President Obama signs the Affordable Care Act two years ago. (J. Scott Applewhite/AP)
It seems like President Barack Obama's controversial health care reform law has been fodder for Republican swipes and grievances for ages. And it sort of has. Wednesday marks the two-year anniversary of the House narrowly squeezing through health care reform, which the Supreme Court will begin reviewing next week before deciding on its legality sometime this summer.
The law was quickly challenged by states' attorneys general, while congressional Republicans vowed to "repeal and replace" it. The new regulation also galvanized the tea party movement, which was credited with changing the political landscape and driving home a Republican-swinging 2010 midterm election. But since then, the public demonstrations have quieted, in part because the most controversial aspects of the law will not go into effect until 2014. The popular consumer-protection parts of the law were intentionally front-loaded.
Even so, a recent Gallup poll found that Americans are evenly split on whether they think the health care law should be repealed. Only 1 in 7 respondents in another poll said they had experienced something positive from the law. A recent Congressional Budget Office (CBO) report estimated that 5 million people may lose their employer-based insurance between 2019 and 2022. The CBO also found that 2 million fewer uninsured Americans would gain coverage by 2016 than previously thought, and that the law would also be slightly cheaper than original estimates.
With the Supreme Court arguments about to begin, let's make sense out of what's happening health care wise. Here's a quick rundown of what's gone into effect and what to expect in the future, with the help of research from the Kaiser Family Foundation.
Already in effect
The more popular, consumer-protection oriented parts of the law were scheduled to go into effect first, and that's not a coincidence. The president knows he needs to build public support for the law before rolling out the more controversial measures.
Insurance companies have already submitted to new rules, which will prevent them from setting a "lifetime limit" on benefits for any of their paying customers. They can't refuse to cover children who have preexisting conditions or kick off kids from their parents' plans until they reach 26 years old. (About 2.5 million young people have stayed on their parents' plans under that last feature, according to the Obama administration.)
Seniors who reached the Medicare part D prescription coverage gap received extra money for drugs, small businesses that insure their employees qualified for new tax credits, and about 50,000 adults with preexisting conditions who have been denied coverage in the past joined a new high-risk pool created by the law. (And by 2014, insurance companies won't be able to deny coverage to sick adults.)
Hoping for a John Boehner-like glow? Your wallet might take a hit with the new 10 percent tax on indoor tanning, which the law ushered in. But other, more essential services will see savings, with some families benefiting from certain preventative care measures, like checkups, which must be offered free to those on Medicaid.
Some plans that haven't changed significantly since the law passed are "grandfathered" and can sidestep some of these new changes.
What's coming this year
We've already had a preview, with the controversy surrounding Rush Limbaugh's attack on Georgetown law student Sandra Fluke's endorsement of free birth control, but by this coming August, insurance plans must offer contraception to women without a co-pay. It's part of a list of preventative services, like cholesterol screening, that the law says must be given without cost sharing. After religious groups protested, President Obama said religiously affiliated organizations like Catholic hospitals would have another year, until 2013, to comply with the mandate. The administration says the insurer will have to reach out directly to the customer to offer contraception, so that the religious employer does not have to.
Depending on your insurer, you might just benefit from a little extra cash. For the first time this year, some insurance plans that spend more than 20 percent of their customers' premiums on nonhealth-care related expenses such as marketing will be required to send customers cash rebates. This rule is meant to encourage insurance companies to keep premiums down by punishing them if they don't reduce their overhead.
One of the most popular components of the health care law (according to a Kaiser Family Foundation tracking poll) is set to go into effect this fall, when health care plans will have to publish a uniform, easy-to-understand description of their benefits so that customers can comparison-shop.
Healthcare is changing. Changing radically and driven by powerful forces of cost, technology and consumer empowerment.
Here's what you can look for:
1. The electronic medical record. All your health records will soon be stored electronically. The don't live in a file at the doctor's office, radiologist or hospital anymore. This "instantly accessible" tool will be a significant advance for care anywhere YOU may be. Further, the emergence of the EMR will help drive superior care and less medical errors as computers can flag potential problems.
2. The clinical cloud. It's no longer only your music that will be downloadable. But soon, your health record will be digital and follow you. You CAT scan and ECG are a click away for any necessary viewing.
3. Retail Medicine. Yep, it's already there. But the medi-clinics on the corner will be replaced by chain-style medical offices that will appear in your local mall or big box store. Even retail pharmacies will expand their service to include some medical care.
4. Smart phone monitoring. Your smart phone will monitor your ECG, blood sugar, sleep patterns (to name a few) and alert you and your doctor when there's a problem. It will track and record these trends and offer valuable diagnostic information.
5. Expert engagement at a distance. Distance is no longer an issue. With video engagement and the medical cloud at hand, difficult (and even simple) cases can be evaluated by experts around the world. Even surgical proceedures by physicians thousands of miles away--with the help of robotic.
6. Implantable devices. Pain, depression, and common conditions that are generally treated with pills will be succesfully managed with implantable devices that use both drugs and electric current to stimulate and normalize conditions with less toxicity and superior long-term managment.
7. On-line office visits. At-home diagnostic tools and data transfer to a physician's office will reduce the need for an actual office visit. Video conferencing and these diagnostic tools will provide an accurate assesment, care and risk-management.
8. The patient-doctor. The empowered patient will learn to make informed decisions based upon new at-home tools and techniques. We will measure our own blood chemistries and take and transmit our ECG's. Our actions, guided by experts will allow us to be engaged and informed.
9. Value driven intervention. Cost will emerge as a key factor in care. And value will be an important element. Patients will be rewarded for seeking cost-effective care and value seekers "shop around" procedures like CAT scans on the basis of technology and cost. Long gone will be the day of having a complex test without knowing or caring about the price.
10. The vanishing private practice. The economics of medicine are squeezing the solo practitioner. Seeing "your" doctor at Walmart may be more likely than that small practice in your home town.
We believe every kid in Oregon should be a healthy kid and our goal is to make sure they have health coverage.
Depending on family income, children may be eligible for free or low-cost health coverage for doctor visits, dental care, vision, medicines and more through the Healthy Kids program.
Our site has information about Healthy Kids, including eligibility, services covered, and how to apply. There's also a place to find out how to help us spread the word and/or to partner with us to help families apply.
1. Focus on patient safety
1. Focus on patient safety
Hospitals will dedicate themselves to preventing medical errors and improving patient safety at all levels of the organization. Wireless will be an enabler - helping to merge and deliver information to avoid errors.
2. Electronic medical records arrive
Electronic medical records will become a reality. Transportable "e-records" will help to support higher quality care, while protecting patient privacy and cutting costs. Cell phones will become the "key" and only communication device we will need.
3. Cost containment
As healthcare costs continue to increase, driven by medical inflation and volume growth, policymakers will consider limits on reimbursement rates for doctors and hospitals as well as technologies to reduce costs in the long term. Administrators will again be asked to do "more with less."
4. Pay for performance
Incentives to reward physicians and hospitals for quality care and improved outcomes will take hold. Modeled after the Centers for Medicare and Medicaid Services' voluntary quality-indicator reporting system, similar "pay for performance" incentives will help improve the quality of patient care.
5. Information technology gets respect
As information technology is recognized as a vital part of hospital operations, consuming a higher percentage of the organization's budget, IT management will become an integral part of the clinical management process and member of the management team.
6. Consolidation of insurers
Insurers will continue to consolidate creating additional leverage in contract negotiations. Similar to company pension plans, our health insurance will become defined contribution not defined benefit. 401K-style health plans arrive.
7. Nurse staffing
Following California's legislation that sets mandatory staffing levels in reaction to nursing shortages, more states will consider similar legislation, prompting a deep fissure within the industry over whether such laws are necessary or harmful to staff and patients. The laws themselves will cause more shortages.
8. Healthcare professional shortage
As demand outpaces supply, the industry will increase compensation and develop pro-active recruitment programs to help promote healthcare careers at higher education institutions.
9. Here come the baby boomers!
The aging "baby boom" generation presents a major public policy concern for long-term care due to its size and anticipated use of resources, as well as boomers' "high maintenance" reputation compared to their predecessors.
10. The uninsured
The large uninsured and underinsured population will continue to present the system with a grave dilemma. Due to economic pressures the many working poor and young workers in their 20s will choose to be uninsured