ACA Off to Good Start, But Will Coverage Translate to Care?

waiting room photo copyIt was nice to be out in the Pacific Northwest for a few days enjoying the rain, seeing my kids, and spending time over at the Alliance office. It was also good to see the beginnings of the effect that the Affordable Care Act is having. The guy in the bar who tells me his brother was alive because he had qualified for Medicaid. The waiter who tells me he signed up for insurance, even though he is young and healthy.

It was fascinating to sit through an Alliance staff meeting where we were shown the options they have under proposed new health insurance plans. They were being offered pretty comprehensive benefits and a couple of economic choices. The economics had to do with the size of deductions and co-payments the staff thought they could bear.

What is really different are the new limits on how much co-payment and deductability a person has to sustain in a year. Well, it is still pretty steep, between $3,000 and $5,000, depending on your plan, but that’s it. No more $80,000 medical tabs. No more need to sell the heirlooms, the car, and the family home just to survive. Maybe just the car.

This ACA is working, in spite of all the yelling about it on the part of the President’s enemies.

“The lady doth protest too much, methinks.”

Enrollment in the troubled exchange system has met expectations – 7.1 million people are enrolled now and probably a bunch more as everyone gets a break to finish the paperwork. The waiter I mentioned earlier is getting a subsidy, and so are a substantial majority of the exchange enrollees.

But the good stuff is that there are going to be 6.3 million newly eligible Medicaid recipients. In spite of the absolutely shameless refusal by some Tea Bag states to accept the Medicaid expansion in the ACA, a whole lot of poor folks are suddenly insured.

Delivering good health care to all these new folks is going to be one hell of a challenge. It is going to take a while for the medical system to catch up to some fairly weighty pressure. But here’s what I think is going to happen – the medical system is going to change because the monopoly of the specialists is going to be broken. More cash is headed into prevention and primary care, which points both to better health and to better cost containment.

The biggest challenge will be reversing the scabrous lesions on the system associated with poor health outcomes for people of color and non-English speakers. But there are tools and ideas and resources in the ACA for working on this and we all need to make doing this work a priority.

But all in all, the Obama administration deserves some real kudos here. They have overcome some really big barriers and all of us are better off for their effort. Let’s give them some applause.