As President Barack Obama was sworn into his second term at the White House, the Patient Protection and Affordable Care Act — commonly known as Obamacare or ACA — was set in stone for the next four years with virtually no risk of repeal. Even though the legislation was initially approved in April 2010, many Americans still don’t know how this legislation will affect their health service providers and insurance cost over time.
Dr. Elbert Huang, an associate professor of medicine at the University of Chicago, worked on the implementation of the Affordable Care Act in Washington D.C., from 2010 to 2011. He said it was an opportunity he could not pass up. Huang helps to answer some common questions people have about the new health-care reform.
Q: When Obama first signed the legislation in 2010, what changes did we see to health care immediately?
A: In general the first portions of the law [to be implemented] dealt with insurance coverage regulation. One of the early changes was allowing parents to keep children under their insurance until the child turns 26, regardless of school enrollment status. The other changes were related to pre-existing conditions. Now insurance companies are not able to prevent people from getting insurance and they can’t make it difficult for someone to keep insurance if they get sick. There was also affordable preventative care [such as screening tests] for those on Medicare. Most of the procedures for these patients have no co-pay.
Q: What should we expect to see this year?
A: It’s difficult to say what regular people on the street will see this year. People probably won’t notice anything because 2012 and 2013 are preparation years for what we’re going to see in 2014. The states that have decided to participate and set up their own insurance exchanges for the following year are doing all of this outside of the public eye.
Q: It’s been estimated that in 2014, approximately 30 million new people will be able to purchase private insurance on these federal or state regulated exchanges, making it the largest spread of health coverage since the establishment of Medicare in 1965. What will this do to medical facilities? Will there be enough medical care to go around with that large of an influx?
A: There is already a lot of experience from the Massachusetts [law] that tells us what will happen. It depends on where you live in the country. How many people are insured, how many will become insured in 2014 and how many medical facilities the area has. It will vary from place to place. We know that the system will work in terms of getting people insured because almost 98 percent of people are covered [in Massachusetts]. The reason it’s somewhat disturbing for other states is that [Massachusetts] has the highest density of primary-care doctors per population. Some of these newly insured patients might still end up in the emergency room instead of a primary-care office and there’s always a concern about discriminating against people who have certain types of insurance.
Q: So we’ve talked about how this will impact patients. What about the doctors? Is Obamacare going to be a positive or negative change for both public and private medical facilities?
A: Right now we pay doctors for every piece of work they do. That hasn’t changed. Most doctors can and will function just as they did before. But because of more pressure on insurers, hospitals and doctors are going to be under more scrutiny to maintain costs and be efficient when practicing medicine. But this has always been the case too.
The law is actually very friendly to primary care-doctors. There’s a financial incentive for primary-care doctors to stay in business. In general it will make it easier for private practices to run as efficiently as a public hospital. But it will definitely encourage doctors who are innovators. The law has set aside about $1 billion to fund pilot studies in health- care innovation. University of Chicago currently has two large-scale grants from the fund, to study more efficient medical practices.
Q: You mentioned the added pressure on insurance companies. Because of Obamacare, they are now required to spend 80 percent of a patient’s premium dollar on actual medical care. How do you think this will impact the health insurance business, and why was this an important factor in the legislation?
A: The insurance regulation definitely puts a squeeze on insurers, but this is a good thing. Premiums have continued to rise for years when the economy has continually gotten worse. Even doctors think that insurers spend too much money on administration and advertisements. This law has helped to shine a light on incredibly high health-care costs in the U.S. and hopefully bring about a better use of our health-care dollars.
Q: After personally working on the legislation, what are your final thoughts about Obamacare? Do you think we’re heading in the right direction with this legislation?
A: The Affordable Care Act is an incredibly complex and imperfect law, but this is landmark legislation for American health-care history, kind of the starting place for a lot of important changes. The country was already facing problems of rising health-care costs and this has sort of sparked the changes that needed to happen. More people are going to be able to afford coverage, which is really a moral step in the right direction for everyone. It will be a bumpy road but in about 10 years expect to see a much better health-care system.