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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.)

Legacy Comments2

Got that right SCO. The married daughter's husband has an individual policy. My guess is he had access to a family plan at work, but I guess he decided it was too costly. So with ACA a married child can stay on your plan. Nice. By the way the idea that 60 % of bankrupcies are as a result of medical costs is BS. That info was gotten from the Huffington Post and the Daily Koos. It has been proven wrong. Only 17% of bankrupcies are due to medical. Most are caused by unemployment, drug use, and over spending etc.. People think that the Gov is free. Have no clue who pays for this stuff. I did not like the idea that kids could stay on your plan till 26. I figured if they graduated from college at 22 they did not need 4 years to find work and health ins. Better yet, graduate from HS at 18 and you have 8 years to find a job and ins. Guess how many so called kids will be sitting on their folks couch till they are 26 and living with them.

You said "I have two daughters between the ages of 21 and 26 who do not have access to health insurance coverage." You didn't say whether the older one worked or not, no matter, if you can afford to have a child, you most certainly can afford your own health care plan, a High Deductible Health Plan would have worked just fine. Same for your younger daughter. It is unfortunate that a doctor would distort the truth when the truth is, both his daughters DO have access to health insurance, they just don't want to pay for it themselves.

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