By Ron Pollack
Families USA Executive Director
The Supreme Court decision is behind us, and the argument over whether the Affordable Care Act is constitutional has been settled. Despite all the weight that had been given to a Supreme Court’s decision, however, the ruling itself seems to have done nothing to quiet the clamor over the law; it’s just changed the text of the arguments.
The best place to get the truth about the law isn’t from the media “talking heads.” The people to ask about the law are those who have already benefited from parts of the law that are already in effect. For the most part, these aren’t advocates on the front lines of the debate. They’re just millions of ordinary folks, seeing some changes in their lives that may not be earthshaking but are nonetheless important. These are folks like the parents of young children with pre-existing conditions who can now obtain health coverage for their kids, or folks like seniors who can keep a little more money in their pockets when they purchase prescription drugs.
The “doughnut hole.” Over the years, it’s been hard to say the name of this Medicare Part D coverage gap without wanting to smile, but it’s been no smiling matter for seniors trying to make sense of their drug coverage and to come up with the needed cash when they hit this gap. Like a bad dream, however, the doughnut hole is going to fade away. That terrible gap, where seniors have to pay 100 percent of the cost of their prescription drugs until the other side is reached, is getting smaller every year. By 2020, the doughnut hole would have grown to $6,000 a year; instead, under the Affordable Care Act, by 2020, the doughnut hole will be gone and seniors will only have to pay their copayments. The fact that something so bad is being eliminated is real reform.
Reform also means that there are no longer any deductibles or copayments for annual wellness visits and such basic screenings as bone mass measurements; cervical cancer screenings, including Pap smear tests and pelvic exams; mammograms; diabetes screenings; prostate cancer screenings; cholesterol and other cardiovascular screenings; and more. It’s just common sense reform. Removing any disincentive for seniors to get important preventive care helps make Medicare a more comprehensive health care plan—and keeps seniors healthier longer.
How about the new policies for hospital stays under Medicare? Like so many provisions in the law, this one is helpful in important but sometimes invisible ways. Under the Affordable Care Act, Medicare will reduce payments to hospitals that are among 25 percent worst in terms of allowing patients to pick up health conditions they didn’t have when they entered the hospital. A big deal? It certainly is to those exposed to such conditions and their families. Many or most of us may not directly see this change, but we will all benefit from this provision of the law.
A related measure is a payment adjustment in Medicare to encourage hospitals to make sure their patients are ready to leave before they actually leave. This “readmissions reduction program” is another effort to make sure you or your loved ones get out, go home, stay home, and improve.
And there are great pocketbook savings for seniors in a program in the Affordable Care Act that opens up the purchase of durable medical goods like wheelchairs, nebulizers, and oxygen tanks to competitive bidding. This was initially implemented in limited markets, but it is expanding and is projected to save billions. Will everyone see this program and use it? No, but those who do will truly benefit.
And that’s the message here. No American is likely to see every benefit in the law, but every benefit will be enjoyed by some American. That’s progress. That’s real reform.