A Common Sense Approach to the ACA

By: Justin Irizarry

The recent failure of the Trump Administration and GOP leadership to pass a bill to reform Obamacare was shocking. Notwithstanding the extremely short time taken by leadership to bring a replacement bill to the House and Senate, and despite claims that the program will fall apart in the near future, the bill’s collapse largely can be attributed to its lack of human compassion and the fact that once an “entitlement” is provided, it is nearly impossible to take it away. So, where does this leave us? In a place that allow us, as a nation, to take time, a deep breath, reexamine the landscape and create a more palatable option.

No matter what your feelings are about The Affordable Health Care Act, this legislation has had both a historic and disruptive impact on healthcare consumption, delivery methods, and healthcare business opportunities. “Obamacare” transformed traditional medical delivery methods, encouraged a wide-range of entrepreneurs to enter the healthcare industry at the ground floor, fostered the emergence of the empowered patient, spurred the retailization of healthcare, and drove the expansion of technology.

The Kaiser Family Foundation recently reported that 20M people gained coverage under the ACA and was the highest number of Americans ever insured. However, the most popular plan choices were the second-lowest silver plan. This plan is the benchmark that is used to determine the amount of financial assistance individuals and families receive and the type and quality of care available. As a result, the previously “uninsured” became the newly “underinsured”.

According to the National Institute of Health, NIH, the average emergency room visit is 40% higher than the median US monthly rent payment, which is $871. The Center for Disease Control estimates that injuries alone cost the US economy a staggering $671 billion per year. Both organizations value healthcare franchise visits at $20 billion(1) a year and orthopedic care is valued at an additional $48 billion(2) per annum.

Change must include an underlying methodology that includes both a common sense and common cents approach. It is essential that any new plan use, as its basis, the holy grail of the medical industry which is the quadruple aim:  better outcomes, lower costs, improved patient experiences and enhanced provider encounters.

Any new plan needs to incorporate, and expand, the cost saving trends that emerged under the ACA which consisted of the patient becoming empowered, the redirection of non-threatening injuries from emergency rooms to healthcare franchises and a further expansion of the “retailization of healthcare”.

Effective reorganization includes the following elements:

1. A continued movement away from PCP model delivery models towards patient access to as needed specialty care on-demand delivery models offered by healthcare franchises.
2. Less regulation across all sectors.
3. An increased reliance on telemedicine especially for underserved geographic locations, post-surgical checkups, and colleague to colleague consultations.
4. The encouragement of a free market system that provides medical care, research, support services and encourages healthcare business opportunities.
5. An attitudinal change that embraces healthcare franchise systems created to lower health costs and insurance premiums.

Access to affordable, quality healthcare is a major concern for everyone. Access to affordable and sustainable healthcare coverage and care will also require bi-partisan input gathered from industry experts, providers, healthcare franchisors, and patients who will work together to build a new model.

Justin holds a B.A. in Economics from Cornell University, where he was a 4-year varsity baseball scholar-athlete, and a M.B.A. from The Wharton School at The University of Pennsylvania, where he was a Joseph Wharton Fellow. In addition, he has earned the right to use the Chartered Financial Analyst® (CFA) designation, the most respected and recognized investment designation in the world. Justin has more than 13 years of experience acting as a trusted advisor and interim executive for a wide range of companies. His diverse business experience has led him to advise for boards of directors and senior management teams in the education, information, digital real estate, medical, and technology industries. Justin started his career on Wall Street with the Education and Information Group at Scott-Macon, Ltd. As the Vice President of Scott-Macon, he was responsible for sourcing and executing transactions in the $50 – $300 million range. Justin joined OrthoNOW® in 2010 and started the Franchise with Dr. Alejandro Badia in 2012. In addition to his role as Co-Founder &CFO, he serves as the Director of Operations of OrthoNOW® Doral.   

Justin remains active with his alma mater and serves as a volunteer mentor to incoming freshman as part of the university’s Alumni-Student mentoring program and as a university interviewer for South Florida applicants to the university.  Justin was recently named a Top 40 Under 40 by South Florida Business Journal for his contributions to the South Florida community as the CFO and Co-Founder of OrthoNOW®, the nation’s only network of orthopedic urgent care centers, and for his work in developing and activating a business model that changes how South Floridians access expert orthopedic care on-demand and at a cost-effective rate.