Do you hate these parts of Obamacare?

I meet folks who say, "I don't like Obamacare". I find this frustrating, because these same people almost never are able to articulate anything other than a feeling!  When I review the 10 major features of the Affordable Care Act, these same people invariably tell me they are in favor of most if not all. Which one of these ten things do you hate?

1. The individual mandate is probably the most commonly disliked provision, and yet, it is essential.  This is how insurance works. Everyone pays in and "pools their risk". Only the extremely wealthy could possibly afford to go it alone.
2. The exchanges are an important innovation that allows the customer to compare plans in a standard fashion, to pick what works best for them. This can be done through insurance brokers, paper applications or hopefully, via the new web sites when they are working.
3. The expansion of Medicaid is a crucial change for the working poor - those families for whom coverage would otherwise be impossible.
4. Elimination of the donut hole. Seniors on Medicare no longer have to deal with the strange gap in prescription coverage that affected so many.
5. No pre-existing condition limits. This gets rid of the favorite insurance company way of refusing to pay for needed care.
6. Young people up to age 26 can stay on parents' plan. An easy administrative change that has helped millions of young people just getting started.
7. No copay for preventive care and screening tests takes away the barrier to get things that save illness and money down the road.
9. Tax credits to small businesses to encourage them to provide health insurance to employees. This helps employers do the right thing for those who work for them, and attract and keep good employees.
10. Subsidies for lower income Americans. The sad fact is, medical care has gotten so expensive that millions of people who work full time cannot afford the insurance or the care. This costs all of us in higher fees, and this change helps to end that spiral.

The Washington State Health Care Innovation Plan

Imagine a state where everyone had a personal connection and easy access to the medical care they need, and where the care was coherent, coordinated and focused. That is the stated goal of the Washington State Health Care Innovation Plan, according to Karen Merrikin, the new administrator of the plan, who came to Bellingham to meet with interested leaders in our health care community on October 17.  She told the group, “Our current health care system too often provides high-cost, low-value health care and our goal is to collaborate with payers and providers toward health system transformation that delivers reliable, higher-value, lower-cost care in Washington State.”

How to make that happen? The Washington State Health Care Innovation is a five year plan to use the purchasing power of the state to align incentives across all areas of health care delivery for care purchased or administered by the State of Washington. These are the tools she identified:

• Basic infrastructure to manage care
• Aligned quality incentives
• Aligned payment incentives tied to outcomes
• Support for primary care practice transformation, to achieve the patient centered medical home
• Strengthened health IT
• A modernized work force to meet current needs, with emphasis on primary care and behavioral health
• New tools for people to understand and access care
• Local accountability for organizing and delivering care, based in the community. An example would be our local Whatcom Alliance for Health Care Advancement (WAHA).

In order to achieve the above goals, Merrikin described a new organizational structure, with the state divided into 7 to 9 regional zones. The NW Washington region would contain Whatcom, Skagit, Island, San Juan and Snohomish counties. Medicaid administration would move to these areas. Other features would include a community health organization (ACHO), and an embedded regional extension center to support needed practice transformation activities. Key state supports would also be aligned to the region, and a transformation trust fund is envisioned to support training and innovation.

Remaining key questions include “how will the savings be re-invested”?

The draft plan will be presented at the beginning of November, feedback will be solicited through mid-November and the final plan will be finished December 31.

Contrary to What You May Hear, Congress Must Get Their Medical Insurance Coverage Through Obamacare!

Perhaps you have gotten one of these emails yourself. The author is very upset because:

"The federal Congress has just approved with the help of Obama to waiver all Congressmen and their staff from having to use the Obamacare exchanges." 

"For too long we have been too complacent about the workings of Congress.  The latest is to exempt themselves from the Healthcare Reform that passed ... in all of its forms. Somehow, that doesn't seem logical. We do not have an elite that is above the law. I truly don't care if they are Democrat, Republican, Independent or whatever . The self-serving must stop".

The emails often go on to urge you to forward the email, so that we can pass the 28th Amendment to the US Constitution, so that all laws passed by Congress must apply to them as well.

The trouble with all of this outrage is, none of what the email says is true!

One of the provisions written into law with the Patient Protection and Affordable Care Act (commonly known as "Obamacare") passed by Congress is the requirement that lawmakers must give up the insurance coverage previously provided to them through the Federal Employees Health Benefits Program and instead purchase health insurance through the online exchanges that the law created. The exact wording contained in the law is noted below: 

(D) MEMBERS OF CONGRESS IN THE EXCHANGE. 

(i) REQUIREMENT — Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are: 

(I) created under this Act (or an amendment made by this Act); or 

(II) offered through an Exchange established under this Act (or an amendment made by this Act).

An August 2013 ruling by the federal Office of Personnel Management (OPM) was widely and inaccurately reported as exempting members of Congress from this requirement, but,  that reporting was incorrect. Lawmakers are still required to purchase health insurance through government-created exchanges; what the OPM's ruling actually declared was that members of Congress and their staffs did not have to give up the federal contributions towards the costs of their insurance premiums which they had previously been receiving (and which are afforded to millions of other federal workers). 

There is a nice discussion about all of this at: http://www.snopes.com/politics/medical/28thamendment.asp#SWW7Rgj0DiIUEVPg.99 

Obamacare Insurance Exchanges are coming!

Very proud of my state! Washington Health Plan Finder - Starting this fall - click - compare - covered! http://t.co/63sodzlMA2
— David Lynch, M.D. (@DrDaveLynch) July 29, 2013

The pace of change in medicine

As I consider the money we waste and the millions of people in our country without access to the medical care they need, I sometimes feel impatient and frustrated that it has  taken us so long to see the change we need to actually happen. When these moods strike, I have found that a little perspective on the rate of change in medicine over the years often helps me to feel better. 

Sometimes ideas that are obviously correct, and meet stated needs still take forever to be adopted, and medical history documents that progress is usually measured by decades. Consider that it has been less than 400 years since the English physician William Harvey published his study suggesting that it was the heart, acting as a pump, that was responsible for the movement of blood throughout the body. The acceptance of this "radical theory" by the medical establishment of the day was very slow in coming, and almost 200 years had to pass before Harvey's revolutionary understanding was fully substantiated and accepted by the doctors of that time.

When the Scottish naval surgeon James Lind published his findings that citrus fruit cured scurvy in 1754, it took more than 40 years for the Navy to include lemon juice in the sailor's diet.

In our modern era, the number of medical "firsts" that have changed the practice of medicine, and improved patient health and wellness has dwarfed all of those in previous recorded history, and the promise of what can be done has never been greater. What has not changed, however, is innovation in how our society can pay for and provide care so that these benefits are available and sustainable for our citizens of all ages who need them. That is the breakthrough that our generation is called upon to make.