It is difficult to ignore the impact that the “Patient Protection and Affordable Care Act”, lovingly known as “Obamacare”, has had on our national government. Love it or hate it, “Obamacare” is here to stay.
I am hopeful that the Patient Protection and Affordable Care Act will do what its’ name suggests…provide consumer protection and be affordable. For many people living in the Methow Valley, who currently have health insurance, not much will change. If they are enrolled in Medicare, Medicaid, or the Children’s Health Insurance Plan, or if they receive health insurance through their employer, there should be little or no difference. The biggest impact will be for low-income individuals and families who did not previously qualify for Medicaid. Because Washington took the option from the Federal Government to expand the Medicaid program, anyone earning up to 138% of Federal Poverty Level will now be eligible for state funded health insurance. For an individual this means up to $15,856.00 per year or for a family of four, earning up to $32,499.00 per year. Up to 400% of FPL, families may be eligible for reduced premiums. However, if Facebook chatter is any indication as to how this demographic might look at Obamacare, there still seems to be some disagreement on affordability. This might require a shift in thinking if you have been uninsured in the past by choice and now must pay a monthly premium or face penalties.
Without a doubt, there have been consumer protections that have already been implemented by most insurance companies because of the law. We should all be relieved that no parent will have to watch the lifetime benefits of a child with cancer expire because the cap had been reached; and, no one can be denied insurance because of a preexisting condition. These are important safeguards for everyone.
As with any new law in healthcare, there are changes ahead for the medical profession as well. There is a shift away from the current fee for service model to new payment systems like Accountable Care Organizations, which reward quality, not quantity. As with any major change, navigating the new environment can prove challenging, particularly for small practices. Updated coding will require further education and documentation requirements. Practices, too, will have to be aware of plan options and limitations, just as consumers must, and I’m sure many patients will rely on their primary care provider offices to provide information. Certain plans may not offer full benefits out of your area. People may not realize this until they wish to see a specialist or choose a hospital and find out they must pay more out of pocket than they anticipated. Also, with many plans, deductibles could be high and patients will still face charges for their visits that might have been covered under a prior plan. Practices will also be looking at insurance options from the employer perspective as well. Each practice will have to assess the plans and compare them to what they currently have. Again, Room One is particularly helpful in this effort. As well as their “in person assisters,” they spearheaded educational opportunities in our area by coordinating a Community Forum to help small businesses understand the new healthcare law.
So, whether you think, as some do, that Obamacare will hopelessly divide the country and lead to financial ruin, or, define us as a more compassionate nation and lead us to better outcome driven healthcare at lower cost, it looks like it will roll out as scheduled. Let’s try to work together to make the necessary compromises to put us on a path to better health for all, as individuals, and as a nation.
- Bev Jenson, Methow Valley Family Practice, Clinic Coordinator