How this Healthcare Reform Debate Affects Us Here at Home

The airwaves are saturated this week with news of the U.S. Supreme Court’s review of The Patient Protection and Affordable Care Act (known to critics as ‘Obamacare’). The bill is being weighed, measured and stress-tested.

Those who loathe health care reform predict a bankrupting of America, while supporters ask how America’s present health care system let us sink to 48th in the world in infant mortality, below Cuba at 39.

The Supreme Court is examining the legality of three key provisions of the act signed into law on March 23, 2010.

The Individual Mandate

The so-called “Individual Mandate” requires most Americans who do not already have coverage under Medicare, Medicaid or an employer to purchase insurance beginning in 2014. The law offers assistance to help pay for the coverage for those who cannot afford it.

The Expansion of Medicaid

Medicaid is a joint effort by federal and state governments to insure about 50 million lowincome Americans, including more than 30 percent of all children in the nation.

The new law makes millions more Americans eligible for Medicaid by raising the qualifying income level. By 2020 states will pay the additional costs of covering more people.

Severability (All-or-nothing)

The court will decide whether the “individual mandate” can be removed from the law, allowing the other parts to stand.

KEY ELEMENTS OF THE ACT

Coverage Can’t Be Denied

Before the act became law, insurance companies selling individual policies could deny coverage due to pre-existing conditions, such as cancer or even having been pregnant. Since the bill went into effect, insurance companies are already banned from denying coverage to children because of a pre-existing condition. In 2014, it will be illegal for insurance companies to discriminate against anyone of any age with a pre-existing condition.

Choice of Doctor

Americans joining new insurance plans are able to choose from any primary care provider, OB-GYN, or pediatrician in their health plan’s network, or emergency care outside of the plan’s network, without a referral.

Preventive Care—No Co-pays

All Americans joining a new health care plan can receive recommended preventive services, including mammograms, new baby care and well-child visits, with no out-of-pocket costs.

Women’s Costs Reduced

Before the law, women could be charged more for individual insurance policies simply because of their gender. A 22-year-old woman could be charged 150% the premium that a 22-year-old man paid. In 2014, insurers will not be able to charge women higher premiums than they charge men. The law also helps states crack down on excessive premium increases.

Prevention without Costs

The law requires new health plans to cover recommended preventive services, including vaccinations, cost-free. Regular well-baby and well-child visits are also covered from birth through age 21. These services do not require a co-pay or coinsurance when offered by providers in your insurer’s network.

Preventive services benefits apply if you’re in a new health plan that was created after March 23, 2010.

Children Stay on Parents’ Plan

If your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 (except, in some cases, when your child’s employer offers health coverage). It doesn’t matter whether your child is married, living with you, in school or financially dependent on you, they can still retain coverage.

Stronger Medicare

According to a government Medicare information website, “The Act protects current benefits, strengthens Medicare for the future and offers new benefits that will help cut costs.” The gap in drug coverage known as “the donut hole” is being closed, reducing seniors’ out-of-pocket costs.

In addition, people on Medicare may receive recommended preventive care such as mammograms and colonoscopies for free.

An Opposing View

Last year we had a $1.3 trillion budget deficit. This year it falls to $1 trillion but the federal government will spend 31% more than it takes in—without ObamaCare.

Given that Medicare cuts and other financial contortions used to score health reform’s future deficit effects are likely to never be enacted–coupled with our country’s inability to otherwise raise revenue–we’re digging ourselves into a major hole. Meanwhile, the bill will still leave 25 million uninsured, fails to control aggregate health spending in any meaningful way and raises private health premiums substantially.—David Whelan (Forbes Magazine)

A Supportive View

Political parties disagree on many health care reform provisions, but there is longstanding bipartisan support of Community Health Centers that provide primary and preventive health care to all regardless of insurance or ability to pay.

Health care reform expands the Community Health Center program to extend their highquality and cost-effective model of care, reaching 20 million additional people over the next five years. This expansion alone will save the health care system more than $122 billion by helping to keep people healthy and out of costly hospital emergency rooms.—National Assn. of Community Health Care Centers

This is part of the March 30, 2012 online edition of The Mountain Enterprise.

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