Sackerson has asked me to
write a short piece on the effects of the Affordable Care Act, based on my 39
years of fighting insurance companies in the US.
Since this is primarily
for readers in the UK, it helps to understand that many Americans do not
consider healthcare to be a right, or even an issue of infrastructure. The fact
that it is referred to as the 'healthcare industry' should show that the emphasis
is on the money.
There are many different
programs for it, including:
·
Veteran's Administration – a completely separate
set of doctors, hospitals and testing facilities, paid through the Defense
budget, only for those who have served in the Armed Forces. In the past two
decades, its funding has been reduced by conservatives. The inevitable problems
which have arisen during two wars have been used as justification that the
system should be privatized.
·
Medicare – a federal program for
the elderly and disabled, paid by payroll taxes. Ever since it was introduced
by President Johnson in his Great Society initiative, it has been another
target of conservatives.
·
Medicaid – for the poor, paid by a
mixture of state funds and payroll taxes. Also introduced in the Great Society
and yet another target for anti-government conservatives.
·
Group insurance through
employers
– lose your job, lose your coverage. Only available if you work enough hours.
·
Group insurance through
unions –
rapidly going away as the unions do.
·
Group insurance through
small business co-ops – typically expensive.
·
Personal purchase – very expensive.
Most of these offer
multiple plans, requiring specific doctors and hospitals (or a hefty financial
penalty),with assorted co-pays, lifetime maximum benefits and deductibles. I
have three degrees in Mathematics, and I still cannot figure out what
procedures other than basic office visits will cost, as the bills dribble in,
sometimes for a whole year.
That said, here are some
of the changes that have taken place:
More people covered
Before: An estimated 31 million or more uninsured.
After: Over 20 million people with affordable insurance.
Insurers' profits capped
Before: Insurance companies kept up to 54% of all premiums.
After: Insurance companies restricted to 20% of premiums.
Fewer health-related bankruptcies
Before: Medical bills were the #1 reason for bankruptcy.
After: Medical bankruptcies down 90% or more.
Less misuse of emergency services
Before: People without coverage used Emergency Rooms for primary care,
paid by increased hospital costs for everyone else. Hospitals are required by
law to treat critical patients.
After: Much less pressure and cost for many of those hospitals. Better
outcomes for those with chronic conditions.
Extended coverage for dependent children
Before: Dependent children age 18+ not in college, or 22+ in college lost
coverage on their parents' policies.
After: Coverage for dependent children up to age 26.
Birth control
Before: Many policies did not cover any birth control, although most
covered viagra.
After: All policies cover birth control.
Cover for pre-existing conditions
Before: People with pre-existing conditions, from arthritis to cancer and
much more, could either be refused coverage for those conditions, refused any
coverage, or made to pay for much higher risk and higher cost policies.
After: Pre-existing conditions covered with no penalty.
Benefit caps removed
Before: Most systems had a lifetime maximum benefit, typically around $1
million, which could be exhausted in a couple of months of intensive care.
After: No lifetime maximum.
DRAWBACK: unintended effect on work contracts
Before: Small companies (around 50 people) could offer as many hours to
their workers as they wished without offering benefits.
After: Part-time workers with over 30 hours per week must be offered
coverage, so many people had their hours cut back.