2011: a very good year for health reform

Dr. Linda Bergthold has been a health care consultant and researcher for over 25 years. She worked on the Clinton Health Reform plan and was the head of the Obama health care blog team in 2008. She also writes for The Huffington Post on health reform and insurance issues.

The list of health reform accomplishments in 2011 is lengthy, with federal government implementation of numerous provisions designed to expand health coverage, strengthen Medicare, and increase access to medical care.

You may have heard quite a lot by now about what health reform did for you or your family in 2011:

1. For the over 65 crowd: lower premiums in your Medicare Advantage plan; relief from drug costs via rebates in the donut hole.
2. For the 26 or under crowd: you can stay on your parents’ plan until you turn 26; and 90,000 children under the age of 19 can not be denied coverage because of a pre-existing condition.
3. For small business owners: you are eligible for a substantial tax credit if you are willing to help pay for health insurance coverage for your workers.
4. For the uninsured: If you have been uninsured for six months because you couldn’t afford coverage or had a serious medical condition, you can enroll in your state’s pre-existing condition pool.
5. For the buyer of individual health insurance: some relief from high costs through the rebates offered by health plans because of their failure to comply with the law’s medical loss ratio.

But did you know about these other activities that were initiated as a result of the passage of the Affordable Care Act?

1. For all those disenchanted about the lack of a public option in health reform, there is a ray of light. The Vermont House of Representatives voted 94 to 49 in May to establish Green Mountain Care (GMC) as the first step toward establishing a single-payer program in that state.

   Vermont’s Governor, Peter Shumlin, declared that he intended to take the next steps to request a waiver from the federal government to set up a single-payer system. If Vermont succeeds in its efforts, it could pave the way for other states to consider similar options.

2. At the national level, the ACA funded a new nonprofit called the Patient-Centered Outcomes Research Institute (PCORI). This organization has been granted substantial revenue (almost $200 million by 2012) to do something that is sorely needed – research what really works in medicine and health care.

   What else but an independent entity could do the kind of credible and objective analysis that evaluates one drug, device or treatment against another? Patients will be at the center of everything that PCORI does – from deciding what to study to helping make decisions about what research grants should be funded. The research grants will start rolling out in 2012.

3. Many have asked how the system can accommodate the newly insured people in 2014, with current shortages of doctors and nurses in some areas. The ACA is already working on that.

   A newly created Prevention and Public Health Fund is funneling $168 million to medical schools to train more than 500 new primary care doctors by 2015; $32 million for more than 600 new physician assistants; $30 million for 600 new nurse practitioners – just to mention a few of the training programs underway.

There are other innovations as well – hospitals around the country are working on their infection rates and readmission rates; health plans are reaching out to members about prevention in a more aggressive way; doctors and hospitals are forming closer alliances to reap the rewards of better coordination of care; community clinics are receiving funding to modernize and expand; and the government is continuing its support for the use of technology in medicine through implementation of the HITECH Act which provides funds to doctors and hospitals to modernize their medical records.

You will hear a lot of bashing of “Obamacare” during the current political season. But while we wait for full implementation of health reform in 2014, there have been meaningful changes that are helping American families every day.

Dr. Linda Bergthold’s previous work for healthinsurance.org includes What has the health reform law done for you, lately? and How health reform’s 10 essential benefits could improve your insurance coverage.

Tags: aca, donut hole, health reform, individual health insurance, medical loss ratio, preexisting conditions, risk pools, small business

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