Friday, October 9, 2020

The Affordable Care Act is Again Under Attack

A family member of mine, who would have been uninsurable before the passage of the Affordable Care Act because of a pre-existing condition, recently received a check from his insurance company for $350. It is a small percentage of what he paid for his coverage in 2019, but still, how often does someone get a check from their health insurer?

Well, he got the check because his insurer spent less than 80% of what they collected in premiums paying providers for the care they delivered. And why did they have to pay the money back? Because of the Affordable Care Act (ACA)! 

People know so little about the ACA, called Obamacare by many who want to deride it. The legislation is imperfect, but it has been successful in many ways – requiring health insurance companies not to keep too much premium as profit is one of those ways. 

The future of the ACA is again coming into question with the Supreme Court in its new term, which started this past Monday, and with the Senate looking to act on President Donald Trump's nomination of federal appeals court Judge Amy Coney Barrett to succeed the late Ruth Bader Ginsburg.

For this reason, I wanted to take some time this week to point out the part of the Act that has to do with the medical loss ratio (MLR), or the percentage of premiums that the insurer spends on care. This is a protection for the buyers of health insurance. If an insurer spends less than 80% on care, it owes the insured a refund. 

The purchaser of the policy receives a rebate directly from the insurer through either a check or a reimbursement to the account (credit card, for example) with which the premium was paid. Unfortunately, very few people realize they may be due a refund, so they don't know to look for a check from their insurer. 

There is much more waste in our healthcare system than in most other developed countries, but at least the Affordable Care Act is providing some protection for citizens by keeping insurers from making too much profit at the purchasers’ expense. 

Most Americans support the part of the Act that protects them from being uninsurable for a pre-existing condition and they also like the fact that their children can stay on their insurance until 26, but what do you think about the 80% rule? Would you be upset if it went away? Let me know what you think.

Thank you!!
My sincere thanks to all of you for your role during our Baldrige survey last week. I think it went well, and all we can do now is wait as the examiners complete their work and submit their report to the program judges. The judges will then evaluate our application and determine whether we meet the criteria to be recognized as Baldrige Award recipients. It is possible that if we don’t receive the award we might be Category Best Practice recipients again. In mid-November we will be notified and in December, we’ll receive a comprehensive feedback report from which we can continue to learn and improve.

GBMC has been using the Baldrige criteria to build systems. Regardless of the outcome, I’m so proud of all of you! GBMC HealthCare is improving in all areas, which means we are getting closer to achieving what is embodied in our vision phrase: “To every patient, every time, we will provide the care that we would want for our own loved ones.”

Again, my sincere thanks again for all your hard work and dedication for the sake of our patients and the community.

Let’s celebrate our colleagues!!

This week is Healthcare Supply Chain Week (Oct. 4-10), which celebrates resource and materials management professionals for their important contributions to healthcare. We all benefit from the work of our entire supply chain team

I am proud to recognize the great work of our pediatric nurses as this week is also Pediatric Nurses Week (Oct. 5-9). Our pediatric nurses, to me, are a special group of medical professionals who provide care and compassion to young patients and do critical work to improve healthcare delivery. Pediatric nurses face many challenges; they have to speak with children, pinpoint their pains, and manage fears. If you’ve had young loved one in the hospital, then you can understand the challenges that can come with this career choice. So, thank you to our pediatric nurses that constantly deliver the care that we would want for our own loved ones no matter how challenging their work can become. 

It is also Healthcare Foodservice Week (Oct. 5-11). I would like to express my gratitude to the men and women who work hard to keep our patients and colleagues fed. 

Thanks to all GBMC physician assistants (PAs) this week during National PA Week (Oct. 6-12). This is the week when PAs celebrate their profession and showcase the value they bring to today’s healthcare team. I am so grateful for their hard work!


  1. Dr. Chessare: Thank you for that bit of little known information regarding the ACA and the Medical Loss Ratio (MLR). I'm always amazed at the number of people who are quick to bash the program, simply because of their dislike of former President Obama. Hope more people will appreciate the good the ACA does and his intent; and vote against the abolishment of the program. The ACA is very much needed by many Americans.

    1. Thanks, Unknown. The ACA is a very complex bill. Sadly, very few people know what it actually contains.


Thank you for taking time to read "A Healthy Dialogue" and for commenting on the blog. Comments are an important part of the public dialogue and help facilitate conversation. All comments are reviewed before posting to ensure posts are not off-topic, do not violate patient confidentiality, and are civil. Differing opinions are welcome as long as the tone is respectful.