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OPINION: Obamacare is a step forward, but it could be better

December 11, 2015 By Raanan Geberer Special to Brooklyn Daily Eagle
Cartoons courtesy of Cagle Cartoons
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When the Affordable Care Act (ACA), popularly known as Obamacare, was passed into law, its detractors railed against it as though it were the devil incarnate. Many of its supporters, on the other hand, hailed it as a revolutionary change that would transform American health care for the better. The truth is somewhere in between.

The program provides health care to many people who otherwise would have trouble getting it, and it takes into account people’s income and adjusts monthly fees accordingly. However, Obamacare health plans don’t always provide the same benefits as others, and getting your insurance renewed every year can be a time-consuming, frustrating process.

When I first applied for insurance under the ACA, I tried to do it online, but I soon realized I could never negotiate on my own the arcane requirements and requests for information. I decided to visit one of several authorized health care “navigators” in my area. I ended up at the Community Service Society, speaking to a very well-informed, nice young woman.

I brought all my tax information, and it took her only about five minutes to get through it. Since I had already decided on a provider and a plan, that was no problem. Within a half hour, I was enrolled in Obamacare.

Renewing the policy wasn’t so easy. This time, I had to go directly to a representative of the provider. She had to call the state Department of Health while I sat there because of a technicality that stated that I couldn’t renew my policy until I had authorized her to act in my behalf.

I had to wait about 45 minutes until she got the Department of Health on the phone. She then handed the phone to me, and I had to assure the state bureaucrat in Albany that I indeed authorized the representative to fill out the forms for me. After that, things proceeded smoothly — but I can think of other things I could have done during those 45 minutes.

Once I was covered under the program, there was no delay in getting covered for doctors’ appointments and prescription drugs. However, the provider I had chosen was, in my opinion, a little too strict about the drugs it covered. For several years, I had taken Advair, a preventive asthma inhaler. The new plan didn’t cover Advair. I told my doctor, who looked at the “formulary” (or list of approved drugs) and identified another drug, Symbicort, that basically did the same thing.

However, when I called the provider, it turned out that the approval process for Symbicort was so rigorous, it could take months. Frustrated, I ordered Advair from a Canadian drug company instead. Finally, after six months, the provider liberalized its policy about Symbicort and I was able to get it at the drugstore with no problem.

Getting back to the big issues surrounding the ACA, one very big misconception is that the program is intended for the very poor. That is not necessarily the case — the very poor are usually on Medicaid. The typical Obamacare consumer might be someone who is between jobs, someone who retires early and isn’t eligible for Medicare yet, someone who works part-time (such as this writer) or someone who works only on a freelance basis.

Another misconception is that it is a form of socialized medicine, such as the state-run medical systems in Europe and Great Britain. The opposite is true. Obamacare, by enrolling large numbers of new customers, is one of the biggest boons that the health insurance industry has ever received.

Wikipedia, for example, mentions how the advent of Obamacare led to a “dramatic growth” in Fidelis Care, a health care provider originally established by the Diocese of Brooklyn and Catholic Medical Center of Brooklyn and Queens, with enrollment eventually topping 1 million. As for the pharmaceutical companies, Forbes predicted in 2013 that Obamacare would guarantee the drug industry an additional $10 billion to $35 billion in profits.

Here are some more statistics on Obamacare. According to the U.S. News and World Report of June 8, 2015, the percentage of Americans without health insurance has declined 5.2 percentage points since the end of 2013, when the program was introduced.

In addition, readmission rates within 30 days for patients with heart attacks, heart failure or pneumonia have decreased by several percentage points because of penalties in the ACA. In the past, the same article says, many hospitals would freely readmit patients, then bill the insurance companies a second time.

This is not to say that there are not problems with the ACA. One is the anticipated tax on expensive “Cadillac” health care plans offered by some employers, which include a high level of benefits. Many of the people who have such plans as a result of their contracts are government employees, and many of them bitterly protest such a penalty. I don’t have an answer for this.

In general, I believe the ACA is a step forward. However, there is definitely room for improvement — especially on the consumer side.

Raanan Geberer, a freelance writer, recently retired as Managing Editor of the Brooklyn Daily Eagle. He had been Managing Editor of the Brooklyn Daily Bulletin until 1996, when the Brooklyn Daily Eagle was revived and merged with the Bulletin.

 


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