What Health Reform Means to You and Me

The Law

The Affordable Care Act was signed into law by President Obama in March 2010.  Most of the provisions haven’t gone into effect yet, so many people still wonder what health reform will mean to them.  The next, and biggest, provision to go into effect happens on October 1st when health insurance marketplaces will begin open enrollment for plans starting in January of 2015.  The plans offered in these marketplaces need to provide at least the following basic health coverages (Healthcare.gov):

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services

The law also requires that all plans cover certain preventive services at no cost, including immunizations and screening for common health issues like high blood pressure.  For more info check out Healthcare.gov’s breakdown here https://www.healthcare.gov/what-are-my-preventive-care-benefits/.

What Happened In Massachusetts

    Many people are worried about how the law will affect insurance prices, their personal budgets and government spending.  The good news is we can use Massachusetts to get an idea of what may happen.  Massachusetts passed Health Reform in 2006, and the federal law is largely modeled after it.  Here’s what has happened in MA over the last 7 years.

   

1.) Health insurance rates increased -  Massachusetts has the highest rate of health insurance in the country with 98.1% insured at some point in the year (mahealthconnector.org) and 96% insured year round (http://www.hhs.gov/healthcare/facts/bystate/ma.html) compared to 81.8% nationally (CDC). 

2.) Uninsurance rates fell the most for minorities going from 15% uninsured to 3.4% for African Americans and from 20% to 9.2% for Hispanics. (Study: Romneycare Didn't Increase Hospital Costs)

3.) The State budget increased.  Getting near universal coverage in a fair and equitable way unsurprisingly costs money; however, health reform only increased the budget by 1% (mahealthconnector.org) and Massachusetts purposely left out cost containment from the bill with the idea that those measures would be passed later.

4.) Premiums and health care use did not increase faster than they would have.  When increases in premiums and use were compared to New Jersey, New York and Pennsylvania (similar states without health reform), there were few to no differences.  Yes, Massachusetts has the highest premiums in the nation, but that was true before health reform. (Study: Romneycare Didn't Increase Hospital Costs)

5.) Finding and understand health insurance got easier.  As a resident of Massachusetts who has purchased health insurance through the Connector twice now, I can honestly say that the process is very straightforward.  It is never easy to understand everything about how you will be covered with health insurance, but the bronze, silver and gold ratings make it easier to get a general idea without reading hours of technical insurance documents.  Below is a snapshot from mahealthconnector.org to help you get an idea of what Massachusett's exchange looks like.

Conclusion

    Though you can never know everything that will come from a law the magnitude of the Affordable Care Act, most of the evidence we have so far suggests positive results.  With the recent releases of lower than expected premium rates from Maryland, New York, Oregon, Montana, California and Louisiana, it looks like states other than Massachusetts will be able to benefit from universal (or near to) health care coverage.