Arrow-right Camera
The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Health care system has improved because of Affordable Care Act

Dan Baumgarten Special to The Spokesman-Review

The intense political debate over national health care reform has distracted many from the urgent problems that Washingtonians face getting health care, as well as the life-changing benefits the law is already providing.

Here’s the core of the story: Our health care system was broken. Affordable health care remained out of reach for many, and the insurance industry could get away with abuses such as denying coverage to people with pre-existing conditions, imposing lifetime and annual limits on coverage and persistently increasing premiums.

As the former executive director of Community-Minded Enterprises, a nonprofit in Spokane committed to strengthening communities, I saw these problems firsthand. Every day, individuals and families that were uninsured or underinsured came to our organization looking for help.

As we celebrate the second anniversary of the Affordable Care Act, it’s critical to note that important provisions are already in place that are protecting families and holding the insurance industry accountable. Your insurance company used to put annual or lifetime limits on your coverage. People would find that when they needed coverage most – a diagnosis of cancer, a sudden heart attack – their plan had limits on the coverage they could get. Lifetime limits are now banned, and annual limits are on their way out.

Before the law, insurance companies could investigate people with high health bills and find reasons to cancel their coverage. Today, insurers can’t “rescind” your policy because of a mistake you made when filling out your enrollment form.

Before the law, children with health conditions could be denied coverage. Today, insurers aren’t allowed to refuse to cover a sick child. And young adults won’t get thrown off their parents’ insurance when they’re trying to get on their feet.

To help shield families and small businesses from unwarranted premium increases, the health reform law requires that insurers spend 80 cents of every dollar on health care expenses. Health insurance companies are still fighting against the 80-20 rule, but if an insurer fails to meet this standard, the policyholder will be refunded the difference. That alone is expected to put $2 billion back in the pockets of small businesses and consumers.

Seniors also have new drug discounts. In 2011, 60,209 seniors in Washington saved $36 million on prescription drug costs, thanks to the new health law.

And perhaps most importantly: People in private insurance and Medicare, including 1.2 million privately insured people and 653,723 seniors in Washington, are guaranteed preventive health benefits. The law requires preventive services be provided without cost-sharing, making cost a non-factor in ensuring that your family gets basic health-saving care.

In 2014, additional reforms will go into effect. Insurers will not be allowed to deny coverage for adults with pre-existing conditions or charge you more because you are sick. The creation of exchanges will allow people to purchase coverage in a marketplace where insurance companies compete for your business based on price and quality. Coverage will be made affordable with income-based tax credits and limits on the amount people are required to contribute to premiums.

The lynchpin that makes these reforms affordable is that we will all be incentivized to carry insurance – closing the gaping uninsurance problem and cost-shifting that currently occurs. Right now, more than 1 million Washingtonians are uninsured. However, the uninsured still receive health care. They just get it at the wrong time, when their health issues have become emergencies. Because they have no insurance, they have no way to pay. So the rest of us pick up that bill – the uninsurance problem currently shifts $43 billion per year nationally to taxpayers and the insured. That’s around $1,000 per year in extra costs for the average family. By making insurance affordable, the Affordable Care Act removes the barriers that many face in obtaining insurance – leading to a more efficient and effective system overall.

For too long, insurance companies have denied coverage to those who need it most while relentlessly increasing premiums. Those days are coming to an end. If we step back and consider the first two years of this law, we have a long way to go, but we’re making critical progress. We need to keep pushing forward, making our nation’s health care as fair, as preventive and as inclusive as possible.

Dan Baumgarten was executive director of Community-Minded Enterprises (CME) for 15 years. CME’s Health For All program has helped more than 75,000 uninsured Spokane-area residents find improved access to health care.