Posted by Mark Ryan, MD April 16, 2011 at 12:36 AM
Just over year after the Patient Protection and Affordable Care Act (PPACA) was passed, surveys show that many Americans are still unsure of what the law will mean for them. A recent Kaiser Family Foundation poll (pdf) showed that 52% of respondents feel that they lack sufficient information to assess the PPACA’s impact–a proportion similar to that seen after the law was passed last year. At the same time, there is increasing understanding that our current health care system is dysfunctional and needs to be reformed: the Commonwealth Fund recently found that 72% of Americans believe that the current system needs fundamental change or major reform. To support this, poll respondents noted “difficulties accessing care, poor care coordination, and struggles with the costs and administrative hassles of health insurance.”
In this context, it is revealing to review an earlier Commonwealth Fund publication titled “Help on the Horizon: How the Recession Has Left Millions of Workers Without Health Insurance, and How Health Reform Will Bring Relief.” This report found the following:
- Millions of Americans lost their jobs and health benefits in the last 2 years: nearly 60% of those who had health benefits through their job lost those benefits, and only 14% kept their coverage through COBRA.
- There are few affordable options for health insurance for workers who lost their jobs and benefits: 60% of Americans who sought coverage in the individual market reported great difficulties finding affordable coverage, and 35% were excluded from coverage or faced higher costs due to a preexisting health condition.
- The number of adults who have spent time without health insurance has increased in recent years: 52 million people reported being uninsured during at least part of the previous year in 2010 (up from 38 million in 2001). People were more likely to have gone without insurance if they reported low or moderate incomes, if they were members of a minority group, or if they were young adults.
- People are spending large proportions of their income on healthcare costs: nearly 1/3 of respondents reported spending at least 10% of their income on healthcare costs, up from 1/5 in 2001.
- More and more Americans report facing significant medical debt: 40% reported financial problems related to the costs of their health care.
- Americans are foregoing needed care because of costs, and are less likely to get preventive care: 40% reported skipping needed care (avoiding doctors’ visits, prescriptions, tests, etc) due to costs, and rates of recommended preventive care were notably lower among uninsured individuals.
Clearly, the system we have had is broken, and the current recession has only made things work. Unemployed Americans lack the necessary leverage to get affordable and comprehensive coverage, resulting in deferred care, financial hardship, and presumably increased risk of illness and harm over time. The 72% in the Commonwealth Fund noted above clearly have a reason to feel our system needs to be changed.
Fortunately, that change is already underway. The PPACA will address these issues once it is fully in effect in 2014. In 2014, the PPACA will provide for nearly universal coverage for American citizens by expanding Medicaid eligibility, subsidizing private health plans with more robust patient protections, and spurring new options for health insurance through the state health care exchanges. Once fully in effect, the PPACA will also prevent insurers from charging more or denying care for individuals with preexisting health problems. The early reforms already in effect allow young adults to stay on parents’ insurance until they turn 26, eliminates lifetime caps on benefits, and requires health insurance plans to provide preventive care without requiring patient copays.
The better the existing healthcare system’s problems are defined, and the more information we gather about those affected and harmed as a result, the more clear the need for reform is. As this need becomes increasingly clear, it is also increasingly clear that the PPACA’s major reforms are targeted at addressing the current system’s most crucial problems.
We need to stop trying to justify the PPACA by finding more and more proof reform is needed–we have that proof. We also need to stop trying to prove the PPACA is the answer–we have that proof. What we need to do is to continue working to ensure that all Americans understand the law’s benefits and how it will help them. We already have all the proof we need.