THE BRAVE NEW WORLD OF HEALTH REFORM

Brave New World of Health Reform - PRO newsletter Sept 2013Part 2 of a Multi-Part Series by Carolyn J. Shelby, CLTC

Anytown, USA — It’s one minute past midnight, New Year’s Eve and 2013 has just begun. An ambulance screams into the entry to the local ER. The paramedics pull out a gurney. On it lies a 63 year-old Parkinsonian. She and her husband were driving home from a New Year’s Eve party when their car was broadsided by a drunk driver. Her husband sustained minor scratches, but she has multiple broken bones, a concussion and possible internal bleeding.

There is no doubt that her injuries are going to require surgery, perhaps multiple surgeries, a long hospital stay and then a fearsomely long rehabilitation because of her Parkinson’s.

If only she were 65, Medicare would take care of the lion’s portion of her medical bills.

But, at age 63, with a middle class income and no group insurance, she and her husband opted for an insurance plan with a ceiling on annual benefits and deductible so high, it would take half of their annual income to pay.

As she is rushed to radiology, her husband sits across the desk from the Admissions Clerk. The clerk looks at his insurance card and one of her lips curls up with displeasure. The husband’s heart sinks. What will this cost? Will they have to declare bankruptcy? Did the drunk have insurance? Or are they paying for this themselves?

Now… imagine it’s not the first few minutes of 2013. It is, instead, the first few moments of 2014. The husband hands their new Health Exchange insurance card to the lady in Admissions. She looks at it, intrigued. It’s the first one she’s seen. And then she starts on the paperwork.

A mere four months from now, the entire landscape of health care in this country makes a quantum shift into the future. Almost all Americans will be able to access health insurance, and thus health care, no matter what pre-existing conditions they may have. Their premiums will be the same as those for everyone else their age. Gender no longer will be a consideration. If their AGI (adjusted growth income) is less than 400% of the Federal Poverty Level (meaning approximately 45% of people in this country), they will enjoy a sliding scale of subsidies and tax benefits to help them cover their premiums. In addition, the ACA has put limits on how much insurance companies can increase their premiums, and demanded that before they do, they must first prove to the ACA that their increases are justified. Hospitals providing superior results are being rewarded by grants. Those with poor results will see their government funding wither. And, even though medical costs increased by more than 13% per year during this century’s first decade, once it became clear that the ACA was going to be passed, rising costs, not surprisingly, started to slow.

Do you know why? Do you even know the Affordable Care Act is happening?
Nearly half of America doesn’t even know the basics of the Affordable Care Act (aka The Patient Protection and

Affordable Care Act, aka Obamacare). Of the citizens who do, approximately two-thirds oppose it, despite the fact that when the individual points within the Act are explained to them, they wholeheartedly are in favor.

We regret that we did not have sufficient room to run Carolyn’s full article “Welcome to Health Industry Insanity 101” this month. Please join us next month for more information that comes into effect January 1, 2014. 

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