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Patient Protection and Affordable Care Act

By Dr. Joseph Andresen

Healthcare reform.

My name is Dr. Joseph Andresen. I am a practicing physician and anesthesiologist.

Firstly as a physician, I want to tell you of the story of a patient. Mary was brought to the operating room after admission from the emergency department. She had a high fever, racing heart rate and low blood pressure. An infection had spread throughout her body and blood stream. Emergency surgery was needed immediately to treat her life-threatening infection. I asked Mary why she had not come to the hospital sooner. She tearfully replied, “I have no medical insurance. I waited until I knew my life was in danger.”

Secondly as a father, when my daughter was 3 years of age, she had a life threatening illness. I didn't know if she would survive. She underwent several surgeries and thankfully recovered. 19 years later she is a college student and enjoys good health. However, she was not eligible for health insurance and relies on a high-risk pool state program that costs hundreds of dollars a month.

Finally as a patient, when 15 years ago, with a young family, I was diagnosed with cancer. I'm thankfully alive today because of the excellent physicians who took care of me, and with medical insurance that covered my care. However ten years passed before I could again qualify for an individual health insurance policy.

On March 23, 2010, President Obama signed “The Patient Protection And Affordable Care Act” into law. After more than a year of national debate, partisan bickering and town hall meetings, a health reform mandate is now a reality. But what does that mean for you and me, our doctors and hospitals? The intent of this legislation is clear: to provide affordable health insurance to 32 million more Americans, to bend the cost curve of escalating heath care costs, to improve quality and to bolster preventive health care services.

Looking back over these past 12 months, I think we can all agree that the legislative process is uncertain, sometimes unsightly, but hopefully productive in the end. Health-care by its very nature is an emotional topic. Your relationship with your doctor is personal, private and one that requires the utmost trust at times when we are most vulnerable. No one wants intrusion into this relationship, neither from the government and insurance companies nor bureaucrats. Yet we do rely on our federal and state agencies for our safety: of our food and water, prescription medications, police and fire protection, even airline travel. And if you're a senior citizen, certainly your Medicare benefits.

What Led To The National Discussion Of Health Care Reform With Such Urgency?

There have been growing numbers of both working and unemployed Americans without health insurance. An estimated 40,000 lives are lost annually due to delayed treatment or lack of medical care. Medical bills are now the leading cause of bankruptcy, home foreclosures and financial ruin. And as a nation, we find ourselves paying too much and in many cases getting too little.

As we see in the chart below, we currently spend more than twice as much as our industrialized counterparts yet rank much lower in the major measures of health and longevity.

What Have We Learned Over The Past Year?

Health “insurance” is really a means of financing healthcare. Unlike auto, fire or homeowner's insurance, it is something that we expect to use and rely on regularly. Secondly, misinformation has hurt our understanding of the issues, and hindered the constructive dialogue so desperately needed to find solutions to the problems that we face. As an example, the originally proposed legislation had a provision to provide physician counseling for patient autonomy in making decisions for end-of-life care. Just as we may seek the expertise of an attorney for estate planning, your physician is the best person able to inform you of your rights, to ensure that medical care decisions are followed in the future, and at a time when we may not be able to make them competently for ourselves. The mischaracterization of this as the creation of “death panels” by a vocal minority, and the fear and hysteria generated by such claims resulted in this important provision being dropped.

Another example was the claim that the health care reform law would result in a government take-over of medicine and bureaucrats would come between you and your doctor. The new law does nothing to interfere with the relationship between you and your doctor. Those who are happy with their current health insurance coverage may keep it. However insurance companies will be held to much higher standards both by states and the federal government, and there will be much more scrutiny of the nearly half a trillion dollars paid out each year for Medicare services to prevent waste, fraud and abuse.

What Benefits Should We Expect?

Let's look at the first goal — to expand access to coverage. The new law will now require most U.S. Citizens and legal residents to have health insurance. With insurance coverage, those seeking treatment should have improved access to care without the fear of financial ruin. Requiring the vast majority of citizens to participate broadens the (risk) pool so that average costs of premiums are reduced and those with chronic illnesses aren't excluded.

A healthy young person may ask, “Why should I be required to buy health insurance?” In the event of an accident or serious illness, the costs of treating those who are currently uninsured increases health insurance premiums by $1000 per year on average, for all who are insured. Thus, everyone needs to participate to keep overall costs under control. A $95 individual tax penalty would begin in 2014 for those uninsured, continuing to be phased in and reaching a maximum of $695 for individuals, $2085 for families by 2016, who continue to voluntarily remain uninsured. Certain exclusions would apply to those demonstrating religious objections, financial hardships, or who are American Indians.

There are now significant protections for consumers through sweeping health insurance reform. This includes a, “no pre-existing condition exclusion,” the ability to take your policy with you when you change jobs, no lifetime caps, a minimum standard of required benefits in all policies, and at least 80% of all premium dollars collected going directly towards medical care. Health insurance exchanges, tax credits for small businesses, premium subsidies for low-income individuals, and expansion of Medicaid eligibility with increased federal funding — will expand coverage to 30 million more Americans.







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