Finally the legal battle is over; the Supreme Court has upheld the Affordable Care Act! Although the political battle still looms large, and may continue long after this year’s election,at least the law’s constitutionality is no longer in question. We can now hail what the law has already achieved and continue rolling out the significant reforms yet to come.
The ACA has already established significant health insurance reforms that are likely politically impossible to overturn. Children can no longer be denied insurance coverage because of pre-existing conditions,adults in 2014,and two and half million adult dependent children under age 26 are insured through their parents. Free preventive services are becoming more common, and will be universal going forward. Fewer insurance policies have lifetime caps on benefits or can cancel insurance when illness strikes, and once 2014 comes lifetime caps and recissions will be banned. Insurance rate increases above a certain level must be approved and cash rebates will soon be paid to customers of insurers that have exceeded limits on administrative costs.
Understandable summaries of coverage, benefits, and cost-sharing will debut this year. Insurers must make public their quality improvement efforts. AndConsumer Assistance Programs have been set up at the state level to help consumers find coverage or appeal decisions made by their insurers.
Medicare is providing better value for seniors. Extra drug costs because of the “donut hole” are being eliminated over the next several years. Free annual preventive exams are available as well as no-cost preventive services for the first time in the history of the Medicare program. The program has been financially strengthened by cracking down on fraud and abuse. Privately run Medicare Advantage programs, which naysayers predicted would die under Obamacare, are stronger and more popular than ever, but no longer allowed to waste taxpayer dollars.
Physicians and non-physician health care providers, although skepitical of change in some numbers, are changing their practice - adopting electronic medical records increasingly and coordinating care better. Drugs have become more affordable for hospitals serving children and low income populations. A newnonprofit institute has been established to help determine which therapies are most beneficial. Preventive care benefits with no cost sharing help docs keep their patients healthy. Primary care physicians, and some specialists in rural communities, have received increased reimbursement from Medicare. And clinics have received funds to try innovative ways of delivering care that increase quality, and reduce costs, thus providing more value to their patients.
It is now time to push forward to full implementation of the ACA. In 2014, small businesses of 50 employees or more will need to provide health insurance to their employees. Individuals, if not insured by their employer, will need to have insurance. Tax incentives for businesses, and tax credits for individuals and families who need help paying for premiums, will then be available. Medicaid will be expanded to cover more folks at the lowest income levels. Now that the Supreme Court has ruled, States need to stop obstructing and starting building theirhealth insurance exchanges. These easy to use electronic marketplaces will allow individuals and small businesses to purchase affordable insurance. The law will only allow insurance plans that provide high quality benefits to participate in the exchanges. There will be a variety of premiums options, to match individual pocketbooks, and reasonable limits on out-of-pocket costs. And discriminatory premium pricing; charging patients with chronic condition - like hypertension or diabetes - higher premiums, will go away.
The Constitutionality of Obamacare is no longer in question. It is a reasonable first step in getting most of our country’s uninsured access to care that is not dependent on a visit to an emergency department. It starts us down the road of health care cost control by championing value in health care delivery versus cost shifting to the ill and elderly.
It is time for America to work together to fix our health care system so everyone can get good health care when they need it. As doctors, we ask politicians across the country to work with us to implement the ACA and move health reform forward for our patients and for the country.