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The Affordable Care Act: Working to provide care!

 Now on to the topic of health care reform better known as the Affordable Care Act or to some “Obamacare”, which I have to say, is a name I have never liked.  I cannot say that I agree with every aspect of the ACA, but there are portions that are very good for those with HCM and other pre-existing medical conditions that will keep us from becoming disenfranchised from access to healthcare.

teen middle age fitness

Let’s start with just as a small history lesson as to how health care in the United States got to the point that it’s at and how the ACA may balance the playing field a bit.

There is a great article in the New Yorker that gives a fantastic history for those so inclined to read it all here is the link:http://www.newyorker.com/talk/comment/2009/12/07/091207taco_talk_lepore

But here is the snap shot:

In 1916 a Yale economist, Irving Fisher predicted that universal health coverage was just around the corner. “Within another six months, it will be a burning question,”.  Some historians think this was the comment that caught the attention of the physician community, specifically an organization called the American Medical Association.     It was the AMA who was against reform, due in part to the way in which medicine was practiced that time.  Medicine was a business, even then and has continued to grow as a business model, making the USA a very different system then others in the world.  The medical establishment of the day feared loss of control to the hands of government.   In years to come they lost control to insurance companies with profit motives, then the AMA changed their tune and began to work toward reform.

Now let’s look to more modern times. Unless you have to access care through on of the “government run” health care plans, you likely don’t know how they work, let’s review the basics.  .   Medicare is a national social insurance program, administered by the U.S. federal governmentsince 1966.  This is a system paid for in whole by the federal government, to which participants fund through taxes (with the exception of those deemed “disabled” and who meet the qualifications of the program).   Medicare provides care to approximately 48 million (40 million age 65+ and 8 million younger with disabilities).  This coverage is not 100% coverage and supplemental coverage is normally carried in addition to Medicare.

Medicaid in the United States is a social health care program for families and individuals with low income and resources.  Medicaid is managed by each state and they determine qualifying criteria.  Federal funding is given to states to manage these programs, and each state handles this program slightly differently.  For more information on these programs please visit:https://www.cms.gov/About-CMS/Agency-Information/History/index.html?redirect=/history/

For those who noticed signs and banners on TV from protesters against the ACA – such as “keep government out of our Medicare” or “I don’t want government in my healthcare”, the reality is we have a form of government healthcare and have for 40 years, yet our capitalistic society continues to flourish and function.   The reality of the ACA is not to expand “government control” of healthcare; it is to ensure that all citizens have coverage to avoid building a system that is completely unstainable.  The coverage the ACA seeks to provide for the largest percentage of those who will access care through it is in the private market and those policies must me specific requirements.  The “exchange” system set up on www.healthcare.gov, was a nightmare the first few months (as are many new websites – but like many of you I was frustrated at the amount of money dumped into the system that didn’t work well).  It is now working well and millions of Americans are accessing information to make choices about what policy is right for them.  You see it is THEIR choice as to what policy to pick.  The argument that “the government should not force people to purchase coverage” is one that does not work for me – the reality is if you are a member of a society you need to be a responsible member of the community.  If you are sick or injured (which will happen to ever person on the planet – it is simply a consequence of being human) you will need access to care and you will have to pay for that care, if you don’t we, your fellow citizens do.   If you “opt out of coverage”, you pay a fee to the government, which will be used to pay for those healthcare expenses of the uninsured and do not pay their bills rather than passing on that burden to other citizens as it was done prior to ACA.

Now I want to share 3 stories, they are brief examples of those who are benefiting from access to care through the ACA.

Hugo – Being self-employed and diagnosed with HCM, Hugo found himself in the unfortunate situation of having a pre-existing medical condition and no private insurance company would issue him a policy (prior to the ACA).   Living with an ICD and the reality of a replacement device in his future he was left fearing financial disaster until January 2014 when he was able to access a policy through the ACA.   He had his choice of programs, he did not qualify for tax credits and he is happy to have health care through his new plan. Learn more about Hugo and his work here:https://www.facebook.com/ICDUG

Jean – in full disclosure – Jean is my “kinda sister-in-law” also known as my nephew’s mother.   Jean is a single mother and had no coverage for herself or her child for years.   Having struggled to support herself and her child and working in a field that historically did not provide health insurance, she was unable to find reasonably priced coverage after having a bout of lymes disease.  On January 1, 2014 she and her son (a full time college student) were able to obtain a great policy that will give them both the ability to seek long overdue medical attention.  – read more on Jean’s story: http://www.njspotlight.com/stories/14/03/03/with-insurance-deadline-looming-democratic-legislators-pitch-in/?p=all

The last story happened 2 weeks ago, and I have to admit I like this story.   Lisa C. whom I have known for many years through the HCMA contacted the office with a question about how to get refills of her cardiac medication. Lisa C. has a long HCM history (similar to many of our members) and has an ICD and has undergone various procedures in the past to manage her arrhythmia.    She has not seen her doctor in a few years because she was uninsured.  My first question was “why don’t you have health insurance”.   It was a financial issue; her husband’s employer did not offer spousal coverage, she had applied for Medicare and was turned down and the household income was too high to qualify  Medicaid.   I asked “did you sign up for the Affordable Care Act yet?” she replied “No, I don’t like Obamacare”.   To be honest this is when I take a deep breath and say “why?”.    She answered like many others I have spoken to before, in short she didn’t completely understand what the ACA was or how she could access it.  I directed her towww.healthcare.gov  to apply.

Most people who are in positions like Lisa C. have many of the same misconceptions about the ACA.  Including the biggest misconception that signing up with healthcare.gov is signing up with a “government run program”.         Over the next few hours I received a series of Facebook private messages from her as she navigated through healthcare.gov.

–ok it says I can get a tax credit, but more info to come, they are sending information off to someone else since I have a health condition?

— ok it says I can get $88 a month credit for insurance

–last question here I hope, a cardiologist is a specialist right? or is it that a Electrophysiologist is a specialist in cardiology?

–Thank you for your help today, I will be enrolling in the morning for a silver package w lower deductible, just need to confirm droffice takes that insurance then I will set up an appt w someone in their office.

–You got my butt in gear; I put this step off for too long it’s going to feel better I know to have it done

Read more about Lisa’s story here: http://www.barnesjewish.org/news/?id=5032&sid=2&nid=1983

In one day with a little information, not from a political source or media with a spin, Lisa C. went from “not liking the ACA” to one of the 7 million who rejoined the world of the insured!

For a great link on how the ACA works I encourage you to watch this: http://www.youtube.com/watch?v=vju70I6qSKk

How the other aspects of the ACA are working (or not) are topics for other Blog posts (and maybe a bottle of wine!)

Cheers!

Cheers!

Thats all for now!

Be well,

Lisa – the Bighearted Blogger