It’s Valentine’s Day –a day to focus on those closest to us. The Affordable Care Act will make sure health care is available to those we love.
Learning more about the ACA at Health Action 2012 was a great experience but also very sobering. We are at the crossroad for health care reform and the future of the Affordable Care Act.
The question is:
• Will we cover nearly all Americans, control costs, improve quality of care and outcomes, and require insurers to spend most of the premiums on health care rather than administration or profits; or
• Will we return to ever-increasing premiums, numbers of uninsured, costs, and profits for insurers, as well as denials for pre-existing health conditions, annual and lifetime benefit limits?
This critical question will be partially answered when the Supreme Court rules on the constitutionality of requiring nearly everyone to purchase insurance or pay a penalty, and of expanding Medicaid to families and individuals up to 133 percent of the poverty level ($29,327 for a family of four).
The remainder of the question will be answered by the outcome of the November election. Those who don’t support the law are calling for its repeal.
At the conference, we were reminded how important it is for each one of us to understand the law and its benefits. It provides control and security through new consumer protections. It holds private insurers accountable for meeting the needs of and providing quality, competitive products to those who purchase their coverage. It creates a competitive marketplace where individuals and small businesses can compare products on an apples-to-apples basis, purchase coverage, and where individuals can obtain subsidies for premiums and cost sharing.
In addition, insurers must:
• Provide “essential benefits,”
• Cover young adults up to age 26 on their parents’ employer-sponsored plans,
• Not charge extra to those with health conditions such as diabetes or asthma,
• Not cancel coverage when someone becomes ill and needs it most,
• Not set limits on the amount of benefits they will pay in a year or someone’s lifetime,
• Not deny coverage to someone with a health condition, such as diabetes or cancer, to name just a few.
In addition to the Medicaid expansion, the ACA also provides premium and cost-sharing subsidies to help those with incomes up to 400 percent Federal Poverty Level ($88,000 for a family of four) afford coverage.
Cost control is a key topic and a focus at Health Action 2012. It will not, however, be accomplished by cutting essential benefits, or reducing the number of people who have coverage. Rather we must provide services with value in a more efficient manner. Dr. Stuart Altman counseled against putting access to care in peril in the name of cost containment.
Dr. Atul Gawande also focused on the need to provide better quality services in a more efficient manner. He described systems of care as a solution, focusing on the quality of care provided, the outcomes achieved, and not the number of services provided.
Health care also impacts other essential services. Gawande said that while attending a parent-teacher conference at his son’s school, he questioned his son’s class size, concerned that he was not receiving enough individual attention. The principal explained that the high health care costs of school employees (including a former patient of Dr. Gawande) reduced classroom resources resulting in higher class sizes — even in this very affluent school. Dr. Gawande concluded health care costs directly impact his son’s education.
Pollster Celinda Lake noted from recent polling that women, who make 80 percent of family health care decisions, are not knowledgeable about the ACA.
It’s essential for women to take the time to become familiar with this critical law and these benefits and protections for themselves, their children and their parents. Michigan Consumers for Healthcare provides up-to-date information on the law and its implementation from both the state and national perspectives.
The ACA, if fully and well implemented, will impact every American by providing more control and health security. Isn’t that a Valentine’s Day goal worth pursuing?
– Jan Hudson