A noteworthy anniversary

A noteworthy anniversary

March 24th, 2011 in Opinion Times

Republican opponents of health care reform rarely miss an opportunity to bash the Affordable Care Act, so many were quick to use the one-year anniversary yesterday of the act as another chance to criticize reform, never mind the obvious need for the millions of Americans who cannot afford or qualify for insurance. The smarter, more accurate way to look at the ACA is to note the protections from insurance industry abuse that the act has already put in place, and the other valuable reforms and benefits that will come when the act is fully implemented in 2014.

Americans who care about the sustainability and affordability of their health care insurance have good reason to appreciate the reforms already in place, and good reason to wonder what, precisely, Republicans would offer to replace the Affordable Care Act if they managed to keep their promise to "repeal and replace" the bill and lift their silence on a plan of their own. Where is it?

The protections implemented so far include:

* Elimination of the insurance industry's denial of insurance to children with so-called pre-existing conditions.

* Extension of family coverage to dependent children up to the age of 26.

* A Medicare Part D rebate of $250 for enrollees who reach the dreaded gap in prescription drug coverage.

* Elimination of the industry's cap on lifetime benefits for policy holders.

* Creation of a small business tax credit to cushion the cost of providing employer-based insurance.

* Creation of an early retiree reinsurance program.

* Elimination of patient cost-sharing requirements for preventive services in newly purchased insurance.

* Requirements for insurers to provide coverage for emergency services and OB/GYN services.

* Creation of a national high-risk pool to make insurance more affordable for Americans who have trouble finding coverage.

As implementation of the full ACA benefits rolls out this year and over the next two years, more benefits will be introduced, along with other insurance and medical industry reforms designed to improve health care practices, broaden coverage and reduce overall health care costs to individuals, employers and government health care programs.

Insurers, for example, will be required to end exclusions for pre-existing conditions for adults, and to provide true flat-rate insurance for all enrollees. They will have to eliminate annual caps on benefits. They also will be required to spend more of their premium dollars on the delivery of actual health care, and thus will have to spend less on lavish overhead and executive salary and administrative costs. This provision will require insurers to spend at least 85 percent of premium dollars in large group plans, and at least 80 percent for plans in individual and small group markets.

Insurers will also come under requirements to provide adequate minimum plans that provide decent family and individual coverage.

To help Americans find affordable insurance when employer-based insurance is unavailable, state governments will be required to create insurance exchanges, and families and individuals will be eligible for tax credits or federal subsidies that will be provided on an income-adjusted basis up to four times the federal poverty level.

A host of other reforms, ranging from efficiency, quality and innovation in the medical industry to malpractice, nutrition, standardized diagnosis codes and medical records, will further expand the scope and value of the ACA to all Americans.

Ultimately, the ACA, as documented by the non-partisan Congressional Budget Office, will cost less than the existing status quo over the first 10 years, and will save substantially more money over the second decade out.

It will do so while expanding coverage to more than 30 million uninsured Americans, and while ensuring both the affordability and availability of health care insurance over the long term.

Opponents - and especially Republican leaders who oppose reform like the puppets they are for the insurance industry to keep their campaign donations coming - rarely discuss the benefits and the necessity of reform versus an unreformed system. But that is essentially the choice: An improved and reformed system, or continuance of an out-of-control and unsustainable system in which insurers would continue to cherry-pick the healthy and leave everyone else uninsured or underinsured, and always subject to medical bankruptcy.

Americans aware of the big picture and long-term trends of a failing system will surely want many more annual anniversaries of a system on the path to full reform.