A Healthcare Insider's Point of View on the ACA

A Healthcare Insider's Point of View on the ACA

After an extensive career in healthcare sales and marketing, I entered a master's program at the University of Denver.  With every intention of continuing my career in the field, the master's program was intended to prepare me for a digitized healthcare system - I was studying Healthcare IT and Healthcare Leadership. 

Since the program was specific to healthcare, I shared classes with many students with extensive knowledge and background in the field, including doctors and nurses.  Despite our different perspectives, there was one thing we all could agree upon -- insurance companies are a big part of the problem.

After in-depth study of our healthcare system and comparison to other industrialized nations, I became disgusted with our governing officials for continuing calls to 'Repeal and Replace' Obamacare.  I am convinced that our country's unique issues are due to political posturing and back-room deals between corporations and government officials, rather than a true desire to fix the system.

After completing the master's program in Healthcare, I left the industry for good.  In good conscience, I could no longer work for suppliers such as pharma and device companies.  I was feeling like part of the problem instead of contributing to a solution.

There are other issues that contribute to the mess.  Unique to the U.S. among the industrialized world, relying on employers to offer health insurance ignores key facts such as rising costs which has forced many employers to cut back or eliminate such perks altogether.  Our elected officials ignore the countless Americans who are forced to declare bankruptcy due to medical bills or that coverage can be lost with the job or changed at the employer’s whim. Citizens in any other industrialized country have permanent, portable insurance not tied to a particular job in a particular country. 

At the same time, the availability of employer-sponsored coverage and the share of the population with this type of coverage has declined over time.  From 1999 to 2013, the share of companies that offered employees health benefits declined from 66% to 57%, primarily due to fewer organizations being able to offer coverage due to increasing costs. 

Health insurance makes a huge difference in whether people get necessary care and where they get their care.  Ultimately, it makes a difference in how healthy people are.  By 2013, the year before the major coverage provisions of the Affordable Care Act (ACA/Obamacare) went into effect, more than 43 million people lacked health insurance coverage.

Was the ACA perfect?  By no means.  But it certainly was a step in the right direction. 

One of the main goals of health reform like the Affordable Care Act (ACA) is to expand insurance coverage and, ultimately, to increase access to care. Millions of people have enrolled in the new coverage options and the uninsured rate dropped to a historic low. 

By 2016, it had already accomplished a lot:

  1. In 2013, the year before the implementation of the Affordable Care Act’s (ACA) major coverage expansions, 17 percent of the U.S. population under age 65, about 45 million people, lacked health insurance. By the end of 2015, two years after implementation, the uninsured rate had declined to 11 percent, according to data recently released by the U.S. Census Bureau. 
  2. Uninsured rates for adults ages 19 to 64 declined in all states from 2013 to 2015, and by 3 percentage points or more in 48 states and the District of Columbia.

  3. According to the Department of Health and Human Services, as of 2017, 17.6 million Americans now have health insurance because of Obamacare.

  4. Under the ACA, as of 2014, Medicaid coverage has been expanded to nearly all adults with incomes at or below 138% of poverty in states that have adopted the expansion, and tax credits are available for people with incomes up to 400% of poverty who purchase coverage through a health insurance marketplace (Kaiser Family Foundation).

  5. Among all income groups, there were significant improvements, including increases in the proportion reporting a regular source of care and in those reporting decreases in unmet needs because of cost of care.

  6. Nearly all states experienced two consecutive years of decline in their adult uninsured rate. The only exceptions were Massachusetts, which had the lowest uninsured rate of any state to begin with, and South Dakota.

  7. Prior to 2009, insurance companies could and did refuse to pay for costs associated with any condition that the patient had already been diagnosed. Since 89% of all 45-year-olds in the United States already exhibit at least one chronic disease, it was nothing more than a scheme by insurance companies to further enhance profits.

  8. Obamacare allowed children to be covered on their parents' policy until the age of 26, a popular inclusion.

  9. Obamacare not only put an end to discriminatory "gender rating" and exclusions for pre-existing conditions, including pregnancy, it also outlawed annual and lifetime benefit limits that left many Americans bankrupt.

  10. For decades now, it has been the insurance companies that have benefited the most in the United States market.  Through lifetime caps on reimbursement, the exclusion of pre-existing conditions and other stipulations designed to minimize their exposure, profits and CEO salaries have ballooned.

  11. Lack of prenatal care was perhaps the most egregious example of insurance company discrimination against women.  Access to prenatal care is incredibly important to ensure that babies are born healthy.  In 2007, the Institute of Medicine reported that the costs associated with premature birth in the United States was $26.2 billion each year.

  12. Expanded coverage enabled millions to seek earlier treatment - decreasing the probability of not receiving medical care by between 20.9 percent and 25 percent.

The Republican Party has long been an advocate for fiscal responsibility, but the GOP's mantra to 'Repeal and Replace' is in itself a wasteful exercise.  Many laws are modified over time, for instance, the initial legislation for Medicare and Medicaid wasn't perfect yet the legislators worked to modify it to improve it.  There are many important reasons why the legislation should be modified instead of scrapped altogether - there are some very popular facets to Obamacare that would be eliminated by dismantling the entire system. 

According to the Commonwealth Fund, the GOP's calls to 'Repeal and Replace' would have the following results:

  • Reduce the number of insured by nearly 20 million

  • Increase out-of-pocket costs from an estimated $3200 to $4700

  • Increase the deficit by +$33.1 billion

 

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By refusing to provide preventative care, the current system forces much of our citizens to ignore their health issues until they have significantly progressed.  When they do present for care, any interventions are much more expensive than they would have been had they been handled preventively.  Of course, the patient would be better cared for as well.

These higher costs aren't covered by insurance or the hospital, so they get passed along to taxpayers.

 

 

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