Two years ago in March, President Barack Obama signed into law a historic piece of health care reform, the Affordable Care Act of 2010 (ACA). Since then, despite the heated political debates, much action and transformation in the health care arena has taken place, especially in California.
Some of the statewide changes include setting up a health care “Exchange” to provide low-cost health insurance to millions more people by 2014. Policymakers are currently choosing the “essential” benefits to be covered in these plans. Another change is setting up Accountable Care Organizations (ACOs) to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients across various health care settings. The idea is to reduce costs and increase wellness. ACOs that lower their growth in costs while meeting performance standards on quality of care and putting patients first will be rewarded through Medicare’s Shared Savings Program.
The state is also preparing to shift 1.2 million beneficiaries with Medi-Cal fee-for-service coverage into Medi-Cal managed care. This process has met some significant challenges in ensuring/guaranteeing that beneficiaries experience a seamless transition in their access to providers, treatment and medication, and hence may be delayed or slowed.
Some other health care reform induced changes in California that are highlighted in a recent report by Health Access (PDF) include:
- About 8,600 Californians with pre-existing medical conditions have gained access to affordable health insurance. Patients who have illnesses such as cancer or multiple sclerosis – who face high costs or denials on the open market – can buy insurance through the program.
- More than 350,000 young adults have been able to stay on their parents’ health insurance plans until they are 26.
- More than 370,000 low-income people have been covered by an expansion of Medi-Cal, the health insurer for low-income Californians, that is part of the state’s “bridge to reform” waiver to alter the state-federal program.
And, in addition, Medicare beneficiaries across the state and the country are experiencing numerous specific benefits from health reform, including:
- Many new and continued Medicare preventive benefits, mostly at no cost. Some of these include: an annual wellness visit, cancer screenings, smoking cessation counseling, and obesity screening and counseling.
- Lower out-of-pocket Part D prescription drug costs for people with large medication expenses. Beneficiaries who reach the coverage gap (also known as the donut hole) now only pay 50% of their brand name drug costs and 86% of their generic costs versus 100%. This amount will decrease gradually until 2020 when beneficiaries will just pay 25% of their drug costs. The gradual closing of the coverage gap has resulted in over $171 million of savings to beneficiaries, according Health Access’ recent report (PDF).
- An end to wasteful overpayments to Medicare Advantage (MA) plans, saving both taxpayers and the Medicare program millions of dollars. By 2014, MA plans will be required to invest at least 85% of all the funds they collect in premiums and copayments back into quality health care services for beneficiaries versus high administrative costs and profits.
Currently, the health care reform law is only partially implemented. If and when it is allowed to be fully implemented, virtually all Americans will have access to affordable health care coverage. Also, our health care system will run more efficiently and effectively, ensuring quality of care for all residents and reversing the trend of skyrocketing health care costs. Health care reform benefits all, beneficiaries, families, young adults, children and our communities. Let’s keep it going!