Last night, Barack Obama was re-elected president of the United States.
So, the Affordable Care Act (ACA or Obamacare, as it’s commonly known), having survived its precipitous birth and a few close-calls with death, is poised to enter a prolonged and awkward adolescence.
I haven’t spent a lot of time educating myself about Obamacare because of the possibility that it would be overturned after the election. Now, however, I want to know more, but it’s not easy to get clear answers because so much has yet to be decided and defined.
Kaiser Health News has prepared a brief summary, After the Election: A Consumer’s Guide to The Health Law, of the law’s provisions and the dates they go into effect.
I am not a huge fan of Obamacare because it seems to be more health insurance reform than health care reform. Expanding insurance coverage to more people, although an admirable goal, will most likely increase the use of medical services and therefore increase spending.
When Medicare and Medicaid were enacted in the 1960s, both programs saw a huge increase in the use of medical services, and both programs FAR exceeded cost expectations.
One provision of Obamacare already in effect is that preventive care, as determined by the government, must be covered without co-pays or deductibles. (I don’t think of this care as free, since my premiums have gone up significantly; I prefer to think of it as pre-paid.) Ideally, people will see their health care providers more regularly and stop the explosion of chronic, emergent and expensive health problems. In theory, this will decrease costs over time.
Much depends on the population’s willingness to obey the mandate that everyone have health insurance. But will the premiums be too high and the penalties too low?
The mandate takes effect in 2014, as do the much talked about health insurance exchanges. Exactly how will these work? Which states will offer state-run exchanges, and which will opt for federally-run programs? Whatever each state decides, the exchanges must be operational by October 2013—less than a year away!
Also starting in 2014, no one can be denied insurance for a pre-existing condition, and all plans must cover “essential health benefits” as decided by the government, including mental health, substance abuse, prenatal care, birth control, dental care and vision care for children, and prescription drugs.
Companies with 50 or more full-time employees will have to provide health insurance or be fined. Will employers comply, or will they lay off or make workers part-time to avoid the penalties?
Will special interest groups, such as the pharmaceutical industry, be able to manipulate the provisions of the law to their benefit?
I believe our country is desperate for true health care reform and cost control. But is Obamacare trying to balance an unwieldy attempt at universal care on top of an extremely fractured and unstable health care framework?
I reserve the right to be cautiously pessimistic.