Here Are Reasons Obamacare Will Succeed

By January 1, 2014 Uncategorized No Comments

Despite the uproar over the Patient Protection and Affordable Care Act, or Obamacare as it is also referred to, there are some good things about the Act. After all, it was devised to get insurance to the millions of Americans who had no hope of ever getting insurance for various reasons. It was invented to save money, not only for the uninsured but for the government as well. In the coming years, billions of dollars will be saved from a health care system gone mad. It is now regulated, standardized and affordable. Here are ten reasons the ACA is a good thing.

1. Equality

Back in the day, insurance companies could charge women more for premiums simply because they were women. They charged more to those with pre-existing conditions including to children under the age of 19 with pre-existing conditions. Insurance companies routinely denied coverage to these people. No control existed and people simply could not afford the high premiums. They just went to the emergency room when they got sick. This was prohibitively expensive, leaving untold scores of people bankrupt when they couldn’t pay the bill. Now insurers are required to offer their wares to any and all irrespective of sex or pre-existing conditions. This keeps prices down and lightens the load on ERs everywhere.

In 2015 Obamacare rates will be regularized, or more equal for all. Think about it. An enterprise was enacted with new boundaries and with no previous experience. This made the insurance industry comparable to a bungee jump: there was the base, or the government, to which the cord was attached. There was, however, nothing but thin air when the insurance jumped into the great beyond.

In 2015, insurance companies will have some basis on which to compare notes, so prices will reflect that experience. They will have data on previously uninsured Americans with pre-existing conditions. There will be data on previously uninsured children, women and the youth of America. There will be information concerning what services were used, how often and how much it cost. A basis for comparison will have been established, so now the bungee jump will be more productive. In 2015 Obamacare rates should not rise that much since the base of the operation, or the government, will not allow the bungee cord to run anyone into a bridge support. All things being equal, the insurance companies will better understand the new regime, and they will be able to more accurately generate reasonable rates.

2. Accountability

In the past, insurance companies set lifetime limits or high dollar amounts on their coverage. With ACA,an insured person may seek medical treatment without worrying that they’ll have to stop getting help when their dollar limit is reached. Now they can receive treatment for as long as it takes to fix the problem. Additionally, insurance companies must justify rate hikes before they take effect. They must also use 80 percent of their income toward coverage for their insured, with rebates if the amount goes over. No more billion dollar advertising budgets or bonuses for the board of directors. Healthcare fraud is also a major portion of the ACA. In the past, health care fraud was responsible for millions of dollars taken away from the sick and the innocent. The ACA is holding the medical community accountable, so sick people don’t pay more.

The 2015 health insurance rates will be interesting to see. Insurance companies are only now garnering information on their unexpectedly older insured’s, due to the time lapse of getting treatment and the filing of claims. This is called the risk pool. A general projection of these data was made to reflect in the 2014 insurance rates, but for 2015 there should be more concrete evidence.

Additionally, those whose insurance carried over into Obamacare as opposed to those whose policies had to be reissued in order to comply with the ACA constitute a facet, which will impact 2015 health insurance rates. Here is a basis for comparison, with known quantities and usage. This, too, will help keep future rates reasonable.

3. Help for the Helpless

Formerly, if a patient’s insurance was cancelled becaus he or she got sick or made an honest mistake on an application, there was no recourse. The person was out of luck and out of insurance. Now, under ACA, there will be no cancelling of policies for any reason other than non-payment of the premium, which can only occur after the ninety (90) day grace period lapses. There is an appeals process with a three day turnaround on a decision. Children may stay on their parents’ policies until age 26. Young adults don’t usually make enough to afford insurance on their own, unless they’re insured through their company. Now they have a chance to stay covered until they make better money and can afford it themselves.

4. More Doctors

More Americans are becoming insured. This puts a terrible load on the primary care physicians in practice. The ACA has made provisions for the training and establishment of new primary care physicians, nurses and the foundation and operation of health care centers. It also promotes better coordinated care between physicians and specialists and gets better rates for doctors who accept Medicaid and/or work in rural areas.

5. Women and Seniors

Medicare has been expanded to include yearly checkups, wellness and preventive care measures for seniors. These measures are free of charge and do not impact Medicare premiums or deductibles. Women now have access to wellness and preventive care, for which they formerly paid. These, too, are free and include breastfeeding, contraception, domestic violence, gestational diabetes, HIV screening and counseling, sexual diseases and wellness visits.

6. Donut Hole

Medicare Part D is the prescription drug plan for those seniors and some disabled people on Medicare. Each year, the donut hole will be phased out until 2020 when it will be closed for good. Until then, those using Part D will pay their deductibles as well as the cost of their drugs until the total amount paid out-of-pocket by both the participant and the Part D plan reaches $2,960. This amount is for the 2015 calendar year and may change in future years. After that, they will be in the donut hole, which means they will pay a certain percentage of their prescription drugs in addition to any dispensing fees. The plan will pay the remaining percentage.

The reason that the donut hole period is so financially straining to Medicare participants is because they typically have to pay more than half of the cost of a prescription drug when they were used to paying only a copayment or coinsurance payment before. For seniors and the disabled who are on expensive prescription drugs, that donut hole could mean thousands of extra dollars each month they don’t have if they live on a fixed income. For these people, the ACA is a blessing in plain sight. In 2015, the insured will receive a 50 percent discount from drug manufacturers along with a five percent subsidy from the government, leaving the insured paying 45 percent for their prescription drugs. The government subsidy will rise each year, leaving less for the Part D participant to pay out-of-pocket, until the donut hole closes in 2020 for good.

The health insurance marketplace is a thing of confusion to many seniors and the disabled. However, these folks don’t have to bother with their state health insurance exchange unless they have Medicare Advantage. Moreover, if seniors and the disabled buy Medicare supplement policies, they could save a lot of money shopping the health insurance marketplace for good prices on premiums and deductibles.

7. Money Talks

One of the best things about the ACA is that it gives the lowest income families and individuals a chance to buy affordable insurance on their state’s health insurance exchange. Government subsidies are probably responsible for a majority of people getting insurance who fall into the range of the federal poverty level. Folks applying to their state’s or the federal health insurance marketplace may choose to receive their subsidy monthly to help pay premiums, or they may choose to have it applied to their federal tax return in April. Additionally, many states voted to expand Medicaid, so those who still can’t afford health insurance can get coverage. This is even more attractive given the number of primary care physicians who are being given a little extra for accepting Medicaid patients.

8. Healthcare Spending

The enacting of ACA has lowered healthcare costs over the last three years, according to the White House. When healthcare costs are under control, health insurance premiums are lower. If health insurance premiums are lower, employers can afford to higher more full-time workers because the cost of their group health insurance plan is less than budgeted. Additionally, healthier and more secure workers are productive workers, which will ultimately boost sales and company finances.

9. What Works

Weeding out expensive treatments and prescription drugs that don’t actually help much is one of the provisions of ACA that means the most to everyone. Doctors are concentrating more on their patients’ basic needs, prodding, asking questions and getting to the root of the matter. Questionable treatments and drugs, therefore, have no place in the American medical world. Value, not volume, is the order of the day, which thrills those ill that formerly despaired of actually getting healthy again. This too will keep the prices down and will take a load of destructive side-effects and time-and money-wasting treatments off the medical market.

10. Essential Benefits

The ACA has made it mandatory that all insurers include in their policies ten essential benefits. These benefits are the most important to Americans, because:

  • A potentially serious condition or disease may be caught and treated or controlled before it blows up into a full-blown and expensive disease
  • Americans may now afford a doctor instead of the emergency room, thereby saving money on bills they can’t pay
  • No one has to worry about affording screenings and diagnostic testing for cancers and other conditions that could have been prevented

These and more were considered when the ACA was being drafted. Health care costs were blown sky high because people couldn’t afford the most basic testing and preventive care, going to the emergency room only when a condition or illness got so bad they needed help. Then the ER bills were so awful a lot of people had to file bankruptcy. There are many who were never able to pay the bills. The essential benefits were added to the ACA to bring down medical costs and save lives. They are:

  1. Outpatient care, or ambulatory services
  2. Prescription drugs
  3. Emergency care
  4. Hospitalization
  5. Mental and behavioral health care
  6. Rehabilitative and habilitative care
  7. Laboratory tests
  8. Preventive and wellness services
  9. Pediatric care
  10. Newborn and maternity care

Quality is defined as a product or service that is worth something. The ACA has defined quality health care and is making it affordable for all. That’s a good thing.


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