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Politics aside, examine positives of ACA

Tue., Dec. 24, 2013

Congress passed the Affordable Care Act in 2010. Since then we have seen court challenges, endless politics and questions from all sides about what happens next. Some provisions of the law are already in effect and others begin soon.

I am frequently asked what I think about the law. Since I do not want to be perceived through the lens of politics, I try to keep to the facts and what we have seen so far.

Since my cancer diagnosis, I have a pretty significant pre-existing condition. Starting in 2014, my health history will not prevent me from purchasing health insurance. This change went into effect in 2010 for children and goes into effect for adults in 2014. Also, your health insurance can no longer be canceled if you made an honest mistake on your original application, or for information that has little bearing on your health. If you participate in a clinical trial for cancer (as I have) or other life-threatening diseases, your coverage can no longer be dropped or limited. Lifetime limits of health insurance coverage on certain essential health benefits were eliminated– which means that you will not run out of insurance because of an expensive illness.

Because of the ACA, a friend of ours was able to stay on his parents’ health care plan during school until he turned 26.

Preventive care services appropriate for your age, gender and risk factors will be covered by insurance at no additional cost to you, including cholesterol tests, mammograms, colonoscopies and vaccines, making it easier to stay healthy.

Medicare Part D has a drug coverage gap (often called the “doughnut hole”) that will be gone in 2020. I have seen people living on limited funds struggle to get their medications, so I look forward to this becoming less of a concern.

All plans under the ACA are required to cover at least one drug in every class from the official list of approved medicines. If your current medication is not on the list and you cannot change to a covered medication, your health care provider can request an exception for medical need from your insurance.

A lot of the news lately has been about individual plans being canceled. You may need to look for a new health plan and can choose to shop for that plan on the state health benefit exchange, Washington Healthplanfinder. Regardless of where you look for health insurance, it is possible that it will cost more, but it will also probably cover more. Depending on your income, you may qualify for financial assistance from the government. You can check on Washington Healthplanfinder to see if you qualify.

Those who can afford to but do not purchase health insurance will pay a fee when filing taxes beginning with their 2014 tax return. It is initially a small amount, but will increase sharply in 2015 and again in 2016. If the lowest priced coverage available to you is more than 8 percent of your household income, you will qualify for an exemption. There are other circumstances that can exempt you from the fee. You can learn more about them at exemptions/.

Primary care physicians are paid less than other specialists, but this will improve slightly under the new law. Hopefully, medical students will be encouraged to consider careers in pediatrics, family medicine or internal medicine.

Many different aspects of health care coverage have changed, including improved access to health care for my patients, friends, family and myself. I can honestly say that as a patient and as a physician I feel the future of healthcare in the United States is brighter now.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.


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