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.
Be well,
David Edelberg, MD
Regarding Obamacare my agreements are help with pre-existing states; not so sure about coverage for children to age 26 unless a full time student. My disagreements are with the reduction in costs for patients.
My concerns include the rationing – for sure is already set in motion with insurance carriers now with “committees or panels” which determine which prescribed meds are approved.
More important is ….
Will you and your Practioners accept reimbursement levels set by this program?
Sincerely,
Ellen
Unfortunately, millions in this country will now have only part time jobs because of Obamacare. ACA was not well thought out by this administration. Tell those that now have only part time jobs , they should like Obamacare.
Bill Branch
Oh, give me a break! From the U.C. Berkeley report quoted above: The 2.3 million workers identified as at greatest risk for work hour reduction represent 1.8 percent of the
United States workforce. This is consistent with the research on the impact of Hawaii’s health care law on
work hours. Hawaii requires firms to provide health insurance to employees working 20 hours a week or
more, so the cost to employers for full-time workers are much greater in Hawaii than under the ACA, while
the hour threshold is lower. Buchmueller, DiNardo and Valetta (2011) found a 1.4 percentage point
increase in the share of employees working less than 20 hours a week as a result of the law.4 In
Massachusetts, where the employer penalty is smaller than in the ACA ($295 per year), there was no
evidence of a disproportionate shift towards part-time work compared to the rest of the nation.
The report shows how few jobs will be lost compared to how much economic benefit the ACA offers us.. Nothing like distorting information for the benefit of Wall Street executives. Let’s see a report on how many jobs were lost in order to increase THEIR health benefits.
Addie
Hi Margo
Your source material, the Wall Street Journal, will naturally take the point of view that since Obamacare might be bad for business it’s bad for America. I would guess that 99% of WSJ subscribers have excellent health insurance and may indeed have to sacrifice “something” so that, as you say “Certainly lower income folks or those with chronic conditions….might be the winners in healthcare.” I don’t know if I’d use the word “winner” as what happens when a poor or chronically ill person has access to the health care system. But we need to face facts–the reasons all the huge physician associations (the AMA, the family practitioners and the internists) are for Obamacare is that we’re all exhausted trying to provide health care for the uninsured. When patients can’t afford even the basic diagnostic tests or medications, something is seriously wrong with the system. Although you may not agree with this, I think that those that have “everything” might have to give up “something” to help others. But it’s unlikely the whole system is headed for collapse.
Yes, someone who never has bought health insurance will be very irritated that he now is compelled to do so. Since his baseline rate was “zero,” his rate will definitely go up. But if that person, proud of his independence, became ill, suddenly he’d rely on the rest of us to take care of him. I addressed this in a previous health tip entitled “The Moral Obligation to Buy Health Insurance” http://wholehealthchicago.com/4970/the-moral-obligation-to-buy-health-insurance/
Dr E
Wow, one doctor who thinks Obamacare is a good thing, compared with how many that know what a mess it will be?
Joe
Unfortunately, financial analysts have found that health insurance premiums will increase under Obamacare for most folks who are relatively healthy, and who already have individually purchased coverage. See for example Wall Street Journal (7/1/2013, “WSJ: Health Insurance Rates Could ‘Double Or Even Triple’ For Healthy Consumers In Obamacare’s Exchanges”), and Forbes (5/30/2013, “Rate Shock: In California, Obamacare To Increase Individual Health Insurance Premiums By 64-146%”). Not to mention that full time jobs (with benefits, such as health insurance) are increasingly more difficult to find, even for professional positions, due to the employee health insurance requirements that Obamacare will bring. (This of course was one of the big reasons that Obama delayed enforcement of the employer insurance mandate until 2015, until after the 2014 election). The UC California Berkeley released a report in February 2013 (“Which workers are most at risk of reduced work hours under the Affordable Care Act?”) stating that 2.3 million workers currently employed full time are in danger of losing hours as companies struggle to cope with Obamacare mandates in future years. Some employers have already started to reduce hours (“Companies cut part-time worker hours to avoid Obamacare requirement: report”, New York Daily News, 5/2/13), while others are shifting to contract workers or temp services for their employee needs (“Temp staffing jobs hit record as firms dodge ObamaCare costs”, Investors.com, 6/7/13).
Yes, certain lower-income folks, or those with chronic conditions who lacked employer’s group insurance opportunities, might be the overall healthcare winners, as will young adults under age 26; however, if they can’t find regular full-time employment due to these “unintended consequences” of Obamacare, how much improvement would they really see in their lives? In any case, couldn’t these un- or under-insured people have been helped in a way that wouldn’t have upset the applecart for everyone else?
Margo
Andrea, that is HILARIOUS!
Addie
btw, Greg, sorry about your prefrontal.
Andrea Holliday
Thanks, Doc! I knew I needed to read up on the ACA — wow, I’m going to have health insurance again! — but was slightly dreading the amount of research that would be required. When I saw your blog post, I knew you’d give me the good general overview I needed to get me started.
Andrea Holliday
Hi Greg
Since Obamacare hasn’t really started, I don’t have any reason to dislike it yet. I think it’s a bit premature to judge something before it started. Get back to me in about five years. I figure it will take that long for all the kinks to be ironed out
Dr E
I’m dreaming that the new competitive market :
1) causes a rush for competing insurers to cover hearing aids
2) makes the indigent a huge market force causing insurers to compete to supply low cost medications, equipment and other necessities, relieving Medicaid of some burdens.
3) puts more money into everyone’s pockets so they can contribute to candidates supporting a single payer system, making insurance companies obviously unnecessary middle men.
Addie
Do you ever spill your Kool Aide when you’re skipping into your clinic in the morning? Your 4 “likes” are glorious. Why not enumerate the miriad of “dislikes” to Obamacare???
Gregg Foster