Since its passage in 2010, the Patient Protection and Affordable Care Act, otherwise known as “Obamacare,” has helped to improve access to health insurance and expand coverage for certain services that used to be out-of-pocket costs to all of us.
But from a doctor’s perspective, what has it done for my patients?
And what might we lose if it were ever repealed? Because let’s face it, it’s already been tried dozens of times, and now Republicans control both houses of Congress.
There are five major areas where I have personally seen the ACA having a positive impact.
• First, I have a lot of patients under the age of 26. Many are in college, and before the ACA, they had to buy their own health insurance if they were over 23.
If they couldn’t afford it, they didn’t have coverage. Most were healthy, but you can never predict when an accident might happen. Or even a simple cold or cough! They would go to their school health center, if at all, and when I did see them, whatever I could do would have worked a lot better if I had been able to start treating them sooner.
With the ACA, parents are able to keep their children on their own health insurance plan up to age 26. The Hawaii Medical Service Association was one of the first health insurance plans in the state to implement this, even before the mandated date. Now, young adults just starting out can still have insurance coverage.
• Second, if you are sick, you can still get insurance. It was not that long ago that a friend of mine in medical school was left without coverage for her severe asthma because she had it from birth and it was considered a pre-existing condition. All of her inhalers and other medication had to be paid for in cash.
In fact, prior to the ACA, if someone had cancer and needed insurance, they might not qualify because the health insurance company considered them “too risky” for coverage.
Medicare has been one of the only insurance programs that never had a pre-existing condition exclusion, and now, all insurance companies have to offer this. Sick people need insurance coverage, or medical costs could bankrupt them. Now, they can’t be turned away.
• The third major benefit of the ACA is the elimination of a lifetime cap on benefits. Imagine if as a small baby in Kapiolani your life-saving care costs the insurance company a million dollars.
What if for the rest of your life you had a cap on how much more you could ever spend on your health care? One major accident or hospitalization could result in financial ruin!
• A fourth major benefit of the ACA is no more cost for preventative services. This is a major savings for anyone with insurance, Obamacare or not. Co-pays keep going up, and sometimes it’s hard to afford a screening test that’s done to stay healthy, meaning many people wait until they are sick to do any testing.
But doctors know that catching certain things early, like cancer, can make it easier to treat, or even cure. Since 2010, 71million people have taken advantage of this part of the ACA, doing mammograms, colon testing, and other screening procedures with no cost or co-pay.
Finally, drug coverage is improved. The donut hole is slowly going away.
By 2020, the cost for prescription medication, both branded and generic, will be discounted to 25 percent of their cost for Medicare recipients.
Up until now, after the initial $2,850 was spent, people had to pay for all of the medication at full cost until reaching their out-of-pocket spending limit of $4,550. This year, there is a 47.5 percent cost for branded and 72 percent cost for generic medication in the “donut hole.” This cost percentage is slowly going down.
For seniors on a fixed income, choosing between paying for the medications or buying food results in poorer health. Taking this stress away by providing greater coverage is helping keep our kupuna healthy.
There are other benefits that the ACA has provided, many even I am not familiar with yet. Overall, it was a huge step in the right direction for improving health care access in the United States.
Now, I’m not naïve enough to think that it’s perfect. Mandating the purchase of private insurance from companies is what brought the ACA to the Supreme Court in 2012, although that provision was upheld. But not having any controls on the insurance cost, that’s a potential pitfall.
I’d rather see the subsidies and insurance plans on the ACA include some type of private purchase into the Medicare or Medicaid system for those under 65.
We’ve heard about insolvency for the last few years, and what better way to secure more funding than to have people able to pay for health insurance pay into a plan that needs it the most?
The rollout of the health care exchanges, that’s another problem. It took months for some systems to be workable, and funding for the state-run exchanges has run dry. The Hawaii Health Connector received $200 million dollars in federal grants to run their program, but still needed a $1.5 million dollar bailout from the Legislature this past summer.
Future plans for the Connector are still in progress.
It’s not perfect, but overall the ACA has improved the lives of some of my patients, and I hope that no matter who is in charge in government, the plan stays in some form for future generations.
Revise and improve, yes, but repeal, no. For the 15 million people who now have coverage since the passage of the ACA in 2010, the risk is real.
I just hope we don’t have to start all over again.
