Friday, December 9, 2011

Obamacare is already here; so shut up already!

An average of $569 – that how much some 2.6 million Medicare recipients will save on the donut hole this year thanks to the Affordable Care Act, or as we have all come to know it, Obamacare. 
Over time, the donut hole will gradually close and the cost of prescription drugs will diminish by many billions of dollars.  (If you don’t know what the donut hole is, Google it; it would take too much space to explain here.  It’s enough to know that you can thank George W. Bush’s giveaway to Big Pharm for it as the “tradeoff” for the never paid-for Medicare prescription drug coverage.  You seniors were okay with that, weren't you?)
A Sound Off caller, complaining about government inefficiency today, ended his comment with “Imagine if you will, what’s going to happen when Obamacare kicks in.”
Most people don’t seem to grasp that Obamacare has already “kicked in” and is about two-thirds implemented.  Check out this time line that tells you month by month when various aspects of the law have/will “kick in".  The check marks across the top indicate what has already happened.
It’s true that the insurance mandate won’t start until 2014, but many other parts of this big, complex, law are already operating, or businesses and health care providers  are implementing aspects of it on their own.   You’ve actually been seeing it, in your doctors’ offices and hospitals and in state government, you just don’t realize it. 
The law will lead to standardized, computerized medical records and forms, something a lot of my doctors have already done.  It’s kind of cool when my doctor just sends a prescription by email and the medication is already waiting for me by the time I get to my pharmacy.   And my gynecologist goes from exam room to exam room pushing a computer stand with a computer that already contains all my records.   These modernizations will be huge money savers down the road if they are not already.
In addition, the pre-existing insurance plan tab on the time line shows you what each state has done to provide pre-existing condition insurance.  Here in Pennsylvania, it’s called the PA Fair Care plan. It costs $283 a month, requires a $1,000 deductible and provides coverage for those who are citizens, have been uninsured for six months and have been denied coverage for a pre-existing condition.   Go to this site for details and a web site and telephone number.
This plan really exists. It may not be a Cadillac plan, but it helps.  I know someone who has it and recently had to be hospitalized.  He’ll probably have some uncovered medical bills and that $1,000 deductible to pay, but at least he will not have to file for personal bankruptcy, as he may well have had to do before getting the coverage.
Some of you may have seen the front-page article in the Philadelphia Inquirer Nov. 23, saying that Gov. Tom Corbett is beginning to create what the paper described as “a key and widely supported” state-run health insurance exchange to allow people to shop for the lowest cost health insurance.  Back to the time line:  that part of the law is scheduled to “kick in” Jan. 1, 2014.
As for government inefficiency, the new law does, or will do, a great deal to improve efficiencies.  For example, the Obama Administration has already greatly increased the investigation and prosecution of health care fraud.  The government estimates that fraud costs taxpayers $60 billion a year.  Sixty billion a year! Some estimate that may be the low end. 
The Bush Administration allowed this problem to fester by failing to hire investigators to fill existing vacancies, adopting a laisse faire attitude toward fraud and failing to change a loophole in the law that required Medicare and Medicaid to pay providers and then determine if they were legitimate.
The Obama Administration, even without the Affordable Care Act, instituted special Medicare strike forces in Baton Rouge, Tampa, Brooklyn, Miami, Los Angeles, Houston and Detroit to go after fraud.  Just today (Dec. 9) a judge in Miami sentenced a former executive of the American Therapeutic Corp. to 35 years in prison for health care fraud and the same judge has already sentenced two other ATC execs to 50 and 35 years respectively. Wowser, the Feds are not messing around.
Other provisions of the law restrain health insurers from precipitously raising rates and overcharging for premiums, as well as strengthening the Medicare Advantage program to prevent insurers from gouging subscribers and denying benefits.
Another efficiency included in the Affordable Care Act is the Independent Payment Advisory Board that was scheduled to begin operations in October to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund.  The board is not, however, the “death panel” that the Tea Party conjured up. 
The new law will provide incentives for physicians to join together to form “Accountable Care Organizations” or “medical homes” where groups of doctors will coordinate patient care to help prevent disease and illness, and reduce unnecessary hospital admissions.  I’m already doing that on my own, consolidating my health care among doctors at one hospital who can work together to treat the whole me instead of this part or that part.
Contrary to predictions, rather than kill jobs, Obamacare has created 295,000 new health care jobs. 
And, according to Forbes magazine, a significant number of small businesses are offering their employees health insurance, thanks to the provision in the law that gives them a credit worth up to 35 percent of their contribution to their employees’ health insurance.  That provision “kicked in” Jan. 1, 2010.
We will see what the U.S. Supreme Court rules on the last provision  of Obamacare, the health insurance mandate, and I don’t even want to try to handicap that decision, but much, perhaps 70-80 percent of Obamcare won’t and can’t be undone no matter the Court's decision and for that we should all be grateful.


  1. Hi, Jodine,
    Thank you for covering this most confusing subject. I will study this and pass it along to others.

  2. Please name one thing the government runs that is efficient?
    You also left out that many on the right side of the aisle are calling for the entire act to be repealed! What the SCOTUS doesn't do, the newly charged and strongly reinforced R congress and newly Republican Senate will do soon after the 2012 elections are held!