I am going discuss ten important facts that everyone should know about a government document that is going to revolutionize our country’s healthcare system. The document is thousands of pages long and I do not claim to know everything about it. This is my attempt to highlight some important aspects.
1. Why am I, a Facial Plastic Surgeon in Charlotte, writing about this?
Some would ask, why would I write this column considering that I am starting a new medical practice in a foreign town where I have few contacts? Shouldn’t I have other more important items to be completing? While that is probably true, I believe it is important to attempt to understand this important legislation, as it will affect every man, woman, and child in America. It will affect our health, our families, and our pocketbooks. I felt it was important to write this blog post because I am an educated physician and citizen, and I was terribly misinformed with the little information I had about this law. I recently attended a lecture where an attorney named Maria Linck spoke about this, and I found it so interesting that I wanted to share the information.
2. What is wrong with the current healthcare system in the first place?
The healthcare system does a great job of taking care of people that have access to it, but how can we improve the system and make it more efficient?
1) There are inequitable aspects of our healthcare
a. Insurance companies are making a ton of money
b. People that were sick are getting dropped by insurance companies
c. The poor and elderly are covered, but the working poor cannot afford healthcare.
2) Healthcare costs are rising. In comparison to the rest of the world, U.S. healthcare is more expensive, but we are producing outcomes similar to other countries.
b. Insurance companies continue to make significant amounts of money
c. More of the working poor cannot afford health insurance
d. 16% of the population, or 48 million people, were without insurance in 2008. There were projections for this number to grow to over 60 million in 10 years due to rising costs of insurance premiums.
3. What does the current law require the health insurance companies to do?
I believe that the current business model for insurance companies has many conflicts of interests. This can breed distrust and corruption. The law attempts to change the current system.
Currently, insurance companies can deny health insurance to sick people or people with pre-existing conditions. I feel there is something wrong when insurance companies can refuse to help the people that need their help the most. The new law prevents them from denying coverage to these people.
1) If you have insurance and you get sick, insurance companies can terminate your coverage. With the new healthcare plan, insurance companies can no longer do this.
2) In the new healthcare plane, insurance companies have to renew coverage.
3) If you have been sick in the past or are currently sick, insurance companies can charge you much higher fees. In the new healthcare system, insurance companies can no longer charge you higher fees.
a. THIS IS MY FAVORITE PART…. They can only keep 20% of our premiums for profit. If they are not using our premiums to take care of sick people, then they HAVE TO GIVE IT BACK TO US! Hopefully this will change their current model, under which the more procedures and claims they deny the more money they make. Now they will get more profits by covering more people. This will actually drive them to seek more customers. Could this be the drive to lower the cost of health insurance??
b. The new healthcare system would cover all preventative care.
4. In the new healthcare system, how will the working poor get coverage?
They will be expanding Medicare to cover these people.
5. How will we get insurance in the future?
Starting in 2014, if an employer doesn’t offer insurance, individuals will be able to buy it directly in an Affordable Insurance Exchange. An exchange is a new competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer a choice of health plans that meet certain benefits and cost standards. Many different insurance companies from all over the country can participate. Hopefully, this will increase competition and drive down costs.
6. In the new system, the government is going to require everybody to purchase health insurance or pay a fine. Why would they do this?
In order for the health insurance system to work, you have to have healthy and unhealthy people in the pool. It spreads out the risk over a wide range. If everyone participates we all gain. If we don’t have universal participation, then the system will not work. This has a socialistic ring to it. This is currently being challenged in the Supreme Court.
7. What are the fines?
• Uninsured Individuals: $95 in 2014, $325 in 2015, $695 in 2016 or up to 2.5 percent of your income in 2016
• Uninsured Families: 1% of income in 2014, up to 2.5% in 2016
• A cap of the cheapest national average healthcare plan
• Families will pay half the amount for children, cap of up to $2,250 per family.
8. Will employers have to provide health insurance to employees?
• Employers with more than 50 employees must provide coverage or pay penalty of $2000/employee
• For qualified small businesses and small non-profit organizations, there is a credit up to 50% of the employer’s contribution to provide health insurance for employees. There is also up to a 35% credit for small non-profit organizations.
9. How is the government going to pay for this?
• Medicare payroll tax increased for “high” earners (>$200,000 individual/$250,000 family)
• 3.8% tax imposed on unearned income for “high” earners
• 2.3% excise tax on medical devices (not including glasses or hearing aids)
• Tax on the best insurance plans (the so-called “Cadillac Plans”)
• Tax on tanning salons
10. What are my take home points as a facial plastic surgeon in Charlotte?
There is much more detail in the act that I did not discuss, but I think this highlights many points that we have concerns about. In my opinion, the law has some good and bad points. This change has many unknown areas, but I hope this article spurs interest for people to seek their own opinions about what aspects of the law they like and what aspects they don’t like. I believe that some form of this law, if not all of it, is going to stand in the Supreme Court. I think we just need to prepare for the changes as individuals, employees, employers, and physicians.
I want to give a special thank you to Maria Linck, who spent countless hours reviewing this law and providing most of the information and tables in this article.