Simplifying Obamacare (Continued)
Reining in the dollars
By 2014, the ACA bans rate discrimination based on gender. As things stand now, women are generally charged more for comparable plans than men of the same age are. Annual spending caps will be phased out, a blessing to anyone who has the misfortune to be diagnosed with cancer or any other treatment-intensive, dollar-intensive disease. And the ACA also ends so called "lifetime limits." Prior to this protection, your health plan could drop you mid-illness if you cost them more than a set amount of money over your lifetime.
Other financial constraints on health plans include laws that force insurance plans to spend between 80-85% of dollars paid for premiums by their members on actual healthcare itself. As it stands today, plans can spend as much as they like on administrative overhead, marketing, and Lear Jets — while denying your Byetta. In the future if they don't reach that mandated target, they have to refund premium dollars to their customers. Cha-ching! In the coming years will health plans beg us to use more test strips rather than draconically limiting them?
Also on the money side, going forward, plans must publicly justify unreasonable rate hikes, defined as anything more than 10%. That's quite a change from our current environment that has seen rate hikes of up to 87% in a single year without justification or oversight.
And for the grey set, the law fills in the infamous doughnut hole in prescription drug coverage, a bit at a time, between now and 2020.
Reducing costs by (trying) to make people healthier
The ACA provides a new and expanded emphasis on preventive care, historically only about 2% of all healthcare dollars spent in the USA. In the ACA, preventative care is largely limited to screening tests such as blood pressure, cholesterol, colorectal cancer, depression, diabetes, gestational diabetes, HIV, mammograms, etc., along with some immunizations.
Sadly, diabetes education isn't covered, but you can get counseling for alcohol misuse if diabetes gets to be just too much for you. Many of these prevention services will be co-pay free — meaning zero burden on your wallet or purse. Of course, some "grandfathered" health plans don't have to play by the new rules when it comes to preventive care until 2018. The ACA draws from the existing U.S. Preventive Services Task Force, an independent panel of doctors, nurses, and other health experts, to make decisions on what's state of the art in prevention.
Carrot, Raisin, and Pecan Bread Roasted Cauliflower with Red Peppers Lemon Watercress Swordfish Steak and Vegetable Soup Asparagus Mini-Quiches Spinach Salad Pumpkin Bread with Pineapple Spread Spring Vegetable Soup with Matzo Balls Southwestern Stuffed Potatoes Nacho Party
One of the "parents' business" items on our current trip to Virginia was a visit by a case nurse from an agency that is trying to get the Out-Laws additional personal and health assistance. While the old folk found her questions intrusive, they were reasonable follow-ons based on the OutLaws' current states of cognitive and physical health. One of the sets of questions was about their medications. A list of them was posted on the door to the den. The case nurse assumed...