Watch: The Affordable Care Act in Pennsylvania
Nell McCormack Abom | 09.27.13
New York Times best-selling author, T. R. Reid, shares what’s ailing America’s health care system and how to fix it. His book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, stirs debate across South Central PA.
Plus, the final countdown to Obamacare begins. How does it affect you?
Take a look:
The legislation that creates Obamacare is massive – some 406,000 words. It already has brought significant changes to the American health care system and caused some companies to trim their benefits. The goal of the law is to drive down the number of Americans without health insurance (50 million, the Congressional Budget Office estimated in 2010), improve health outcomes, and cut costs. The CBO estimates Obamacare will reduce the number of uninsured Americans to 23 million by 2019. How? About 16 million of the uninsured will enroll in a more expansive Medicaid program and another 16 million will be covered by private insurers. Gov. Corbett has not yet chosen to expand Medicaid despite heavy pressure from Democratic lawmakers and even some fellow Republicans. Momentum for expansion might have grown and there are indications Corbett will have an announcement about Medicaid next week.
Each exchange will offer buyers five levels of health-care coverage from “Bronze,” through “Platinum,” to “Catastrophic” with price-tags to match the offerings. We don’t know yet how much the plans will cost but two studies released last week give a hint. There will be federal tax credits to help families afford a package. Families with incomes up to $88,000 could qualify for a credit. Private employers with more than 50 workers won a one-year delay in having to offer employees coverage. Smaller companies already can benefit from a tax credit for offering health insurance.
Starting in 2014, you cannot be denied coverage for a pre-existing condition. Insurance companies no longer will be able to set annual or lifetime limits on reimbursements. And, insurers must keep their administrative costs to 20 percent of the premium income for most plans. Insurance companies still can deny claims and they can take their grand old time paying a claim.
How are we paying for this massive law? Taxes. Drug makers, medical-device companies, health insurers, even tanning salons face new taxes and fees to help pay the estimated first-decade $940 billion cost of Obamacare. Wealthy Americans will chip in more in Medicare taxes and Uncle Sam will hit up their financial earnings, too. Cost controls could be on the way, as well. Obamacare creates a new federal agency to recommend how much Medicare will pay physicians and health systems for each medical procedure.
Our other guests include Dr. Matthew Howie, a family physician and medical director of the York Hospital Community Health Center. “We are geared toward the medically underserved,” Dr. Howie says. “So, these are individuals who are on Medicaid, are underinsured or who have no insurance. And we also have a number of low-income folks who are on Medicare.” Several partners in the medical community in York devised a process to identify people with gaps in coverage and to offer them discounted services. For the patients Dr. Howie treats, Obamacare is a lifeline. “My personal belief is that the ultimate goal should be universal coverage and there’s lots of reasons why that makes financial sense as well as medical and ethical sense,” he argues.
Christine Amy also will join us. She is a self-described community organizer and project director of Aligning Forces for Quality in South Central Pennsylvania. It’s part of the Healthy York County Coalition and began in 2007 through a grant from the Robert Wood Johnson Foundation. Amy says AF4Q takes a very patient-centered approach to medical care.
Amy says, "Health care at the national level is in crisis. It takes local people working together from a multi-stakeholder basis, such as the doctors and nurses that give care in the hospitals have to work with patients, but also with the people paying for the care – the employers and the health plans.”
Since 2007, her group has worked with those stakeholders to close the gaps in health care in York. “The way we pay for care is a big problem,” Amy explains. “We pay for quantity of care not quality of care. And that’s caused by your health care benefit plan which is managed by your employer or your health plan. It’s not really managing the relationship between you as a patient and your health care. It’s about getting a bill paid.”
AF4Q took the first step to more patient-focused care by publicly reporting data from doctors. They uploaded information about local health treatment and outcomes on their website to better engage consumers/patients about their options for care. Amy would like to see Obamacare prompt a wholesale revision in America’s approach to medical care. “We don’t help people to do the things they need to do to get better,” she reasons. “We pay for someone to have a heart attack but we don’t pay for wellness, eating right, exercising, understanding their condition and how to self-manage their care. We pay for catastrophic events and then wonder why our health care system is going bankrupt.”