It's been hailed as the new breed of health care that will help save the dysfunctional American medical system. It's also been vilified by GOP, which lead to them shutting down the government and putting thousands of federal workers on unpaid leave bringing modern life as we know it to a standstill.
Regardless of the level of hyperbole, the Affordable Care Act (ACA) is an important piece of legislation that needs to be understood because of its broad impact on medical care going forward. With that in mind, here's a thumbnail summary of the basics of the legislation.
Enacted in March of 2010, the ACA is basically a health reform law. The intent is to expand health coverage to a minimum of 30 million Americans who currently lack health insurance, increase benefits and lower health care costs for consumers, and solidify and foster innovation in the health care system.
While the legislation itself is complex, the goal is relatively simple to understand. The ACA is designed to stop, or at least slow, the growing number of uninsured, and slow the rise in health care spending, which currently consumes almost 18 percent of our GDP, a number that is expected to rise to 20 percent by 2020. Optimally, for many Americans, the ACA will put more money in their pockets by reducing health care expenditures.
The White House's The Economic Case for Healthcare Reform states,
For a typical family of four, this implies that income in 2020 would be approximately $2,600 higher than it would have been without reform (in 2009 dollars), and that in 2030 it would be almost $10,000 higher. Under more conservative estimates of the reduction in the growth rate of health care costs, the income gains are smaller, but still substantial.
The ACA expands Medicaid coverage significantly, and there's also an increased emphasis on preventive care via the creation of the Prevention and Public Health Fund.
Under the ACA, insurers must cover ten essential health benefits, including familiar standbys like hospitalization and emergency services, along with items such as prescription drugs and preventive and wellness services.
Consumers will be able to pick from a number of insurance plans offering different levels of coverage, with varying costs for co-pays and premiums. This is the health insurance exchanges part of the law that is a significant aspect of making the law affordable.
Finally, ObamaCare is designed to cover pre-existing health conditions, preventing insurers from using these as a basis for denying coverage or charging more for services. The law also caps annual health care spending for both individuals and families, with the total for the former topping out at $6,350 and the family limit capped at $12,700, beginning in 2015. In addition, it allows young people to stay on their parent's insurance plan up to the age of 26.
Healthcare.gov, the government website designed to allow consumers to shop for plans and sign up, was recently shut down due to a combination of technical bugs and overwhelming flood of consumer interest and insurers and businesses seeking detailed information on how to implement different provisions of the ACA. Currently, for many, consumers are able to log on, compare the plans and apply for the plan that will be most beneficial to their families.
With major parts of the ACA scheduled to be enacted in 2014, the government is working diligently to update the site. The House Energy and Commerce Committee is currently investigating the contractors responsible for the site in order hold them accountable and make sure fixes are quickly and correctly implemented. Secretary of Health and Human Services, Kathleen Sebelius, apologized for the technical issues surrounding the launch of the website.
USA Today quoted Sebelius saying,
Hold me accountable for the debacle. I'm responsible.
While there are enough controversies surrounding the new law to keep pundits and columnists in business for decades, one of the biggest has been the recent decision by governors in 22 states to deny Medicaid expansion by refusing to support the insurance exchange program, which is designed to broaden the reach of the Medicaid program. The basic goal of expanded Medicaid is to provide health insurance to anyone who makes up to 133 percent of the poverty level.
There are numerous examples across the country of complications resulting from Governors failing to expand Medicaid programs, but North Carolina may be the most prominent. Because the state turned down additional federal Medicaid funding, many of North Carolina's rural poor are expected to go uninsured, and potential hospital closings are being reported as well by the likes of Huffington Post.
Senator Mike Woodward states,
North Carolina's tax money is paying for Medicaid growth in other states,
when asked about the failure of leadership to have a special session to expand Medicaid in North Carolina. The spokesman for the North Carolina Hospital Association, Don Dalton states,
Hospitals statewide are facing $800 million a year in cuts to reimbursement rates and would welcome a Medicaid expansion,
when WRAL spoke with him about the refusal of leadership to broaden the state’s Medicaid. WRAL also indicated Dalton emailed with concerns stating,
Providing Medicaid or an alternative insurance option for the state's poor would open access to the health system, particularly crucial primary care. Treating illnesses at earlier, less costly stages and teaching patients how to live healthier will help reduce health care expenses and help mitigate overcrowding in hospital emergency departments.
While no one can predict how the rest of the rollout will go, there is little doubt that the next few months are critical with open enrollment closing in March 2014. Polls continue to show a widespread lack of understanding by many people, which means we must do our homework and become educated about the ACA.