Although many provisions of the Affordable Care Act were put into place a few years ago, the “next round” of the Affordable Care Act was just rolled out last week, including the health insurance marketplaces. Despite all that is happening, the Affordable Care Act remains a long and complex law that few understand. Here at Intake.Me, we are not taking any political stance, but wanted to reflect on how the law affects patients and the health tech innovators like us that serve them.
But what has the Affordable Care Act done for patients?
- #1 – Prohibited denying children insurance due to pre-existing conditions, and extends this to adults in 2014 For patients who live with chronic disease or caring for children living with chronic diseases from congenital heart disease to childhood cancers, this is huge. Anecdotally, this is a reason that many have stayed with employers, family members or spouses when they would rather have struck out on their own, have taken on extraordinarily high premiums for some form of “high risk” insurance plan because some past health condition. It changes our health insurance system from one that drops you when you most need help to one that is trying to figure out how to best help our sickest patients.
- #2 – Abolished lifetime limits on healthcare, and abolishes annual limits in 2014 Especially for patients who require expensive treatments, like new biologics or chemotherapeutics, this act alone will likely lead to major savings in the long run in terms of insurance payments. This is another way that the Affordable Care Act moves the insurance companies away from punishing people who actually need health care towards helping them.
- #3 – Made insurance more available to more people, rather than dependent on your employer This is the idea behind the health insurance marketplaces, which also include some options for small businesses to buy insurance. For people who are below a certain income level, the marketplace is associated with a tax subsidy as well (though if you are in a state that has not expanded Medicaid, you might be paradoxically without a subsidy if you are below the poverty line).
- #4 – Made certain medications more affordable for some people The regulations around medications remain extraordinarily complex. However, hidden in the many pages of the healthcare law are some things that may help medication costs, most notably phasing in federal subsidies to close the “doughnut hole” for Medicare drugs (from this year through 2020) and authorizing the FDA to approve generic versions of biologic drugs.
- #5 – Launched new initiatives for to encourage innovation This includes the Center for Medicaid and Medicare Innovations and the Patient-Centered Outcomes Research Institute (PCORI). The most relevant one for patients in PCORI, which is the first institute dedicated to doing comparative research about what actually works for people in practice — and most promisingly, they are working to include patient representatives to review new research programs!
The law does a great deal to empower patients – from shifting regulations on the insurance industry away from penalizing patients for needing cared to involving patient voices in government-supported efforts to develop new innovative care delivery and research programs. However, it also leaves many questions unanswered and problems unresolved.
- By putting everyone into some insurance pool because of the individual mandate, what will that mean for healthcare? In some ways, the mandate is forcing people who would otherwise go without insurance get insurance, and for patients with certain conditions, it does seem that they would still be sorted into a “high risk pool,” which I hope but do not know whether it will serve the needs of “high risk” patients.
- Will the health care system be able to handle the increased need for care? We already face a shortage in primary care doctors and the doctor shortage is expected to worsen in the coming years, with the aging population and the health care law.
- Also, the impetus for the law was an attempt to curb runaway healthcare costs. Will this be enough to curb the rise of health care spending and move health care outcomes in the right direction? Or will these new programs just fuel more spending in the costly health technologies (like next generation MRI machines) that got us here in the first place?
As others have written, these unanswered questions are why the health reform law provides plenty of avenues for health innovators to continue to find solutions to fix our healthcare system. Though the insurance market remains as highly regulated as ever, the increased individual buy-in and involvement in the healthcare system encourages the formation of many new technologies to give consumers the tools to improve their health. Unlike the old technologies that were based in health systems and cost everyone millions of dollars, consumer facing applications are increasingly mobile and increasingly focused on making healthcare more effective and efficient. Only time will tell whether these innovations coupled with the Affordable Care Act will be enough to bend the cost curve on American healthcare and ultimately improve the healthcare system for everyone,
What do you think? Did I get that right? Has your experience with the health care system after reform been different?
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