By Nicole Hennessy
The phrase “health care reform” is often followed by the word “debate.” And with any legislation as extensive as the Patient Protection and Affordable Care Act (PPACA), there’s a lot of misinformation and kinks that need to be worked out.
On Oct. 11 in the Oak Room at the Gemini Center, Rachel Rosen DeGolia, executive director of the Universal Health Care Action Network, and Dr. Constance Magoulias, who practices at MetroHealth Medical Center, helped community members understand why reform is even necessary at all.
Referencing the PPACA, DeGolia said, “The way I like to summarize the overall impact of this law is that it begins to move us from a sick care system to a health care system.”
By “sick care system,” she went on to explain, she means a system in which not a lot of preventative measures occur. Under the PPACA, she explained more checkups and screenings would catch health issues early.
“Eighty-five percent of the public, give or take, has health insurance,” she explained. That’s a pretty high number. But “15 percent is still a lot of people.”
Before the lecture, pamphlets prepared by Consumer Reports – “Health Reform: Seven Things You Need to Know” – were passed out. In her talk, DeGolia mentioned a lot of what the report covers.
Some of the new protections and benefits available today under the PPACA, the pamphlet states, have to do with practices insurance companies can no longer get away with. These include practices such as canceling a client’s insurance if he or she gets sick or racks up too many medical bills, exceeding a “lifetime limit” provision. Also, customers can appeal insurance company decisions and receive a response within 72 hours “for urgent medical situations.”
“The law is being phased in over several years,” DeGolia said. “A lot of it won’t even come online till 2014.”
Going through more improvements, such as prohibiting insurance companies from denying coverage based on a consumer’s pre-existing conditions, she shared a story of a girl born with cerebral palsy.
“This little baby was born with a pre-existing condition. Before this law was passed, she could be denied insurance from the day she was born,” DeGolia continued, adding that the only way her parents could have paid for her insurance was to make sure their income was low enough to qualify for Medicaid.
More people will be eligible for Medicare, and young people under the age of 26 are now able to stay on their parents’ private insurance until the age of 26, DeGolia said.
While all these provisions sound positive, she got to negative aspects about halfway through her lecture: “There will still be maybe 15, 16 million people without insurance when this law’s fully in effect,” she said, “so our work is not yet done.”
Magoulias said she sees a lot of patients with no insurance who can’t afford their medications or doctor visits. One story that she shared was of a man with severe asthma who could no longer afford an inhaler.
“The next thing I heard, his wife had called me like, six months later, and told me her husband had died of an asthma attack,” she remembered.
Like DeGolia, she proceeded to list examples and reasons she supports the PPACA.
“What we don’t know yet,” the Consumer Reports pamphlet reads, “In the next year or two, regulators, insurers, and the states will work out many of the unknowns.”
These include the actual cost of plans, whether or not insurers will be encouraged to lower prices or what states that don’t opt into the expanded Medicaid program will do for their poorest citizens.
But, as DeGolia implied thoughout her entire lecture, something is better than nothing.