- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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).
- 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.
Sunday, March 25, 2012
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.
Friday, December 23, 2011
The Wise Men’s Christmas Gifts – A 2011 Perspective
Over the past few weeks in my pediatrics clinic in southeast Washington DC, as I have wished Merry Christmas to my patients and families, I have pondered about the Three Wise Men who paid homage to Jesus, an infant born in poverty. As we all know, they traveled a great distance and came bearing meaningful gifts of gold, frankincense, and myrrh because of their belief in the promise of a child. The scripture has made me ask the question, are the self-proclaimed wise men of today giving the best of themselves for our children, especially those born in poverty? What would be the modern equivalents of gold, frankincense, and myrrh today?
The meaning of gold is obvious, and to me its modern equivalent is funding for programs and assistance that address the needs of our country’s children. It was tragic to watch some members of Congress squabble over how to fund unemployment insurance (which was a part of the bickering over the payroll tax cut), and other critical elements of the social safety net. Unemployment insurance (the average UI check is about $300 per week) provides vital assistance to 3.1 million Americans struggling to make ends meet, even if only temporarily. Maintaining this poverty-reducing support should not be as difficult as Congress makes it out to be.
Together the Child Tax Credit and the Earned Income Tax Credit (EITC) lift more children out of poverty than any other program. The American Recovery and Reinvestment Act in 2009 made improvements to the Child Tax Credit, providing up to $1,433 more for families earning wages at or just above the minimum wage. Similarly, the EITC was expanded for married couples and families with three or more children. These provisions, combined with others in ARRA, kept 2.4 million children out of poverty, but the future of these policies is uncertain after 2012.
Right now there are many who question whether we can afford to build upon these efforts and to develop new innovations in reducing poverty. My argument is that we cannot afford not to. Every year, child poverty costs our economy $500 billion dollars in health care expenses, lost productivity, and criminal justice. Parting with the “gold” for unemployment insurance, EITC, housing, and TANF is easier when it is rightly seen as an investment – in both our financial and our moral future.
To understand the significance of frankincense, it helps to know that it is a resin once used for medicinal purposes: healing wounds, treating arthritis, repelling mosquitoes, etc. It was (and still is) a symbol of health and life to many people. As a pediatrician, I feel the modern corollary to frankincense could be Medicaid, which takes care of multiple health needs for millions. Nearly all of my patients in southeast DC are enrolled in the program, which allows them to get regular check-ups, dental care, eye exams, mental health care, and much more. Today, Medicaid and the Children’s Health Insurance Program (CHIP) is the nation’s largest health insurance program for children, providing access to health care to 38 million children – that’s 1 in 3 – across the country.
Unfortunately, there are still 8 million uninsured children in our country, but 2/3 of them are eligible for Medicaid/CHIP. Sadly, certain members of Congress and other Presidential candidates want to convert Medicaid into a block grant program or apply unfair spending caps to it. These measures would allow the states the so-called “flexibility” of denying more children access to health care. Such ill-advised policies ignore Medicaid’s proven fiscal efficiency: costs of health care per patient in Medicaid have grown slower than costs per patient with private insurance: 4.6 percent versus 7.7 percent per year. Children make up half of all Medicaid recipients, but account for just a quarter of the program's total costs. Clearly, this program, even with its imperfections, should be valued as a gift. Rather than finding ways of undermining Medicaid and CHIP, our political leaders must find ways to support this lifeline to children, the elderly, and the disabled.
The Three Wise Men’s last gift, myrrh, is another resin, once used for mummification in ancient Egypt, for medicinal purposes, and it still has spiritual value to many cultures. It was a gift of faith in what Baby Jesus would grow to be and do for mankind. Such a gift does not require a modern equivalent, but I do question whether our society really demonstrates its faith in children. The above threats to their health care and their basic financial support reflect a commitment to maintaining spreadsheets and to political arithmetic, regardless of the costs to children in poverty – now almost 6 million, or 1 in 5. As a percent of total federal spending, investments in children fell to 8.4% in 2011. The fact that the policies and programs with proven service to children are consistently the first items on the budget chopping block is an indication of how shallow our faith really is.
If our political leaders had more faith in our children’s capabilities and aspirations, then they would open more doors than just the janitor’s closet when it came to creating job and career opportunities. Doing the hard work of providing health care, education, housing, and opportunity for children requires not just tough decisions over limited resources, but also a solid faith in our children’s potential. Such a commitment would lead us to readily provide our children with the best of ourselves.
There are obviously other interpretations on the significance of the Three Wise Men’s gifts, and I recognize how my experience as a pediatrician caring for children in poverty influences my perspective. However, regardless of one’s beliefs about this Christmas story, we find that when the Three Wise Men paid homage to an infant born in humble circumstances, their faith drove them to take action, to go the distance, and to provide resources. That is a timeless example for all of us to follow for all of our children.
The meaning of gold is obvious, and to me its modern equivalent is funding for programs and assistance that address the needs of our country’s children. It was tragic to watch some members of Congress squabble over how to fund unemployment insurance (which was a part of the bickering over the payroll tax cut), and other critical elements of the social safety net. Unemployment insurance (the average UI check is about $300 per week) provides vital assistance to 3.1 million Americans struggling to make ends meet, even if only temporarily. Maintaining this poverty-reducing support should not be as difficult as Congress makes it out to be.
Together the Child Tax Credit and the Earned Income Tax Credit (EITC) lift more children out of poverty than any other program. The American Recovery and Reinvestment Act in 2009 made improvements to the Child Tax Credit, providing up to $1,433 more for families earning wages at or just above the minimum wage. Similarly, the EITC was expanded for married couples and families with three or more children. These provisions, combined with others in ARRA, kept 2.4 million children out of poverty, but the future of these policies is uncertain after 2012.
Right now there are many who question whether we can afford to build upon these efforts and to develop new innovations in reducing poverty. My argument is that we cannot afford not to. Every year, child poverty costs our economy $500 billion dollars in health care expenses, lost productivity, and criminal justice. Parting with the “gold” for unemployment insurance, EITC, housing, and TANF is easier when it is rightly seen as an investment – in both our financial and our moral future.
To understand the significance of frankincense, it helps to know that it is a resin once used for medicinal purposes: healing wounds, treating arthritis, repelling mosquitoes, etc. It was (and still is) a symbol of health and life to many people. As a pediatrician, I feel the modern corollary to frankincense could be Medicaid, which takes care of multiple health needs for millions. Nearly all of my patients in southeast DC are enrolled in the program, which allows them to get regular check-ups, dental care, eye exams, mental health care, and much more. Today, Medicaid and the Children’s Health Insurance Program (CHIP) is the nation’s largest health insurance program for children, providing access to health care to 38 million children – that’s 1 in 3 – across the country.
Unfortunately, there are still 8 million uninsured children in our country, but 2/3 of them are eligible for Medicaid/CHIP. Sadly, certain members of Congress and other Presidential candidates want to convert Medicaid into a block grant program or apply unfair spending caps to it. These measures would allow the states the so-called “flexibility” of denying more children access to health care. Such ill-advised policies ignore Medicaid’s proven fiscal efficiency: costs of health care per patient in Medicaid have grown slower than costs per patient with private insurance: 4.6 percent versus 7.7 percent per year. Children make up half of all Medicaid recipients, but account for just a quarter of the program's total costs. Clearly, this program, even with its imperfections, should be valued as a gift. Rather than finding ways of undermining Medicaid and CHIP, our political leaders must find ways to support this lifeline to children, the elderly, and the disabled.
The Three Wise Men’s last gift, myrrh, is another resin, once used for mummification in ancient Egypt, for medicinal purposes, and it still has spiritual value to many cultures. It was a gift of faith in what Baby Jesus would grow to be and do for mankind. Such a gift does not require a modern equivalent, but I do question whether our society really demonstrates its faith in children. The above threats to their health care and their basic financial support reflect a commitment to maintaining spreadsheets and to political arithmetic, regardless of the costs to children in poverty – now almost 6 million, or 1 in 5. As a percent of total federal spending, investments in children fell to 8.4% in 2011. The fact that the policies and programs with proven service to children are consistently the first items on the budget chopping block is an indication of how shallow our faith really is.
If our political leaders had more faith in our children’s capabilities and aspirations, then they would open more doors than just the janitor’s closet when it came to creating job and career opportunities. Doing the hard work of providing health care, education, housing, and opportunity for children requires not just tough decisions over limited resources, but also a solid faith in our children’s potential. Such a commitment would lead us to readily provide our children with the best of ourselves.
There are obviously other interpretations on the significance of the Three Wise Men’s gifts, and I recognize how my experience as a pediatrician caring for children in poverty influences my perspective. However, regardless of one’s beliefs about this Christmas story, we find that when the Three Wise Men paid homage to an infant born in humble circumstances, their faith drove them to take action, to go the distance, and to provide resources. That is a timeless example for all of us to follow for all of our children.
Wednesday, July 22, 2009
A Public Option Is Not the Boogeyman
As a pediatrician reviewing objections to the inclusion of a public insurance plan in health reform, I can’t help but think of a few of my young patients who have suffered from nightmares. Their parents brought them to clinic, concerned about the quality of their sleep, and the harm these bad dreams were having on their psyche. There are no quick fixes to cure nightmares, but they can be treated, and the process has special relevance to the current health reform debate over a public insurance plan.
First, a person with nightmares needs to be reassured that what she saw and heard was not real. There is no monster under the bed. A similar point needs to be made about the misconceptions around a public insurance plan. One of the biggest fears is that it will put the private sector of health insurance out of business. This is simply not true. We have examples of public agencies and private businesses offering similar services to the American people, and both exist side by side. FedEx, UPS, and DHL are not at risk of disappearing because the US Post Office can also send letters and ship packages for the average American to any destination around the world. A public plan for health insurance will have lower administrative costs than plans offered by the private health insurance cartels, which will have to ask, answer, and act on the question: “Are we getting the best bang for the buck?”
Protectors of the private health insurance industry ask why any American would choose a private plan when they could go with a cheaper public option. Under this line of reasoning, none of us would be driving a Mercedes-Benz when a Toyota Camry can get us from place to place. In a CBS News poll done last week, over 900 Americans were asked the following:
"Suppose the federal government offered a public health care plan that anyone could join at any age. What would you probably do? 1. I'd definitely join the plan. 2. I'd probably consider the plan, and compare it against my private insurance options. 3. I'd probably consider the plan only if I had no other insurance options. OR, 4. I'd probably never join the plan."
Here are the results:
Coming back to the subject of nightmares (or maybe we never left it), to help a patient, her family must be honest about the real stresses happening in her life. Family members who are in denial about a patient’s problems, or who block resolving those problems because of an unwillingness to change, make the already difficult recovery process that much harder. In the health reform debate, critics of the public insurance plan claim that our flawed system is better than introducing any government efforts, wherein a public option would allow government bureaucrats to ration care.
Not only is this argument wrong, but the American people should also remember that the corporate bureaucrats in the private health insurance companies always ration care, first by income and then by illness. Screening patients for pre-existing conditions might become a thing of the past with some of the legislation under construction, but thousands of Americans have been the victims of rescissions, which the health insurance companies told Congress under oath they have no intention of even limiting, much less ending. The opponents of a public option must think sick Americans are doing just fine as they gamble their health and their family’s finances in Russian roulette games against the private health insurance cartels.
Some members of Congress are also spreading the fear that a public option would disrupt quality and research in medicine, pharmaceuticals, and biotechnology. But if that were really the case, then how do we make sense of the Veterans Health Administration? The VHA cares for over 5 million Americans (without rationing), and the overwhelming majority of them have been happier than private health insurance customers with the quality of their health care. The American Customer Satisfaction Index has proven it year after year. Furthermore, thousands of VHA hospitals partner with academic medical centers, contributing to cutting edge research for the betterment of all Americans. These unsung success stories can serve as a wake up call to those who are unaware of the possible benefits of a public option.
A public plan for health insurance is not a panacea, but it is more than a band-aid in reforming American health care. 18,000 Americans die every year because of a lack of health insurance. A public option is thus a vital first step, and it is supported by over 70% of Americans. We should applaud President Obama and many members of Congress for their efforts, but they cannot go it alone. It is time for other Senators and Representatives to support that work. Our problems will not go away with a pat on the head and a glass of water.
First, a person with nightmares needs to be reassured that what she saw and heard was not real. There is no monster under the bed. A similar point needs to be made about the misconceptions around a public insurance plan. One of the biggest fears is that it will put the private sector of health insurance out of business. This is simply not true. We have examples of public agencies and private businesses offering similar services to the American people, and both exist side by side. FedEx, UPS, and DHL are not at risk of disappearing because the US Post Office can also send letters and ship packages for the average American to any destination around the world. A public plan for health insurance will have lower administrative costs than plans offered by the private health insurance cartels, which will have to ask, answer, and act on the question: “Are we getting the best bang for the buck?”
Protectors of the private health insurance industry ask why any American would choose a private plan when they could go with a cheaper public option. Under this line of reasoning, none of us would be driving a Mercedes-Benz when a Toyota Camry can get us from place to place. In a CBS News poll done last week, over 900 Americans were asked the following:
"Suppose the federal government offered a public health care plan that anyone could join at any age. What would you probably do? 1. I'd definitely join the plan. 2. I'd probably consider the plan, and compare it against my private insurance options. 3. I'd probably consider the plan only if I had no other insurance options. OR, 4. I'd probably never join the plan."
Here are the results:
- Definitely Join: 12%
- Compare against private options: 43%
- Consider only if no other options: 31%
- Probably never join: 11%
- Unsure: 3%
Coming back to the subject of nightmares (or maybe we never left it), to help a patient, her family must be honest about the real stresses happening in her life. Family members who are in denial about a patient’s problems, or who block resolving those problems because of an unwillingness to change, make the already difficult recovery process that much harder. In the health reform debate, critics of the public insurance plan claim that our flawed system is better than introducing any government efforts, wherein a public option would allow government bureaucrats to ration care.
Not only is this argument wrong, but the American people should also remember that the corporate bureaucrats in the private health insurance companies always ration care, first by income and then by illness. Screening patients for pre-existing conditions might become a thing of the past with some of the legislation under construction, but thousands of Americans have been the victims of rescissions, which the health insurance companies told Congress under oath they have no intention of even limiting, much less ending. The opponents of a public option must think sick Americans are doing just fine as they gamble their health and their family’s finances in Russian roulette games against the private health insurance cartels.
Some members of Congress are also spreading the fear that a public option would disrupt quality and research in medicine, pharmaceuticals, and biotechnology. But if that were really the case, then how do we make sense of the Veterans Health Administration? The VHA cares for over 5 million Americans (without rationing), and the overwhelming majority of them have been happier than private health insurance customers with the quality of their health care. The American Customer Satisfaction Index has proven it year after year. Furthermore, thousands of VHA hospitals partner with academic medical centers, contributing to cutting edge research for the betterment of all Americans. These unsung success stories can serve as a wake up call to those who are unaware of the possible benefits of a public option.
A public plan for health insurance is not a panacea, but it is more than a band-aid in reforming American health care. 18,000 Americans die every year because of a lack of health insurance. A public option is thus a vital first step, and it is supported by over 70% of Americans. We should applaud President Obama and many members of Congress for their efforts, but they cannot go it alone. It is time for other Senators and Representatives to support that work. Our problems will not go away with a pat on the head and a glass of water.
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