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The
Unmet Promise of ObamaCare
by Marc Siegel, Forbes 06.15.10
The
number one question on my patients' minds as the new health reform
bill passed was whether they would be able to keep their current
health care plan, like the president promised. This past week,
when the new 83-page draft of regulations was released jointly by
the IRS, Health and Human Services, and the Department of Labor,
an answer was offered. Unfortunately, it's a resounding no.
Whenever
the federal government enacts a new law, agencies write
regulations on how this law will be enforced. The newly released
draft is about whether existing insurances can be "grandfathered
in" and continue to be legal policies as the new health
reform bill, known as the Patient Protection and Affordable Care
Act, takes hold. In my field, whenever a new area of practice such
as emergency medicine or geriatrics is established, "grandfathering
in" simply means that if you were already established before
the new board was created, you retain your credential.
But
this usual and customary practice will not be the case with the
health reform bill, as insurers will routinely lose their status
by not jumping through the right hoops.
In
fact, the regulations impose a major vise on private insurance,
restricting a company's ability to increase cost sharing (such as
coinsurance, deductibles and out-of pocket limits) as well as
copayments ("more than the sum of medical inflation plus 15
percentage points or $5 increased by medical inflation"). So
it is unlikely that many insurers will be able to remain viable
without raising premiums (not restricted by the regulations) or
slashing services.
Though
the purpose of all the restrictions on insurance is to cut costs,
as a practicing physician I worry that extending a
one-size-fits-all insurance to more people will have the opposite
effect because there will be no disincentive for patient overuse.
In countries such as Belgium (where one-third of payments are
out-of-pocket), it is precisely these patient responsibilities
which help keep the cost of medical care down, as patients only
come to doctors when absolutely necessary. I have noticed this
effect in my own practice, where patients with high-deductible
insurance (Health Savings Accounts can help deal with out of
pocket office visits) only come to see me when they are sick. And
there is no evidence that frequent office visits by healthy
patients with easy to use insurance contributes significantly to
preventive care.
At
the same time, the draft regulations would imposed such an
inflexible restriction on employers--for group insurance, if an
employer decreases its contribution rate by more than 5% it will
lose its grandfather status--that it is likely that many employers
will drop their insurance plans altogether.
The
draft's own midrange estimates reflect this bleak new world,
predicting that 66% of the insurance plans offered by small
employers and 45% offered by large employers will no longer be
legal by 2013. And the numbers are no better for individual
policies. The draft estimates that individual policies
relinquishing their grandfathered status by failing to comply with
the new regulations will be from 40% to 67%.
Patients
who lose their existing insurance will flock to the new state
insurance exchanges, sign up for Medicaid or pay the penalty for
not having insurance. There will be a drastic shift in health care
coverage, and the result will be lower quality care and more
government oversight coming from HHS as well as newly formed
committees and panels such as the Independent Medicare Advisory
Panel. Young adults under the age of 26, who are eligible to join
their parents' plans, will find that 20% of these parents will
have plans that are not acceptable under the new law.
This
new world of health care, filled with shifts and changes, is
particularly unfortunate when you consider the draft's own
research, which cites a survey in Health Affairs from 2000,
showing that 83% of privately insured individuals stuck with their
plans in the year prior to the survey. . .
Marc
Siegel, M.D. is an associate professor of medicine and medical
director of Doctor Radio at NYU Langone Medical Center. He is a
Fox News Medical Contributor.
Read
the entire Commentary by Dr. Siegel . . .
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