Affordable Care Act—2014

July 1, 2014 - So much has been talked about and written concerning the Affordable Care Act (ACA)—aka ObamaCare—and almost everyone has voiced an opinion. What is generally agreed upon is that no one would have designed a healthcare system like the one which precipitated this monumental change. We will now have more transparency than ever before, which will be good for everyone—patients, care-givers, payers and our nation.

What is new for 2014 is discussed below, following a quick update and review. The original law was passed four years ago, subsequently upheld in the Judicial System, and then had a “rocky” start … to say the least. However, the law survives; eight million folks have enrolled across the nation—an estimated almost one million living in Florida—all through the Federal Government exchange program.

The ACA is fundamentally changing the way Americans are covered for health care. Pre-existing conditions are no longer barriers, lifetime caps (the total outlay of medical expenses paid by insurance companies over a person’s lifetime) are gone, and individuals may purchase insurance with the benefit of being in a group—even though they are “individuals.”

All new plans must include preventive screening provided with no co-pay or coinsurance, even when a person’s deductible has not been met. Screening for colorectal disease, depression, diabetes, and counseling for smoking cessation, as well as immunization, must be factored into the health insurance. Women’s health issues, including breast-feeding assistance, breast and cervical cancer screening, reproductive health, and other women’s services are also included.

However, while these positive changes are particularly beneficial, they are not without some consequences. Previously uninsured Americans—estimated to number 47.3 million—now have better access and a better chance of living a longer, happier, and healthier life.

The cost of health care is now becoming much more transparent than ever before, though not necessarily more expensive. Previously, your employer or insurer was paying much more and you, as a patient, only noted your deductible and co-pay. Those days are over. Now you, the patient, can have out of pocket yearly outlays as high as $6,350, and $12,700 as a family. This sticker shock is similar to that felt by employees whose insurance benefits now have high deductibles.

This new reality and transparency is exacerbating the already acrimonious discussion across the land. Ultimately, involving patients in the cost of their care should have the positive behavioral economic consequences of encouraging prevention and being prudent with their own limited resources.

In a recent Physicians Executive Journal article Sarah Freymann Fontenot, a health law professor at Trinity University in San Antonio relates, “The specter of paying more for health care as it is consumed has resulted in outcry in the public and in the press. As a country, we are being jolted out of our fiscal blindness of years past; health care is far more expensive than we have been led to believe or for which we have been held responsible. Increased personal responsibility for the cost of health care is not an unintended consequence of the ACA; it is part of the law’s design.”

This veil of opaqueness to the cost of care has been lifted. Now we must understand how best to use our new transparency to the benefit of everyone. We can and must do better going forward, rather than spinning our wheels trying to hold onto the past. By being proactive instead of reactive we can move forward as a nation to control costs, improve quality and help everyone live longer, happier, and healthier lives.


 
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Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.