The debate is on as to whether the Patient Protection and Affordable Care Act, also known as “Obamacare” is in full swing. This is a difficult question because it partially depends on your interpretation of “healthcare”. People tend to use healthcare and health insurance synonymously. In reality, healthcare is the treatment you receive from a doctor or hospital, health insurance is product you own that helps you pay for health care. We should take some time to explore both of these.
Prior to the Affordable Care Act one in 7 residents in Illinois were uninsured. Now that number is down to about one in four, however 92% of those reside in the Chicago Metro Area. The uninsured rate has gone down since the passage of the Affordable Care Act, There are several factors to consider here. Some are due to the Law and some the economy. Since the majority of Americans get their health insurance through their job, it stands to reason that when the economy picks ups and the unemployment rate shrinks, so will the uninsured rate. In the law there is a provision that children can stay on their parents’ policies until their 26th birthday. That is an age bracket that often went uninsured so that is a benefit for that age bracket. Prior to the law, many States allowed this benefit to full-time students only. Now, those young adults, do not even need to live in the same house as their parents. The Affordable Care Act also expanded Medicaid. It was left up to the states if they wanted to participate in that portion of the program thirty one states expanded Medicaid. Medicaid is a government run program for lower income families. Some will argue that this is not insurance. It is a medical card provided by the state. This benefit can be lost depending on income. None the less, people can see a doctor or a hospital with this benefit.
Having Health insurance, whether it be through the insurance marketplace, an employer or Medicaid, does not necessarily mean you have easy access to health care. Many doctors have stopped taking Medicaid patients since the reimbursements are lower than traditional health insurance. Many insurance plans have narrowed their network of doctors and hospitals to try to reduce premiums. They have been able to negotiate with a small number of medical providers to control their costs. There are also some medical groups that have decided it was not in their best interest to accept certain insurance networks due to the reimbursement levels. So even though more people may have insurance benefits under “Obamacare”, it is highly possible that doctors and hospitals may no longer service the patients who had previously been under their care.
The State of Oregon began expanding Medicaid back in 2008. Oregon conducted a study for people who could qualify for Medicaid who were previously uninsured. The study cited, in The New England Journal of Medicine, after two years of examining patients with high blood pressure, elevated cholesterol and diabetes, found no statistically significant impact of having Medicaid versus not having insurance at all. This is only one state and a fairly small sample, but calls into question whether expanding Medicaid, spending $450 billion on the program, and adding 11 million more people into the system is the right thing to do.
It is also difficult to quantify healthcare outcomes in only a few years, especially with the current life styles of many Americans. In the United States 34.9% or 78.6 million Americans are considered obese. Obesity related medical conditions include heart disease, stroke, type 2 diabetes and some forms of cancer. The medical cost, according to the Centers for Disease Control, is $1429 a year higher than those of normal weight. Lifestyles and diets obviously play a part in this discussion, but they are often times overlooked.
Harold Pollack, a professor at the University of Chicago says, ” We have never shown in any study that we’ve ever improved health behaviors by giving health insurance to the uninsured.”
The Affordable Care Act has introduced some performance measures for hospitals which focus on penalties for re-admissions of patients for the same illness. This portion of the law seems to be working due to the penalties to the hospitals. The ACA reinforced a trend of providers including doctors and hospitals to merge into regional Healthcare systems. These systems can dominate a market. These are resulting in fewer hospital systems and fewer insurance companies reducing competition. The monopolies that are being created are not a result of the free market, but forces of public policy.
In the United States medical prices vary significantly. In the Washington, DC area MRI’s range from $400 to $1850 and hip replacements anywhere from $11,000 to $125,000. Since healthcare is usually paid for by a health insurance company, the true costs are hid from the consumer. The consumer has no reason to “shop around” for the best price. This will be even more true if there are fewer competing hospitals in an area. If there are no nearby competing hospitals, the hospital has more leverage to dictate the reimbursement fees from the insurance company.
Many experts believe that it is too early to tell if the ability to get a mammogram, colonoscopy or routine check-up will eventually prevent more chronic illness. However, one thing that is known is that many of the newly insured fall into Medicaid. According to the National Center for Policy Analysis, breast cancer patients on Medicaid have worse outcomes than those on privately held health insurance plans.
While at this point we may not know if the Affordable Care Act has improved healthcare, we do know that there is no guarantee that having health insurance will make you healthier.