A note from the author:
I wrote this article several months before President Obama signed the "Patient Protection and Affordable Care Act" into law on March 23, 2010. As a conceptual piece it still captures and shares some of my thoughts about the health reform debate.
If health care reform passes, it will have a significant impact on the delivery of healthcare in the US. Many Americans believe that significant changes are needed to our healthcare system, which is burdened with high costs and inconsistent and confusing health insurance coverage. There is also a lack of access to basic primary care services for a significant segment of the population. Our healthcare system is extremely complex and numerous attempts to reform the system over the years have met with considerable resistance.
The Obama administration has made the reform of our health system the focus of its domestic agenda for the country. This has lead to a vigorous debate that has significantly divided the country as several proposals wind their way through Congress. Powerful health-related interests have weighed in on the debate including the health insurance industry, the pharmaceutical industry, and the American Medical Association on behalf of the country's physicians.
The question is: which changes, and at what cost?
One thing that most members of Congress seem to agree on is that our health system needs to be improved and that any reform needs to assure that all Americans have access to healthcare through appropriate health insurance coverage. Health reform also needs to assure that Americans will be able to maintain a relationship with their doctor and not be overly burdened with health-related costs.
Covering the Uninsured
All of the health reform legislation proposed in Congress includes the provision of health insurance coverage for a substantial portion of the U.S. population who do not have health insurance. Most Americans under the age of 65 have private health insurance provided by their employer as a job-related benefit. More than 85 million Americans get their health insurance through a government-sponsored program such as Medicare, Medicaid, CHIP (Children's Health Insurance Program), and the Veterans Administration. And, a small percent of people purchase a health plan directly from a health insurance company.
Gaps in this combination of private and public health insurance has left upwards of 47 million Americans without health coverage. Most of the people who are uninsured come from families where at least one family member is employed. Americans who are uninsured are more likely to work in low-paying jobs in companies that either do not offer health insurance as a benefit or pass on all or most of the premiums to the employee. Many people without health insurance have no regular source of health care or go without needed care (including not filling prescriptions) because they cannot afford to pay for healthcare services.
Fixing Health Insurance
Because of the lack of standardization, choosing a health insurance plan can be a daunting experience. Plans often offer a bewildering array of choices in the services they will pay for and the amount of out-of-pocket expenses; all of this regulated by the state you live in.
To control the costs of providing healthcare services, many health plans have rules that limit coverage for certain health conditions, especially pre-existing conditions. For example, if you have long-standing hypertension and you have a new health plan, you may have to wait six months to a year before the health plan will pay for any services related to your hypertension. And, if you have diabetes or cancer, you may not be able to get health insurance coverage at all. It is likely that health reform will prevent health insurers from denying you coverage for a preexisting condition or dropping your insurance completely because you develop a serious medical condition.
When Will Health Reform Happen?
The President and congressional leaders are working to pass health reform by the end of this year. It is not certain if that deadline will be met and what the final health reform legislation will include. Any reforms that are passed will take months or years to implement. The final legislation will only be a start. (Note: health reform was passed and signed into law on March 23, 2010)
Our healthcare system is facing a shortage of primary care physicians and the likelihood of a significant epidemic of type 2 diabetes and heart disease because of the worsening lifestyle of Americans. Neither of these serious issues has been adequatley addressed in the health reform bill.
Almost every American will be affected in some way by the passage of health reform. How you are personally impacted will depend on the final details of the legislation signed by President Obama and your age and employment status. If you are employed and get health insurance from your employer, buy your own health insurance, are on Medicare, or you are uninsured, it is important for you to understand the possible upside and downside of health reform.
To learn about the immediate impact of the health reform legislation, read How Will Health Reform Affect Me?
