Point of View

Healthy benefits if Obamacare survives

October 30, 2012 

As election day approaches, health care reform stands at an historic crossroads. Will we continue to implement the Affordable Care Act, as President Barack Obama wants, or repeal the 2010 health reform law, as Gov. Mitt Romney pledges to do?

We often hear about how Obamacare will help the uninsured, most of whom live in working families but lack access to affordable insurance. Indeed, the law will make health insurance more accessible and affordable for those who don’t have it. Over the next decade, 30 million Americans will gain coverage as they obtain tax credits to buy private insurance or are included in Medicaid.

But what about those of us who already have health insurance?

Obamacare offers important new benefits and protections to persons who now buy their own health insurance, or get Medicare or health benefits at work. For many with health insurance who now face costly gaps in coverage, Obamacare already does and will continue to make a big difference.

What would be lost if the act is repealed?

Medicare’s prescription drug benefit has a “doughnut hole” that forces those with high annual costs for prescriptions they need to pay full price. Obamacare has already begun to close that hole – Medicare beneficiaries are now receiving a 50 percent discount on brand name drugs, a benefit that saved 4 million Medicare beneficiaries an average of $600 last year. And Obamacare will close the gap in Medicare prescription coverage entirely over the next decade.

Under the act, North Carolina seniors on Medicare now get a free annual wellness checkup. They also receive free preventive screenings for cancer, high cholesterol and other potential problems. In 2011, over 32 million Medicare beneficiaries around the country used such free preventive health services.

Obamacare pays for these new Medicare benefits by trimming excess payments to insurance companies and other health care providers. Slowing how fast Medicare spending grows this way will also slow the rise of Medicare premiums, deductibles and copayments. This makes Medicare cost less for the seniors and persons with disabilities.

For North Carolinians and other Americans who already have health insurance at work or buy it themselves, Obamacare requires new benefits from – and creates new rules for – insurance companies that make coverage more secure and comprehensive.

Young adults, for example, can now stay on their parents’ health insurance plans until they are 26. Three million young adults have already gained insurance coverage as a result of this policy. And under Obamacare, insurance plans in the individual market will have to cover maternity care, and no plan will be able to charge women higher rates just because they are women, ending gender discrimination in health insurance.

Plus, insurance companies can no longer impose lifetime limits on coverage and, as of 2014, they will no longer be allowed to set annual coverage limits. The end of these caps will provide critical financial relief for families who face catastrophic medical bills.

Insurers must also now cover children with pre-existing health problems. As of 2014, they will have to do that for adults, too. They will also be stopped from charging people with pre-existing conditions higher premiums. New health insurance plans must now include preventive health screenings at no charge.

Obamacare requires insurance companies to spend 80 to 85 percent of all the premium dollars they collect on medical care services and quality improvements – not on administrative costs. Insurers that do not do that must refund part of the premiums to individual consumers or employers. In 2012, under Obamacare, insurers paid their customers about $1 billion in such rebates.

Repealing the Affordable Care Act would not just dramatically increase the number of Americans without health insurance coverage. It would also make coverage less secure for those who already have health insurance, depriving them of valuable new benefits and protections against insurance industry abuses.

The stakes in this election for health reform are enormous. As North Carolinians go to the polls, we should remember that our votes will help determine the future of the American health care system. Moving forward with the Affordable Care Act is vital to guarantee health security for all Americans, both those of us who are insured today and those of us who are not.

Jonathan Oberlander is a professor of social medicine and health policy and management at UNC-Chapel Hill.

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