3 years old & still being born

John Taylor: March 21, 20130 Comments

Three years after the birth of the Patient Protection and Affordable Care Act (aka, Obamacare), the public largely feels ignorant of how it might affect them and has not experienced much outreach or education from those implementing the Rubik’s Cube of rules.

Those are some of the findings of a recent Kaiser Family Foundation poll. And they certainly mirror three online polls on Community Medical Centers’ Intranet “Forum” site.

Those expected to benefit most from health reform are among those who know least about it – folks under age 65 and those with annual household incomes of less than $40,000. Three-quarters of those surveyed were unaware of their state’s positions on Medicaid expansion (California was among the first aggressively push Medi-Cal expansion), and nearly half didn’t know whether their state had created an online insurance marketplace (in the Golden State, that would be Covered California).

Misinformation appears plentiful.  Sizable percentages believe that the law cuts Medicare benefits, creates “death panels” to determine end-of-life care decisions and doesn’t phase out the so-called “donut hole” on Medicare prescription coverage.

Dan Diamond, a contributing editor for the California Healthline, came up with these assessments of what, so far, has worked and what’s not.

To the good: More people are covered. More than 100 million Americans have received no-cost preventive care in the last two years. Providers are innovating on care delivery – taking some risks. The law is limiting the ways that insurers can deny coverage, especially for pre-existing conditions. And eventually thousands of mentally ill homeless people will get regular healthcare coverage.

As for problems: Its complexity is mindboggling – no doubt explaining the Kaiser public polling numbers. It expands the role of the federal government leaving you-know-who to pay for it. It imposes a huge new burden on business, particularly small and growing companies. The implementation, in stages that will continue for several more years, is too slow for some and way too fast for others. And, through mergers and acquisitions, the law invites provider collusion that could spike prices.

As anyone in the health biz trenches will attest, it’s been a long three years – and the next few years will be historic. As Anthony Wright, executive director of California’s Health Access group, is quoted as saying: “The real triumphs will be in 2014, with the major expansions and benefits slated. (But) as with the triumphs, it’s premature to have a complete understanding of the drawbacks.... the main law has yet to be implemented.”

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