Robert I. Field, Ph.D., J.D., M.P.H., Professor, School of Law & Drexel School of Public Health
If you visited the federal health care website, healthcare.gov, in October, you know what a disaster it was. I tried accessing it on October 1 and gave up after staring at a frozen screen for 15 minutes.
The site’s problems went even deeper than the technical glitches. They included basic design flaws. Most notably, the site provided no information about insurance plans or how to sign up for them unless a visitor created an account. This discouraged window shoppers and those seeking general background – people who were often most in need of the site’s assistance.
President Obama promised that the website would work by November 30, but many remained skeptical that a debacle of that magnitude could be fixed so soon. However, the computer geeks must have accomplished something, because more than a million people succeeded in signing up for coverage by the end of December. More than 880,000 visited it on Christmas Eve alone. And almost a million more signed up on the sites run separately by 14 states.
Krystyna Dereszowska, A third-year law student concentrating in health at Drexel
Every family has its holiday traditions, and every year members of my family decide who will play Santa and hand out gifts on Christmas. Meanwhile, everyone else assumes the role of pundit, starting conversations that make me wonder how we’re all related. Not surprisingly, this year seemed to focus on critiques of the health care law, and I bit my tongue as the retelling of elaborate personal experiences contradicted logic and facts.
I don’t mean to be rude. My family members have real concerns about a complicated law that I don’t claim to fully understand myself. But call me the bitter ghost of Christmas Past because here’s the speech I developed in my head as the evening progressed:
Let’s start with the concept of health insurance. Much like other forms of insurance, it operates by pooling risk so that individual claims are paid out from premiums accumulated over time. Except unlike the renters or car insurance you love to cite, everyone will make use of their health insurance at some point. Problems develop when the sick max out their coverage, are dropped for being too sick, or are denied coverage altogether. This is an area where governmental regulation has long attempted to intervene.
Janet Weiner, MPH
It’s tempting to get lost in the politics of Gov. Corbett’s proposed plan to expand Medicaid (see here for scathing commentary, here for gentler one) or the wonky “weeds” of the plan itself (see here for excellent analysis).
But I’m not going to do that now. Instead, I’d like to mention the people left out, because Pennsylvania chose not to expand its Medicaid program in 2014. Thanks to the Kaiser Family Foundation, we have national and state-specific estimates of people who fall into this coverage gap in 25 states not expanding Medicaid this year. KFF estimates that 4.8 million people nationally—nonelderly, poor, and uninsured—will be left out of the ACA health reforms. Six per cent of them live in Pennsylvania.
Across the state, 281,000 adults fall into this coverage gap. Of those, 180,000 are white; 62,000 are black, and 29,000 are Hispanic. The vast majority (81%) are adults without dependent children; 42% are women. And fully 60% are in a family with at least one worker. They are ineligible for subsidies on the individual market (because they are below poverty level) and will most likely remain uninsured because they have no affordable coverage options.
Elizabeth A. W. Williams, Senior Vice President and Chief Communications Officer, Independence Blue Cross
Earlier this month the federal government announced that the number of Americans who purchased their health insurance through the new federal and state Marketplaces more than doubled from October to November. It’s good news, but there are many more people still without coverage. According to a recent report, in southeastern Pennsylvania more than 276,000 adults don’t have coverage.
Having insurance is more than just a safety net if something catastrophic should happen. It’s about being able to go to the doctor for routine preventive care to keep you healthy. For example, women in our region with insurance are much more likely to have routine cancer screenings such as mammograms or Pap Tests.
So, for those who have been postponing shopping for health insurance, now is the time. The deadline is fast approaching. Consumers must sign-up by December 23 to have coverage on January 1. There are still a few challenges with the federal government’s website healthcare.gov, but it has improved and is getting better every day.
Drew A. Harris, DPM, MPH, Director of Health Policy Program at the Jefferson School of Population Health
The Affordable Care Act (ACA) rollout continues and every few weeks another problem arises seemingly without warning. However, those who follow health policy closely aren’t too surprised because every system is perfectly designed for the result you get. Unfortunately, it’s not always the result you want. The glitches and gotchas are largely the foreseeable result of the convoluted process that created the ACA in the first place.
The ACA (aka Obamacare) builds on the existing private health insurance system but bans egregious practices such as charging more or denying coverage for pre-existing conditions and risks; canceling policies just as the bills add up; and capping lifetime payouts. The goal is to let people keep policies that meet acceptable minimum standards and give those who want or need new insurance affordable options. In practice, this hybrid amalgam needs complicated rules to ensure people don’t game the system or get taken advantage of. The simpler alternative of just canceling all health policies and enrolling everyone in standardized plans (single payer) was never given serious consideration.
So far, two inevitable complications have come to light, and a third’s about to.
Antoinette Kraus, Director of the Pennsylvania Health Access Network
No one would deliberately design a health care system that leaves hundreds of thousands of low-income working families out in the cold, but that is exactly what will happen if Pennsylvania fails to expand Medicaid health coverage next year under the Affordable Care Act.
We are talking about hairdressers, mechanics, retail employees, waiters and waitresses, and others working in jobs that do not offer insurance. Their jobs pay too much to qualify for Medicaid now but not enough to get financial help buying insurance coverage through the new federal Health Insurance Marketplace. In other words, these Pennsylvanians are about to fall into the “Pennsylvania Gap.”
Governor Tom Corbett can prevent this by supporting the expansion to proceed in 2014 as the ACA envisioned. Instead, he has chosen a slower and much less secure path, proposing his own complex, 11th hour plan that will require federal approval to move forward and has no chance of getting done by Jan. 1.
Donald Schwarz, MD, MPH, Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Every American needs health insurance. As the glitches on Healthcare.gov are repaired, it appears that all those who are eligible for new insurance options will be able to enroll.
But when that happens, what will happen to the health of Philadelphians? The Affordable Care Act (ACA) creates a structure not only to improve access, but it also strives to create a way to improve health as a way to reduce the costs of healthcare in America. These pieces are outlined in Title IV of the Act.
The Act authorizes a strong new investment aimed at preventing chronic illnesses as a way of saving billions of health care dollars. Part of cost reduction is derived from improving Americans’ access to preventive services by removing all copayments.
Curt Schroder, Regional Executive of Delaware Valley Healthcare Council of HAP
Among its many worthy goals, the Affordable Care Act (AKA Obamacare) aims to nudge the U.S. health care system from sick care to well care. By increasing the focus on routine checkups, preventive care, and better patient outcomes, Americans will be healthier. They will need less intensive, expensive health care. Health goes up, hospitalizations—and costs—go down.
In Philadelphia and its suburbs, hospital stays and days have dropped steadily—down about 12 percent*—since the enactment of the Affordable Care Act in March 2010. On the measure of less hospital care, could Obamacare be working?
As the leader of the region’s hospital association, I can assure you that hospital leaders are indeed working to achieve the goals of the Affordable Care Act. They are rethinking how their organizations deliver health care. They are investing in new ways to keep patients healthier, to keep them out of the hospital. If hospitals were airlines, it would be like changing the wings on the airplane while in flight.