The Affordable Care Act is designed to address problems in the health care system and, believe it or not, “not make life more difficult,” said Sheldon Weisgrau who addressed three separate audiences in Iola throughout Thursday.
Weisgrau said most people’s information of the ACA “has been filtered through politics,” which is not the most accurate. Weisgrau is director of the non-partisan Health Reform Resource Project, Topeka.
The need for reform is simple, Weisgrau said, because “we do not have the best health care system in the world,” with access, quality and cost being the reasons.
He noted 45 million Americans under age 65 are without health insurance, including 250,000 in Kansas, or 14 percent of that demographic. In Texas, sometimes held up as a model for Kansas governance, 25 percent of those under 65 are without health insurance, the equivalent of the entire population of Kansas.
Also, many people are underinsured.
“The No. 1 reason for personal bankruptcy in the United States is medical debt, and those are people who have insurance, just not adequate insurance,” Weisgrau said. “For the past 25-30 years health care costs have exploded and as a result health insurance rates. This is not a symptom of ‘Obamacare,’ but of a long trend.”
THE HIGH COST of health care has exacerbated the way health insurance has been sold, and a facet the ACA intends to address.
Before, the care law insurers did not sell insurance to people with certain pre-existing conditions, such as cancer, heart disease and diabetes. They also “carved out parts of the body” if a person had had certain problems, such as with kidney stones.
“They’d devise a policy that omitted coverage of the entire urinary tract,” the area where kidney stones develop.
In the evening session Weisgrau took the opportunity to highlight the sometimes disingenuous practices of the insurance industry.
“True story: A woman’s health insurance policy was dropped when she was diagnosed with breast cancer. The reason? When she applied for health insurance she did not list her treatment for acne as a teenager as a pre-existing condition.
“Folks, under the ACA, pre-existing conditions will no longer be considered when applying for health insurance. The new law also prohibits the ability to cancel one’s policy.”
Four things will determine the price of the new health insurance premiums: Where you live; how many people will be covered; your age, and if you use tobacco.
Smokers in general incur about 50 percent more in health care expenses than non-smokers because of the many diseases and illness associated with the habit including emphysema, asthma, diabetes, high blood pressure, cancer, and other lung diseases, Weisgrau said. Smokers also will not be able to receive any tax credits for their health insurance premiums.
The quality of health care varies in the United States, he observed, and depends on “where you live, your finances and the color of your skin.”
An estimated 100,000 people die a year because of errors in the health care system.
“To put that in perspective, that is the equivalent of one airline accident each day,” he said. “Don’t you think people would be upset” and crying for change if that happened?
“The uninsured are sicker, poorer and die more frequently — and that’s why ACA was passed,” Weisgrau said.
Changes include better oversight of how a patient fares after he is dismissed from the hospital.
How physicians are paid also must change. Instead of paying them for a service, their pay should reflect the outcome of that specific service.
ON TUESDAY, the marketplace to buy insurance opened to overwhelming demand, making the online system basically inoperable.
“The demand was beyond our wildest dreams,” Weisgrau said.
His advice is for people to wait several weeks before going online to investigate insurance plans.
“There’s no hurry,” he said. “Insurance coverage doesn’t start until Jan. 1,” for those who apply before year’s end. The window to apply is six months, until March for the first rollout of the program.
For successive years, the window to enroll will be Oct. 15 to Dec. 7. By law all U.S. citizens must obtain health insurance or face penalty. The first year’s penalty is $95 or 1 percent of one’s income, or whichever is greater. The second year’s penalty is $325 or 2 percent of one’s income; third year is $695 or 2.5 percent of one’s income.
The Kansas plans are accessible via the federal website, healthcare.gov. The Kansas Insurance Department’s also has a wealth of information, Weisgrau said, and can be accessed at insureKS.org.
Currently, the plans are predominately for those who currently do not have insurance and for those who buy it on their own, including small businesses with 50 or fewer employees.
Depending on income, those obtaining coverage through provisions of the ACA may receive immediate tax credits to offset what they pay for the insurance.
Tax credits are available for people earning from 100 percent to 400 percent of the federal poverty level, which varies also with the number of people in a household.
HE ADDRESSED several myths that have plagued the law.
“It is a very big law, contains 906 pages and 10 titles, because it covers so much, but it isn’t 20,000 pages or 100,000 pages as some opponents have tried to get people to believe,” Weisgrau said. “It’s big because it covers a lot of territory.
“I’ve never seen people so angry,” because of the wealth of misinformation rained on them, he said. “The fact is, the insurance system, public and private is not changing,” but access is for all of the 45 million currently without insurance.
“It’s not socialized medicine and it’s also doesn’t lead to government control. Federal employees are not exempt.
“There are no death panels. When you’re 75 no one is going to decide whether you have to die at age 76, as a woman thought,” he said. “It just isn’t true.”
Insurance is mandated so the young and healthy won’t drop out, Weisgrau said.
His example: A 25-year-old opts to pay the $95 penalty, but then suffers a severe injury. “He can’t call from the back of the ambulance and get insurance if it’s outside the enrollment period,” he said.
On average today a single policy premium is $6,000 a year, $16,000 for a family. Those numbers will be reduced for many people through provisions of the ACA.
Companies will be able to offer lower premiums because what ACA essentially does is create a huge group plan, he said, much as what companies and associations do today. Actuarially, the claims costs are spread over many people, only a percentage of who are likely to require health care in any particular period.
Purchasers also may select from four plans, with the bronze having the lowest premium but the highest deductible and the platinum the highest premium and lowest deductible. People under age 30 may choose a catastrophic plan that has a very high deductible.
For a large and rapidly growing proportion of the population, Medicare will see few changes and none of any significance, Weisgrau said. Medicare came into existence in 1966 and is available to anyone 65 or older.
“Health care reform is nothing new,” Weisgrau said, with attempts beginning in 1912 with President Teddy Roosevelt and resurfacing with the administrations of Franklin Roosevelt, Harry Truman, Richard Nixon and Bill Clinton.
