Sex, Drugs, and Public Health

March 21, 2012

The Act Goes to Court

Filed under: Uncategorized — cbmosher @ 2:03 am

For some reason, the way the U.S. funds medical/health care is thru insurance policies. This is not the way it’s done in many other developed countries, and is inherently inefficient.

Inefficient because insurance companies operate for profit. All money deferred to profit and executive salaries is money not spent on health care.

And, as most physicians know, insurance companies put up lots of barriers to keep (or delay) patients from getting tests and treatment the doctor recommends. That is, obviously, good for their bottom line.

But what it means is that, rather than insurance companies providing health care to their insured – they frequently have powerful financial incentives to NOT provide expensive services.

However, politics in the U.S. is strongly biased against a major shift from
insurance to “Single Payer” (i.e. the government pays for everyone’s health care as it now does with Medi-Care).

Therefore, the Affordable Care Act is a complex law aimed at accomplishing the following:

A. Leave those who already have insurance alone

B. Help those who have no insurance or who are trying to buy
“individual” insurance (not group plan insurance)

Why did we need a law for this? Because obtaining individual policies is very difficult currently for many people due to insurance company activities like these:

– May deny a policy to someone with pre-existing
(i.e. those who need it most)

– May yank coverage if someone’s health care is getting expensive

– May set premiums so high (especially on those with pre-existing
conditions or risk factors) that it’s practically not available

– May put annual dollar limits on benefits paid out of policy.

II. Timelines: There are a lot of them. We’ve passed several and more aspects of the law will be implemented from now thru 2018. Here are just some:

2013          Feds will pay for more Preventive services without insurance co-pay

2014         People will be able to buy insurance on Exchanges, instead of individual policies (where people have historically been

Those who earn under 133% of poverty (around $23,000
for a four person household) will be eligible for Medi-Caide.

Insurance plans will no longer be able to refuse coverage for pre-existing conditions (i.e. deny insurance to those who need it most)

Insurance plans will no longer be able to put annual dollar limits on policies

People without insurance will be required to obtain it (this will drive down insurance costs since healthy people will be in the pool, and will take the burden of care off taxpayers who now end up paying many bills of this without insurance)

2015           Increase in federal funds into Children’s Health Insurance Program.

2018           Insurance companies that are still gouging people will have to pay higher               taxes

III. How has the Act already effected people?

A. Children under age 26 may now remain on parent’s insurance. 
This will help young adults, struggling to get started.

B. Seniors whose drug bills are high and who hit the “donut hole” will receive federal rebates and discounts to help.

C. People on Medi-Care (mostly seniors) are now able to get preventive services like mammograms and cancer screenings free.

D. Many more children are now covered thru Medi-Caide and CHIP.

E. When states have their “Exchanges” set up, people who currently can’t afford insurance will be able to do so.

IV. Conclusion:

Over the past ten years or so, fewer jobs have offered health insurance benefits, so there’s a trend that’s increasing the number of families without coverage.

The Act takes aim at Insurance Companies which have historically denied coverage to those who need it most, dropped coverage at will, balked at providing services ordered by physicians, and set premiums so high that it’s practically unobtainable for many.

We have a model of this Act – Massachusetts’ approach. So far, it seems to be working well and not breaking the bank

Speaking of funding, here’s how the Affordable Care Act gets funded:

A. Insurance companies must provide health coverage to everyone not otherwise covered.

B. Those without insurance must buy it (unless they’re financially unable). This drives the cost of insurance down by including the healthy

C. Low income families will be subsidized

D. New revenues on pharmaceutical companies, indoor tanning parlors, “Cadillac” insurance, and those on Medi-Care with incomes over $200,000 will help offset increased costs.

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