What has ACA done for you, lately? Lots.

18 months after implementation began, Americans are overlooking laundry list of health care improvements

According to a Kaiser Foundation poll out this week, a majority of the public believes the Affordable Care Act (ACA) has actually been repealed or that it has done almost nothing yet. The same poll found that 44 percent of the public has an unfavorable view of health reform; only 37 percent support it.

The ACA has been in effect for over 18 months. Most of the health reform act pertaining to the uninsured and restraining health care costs will not be implemented until 2014. But in the last year and a half, there have been some substantial changes in health care that you may not have noticed. What are these changes and why don’t more people know about them?

Some of the aspects of health reform that are having a positive effect include:

  1. A variety of preventive care services (e.g. mammograms, colonoscopies, immunizations, annual physicals, etc.) are now covered without copays or deductibles.
  2. Annual limits on insurance are prohibited. About 20,000 people currently hit their lifetime limits on insurance coverage. Over 100 million people who currently have insurance now will have no lifetime limits on what the insurance company can pay for their care.
  3. Adult children can stay on their parents’ plans until their 26th birthday, unless they are offered insurance at work. Up to 1.8 million young adults can benefit from this.
  4. Children under the age of 19 cannot be denied insurance because of a pre-existing condition. This only affects about 90,000 children today, but for the families of those children, this is a huge relief.
  5. For small business, there is a tax credit if they extend coverage to their employees. About a third of all the uninsured work in businesses with fewer than 100 employees, so this tax credit can provide a way for these companies to offer affordable insurance starting now.
  6. The prescription drug “donut hole”, where coverage drops off and the elderly have to pay the full cost of their drugs, is being closed already. $250 checks were sent to seniors last year, and in 2011 the rebate was $500. By 2023, there will be no more gap in coverage for prescription drugs for seniors.

There are other benefits of health reform. For example, there has been a significant effort on the part of the federal government to accelerate the use of health information technology by doctors and hospitals. Patients will eventually be able to e-mail their doctors, request prescription refills online, get test results in almost real time.

And there has been funding for community health centers to help them get ready for an influx of new patients, and funding to help train more doctors and nurses. These changes are largely invisible to the public at large.

Why don’t more Americans know about these benefits that are already working for us? There are several theories – one explanation might be that relatively few people are affected by some of these changes at this point, so the polling doesn’t reflect the part of the population that has benefited.

Or perhaps the ignorance is because the media has not really been covering health reform that much. The new Kaiser poll reveals that 58 percent have heard nothing or very little about health reform over the past thirty days. A third of the public polled said they heard only negative reports about health reform, and half of those heard it via the Republican candidate debates.

And a final theory as to why so few of the public claim to support health reform may be due to a general disgust with Washington, D.C. and everything that comes out of the current Congress.

For families who are only one medical incident away from bankruptcy, or who are delaying care because they cannot get affordable coverage, or who have a child with a pre-existing condition, health reform is still a mixed bag. There are benefits they can claim now; but they will not see all the benefits of the ACA until 2014 and beyond.

It is hard to ask people for patience, but patience is what is required. Transforming health care in America will take a decade or more. We can either complain or we can roll up our sleeves and try to make this work.

For a Q and A on what reform has accomplished, see this Huffington Post blog that I wrote on the first anniversary of the ACA back in March of this year.


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.

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