By Darla Shelden
The Affordable Care Act (ACA), passed by Congress and signed into law by President Obama in March 2010 takes full effect in 2014. Advocates say it will give Oklahoma residents more control over their health care choices.
Recently, a local expert and strong supporter of the ACA presented her views during the Oklahoma County Democratic Party weekly luncheon. Among other points, she contends surveys indicate most Americans don’t know basic facts about the ACA, and most think it’s too complicated to understand.
Katherine Scheirman, MD, Oklahoma State Director for Doctors for America and retired US Air Force Colonel said, “The basics are simple, 32 million more Americans will be insured, the worst insurance company abuses will end, and we’ll start improving quality and controlling costs for everyone.”
She said there are four basic parts to the Obama healthcare plan: Coverage, security, prevention and innovation.
“Better coverage means many, many more people will be able to get affordable insurance. They’ll have security from the worst abuses of insurance companies such as terminating people when they get sick, arbitrary limits on amount of coverage, and denying coverage because of pre-existing conditions. Money will be directed toward keeping people healthy through prevention, rather than waiting to treat an illness when they have already gotten sick. For example, eliminating co-pays for preventive services, such as immunizations and annual check ups helps keep people healthy and catches disease in the earliest, most treatable stages,” said Scheirman.
“Innovation means getting more for the money we spend on healthcare. Significant amounts of money are being put into community health centers and for studying which treatments work best. Financial incentives will reward high quality of care, not just the number of procedures doctors do to each patient. There is also an investment in information technology, a push to bring doctors into the information age,” said Scheirman.
This year, the Affordable Care Act requires all insurance companies to provide a standardized summary, explaining the plan in understandable English.
“Insurance companies will now have to justify rate increases and they have to spend 80 to 85 percent of the premiums paid on actual medical care,” said Scheirman.
According to a report from the Robert Wood Johnson Foundation, the Affordable Care Act is expected to provide health insurance coverage to over 335,000 uninsured Oklahomans and reduce the state’s uncompensated health care costs by more than two-thirds.
Currently, 597,000 Oklahomans, or 19 percent of the non-elderly population, lack health insurance. Under ACA, according to advocates, the number of uninsured is projected to fall by 57 percent to 259,000, or 10 percent of the non-elderly population.
Health care policy experts at the Urban Institute use the Health Insurance Policy Simulation Model to build projections of how coverage will be affected by the new law. For Oklahoma and the nation, those projections show that the ACA will bring more people into both public and private health insurance.
This year, 5,761 residents of Oklahoma have already received an annual wellness visit. More than 57,161 Oklahoma residents who hit the Medicare prescription drug coverage gap known as the “donut hole” received $250 tax-free rebates in 2010. Seniors are receiving a 50% discount on covered brand name prescription drugs in the donut hole this year, and by 2020 the donut hole will be closed.
1.9 million Oklahoma residents with private insurance are free from worrying about lifetime limits on coverage. The 182,000 Oklahoma residents buying coverage on the individual market can now know that their coverage will not be rescinded due to a mistake on an application.
“2.5 million American young adults through age 26 can now stay on their parent’s insurance plan,” said Scheirman. An estimated 18,500 young adults in Oklahoma will gain coverage because of this provision.
Scheirman said, “Beginning in 2014, insurance will be more affordable because of subsidies. If you can afford insurance you must buy it or pay a small penalty. Low-income people will be eligible for Medicaid. Subsidies will help people with incomes up to 400 percent of the poverty level purchase health insurance. Why wouldn’t people get health insurance if it were affordable?”
“The health exchanges will be similar to the Federal Employee Health Benefit Program where you have a variety of policies to choose from. You will be making the decision as to what coverage is right for you. It’s not one size fits all. It will still be your choice,” said Scheirman.
Proponents of the health care legislation have called it a “historic victory” and “landmark legislation” that reforms the U.S. health care system by reigning in health care costs, making health care affordable, and protecting consumers from unfair insurance practices. They say the law will reduce the nation’s deficit by more than $100 billion by 2020 and by $1 trillion by 2030.
Opponents have called it a “socialist” and “unconstitutional” government takeover of the health care system that will increase the cost of health care and decrease the quality. They say the law will cost more than $2.5 trillion over 10 years and drive the U.S. deeper into debt. Several congressional representatives and interest groups have initiated attempts to repeal the Affordable Care Act. U.S. Rep. James Lankford’s website contends, “Most Americans reject the notion that government should be intimately involved in their health care decisions.”
Twenty-six states have filed actions in federal court challenging the constitutionality of ACA. As of January 2012, two of four federal appellate courts have upheld it; a third declared the individual mandate unconstitutional, and a fourth said the issue could not be decided until taxpayers begin paying penalties in 2015.
The Supreme Court has agreed to review these cases, and has scheduled oral arguments in March 2012.
“Do we, as a country value our citizens’ health and life enough to make sure everyone has access to basic health care? Whether they’re rich or poor, everyone has value as a citizen of the United States,” said Scheirman.