If you're living with a chronic illness, you're in the right place.

Sunday, October 6, 2013

Affordable Care Act

3:17 PM Posted by Tiffany Taft , , ,
Greetings.  I'm here to talk about the government shutdown.  Ha, just kidding.

Who knew how powerful Mr. White really was?
We're 5 days into the implementation of the Affordable Care Act (aka "Obamacare") and, political ideologies aside - really really far aside - I wanted to go over some of the important parts of this law for people living with a chronic illness.  You know, in case you're like me and didn't have time to read all 2,000 pages; I've reviewed several reputable sources for this information which hopefully will summarize some of the key points.  I'll leave the arguing of the merits or abominations of this law to the pundits, politicians, and anyone else who likes to debate social issues.

Pre-existing condition clauses are a thing of the past.  Under the ACA, insurance companies can no longer exclude a person from coverage due to a chronic condition.  In addition to this, they're supposed to offer affordable plans and not increase premiums if you have a chronic illness that may require expensive treatments.  This may be, in my opinion, the most important aspect of ACA for the chronic illness community.

Prevention of "insurance gaps."  According to a 2011 survey, 25% of adults between the ages of 19 and 64 experienced some time without health insurance, most likely the result of changes of employment status.  70% of those with a gap in coverage had it for at least 1 year.  That's a long time to go without insurance if you have a chronic condition.  Those who tried to buy their own insurance often reported trouble finding something they could afford, and most had trouble doing a worthwhile comparison of the available plans.  Under the ACA, insurance exchanges will provide a viable alternative should a person need it if they lose their employer-based health insurance.  Health insurance is critical for those with chronic illness, and often people will stay with unpleasant jobs because they need their insurance and fear no viable alternative.

Continuity of care.  Related to insurance gaps, jumping between insurance carriers can lead to your go-to physician who's been managing your condition to go from in-network to out-of-network which results in interruptions in care.  Being able to avoid losing these critical physician-patient relationships solely because of a change in insurance plan is a big plus.

Emphasis on integrated care.  You probably haven't heard much about "Patient Centered Medical Homes."  When I first read about this concept, I thought they were talking about nursing homes.  Nope.  This is a new(ish) integrated model for primary care that the ACA advances to possibly be the new way of doing things in medicine. The basic gist is to have your primary-care physician head up a team of medical professionals who facilitate care for you and a group of patients that they're assigned to.  They not only look at your health, but the health of a group as a whole.  The emphasis is on self-care and self-management.  Under this model, there should be much-improved access to care with same-day appointments, proactive tracking of your condition(s), and integrated electronic health records to make sure nothing falls through the cracks and the sickest patients get the most attention.  Sounds nice, doesn't it?  The jury is still out if medical homes really do what they say in terms of improving care and cutting costs.  But it seems they are here to stay.  It does seem to be a reversal of the super-specialization in medicine that's been popular over the past few decades.  If you have more than one chronic illness, you understand how frustrating this disjointed "I only treat a certain part of your body" approach can be.  I've seen clients who have been to 6 specialists for various problems and while each one gave the person a diagnosis, none of them actually talked to each other.  Even within the same health system with the same health records.  So I'm hopeful about this shift.

Those are some of the highlights of the ACA and how it may impact people living with a chronic illness.  Love it or hate it, there are some changes in this law that should have significant impacts.  Like everything else, we'll have to see how things shake out.

Dr. T