Sunday, October 7, 2012

5 Musings regarding the Affordable Care Act

I am a firm believer that the Affordable Care Act was a courageous and necessary step toward addressing health care in America.  Undoubtedly, there are some areas that I'm somewhat leery of and a few areas where I feel somewhat robbed.  Some of specific areas of concern are discussed below:

1.  Health Insurance is NOT equal to Health Care.  I continue to be disturbed that in conversations relating to health "care", health "insurance" is commonly used synonymously.  In my posting relating to customer care, I describe how a particular insurance company failed to pay valid health claims in a timely manner.  Since that time, I have heard numerous anecdotes of neighbors and colleagues who have delayed or not sought health care due to cost issues even though they were insured.  Yes, those deductibles and co-pays are real money.  In one case, a spouse of an employee declined going to an emergency room due to the high cost of an emergency room visit.  While some may criticize gambling with your health over a $50 emergency room co-pay, for many $50 is a significant hit to the weekly family grocery bill.  It seems to me that we need a minimum bill of rights for all when it comes to health care and that these basic needs need to be exempted from co-pays and deductibles much as preventative health is under the current initiative.


2.  The Affordable Care Act mandates that a minimal percentage of premiums go to patient care and requires refunds (rebates) when this is not met.  While this sounds great on paper, it is not a panacea by any stretch.  I was one of those receiving such a letter indicating that a refund was being made... to my employer who administers the health plans.  Apparently my employer is to use these refunds so that future premiums will be less... regardless of whether I will be in this plan in future years and regardless that there are many other plans some of which did not issue refunds because they spent the required threshold on patient care.  The New York Times provided an excellent story relating to this issue.  As for me, I'm not holding my breath that I will see any of this refund... while in the past the insurance company pocketed this as profit, it seems Robin Hood has re-distributed this windfall to large employers...

3.  Over The Counter (OTC) Medications - Initially, insurance companies shifted medications costs to consumers by pushing more medications into the OTC realm.  Indeed, many medications that used to be costly prescription medications are now OTC.  (Examples, include many allergy medications such as Zyrtec, Allegra, etc as well as many acid reduction medications such as Prilosec).  As these medications became OTC, they commonly were no longer reimbursed as part of a prescription drug plan.  As some consolation, they did become cheaper AND before "Affordable" Health Care, it was possible to obtain some savings through use of pre-tax dollars.  Yes, I realize that taxpayers are able to nag their doctor into obtaining a "prescription" so that they still can use pre-tax dollars; however, the practicality of being a persistent nuisance to overworked physicians really diminishes this option.  The bottom line is that OTC are real medications and deserve the same tax treatment as prescribed medications; period!

4.  Permitting "Children" to be Covered on Parent's Health Plan to Age 26... wow so now we have 26 year old children running around... goo-goo, ga-ga...  I have a lot of mixed angst on this one.  Undoubtedly, it was a "quick" fix for many.  Nothing ever comes for free; I have no doubt that the cost for this "benefit" will be rolled into the cost of the family policy.  Also, I can't help wondering at the fairness of this provision as it seems to extend a further advantage to certain ones while still leaving some of the most vulnerable "young adults" to fend for themselves.

5.  Women's contraception:  I am not offended on a moral basis.  I have written previously regarding the dichotomy of the sexes and when it comes to "oppression" of a particular gender, I really question who is oppressing who.  This is a glaring illustration.  Why is coverage for men's contraception, specifically condoms, not included?  While I believe in family planning, including the use of contraception, normal pregnancy is not a health issue.  Disease, specifically sexually transmitted disease, IS a health issue.  So birth control pills which don't stop any disease are covered, but condoms which have been shown to be effective to stop disease (and prevent pregnancy) are not covered by the Affordable Care Act.  Why is this?  Do they believe that since condoms are given out in many schools, parents can scarf up, too?  Oh kids, while you're at school today, can you pick up a handful of those condoms... your mom and I want to get busy tonight...