10 Reasons Why ObamaCare is Good for US

obamacareWhen Secretary Sebelius calls, I listen.

It’s a sort of “Help Wanted” ad from the Secretary of Health and Human Services Kathleen Sebelius that prompted me to write this post. The Secretary called for female bloggers to talk about the benefits of The Affordable Care Act last week when she spoke in Chicago at the BlogHer conference.

Secretary Sebelius’s request was discussed in this story from the Associated Press published July 25, 2013.

“I bet you more people could tell you the name of the new prince of England than could tell you that the health market opens October 1st,” the Secretary told the BlogHer conference in Chicago.

I’m here to help. I’m female and I blog — I was named one of Five Fierce Female Health Bloggers in 2009, and I’m still blogging. I also know a bit about ObamaCare — including the fact that I know that my long, longtime friend of over 20 years in the U.S. health scene inside the DC Beltway, Jeanne Scott, coined the actual phrase “ObamaCare” in the March 2007 issue of Healthcare Financial Management, documented in the New York Times. This fact alone gives me at least as much credibility for this post as any other opiner on the topic responding to Secretary Sebelius. So, in no particular order, here are Health Populi‘s Ten Reasons Why ObamaCare is Good for US….

1. The ACA calls out and invests more in primary care. This will help bring the U.S. closer to the industrialized world’s standard of a stronger primary care infrastructure. Every major economy  on the planet has better health outcomes than America’s, and one of the secrets in the public health sauce is accessible primary care for all health citizens that ensures them an on-ramp to see a medical professional early and regularly. Primary care, the professional front-line and grassroots of health care, helps people bolster preventive efforts, stay on medications, get screened earlier for diseases, and provide health services in lower-cost settings. When folks seek primary care in emergency rooms and specialists’ offices, it raises costs. The ACA earmarks more resources for primary care training and services, such as those for community health centers and school-based care. Schools are often the primary care medical home for kids who don’t have a pediatrician.

2. The Health Insurance Marketplaces (HIXs), called exchanges in the legislation, are already bringing competition to local health plan markets. Early indications are that insurance rates in California, Maryland and New York will be lower than anticipated in January 1, 2014 when the ACA kicks into gear. While rates could be higher for certain individuals (especially younger adults), the overall impact from the beginning, across all newly-insureds, looks to be a net-positive.

3. A subsidiary benefit that the Health Insurance Marketplaces bring to consumers is greater transparency in health care costs and quality. The ACA established four levels of health plans – bronze, silver, gold and platinum - which encompass different benefit packages at different levels of cost-sharing. By creating these standard packages and benefit levels, consumers will be able to make apples-to-apples comparisons between health insurance companies and stretch new muscles as health “consumers,” which we’ve been called for many years, but have been dis-empowered through the lack of pricing knowledge. Instead, health consumers have been sticker-shocked at the point-of-care in doctors’ offices and hospitals, and in pharmacies at the point-of-purchase.

4. Paying attention to prevention is good for everybody. The ACA includes preventive screenings and services. When consumers have to pay out-of-pocket for prevention, millions of people postpone or avoid seeking care, even when modest co-payments have been involved. This has been especially the experience of women postponing health care due to cost.

5. Understanding medical treatments that work, and paying for what does while avoiding what doesn’t, gets us to a learning, high-performing health system. The comparative effectiveness component of the ACA helps get us here to bolster quality services for all Americans. This week, the Mayo Clinic published a list of 146 therapies that aren’t very useful, questioning stenting for heart disease, hormonal therapy for menopausal women, and the use of Cox-2 inhibitors (think: Vioxx). The ACA’s commitment to comparative effectiveness addresses what works in health care and what doesn’t — which helps drive out waste and unnecessary spending in U.S. health care.

6. Paying for value in health care, and not for volume as our fee-for-service health financing schema has largely covered most of the U.S., is a step in the right direction toward bending that stubborn increasing-cost curve. While the ACA doesn’t address health care costs as aggressively or comprehensively as it might have done, I’m not throwing out this health reform baby with that bathwater. The CMS Innovation Center is evaluating many pilot programs testing new methods for health care delivery and financing; those seen as cost-effective and -beneficial can be models deployed through Medicare, Medicaid and commercial health plans.

7. Filling in the doughnut hole for seniors in the Medicare Part D program for prescription drug coverage is a good thing. The so-called doughnut hole is a financial gap requiring Medicare enrollees in the Part D plan to spend up to $2,930 in 2012, with no coverage for the next $3,700 out-of-pocket spending. There is evidence that seniors who fall into the doughnut hole often skip prescriptions, such as antidepressants, at that point in (non)coverage, thus compromising older peoples’ health care leading to greater disease and disability, and higher costs downstream.

8. Covering young adults between 18 and 26 years of age is a good thing for those people, their families, and their employers. This age group has been the most at-risk for not being covered by health insurance. The Commonwealth Found in 2010 that 45% of young adults reported delaying needed care because of costs in 2010, up from 32% in 2001, and 39% reported problems paying medical bills. This group of health citizens is the least-likely to have full-time jobs that provide health insurance.

9.  No lifetime coverage limits on insurance is a good thing for people, especially those of us dealing with serious illnesses. Americans who have been insured and sick, accruing big medical costs, understand this situation all-too-acutely (pun intended). That’s estimated to be 105 million people in the U.S., about equal shares of women, men, and children. Simply put: as of September 23, 2010, health plans were no longer allowed to stop paying for health care because a U.S. health citizen has reached a lifetime spending limit. This covers everyone who has health insurance, whether through a job or a plan purchased individually.

Map of world with health insurance10. Universal coverage as a national objective is the mark of a civilized society. Check out the map: the U.S. is the only highly-developed country in the world without universal health care coverage. “The only developed outliers are a few still-troubled Balkan states, the Soviet-style autocracy of Belarus, and the U.S. of A., the richest nation in the world,” The Atlantic assesses.

Health Populi’s Hot Points: These 10 items are my own priorities, filtering through my lens as a health economist, advisor to the health industry for over 20 years, wife, mother, friend, community member, world traveler, health citizen.

While the ACA isn’t exactly codified as I might have done – especially regarding changing care delivery processes to get more self-care and telehealth into the system – the plan has already positively impacted the overall health care market driving more transparency into the system, getting younger people health-covered, promoting preventive services, and getting health plans moving toward being more consumer-friendly and -accessible for the markets launching on October 1, 2013.

For those of you who like lists of 10, here are several other “best of ObamaCare” lists you may enjoy reading:

US News, 10 good things about ObamaCare

Mother Jones, 10 things you get now that ObamaCare survived

ThinkProgress, Top 10 ObamaCare benefits at stake for women

3 Responses to 10 Reasons Why ObamaCare is Good for US

  1. REPay July 29, 2013 at 3:26 pm #

    Thanks for this post. It is valuable to have who someone with a critical, analytical and knowledgeable eye tell us some good things about the new system. Most of what I have read seems nervous, neutral or downright hostile, to the point I didn’t know what to think…

    I am breathing a little more easily…

  2. George October 11, 2013 at 4:19 am #

    Although I can appreciate the sentiment behind ACA, there are unfortunately a few critical flaws.

    First thing is, if you wanted to make health insurance universal by mandate, you would first want to identify why it costs so much to begin with and reform the existing system to reduce prices (for insurance and medical procedures) before moving forward with the universal mandate. Without this crucial step, what has been done is forcing people to buy health insurance that still costs too much because all of the inefficiencies and drivers of higher costs are still in the system.

    Here are 3 examples.

    No price competition for medical services People with insurance usually don’t shop around for the best price for a medical procedure, since all they care about is ‘what is my co-pay’, so the single greatest market force for keeping prices down does not exist for the most part in the medical services industry, which is price competition.

    Another is huge demand, imagine how expensive your car insurance would be if you filed a claim to cover routine vehicle maintenance, like a new set of tires or a oil change, your premiums would go thru the roof. If the number of claims would go down (reducing demand), prices for insurance should also go down, but of course, the price of medical attention would need to come down first to make it affordable to pay for ‘routine medical maintenance’ out of pocket instead of filing a claim.

    Last example is frivolous lawsuits. There are so many baseless lawsuits against doctors and hospitals each year which costs the medical industry Billions of dollars, and those costs are passed to the patient (actually to the Insurance company then to the patient via higher premiums).

    So some of the most severe factors to high medical costs and therefore high insurance costs are all rolled into the ACA. The mandate will cause an increase in demand for insurance, and the required minimum coverage levels will and are causing the price of insurance for most people up not down.

    Now add the Employer mandate to the mix, requiring employers to buy health insurance for employees at rising price levels (or if they already provided it, their costs will rise), there is a real concern that this will have a major effect on the number of people who will lose hours at work or lose their jobs due to increase company costs.

    As I stated at the opening, I appreciate what the ACA is trying to do, and I am want every American to be insured, but it seems the rush to get something passed as left some major issues unresolved, which likely explains why the country is so divided over it.

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