10 Ways the Health Reform Law is Helping My Patients Right Now

As the Patient Protection and Affordable Care Act’s reaches its 2 year anniversary, there has been much speculation about how the law will effect Americans as we await its fate before the Supreme Court and its full implementation in 2014.  Those conversations are important, but let’s not miss the health reform law’s important accomplishments, many of which are going on right now.  My patients and their families in southeast Washington DC are among millions whose health and peace of mind have benefited through several provisions in the Affordable Care Act.  As a pediatrician, I am obviously partial to those provisions impacting child health, but as an American I am also proud of how the health reform law helps my patients’ parents and grandparents.  Thus, this is list of ACA accomplishments from the past 2 years, in no particular order. 

1. Insurance companies are now prohibited from denying coverage to children with pre-existing conditions.  Though the insurance companies may argue this used to be done for the sake of moral hazard, it was morally reprehensible to deny health insurance to any child, including the four to 17 million children with conditions like asthma, obesity, or other chronic conditions such as cerebral palsy.  Thanks to the Affordable Care Act, this shameful practice became a thing of the past in 2010, and 2 million children have gained coverage since then.  The law will protect adults with pre-existing conditions in 2014.  
2. Young adults can be covered by their parents’ health insurance up to age 26.  Approximately 2.5 million Americans are now covered through this provision.  Having cared for the survivors of childhood cancer, birth defects, and organ transplants, I can only imagine the peace of mind millions of parents must be experiencing, knowing their sons and daughters will continue to receive necessary medical care.  
3. Free preventive health services are now available in our health insurance plans (with no co-pays), and around 54 million Americans have already made good use of these services, which include immunizations, pap smears, mammograms, and colon cancer screenings, just to name a few.  Pediatricians across the country are adopting the excellent screening standards established in the Bright Futures periodicity schedule, through which we can better detect developmental disabilities (including autism, speech delay, and others).  As a physician, it is a relief to know more patients and families can take action to reduce their risk of serious illness and disability.  
4. Another ACA accomplishment in preventive health care is the establishment of the Prevention and Public Health Fund, which supports programs to help more communities avoid tobacco use, obesity, and cancer.  To fully realize these goals, this fund needs to be protected from cuts during debates over the budget and deficit.  
5. Insurance companies can no longer rescind coverage from people who make simple errors on their initial applications.  They are also prohibited from imposing lifetime limits on a patient’s coverage.  This is particularly important to patients like the ones I mentioned earlier:  cancer victims, premature infants, and children with developmental disabilities and rare diseases, all of whom can have health care expenses that exceed an arbitrary lifetime limit.  
6. Between 2010 and 2011, through a provision to help seniors trapped in the Medicare Part D “doughnut hole,” 3.8 million elderly Americans each received $250 in rebates.  As of August 2011, a 50% discount was given to 900,000 Medicare beneficiaries for their prescription drugs.  That is real relief for my patients’ grandparents. Under the ACA, the "doughnut hole" will continue to shrink and ultimately disappear in 2020.   
7. If you have recently thought twice about what you bought at a fast food restaurant because you saw some helpful nutrition facts on the menu, then you are benefiting from a little-known but widely-seen accomplishment of the ACA.  Chain restaurants and vending machines are now required to disclose nutritional information on standard menu items.  Having this information is a small but important step in reversing America’s obesity epidemic.  
8. Federally qualified health centers (FQHC’s) and the National Health Service Corps (NHSC) broaden access to health care for millions of Americans living in rural and inner-city communities where there are few health providers.  This mission, which is all the more important during tough economic times, has been supported through the health reform law’s increased funding for NHSC and its health centers.  
9. Through the ACA, the healthcare workforce is getting guidance from a newly established National Health Care Workforce Commission, which provides important recommendations on how doctors, nurses, dentists, and other health professionals are recruited, trained, and distributed among different communities.  Also, the Graduate Medical Education (GME) program is being reformed to increase the supply of health care workers, especially in primary care (which includes pediatrics, geriatrics, and family practice).
10. Given the concern most Americans have for the rising costs of health care in our country, it important for us to get the most bang for our buck.  Under the medical loss ratio (MLR) provisions of the health reform law, for every dollar given in premiums to an insurance company, 80 to 85 cents must be used for health care, not administrative expenses or executive bonuses.  If they fail to follow through, the insurance companies will have to send rebates to their customers. Though several states have been given a waiver on implementing this rule, it puts insurance companies on notice to spend our premium dollars on our health, not their wealth. 

From my perspective as a physician and advocate for health policy, the Affordable Care Act is off to a strong start, and I look forward to more of the provisions to be implemented in the years to come.  I encourage fellow Americans, including members of Congress, to really look past the melodramatic hype and familiarize themselves with the health reform law.  The ACA has the potential for us to get more bang out of our health care bucks and build a 21st century health care system that delivers high quality care to every American, regardless of where they live, what they look like, or how much they earn.