateful and indebted. If I may paraphrase Winston Churchill: never in the history of this association was so much owed to so many by so few, or actually just one, me. Thank you.

William S. Lewis, MD, was the 2011-2012 president of the Santa Clara County Medical Association. He is a board certified ENT physician and is currently practicing in the Los Gatos area.

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