My Turn: Health reform is here to stay – and that’s good
The election is over, and the health reforms passed in President Obama’s first term are here to stay. The Affordable Care Act (a.k.a. Obamacare) became a polarizing issue in the country, but many of its benefits enjoy strong support from the public. The elimination of the lifetime cap on coverage, the expanded Medicare drug benefit, and the prevention of denial of coverage for pre-existing conditions are important and popular features which expand coverage for disabled individuals and those with serious chronic conditions. Some other enhancements under this law seem to be under-appreciated.
I practice in the field of geriatrics, and one of the limitations of Medicare has been less-than-adequate coverage for preventive services. With the Affordable Care Act, patients are now entitled to annual wellness visits. These visits are 100 percent covered with no deductible. This benefit was designed to allow adequate time to do appropriate geriatric screening including risk assessment for falls (to allow early intervention to prevent injury), cognitive assessment (to detect early-onset of dementia) and vision and hearing screening. Immunizations and counseling for colon, prostrate and breast cancer screening are provided at these annual wellness visits. Previously, these basic geriatric assessments could not be done within the confines of a typical office visit.
Another expansion of benefits that had a great impact on my own family was the ability to cover children up to age 26. I have two daughters between the ages of 21 and 26 who do not have access to health insurance coverage. My oldest daughter is newly married, but her husband’s insurance was an individual policy. She became pregnant and fortunately she was able to obtain coverage under my plan. She required a C-section. The cost of care for her pregnancy and delivery exceeded $30,000. This amount of debt would have been financially devastating to this young couple. Like many others, they could have been forced into bankruptcy. Fifty to 60 percent of all bankruptcies in the United States are a result of medical expenses.
My younger daughter is also on my health plan, and she is scheduled for a surgical procedure this year. She is working two jobs to try to get established but makes very little money. She would not have been able to afford this necessary procedure, and like many others she would have delayed her care if she was required to pay. Her only choice would have been to come to me for money, but many young people do not have that option.
The controversial requirement to require citizens to have health insurance has been upheld by the Supreme Court, and that will go into effect in 2014. This provision requires the creation of health-care exchanges to make purchase of insurance from the private insurance market more affordable. This part of the plan is similar to the law adopted in Massachusetts under Mitt Romney which has been quite successful in expanding coverage to the uninsured. It is time for New Hampshire to set up the health-care exchange so citizens of our state can chose from a variety of affordable private health care plans.
The idea that somehow competition among private insurance companies will solve our health-care problems does not match the experiences of most patients or providers.
Previously, Medicare Plus was touted to bring the magic of the market place to reduce health-care costs for older Americans. It has proved more costly and no more effective than traditional Medicare. On the other hand, the Affordable Care Act set aside funds for innovation and demonstration projects to look at ways to more efficiently provide care. For example, under ACA, Medicare is experimenting with new payment options to make hospitals and health-care systems more accountable for costs. Adequate primary care access has also been shown to reduce health care cost. ACA has provisions to increase the primary care workforce and increase reimbursement to encourage medical school graduates to choose primary care.
Expansion of health care benefits to all Americans needs to occur. Bankruptcy because of medical costs is not acceptable. The inflation of health care costs is recognized by both parties to be a major problem. We need a sensible approach to expand coverage and to control cost. The Affordable Care Act may not be perfect but it is a move in the right direction. Now that the election is over we need to continue to move forward.
(Dr. Paul R. Clark lives in Bow.)