A major overhaul to the current healthcare system is way overdue, especially for anyone who finds themselves at the receiving end of the current system. The Obama administration, should it remain intact, will be standing behind the already approved policies, and we will be the recipients of it for at least four more. The greatest unknowns are: The cost of healthcare. Who’s paying for it. What the quality of care received will look like.
So many external factors play a role in answering those questions even though the ACA has been accepted into law. In reality legislatures, politicians and Presidents never know the final cost when change is made. They only know that change is needed and they take the best stab at it that they can. In the case of the Obama-Care plan, the rich are supposedly shouldering the tax burden. However, the reality is the "rich" are too small of a percentage (1%) to shoulder 99% of the problem. So who will pay for changes to the current healthcare system? The Middle Class.
But before you read on, consider this: The “middle class” is slowly shrinking away in America. With unemployment at the highest rate since the great Depression, importing from China continuing to grow and our current economy not leveling out, who will pay for the current price tag of health care? It would be a grand and infatuated idea to think the rich would pay for healthcare in America, but since they’re only about 1% of America’s wealth, that idea is a far-fetched concept. The poor amongst us can’t, so with only one sector left (the middle class) the answer doesn’t seem clear. Unless Obama pulls a rabbit out of his hat, the timeline below will not work because the middle class will not be around to support it.
No one can simply rewrite a national healthcare program that says it's shouldering itself on the minority of tax payers, expecting it to solve the healthcare deficiencies American’s now face. While change within the current healthcare system would be a God-send, it will become an economic disaster if all we have is “hindsight” later on.
As you wade through the murk and mire of the political waters, the following timeline and what it means to all of us is provided below along with my own personal take on what each one represents (Resource: http://www.healthcare.gov/law/timeline/)
Effective no later than January 1, 2013
*The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care. Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare. For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care. It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. (When you “bundle” anything, something suffers. Less $ = Less quantity and quality of care.)
*To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost. (Preventative care is only beneficial when the patient is also provided with continuing education along with access to nutritional/healthy food and support from within their community to live safer/healthier lives).
*As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. (Government funding = tax dollars from those who are already paying for private health insurance and employers with over 50 employees aka the “middle class”, who are already a shrinking member of society. Once the middle class is decimated, then so are the dollars from where this funding came from.)
Effective October 1, 2013
*Under the new law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid. (Does this coverage apply to families who would otherwise be required to pay for health insurance or pay a “tax” penalty, eligible to receive coverage for their children should they fail to obey the new requirements for everyone to pay for their own insurance if not otherwise eligible? What incentive is there to have insurance if there’s a loophole for not having it?)
Effective January 1, 2014
*Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in an Affordable Insurance Exchange. An Exchange is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too. (Sounds great, but define “affordable”. Members of Congress are mostly individuals who make over $100K annually, while the average family makes almost half of that income. What “they” can afford is hardly what most of us can afford.)
*Under the new law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption. (When this “exemption” is broken down, this is what it says, “Under the Affordable Care Act, starting in 2014, you must be enrolled in a health insurance plan that meets basic minimum standards. If you aren't, you may be required to pay an assessment. You won't have to pay an assessment if you fall within the eligibility requirements for income or other reasons including your religious beliefs. You can also apply for a waiver asking not to pay an assessment if you don't qualify automatically. Sounds ridiculous.)
*Workers meeting certain requirements who cannot afford the coverage provided by their employer may take whatever funds their employer might have contributed to their insurance and use these resources to help purchase a more affordable plan in the new Affordable Insurance Exchanges. These new competitive marketplaces will allow individuals and small businesses to buy qualified health benefit plans. (Probably, the most reasonable section of this Act.)
*Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. (Who’s paying for this? The middle class.)
*Tax credits to help the middle class afford insurance will become available for those with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles). (The amount of tax credit is not clearly represented).
*Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. This applies to all clinical trials that treat cancer or other life-threatening diseases. (Does not clearly state that the insurance coverage apply post clinical trial studies should the procedure require medical care post treatment.)
*The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive. (While this sounds like a good idea, not establishing limits leads to raising insurance coverage costs or limiting coverage. You can’t have it both ways.)
*The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates due to gender or health status. (Everyone should be insurable.)
*The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees. There is also up to a 35% credit for small non-profit organizations. (Shouldn’t it be a 100% tax deduction? Small businesses need as many tax credits as possible.)
Effective January 1, 2015
*A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. (Who determines “quality”?)
The strength of the Affordable Care Act is found in several key points:
*Accessible health care for everyone, regardless of current health condition
*Quality care standards requirements for healthcare providers
*Tax credits for middle class income tax payers
Weaknesses in the Affordable Care Act would be:
*Who is really paying for change? The shrinking middle class
*Determining “quality” of care or rating a doctor’s performance is next to impossible
*Allowing loopholes (i.e. Religious reasons) for not obtaining insurance always opens the door for abuse
Quick Tips for Wellness: Unless American’s vote for change, there won’t be any left in our pockets. Think about that when it comes time to vote!
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