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‘Obamacare’ Working, Despite Criticisms

August 4, 2013
Alan Ruben , The Intelligencer / Wheeling News-Register

There is a lot of uneasiness about Obamacare, primarily because many Americans listen to doom and gloom scenarios by Republicans. Otherwise, health care reform is moving along on schedule to be fully implemented in 2014.

Here are 10 results of Obamacare so far that Americans should be extremely happy about:

1. Say goodbye to the "doughnut hole." Medicare drug plans (Part D of Medicare) stopped providing prescription coverage to people after their claims for covered drugs hit a certain level ($2,970 in 2013), and coverage doesn't resume until spending hits another level ($4,750 in 2013). People whose prescription costs fall into this gap often suffer serious financial hardship. Obamacare is gradually closing this doughnut hole in stages, and it will disappear entirely by 2020.

2. Free Medicare preventive health services. Improving the health of Americans by providing preventive health care is fundamental to Obamacare. The object is not only to treat disease as it occurs, but to prevent it if possible. Diabetes, high blood pressure, obesity, smoking, and high cholesterol affect millions of Americans and have serious and costly long-term consequences when untreated. Because of Obamacare older Americans now have access to a range of free preventive health services that were never previously available.

3. Free preventive services for all women. Under Obamacare, all health insurance plans are required to add eight women's health benefits. These include counseling relating to breastfeeding, contraception, domestic violence, gestational diabetes, HIV screening and counseling, sexual diseases and wellness visits. These benefits are free; no co-payment or co-insurance will be charged.

4. Pre-existing conditions will be covered. Beginning in 2014, no American can be denied health insurance because of a pre-existing medical condition.

5. Fair charges for health insurance premiums. In the past, health insurance companies have effectively excluded persons with certain medical conditions by charging premiums that were completely unaffordable. Under Obamacare, insurers can no longer gouge people with pre-existing conditions by forcing them to pay unreasonably high premiums. The law also restricts insurers' ability to impose age-related premium increases for individual coverage.

6. End of pre-existing restrictions on children's access to health insurance. Parents of children with serious medical problems often found that they were unable to buy insurance for their children because of the prior condition. The new law has ended insurance denials based on pre-existing conditions for roughly 20 million children under age 19.

7. Guaranteed coverage for adult children to age 26. The group of Americans with the worst access to health insurance and health care is young adults who have either recently graduated or recently entered the work force. By law, adult children up to age 26 must now continue to be covered under their parent's policies.

8. Insurance payout limits will finally end. Persons who suffer from devastating illness often find that their insurance coverage runs out just when they need it most. Obamacare will end lifetime limits on insurance payouts. The law is also gradually phasing out annual coverage limits.

9. Minimum expenditure on actual care by insurance companies. Health insurance companies have often used large portions of your premium dollars to pay lavish bonuses to their executives and underwrite unreasonably high administrative costs. For example, the average overhead in the private health insurance industry is over 30 percent, meaning that only 70 cents of every premium dollar actually goes to provide health care. Under Obamacare, health insurers must actually spend 85 percent of their premium dollars to provide health care.

10. New consumer health coverage reports. One of the problems we have when we buy health insurance is that the insurance contracts are written in a way that makes it almost impossible to know what the policy actually provides.

Deductibles, copays, and internal payment limits are often hidden in the fine print of the contract. Under Obamacare, consumers will receive a standardized report which tells, in easily understandable terms, the benefits and limits of their health insurance.

So what about the cost of Obamacare? That is certainly one of the things that people are fretting about. According to the Washington Post, in California the cost of high quality health insurance policies purchased through the health insurance exchange is running considerably below expectations. According to the New York Times, in New York premiums for high-quality policies purchased through the state health insurance exchange are 50 percent lower on average than premiums previously being charged. According to the Huffington Post Business Report, because of increased competition, in Maryland health coverage sold through the state health insurance exchange will be among the cheapest in the country. The U.S. Department of Health and Human Services announced last week that younger, healthier people who buy higher quality policies through the exchanges will probably pay somewhat more than for the bare-bones insurance on today's market. Many younger people whose salaries are still relatively low will receive government subsidies to assist until they no longer need them.

Older people will see substantially lower rates overall. Much of the cost of Obamacare will be paid by slightly higher tax rates on the wealthiest among us - the "top 1 percent."

As a country, we don't have a lot to brag about. We Americans already pay a higher total cost for our health care than the citizens of any other country in the world - by far! The highly respected New England Journal of Medicine, January 14, 2010, reported that the

United States was number 1 in health care spending per capita, but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality and 36th for life expectancy. There are vast numbers of preventable deaths from high blood pressure, diabetes, high cholesterol and other common chronic diseases that are poorly managed because of inadequate access to affordable health care. Nobody says Obamacare is perfect. Neither were Medicare and Social Security as they were first enacted - and they still aren't. But they were steps in the right direction and very few people today feel they were not an improvement over what we had before.

Health care reform, President Obama's signature policy achievement, is probably going to work. All the omens so far are favorable. All Americans, including Republicans, have every possible reason to give Obamacare a chance.

Alan Ruben, M.D., is a resident of Wheeling.

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