By Dr. Scott Saunders
In a speech to the National Association of Counties, Nancy Pelosi referenced the Patient Protection and Affordable Care Act then being debated in congress saying, “We have to pass the bill so you can find out what is in it…” This has proved to be prophetic.
We could not have known what is in the bill at the time because so much of what is now mandated was not in the bill that was voted on in the Senate. In fact, nobody knows “what is in it” even today. There have been so many changes, challenges, and rulings that the fog hasn’t yet cleared.
With all of the ideas and misconceptions about the “Affordable Care Act (ACA)” that we call Obamacare we can fall into the trap of just complaining about it. But what does this law really do? We are all asking the same question, “How will it affect me?” While the specifics keep changing, there are a few things that are known.
- Everyone is required to buy health insurance. Those with low income may receive a subsidy from the federal government.
- Those who don’t have approved insurance plans will be required to pay a fine of 1% of their income next year. This fine goes up each year. There is a 3 month grace period so you only have to have to be insured for 9 months to avoid the fine.
- Insurance companies must provide certain benefits, such as a free (no deductible or co-payment) annual physical exam, and they cannot choose people based on their health history, gender or lifestyle. This increases the risk, and thus the cost to the consumer.
- Employers with over 50 employees must provide health insurance for all full-time employees, or pay a fine. (This just changed to start in 2015.)
The cost of health insurance under the ACA carries a higher price tag. A single, healthy person in Santa Barbara that would have paid about $150 for a high-deductible plan in 2013, will now have to spend over $300 per month. Also, the cost of obtaining care goes up with co-pays of $60 for a regular doctor and $150 for urgent care. Because of this, many clinics are requiring people to walk-in the same day so they can get the higher co-pay, causing many patients to wait for hours to see the doctor.
Most of the rest is conjecture.
- What will happen when everyone has insurance?
- Are there enough doctors to take care of all the new patients?
- Will we have access to health care when we need it?
Doctors are retiring and going into other fields. A colleague of mine, one of the most competent and educated doctors in Santa Barbara, is re-training to be a computer network administrator. Others I know are retiring early, taking only cash, or not taking any new patients. So, with fewer physicians, and more patients how long will you wait to have your health concerns addressed?
What about “end-of-life care?” Obamacare provides for committees that limit what treatments and tests will be available to people. This may be based on age, illness, prognosis, or other parameters. You can be denied care if you are not deemed to benefit from it, no matter what your doctor says.
What if you need a specialist? The law now allows the government to determine the value of a doctor’s service, as well as the salary he or she receives. If a specialty doesn’t receive extra remuneration, who will be willing to go through the extra training, put in the extra time, and acquire the extra debt?
One thing is sure, there will be many more changes in the future....
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