Like everyone who works in health care, I’m both excited and nervous about what the Affordable Care Act (ACA), also known as Obamacare, will mean for both patients and practitioners. I like to view my excitement as an optimistic one, similar to the way people must have felt in the 1930s when Social Security guaranteed a reliable monthly check when you turned 65. Or the mid-1960s, when, despite fists of fury from the AMA, President Johnson signed Medicare into law, promising Americans they’d no longer face poverty if illness struck during their retirement years.
With Obamacare, despite the licks its been taking, for many people it’s so far, so good. Here are four reasons why:
#1 Keeps kids on their parents’ policy until age 26. The Democrats were very savvy to push this through early in negotiations despite protests from the insurance industry, which fought back like the Tasmanian Devil. (That allusion was carefully chosen, I might add. Wikipedia says “The Tasmanian devil’s large head and neck allow it to generate amongst the strongest bite per unit body mass of any extant mammal land predator, and it hunts prey and scavenges carrion…” Sounds like the insurance industry to me.)
Despite the abuse 18- to 26-year-olds not infrequently inflict on their bodies, they’re generally healthy and resilient. Handy for them, because once those in college (where most have group coverage) leave and enter the real world they find low-paying jobs or non-paying internships and no benefits whatsoever. Yet every physician has seen in her practice a 20-something with Hodgkin’s disease, melanoma, multiple sclerosis, or HIV and has watched helplessly as insurance ran out and the parents either plummeted toward bankruptcy or the kid ended up being cared for in a charity ward. Even less-dreaded conditions, like appendicitis, can cost thousands of dollars. Medications, too, like Adderall and Vyvanse for adult attention deficit disorder, are so costly they become unaffordable.
Surveys show families like this aspect of the ACA so much that even Republicans acknowledge that were they to rid the US of Obamacare, this benefit would have to remain or they’d be kissing their re-election hopes adieu.
#2 The ACA will end the odious “pre-existing condition” that allowed insurance companies to cherry-pick enrollees. No longer will they be allowed to comb through your medical history to discover a reason that denies you coverage or attaches a rider that gives you coverage for everything except the particular condition you need to treat. You may not know this, but the first time you use a new health policy at your doctor’s office, unless it’s simply for a general wellness check, your doctor receives a form letter that subtly inquires how long you’ve had the symptoms that were the reason for your visit. They also ask about previous physicians you may have seen.
What they’re doing, of course, is fishing for a pre-existing condition that you may not have mentioned on your application so they can cancel you. Despite this corporate sneakiness, I always encourage honesty on the insurance application form because companies often have access to medical records you didn’t even know existed. If they catch you deliberately lying, they’ll deny you coverage.
But with the ACA, all this ends. The phrase “pre-existing condition” gets dumped into the dustbin of low points in medical history (along with prefrontal lobotomies) where it justly belongs.
#3 The cost of your health insurance will go down, and often fairly dramatically. Even before the ACA passed, actuaries had done the math and knew this would occur, although the Fox News commentators didn’t want to believe it. And now that some states have already set up insurance exchanges, the numbers are looking good.
There are two reasons for this. First, a huge number of very healthy people will be enrolling who never bothered to buy health insurance before because they felt, well, invincible. But now these low-level users/non-users of the health care system are required by law to buy a policy or pay a fine. This brings billions of premium dollars into the health insurance industry that will go unspent on these healthy people, and many (though certainly not all) insurance companies will pass these savings on to consumers in the form of lower rates.
The second reason premiums will drop is good old-fashioned free market capitalism. As the states open their insurance exchanges (where you’ll find companies allowed to do business in your state), dozens of new companies are entering the fray. To lure business away from the established insurance giants, some of these companies are offering rates as low as half of what the customer had been paying previously for precisely the same coverage. For example, in Oregon, one 40-year-old Portland resident saw his premium drop from $422 to $169 monthly. Same coverage, exactly.
This link, to New York State’s approved insurance pricing, might make you want to run screaming from the room and does require some interpretation. As a start, note the prices are grouped in three ways:
- By the number of enrollees per family (single, married, married with kids).
- By tier, which means how fancy or simple a policy you want. Platinum, the most expensive, means very low co-pays and lots of perks like acupuncture, versus Catastrophic, which is less expensive but covers only catastrophic illness.
- By geographic area within New York State (midtown Manhattan being more expensive than upstate).
What should catch your eye immediately is the price differential among companies. For example, on page 2 of the charts you’ll note Bronze (average coverage) for a single enrollee comes in at $548 per month from United Healthcare and at $311 per month from Freelancers Insurance Company. Of course you need to do further homework to understand what each plan actually covers.
#4 No longer will you have to remain in a job you loathe just to maintain your health insurance. The number of times I’ve heard variations of “Bill hates his job, but with my cancer treatments/heart condition/medication needs, we dare not risk losing our health insurance.” A sentence like that, with its numerous unnerving variations, becomes history.
Here’s a story that tells us the complicated insurance sign-up process will be a barrier for many people. No, this system isn’t perfect, but it’s a fair start.
David Edelberg, MD