Like any idea developed by politicians, the “Patient Protection and Affordable Care Act” (PPACA), which we know familiarly as Obamacare, is both useful and flawed. I have chosen to discuss the attributes and faults of this law in three sections: The Good (the positive aspects), The Bad (the aspects that need improvement) and The Ugly (those parts of the bill that are misdirected or exploited). I will be referring to the law throughout this blog as Obamacare (PPACA) for simplicity. I like to look at the official title “Patient Protection and Affordable Care Act” from time to time, because it serves to remind me what the law is supposed to deliver to the individual American; namely, patient protection and affordability.
In this first of a three part introduction to Obamacare (PPACA), I will be describing those provisions of the law that advance Affordable Health Care and Beyond for ALL Americans. Actions that bring affordability to members of HICUP and not to individual Americans as a group do not make the list in Obamacare (PPACA) The Good. Inclusion in the list below does not imply that all methods employed are also good. For example, it is wonderful that the law attempts to bring universal health coverage to all Americans (0% uninsured), but not so “good” that it does so without first reforming the health insurance marketplace. This marketplace functions for health insurance company profit maximization and not for what is in the best interests of the individual American.
Over the past five plus years, the lines between Obamacare (PPACA) The Good and Obamacare (PPACA) The Bad have shifted as our government fine tunes and amends regulations. Remember that vaguely written, special interest-filled laws create regulations that need constant rewriting and amending. Unfortunately, all changes do not necessarily take the best interests of the individual American before those of HICUP members.
Seven Good Reforms in Obamacare (PPACA) The Good
- A transparent marketplace for health insurance costs has been established so that an individual can shop and compare coverage options. For people who couldn’t buy health insurance because of affordability issues and/or poor health (pre-existing conditions), two new health insurance options have been created: the Health Insurance Marketplace and Medicaid expansion. In the Health Insurance Marketplace, individuals can purchase “non-group” insurance and apply for premium and cost-sharing subsidies (when incomes fall between 133% and 400% of the Federal Poverty Level (FPL)). Medicaid expansion would include all Americans with income less than 133% of the FPL.
- A minimum standard for health insurance coverage has been established. If you are under 65 and buy “non-group” health insurance, then it must cover a minimum set of Essential Health Benefits (EHB) and must deliver a minimum “value” (actuarial value of at least 60%).
- Some of the most egregious insurance company practices have been eliminated. For example:
–You cannot be denied health insurance coverage if you have a preexisting condition and the insurer cannot sell you coverage that exempts chronic conditions like diabetes, high blood pressure.
–You cannot be dropped by an insurance company if you get sick and cost them too much.
–You will no longer be subject to lifetime or annual limits on health care spending covering Essential Health Benefits (EHB).
–You can only be charged more for health insurance if you smoke or are older–all other reasons have been eliminated (like having a medical condition).
–Insurance companies must define a single statewide risk pool for all their participants for each of their “non-group” (individual and small employer) markets.
- The law recognizes that the high cost of health care keeps many Americans from getting cost-effective preventive care. You now have the right to certain preventive health care services without paying any out-of-pocket costs.
- The law recognizes that the high cost of prescription drugs keeps many Americans from buying medically necessary medications, especially for the elderly. For Medicare Part D beneficiaries, the prescription donut hole is eliminated by 2020.
- The law recognizes that many small employers do not provide affordable health insurance coverage, especially in jobs that employ young adults. You may keep your young adult children on your health insurance plan until they reach 26 years of age.
- The law recognizes that the measurement and evaluation of medical outcome and health pricing data is necessary and must be transparent to consumers. Obamacare (PPACA) has provisions for various measures to accumulate and measure data that advances the quality of care as a necessary part for achieving health care value. For example, it establishes a non-profit Patient-Centered Outcomes Research Institute for funding of comparative effectiveness research and is developing a national quality improvement strategy.
While most Americans have been affected by the above provisions to various degrees, the uninsured (42 million or 13.4% of the population in 2013) experienced the greatest improvements in access to health care. Many of these uninsured moved into the “non-group” insurance market in 2014 where the greatest reforms have been applied. Unfortunately, The Good aspects of Obamacare (PPACA) are not universally applied to all insurance groups (for example, Medicare and employer-sponsored health insurance do not have to provide Essential Health Benefits) .
The seven good Obamacare (PPACA) provisions above are only meant to lay some groundwork for future discussions and action. These provisions are woefully lacking in individual American affordability measures. For example, elimination of the Medicare Part D donut hole is a small part of high drug price gouging in the United States. An even larger affordability issue arises because Medicare is not allowed (by law) to negotiate for all Medicare beneficiaries for lower prices. I will be expounding on several of the points above in subsequent blog posts.
I feel very strongly about the need for health care quality measurement and transparency (number 7 above). It is easy to create agencies and write reports about health care quality, but it doesn’t mean a darn until quality measures are readily available to all Americans so that they can assess health care value (price and quality). I will be taking our federal government to task with its claim that Obamacare (PPACA) ” puts consumers back in charge of their health care… gives the American people the stability and flexibility they need to make informed choices about their health”. I expect our government to deliver on the information and support necessary to truly put consumers in “charge”. Talk is cheap.
Summary of Obamacare (PPACA) The Good
I have to admit that I don’t LOVE Obamacare (PPACA), but I WANT to love it. It is far from perfect as it stands (after all it was written by HICUP for HICUP). When I first got married, my husband was not perfect. I didn’t throw him out because of this fact—I have simply spent the last 30+ years making him “more perfect”. Let’s do the same for Obamacare (PPACA).
We cannot take back the fact that we were silent or divided when the law was being debated, drafted and finalized, but we can take charge now and get our elected officials to work for us. With the help of a brigade of Americans, the problems can be identified and plans of action defined. Join me today!