What do you have wrong about Obamacare?

Obamacare has been confirmed as the law of the land, and the common belief that it was unconstitutional has been shown to be incorrect. 

The Affordable Care Act will affect all of us, so what other common beliefs that people have about  this law are also wrong? The following is a list of common misperceptions that I have observed.

Common belief: Obamacare is a government takeover of health care. 

ACTUALLY: The Affordable Care Act has no government plan. It preserves private plans and strengthens the private insurance market, making it easy to shop for a plan you like, while protecting people and their health. 

Common belief:  the law is just about insurance and not about cost. 

ACTUALLY: the law promotes new models, innovations, and research to start improving care while decreasing costs. Here in Whatcom County, the Whatcom Alliance for Healthcare Advancement (WAHA) has received one of these grants!

Common belief:  the law is just about insurance and not about health. 

ACTUALLY: the law creates a national Prevention Fund, and invests in training for doctors, nurses, and other needed health professionals 

Common belief:  the law is hurts small businesses. 

ACTUALLY: the law will help most small businesses a lot! Companies with less than than 50 employees get tax credits for up to 35% of employee health insurance 

premiums. Beginning in 2014,  tax credits rise up to 50% of insurance premiums. 

Common belief:  the law just  increases premiums and costs for families. 

ACTUALLY: health premiums were skyrocketing before the law, and this is a major reason for the law! Insurance companies will now have to explain why they are raising rates, and the reasons will be published on a publicly available website. If insurance companies don’t spend most of your premium dollars on health care, they are now required to send you a rebate at the end of the year. 

Common belief:  the law hurts Medicare and seniors. 

ACTUALLY: the law saves 600 million dollars by reducing extra payments to insurance companies, and strengthens Medicare to help seniors  afford prescription drugs, get annual checkups with no co-pays and to make Medicare work better for seniors and doctors. 

Common belief:  We can’t afford Obamacare

ACTUALLY: the law's expense replaces costs we already pay that have been going through the roof for years, and we can’t afford not to have it. The law extends coverage, promotes access to the right care, in the right place, and at the right time. This is one way the Affordable Care Act was designed to save money by keeping people healthier. 

Common belief:  The law is too complicated to understand.

ACTUALLY:  The basic facts are simple. 32 million more American citizens will be insured. There will be help for those who cannot afford coverage. Most insurance company abuses will end. We will start building a system that improves quality and controls cost for all of us.

If you want to be informed, ignore most of what you hear and visit HealthCare.gov which is an easy to use site that explains the law and how it is being rolled out. 

What do money, Winston Churchill, Obamacare and an informed public have in common?

It was Winston Churchill who noted that "The best argument against Democracy is a 5 minute conversation with the average voter". As we await the Supreme Court decision, recent events are once again proving the truth of his assertion. 


It has now been two years since this landmark legislation,  and a recent Kaiser Foundation poll shows that fewer people today know what is actually in the bill than did when it was passed! This lack of knowledge parallels the decreasing public support for the bill. What is responsible for people dumbing down? A just released New York Times article documents that opinion about the Affordable Care Act is related to the money spent on advertising by its wealthy special interest group opponents.  Consider this:  opponents of the legislation have outspent those in favor by a more than 2:1 ratio since the law was passed, and more than 3:1 in the last year. The same study notes that since July 2011 there have been 164 different attack ads produced, and only 16 in favor.


It seems clear that wild spending by monied interests can sway public opinion on this and many other matters. Can it do the same with the Supreme Court? Stay tuned.

Is it time to end employer sponsored medical insurance?

It has been more than a little hard to follow the politics of the healthcare reform "debate" over the last few years. Sponsors of reform have been treated to accusations of death panels, the President has been portrayed as a Nazi and republicans have uncharacteristically complained that money saving measures were an attempt by President Obama to "gut Medicare". Now, the strangest twist of all may be the new proposal from Sen. Roy Blunt (R) Missouri. Simply stated, the "Blunt Amendment" would allow employers who provide insurance coverage and insurance companies themselves to refuse coverage of any health care service required under the new health care law if they feel it violates their “religious beliefs or moral convictions.”  Wow. 
Unfortunately, this phenomenon is uniquely American. 
Coverage of contraception services, for example, has been a settled issue in the majority of our states, supported by both democrats and republican legislators for almost 40 years. Other countries, even predominantly Roman Catholic nations such as Spain and Italy, also provide contraception coverage, and they do not have the conservatively devout trying to end the coverage! The difference is that our way of doing things revolves around the unique way that medical insurance is sponsored in the United States, and that is our reliance on employers to sponsor private insurance options for their employers. 
As I witness this debate, I can't escape the feeling that the only way to end this kind of messy politics may well be to end our dependance the private insurance system itself. We can't have it both ways. If private employers and plans can pick and choose conditions and services to pay for, then the rights of those covered to follow their own conscience and make their own choice is impossible. Diseases felt to be due to an unhealthy lifestyle, for example, might join contraception as prohibited items to cover. The result would be chaos and anything but a just and equitable situation.
It would be ironic in the extreme if the immoderate rhetoric used by the extreme right to oppose efforts to improve our system actually led us to a true national health insurance system such as Medicare for all. President Obama's efforts to compromise on this issue for the passage of the Affordable Care Act may still lead us to a government plan. 

Healthcare and YOU

Sorry to say, but when it comes to understanding health care reform, our media have done a woeful job of keeping us informed and the general public remains very confused and unenlightened. For example, recent studies demonstrate that many Americans who believe they understand how the law works are actually thoroughly misinformed, and some are not even aware it is still in effect.A poll released by the Kaiser Family Foundation at the end of February found that about 20 percent of people wrongly believe that the law ended when Republicans in the House of Representatives voted to repeal it earlier this year, and 26 percent replied that they didn’t know if it was still the law or not! Well, it is.

What is a person to do if they would like to get a cogent, accurate understanding of the new law, without the partisan bias and media spin? Fortunately, there are now some good choices! A new site, called HealthCare and You.org  avoids the heated politics behind the legislation and focuses instead on what the plan means for consumers. People who log on to the site can slect their state, age group, and circumstances to find a personal and customized explanation of the law’s provisions, with a timeline indications when portions of the law will take effect.The site has been developed by a coalition of groups t hat includes the American Academy of Family Physicians (AAFP), the AARP,  the American Medical Association, the American Nurses Association; the Catholic Health Association; the National Community Pharmacists Association; the American College of Physicians; and the American Cancer Society Cancer Action Network. Check it out!

 Want to find out what actual coverage options are available to you right now? Remember HealthCare.gov

How to Rate the New Health Care Changes

The Affordable Care Act contains a series of provisions that are phasing in, as scheduled, until the final period of complete implementation in 2014. Now, with the advent of 2011, several provisions take effect which start to change things for all of us. I give each change a "thumbs up" or "thumbs down" rating below.

• New rule for tax-free savings accounts. If you have an HSA, like I do, so called non-prescription "over-the-counter drugs" that are not actually prescribed by a doctor are no longer eligible to be paid from that account. This is the kind of rule that might look good to a bureaucrat, but to me it is ridiculous. People now will be calling for prescriptions for their Tylenol, resulting in wasted time and money by all of us. Instead of saving money, this will be a fiasco.  Thumbs down!

• Health-insurance companies “medical loss ratio”. Plans will now be required to spend at least 80 to 85 percent of the premium for actual medical care and quality improvements for patients, instead of administrative costs. Those that fail to do so will be required to issue a rebate to their customers beginning in 2012. The US Department of Health and Human Services says on www.HealthCare.gov that this will protect up to 74.8 million insured Americans from unreasonable rate increases. Last year, in 2010, we saw large increases from insurance companies who were attempting to pad their revenue before this provision took place. Thumbs up!

• Closing the Medicare drug coverage “doughnut hole.” Drug companies are now required to provide a 50 percent discount on brand-name prescription drugs to Medicare recipients who fall into the coverage gap in the Part D drug plans. Also, federal subsidies will be phased in for generic prescriptions in the Part D coverage gap. This gap will be progressively be closed over the next 10 years. It would be better to require competitive bidding by these companies, but this is a step in the right direction. Thumbs up!

• Medicare bonus for Primary-care physicians and general surgeons. These doctors will receive a 10 percent bonus payment for treating Medicare patients, which should help to encourage better access, although it is not enough, in my opinion to make much of a difference. Thumbs up!

• Preventive care for Medicare recipients. In a big change of philosophy, seniors will now be able to get free preventive services that include annual checkups and personalized prevention plans. No more waivers! Thumbs up!

• Medicare Advantage changes. Medicare recipients are eligible each year to choose private insurance companies for their care, a system called Medicare Advantage. We have all seen the adds! In the past, these plans were eligible for payments that were higher than ordinary Medicare, and these costs were born by increased premiums for all Medicare beneficiaries. Now, Medicare Advantage payments will be tapered down over the next few years to eliminate this subsidy. The new law has already resulted in higher premiums for many Medicare Advantage plans, but it prohibits these plans  from raising cost-sharing requirements higher than what is required under traditional Medicare. Thumbs up!
 
• Center for Medicare and Medicaid Innovation. This center is already up and running and has launched multiple initiatives to test new ways of delivering care to patients that reduce costs and maintain or improve quality. One idea is an Accountable Care Organization (ACO), which is a new entity in which health-care providers can work together to contract for and manage care. Work is already under way here in Whatcom County to try and build such a system! Thumbs up!

• Community Based Care Transitions Program. One of the most expensive problems in health care, that also is a sign of poor quality is the readmission of discharged patients to the hospital right after they are sent home. This program seeks to improve care for seniors after they leave the hospital, by coordinating care and connecting patients back to services in their communities. Thumbs up!

• Medicaid incentives for prevention of chronic disease. The plan includes grants for states to help begin support services for Medicaid (low-income) recipients to cope with chronic problems, such as tobacco use, weight control, and various health conditions. Thumbs up!

All in all, things are slowly moving in the right direction. More details here:  http://www.healthcare.gov/law/timeline/index.html