The Health Insurance Exchanges of the Affordable Care Act Open Today

The lead up to the government shutdown and today’s opening of the health insurance exchanges have once again brought about a lot of talk about the Affordable Care Act (e.g. Obamacare).  Many Americans are confused about what the Act has brought and what it will bring.

It is a fact that the United States is the only developed country in the world where all citizens do not have health insurance. And, it is clear that some Americans are afraid of the Affordable Care Act in part because of the positions taken by many elected officials.

What people should understand is that several parts of the Affordable Care Act have already gone into effect:

1. The children of workers who have employer sponsored health insurance can now stay on their parent’s plan until age 26. 
2. As of January 1, 2014, insurance companies will no longer be able to deny an individual coverage because of preexisting health conditions. Until now, if you were born with or acquired a disease that would cause you to use your insurance to pay for care, the insurance company could refuse to insure you as an individual. If you were part of an employer sponsored plan or had Medicare or Medicaid, this did not apply to you and you were covered. What many people don’t understand about this part of the Act is, for insurance companies to be able to cover the cost of sick people with preexisting health conditions, there must also be healthy people in the mix. This is called community rating. As a result, the Affordable Care Act requires that everyone have health insurance – either through the government, a private employer or through purchasing individual coverage through the new healthcare exchange. This is called the individual mandate. 

Which brings us to today, October 1, the date the health care exchanges open for everyone who does not have health insurance to purchase individual coverage that will take effect on January 1, 2014. 

Mitt Romney created the idea of these healthcare exchanges when he was Governor of Massachusetts. Governor Romney thought that it was wrong that so many working people did not have health insurance and he also knew that Massachusetts hospitals had huge amounts of bad debt from individuals who got sick and couldn't pay their bills. The State of Massachusetts wound up covering this debt. Governor Romney was also concerned with the cost of health insurance for business owners who were already covering their employees and he wanted to create a true market where insurers would compete for customers and drive costs down. He also recognized that once you start requiring individuals or small employers to buy insurance, you must help them by creating a true market. President Obama’s people later recognized that the notion of health insurance exchanges was a good idea, which is why it is part of the Affordable Care Act. And again, individuals with preexisting conditions will not be excluded (which is great).

One of the big misconceptions of this law is that it contains “government run” healthcare. There is NO provision in the law for the government to provide care. 

Our government already purchases care for everyone over age 65, which is called Medicare. It purchases healthcare for many of the poor and disabled along with the States through Medicaid. Our government purchases care for federal employees. It is true that our federal government already provides care directly to our veterans through the Veteran’s Administration (VA). In fact, the VA, the military medical systems, and the National Institutes of Health are the only organizations where government employees provide care. There is NO new government run healthcare within the Affordable Care Act.

Additionally, one of the major portions of this act that has already taken effect is the Medicare Shared Savings Program. The GBMC Healthcare System is participating in this program through the Greater Baltimore Health Alliance (GBHA) which we created in 2011. The Board of GBHA is over 75% physicians with Dr. Anthony Riley, head of geriatric medicine at GBMC, as the Chairman of this board.

The incentive here is for doctors to work towards the triple aim for those with Medicare:

1. Better health and health outcomes for the Medicare beneficiaries
2. A better care experience for Medicare beneficiaries
3. Lower costs for beneficiaries and the Federal government

Early first year results for GBHA’s participation in the Medicare Shared Savings Program shows that we have saved about 7% per beneficiary. If we improve our quality parameters and save money, some of the savings are then shared back with the doctors participating in GBHA and GBMC.

This is another part of the law that I think is good for Americans. It’s driving value in healthcare. Notice that there is no money given back to the providers unless the quality and patient satisfaction goals are achieved and money is saved. Most people believe this is good because if we don’t drive Medicare costs down, we could bankrupt the country.

Every American has the right to dissent – it’s one of the wonderful things about our country. But every American also has the duty to review the facts before they make up their minds.

So, regardless of what happens (although it does not appear there will be changes to the Affordable Care Act) GBMC will not deviate from its vision – to treat every patient, every time the way we would want our own loved ones to be treated. And we will continue to measure our progress towards our four (or quadruple) aims: better health, better care, with the least waste, and the most joy for those providing the care.

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Babies small and grown who were born at GBMC and parents of GBMC babies 

Finally, this past Saturday, GBMC’s Foundation held its 13th annual Legacy Chase at Shawan Downs. It was a fine fall day in the sun celebrating our vision and commitment to families and the community. Through the 2013 Legacy Chase event we have raised more than $1 million in commitments toward the Endowed Chair in Pediatrics. Close to 8,000 people came out to support this great event which also included several special reunions. This year marked the second year of our annual NICU reunion to celebrate the milestones of our smallest patients and GBMC’s volunteer auxiliary also celebrated its 50th anniversary! And, we had a wonderful group photo taken of babies born at GBMC (above) where several generations made this reunion truly special.

I thank all those who attended and all those who donated time or treasure. Kudos to the GBMC Foundation for another successful, fun-filled event. There’s still time to support the cause by visiting http://foundationevents.gbmc.org/.