No, PPACA is not the end-all, be-all of health care reform; that would be single payer. But it's a damn good start that is accomplishing a lot more than a lot of people think. One of the most contentious points has been the question of rate increases and out-of-pocket expenses, because it's very true that the greatest bulwark against wanton rate increases -- the exchange -- doesn't kick in until 2014.
But it's always true that there is more than one way to skin any given cat and PPACA is having profound, if subtle, effects across the board.
Insurers tried to fight the pre-existing exclusion provision; that didn't end well for them. Then there was that whole accepting 26-year old dependents ahead of schedule thing. There are fun provisions like this one:
Prohibition on lifetime benefit limits and restricted annual benefit limits
Grandfathered and new group health plans (1) may not establish lifetime limits on the dollar value of benefits for any participant or beneficiary; and (2) may only establish a restricted annual limit on the dollar value of benefits for any participant or beneficiary with respect to the scope of essential health benefits
A few weeks ago, we saw this:
...in recent months, several states have taken unusually assertive steps.
In California, state regulators announced that they would order independent reviews of increases being sought by four large health insurers. That move came after the department discovered miscalculations in rate requests by Anthem Blue Cross, prompting the company to withdraw its plan to raise premiums by as much as 39 percent.
In Massachusetts, the administration of Gov. Deval Patrick, a Democrat, used long-untapped power to deny 9 of 10 rate increases requested by the state’s insurers, provoking a lawsuit from the industry.
In New York, Gov. David A. Paterson, a Democrat, signed legislation this month giving the state power to block unreasonable rates. And in Pennsylvania, Gov. Edward G. Rendell, also a Democrat, announced two weeks ago that his insurance commissioner, Joel Ario, would investigate large increases by the state’s biggest insurers.
...The new law requires the health secretary to work with states to establish a process for annual reviews of "unreasonable increases in premiums." Administration officials said Monday that they were still writing regulations to define "unreasonable increases."
...Insurers have warned since early in the debate that the overhaul might result in increased premiums for many consumers. The Congressional Joint Committee on Taxation and the nonpartisan Congressional Budget Office found otherwise, projecting that it would have minimal effect on group premiums, which account for 83 percent of the market. Their analysis forecast that premiums for individual policies would rise faster than they would without the new law, but that the increases would largely be offset by government subsidies.
And just this week, we were treated to the announcement of a not-at-all-subtle and exceedingly profound effect of PPACA. Any new plans issued after September will have to provide a range of preventive services with no out-of-pocket or co-pay expense to the patient. From a sampling of articles, the covered preventive care includes the following, among other things:
Autism screening for children at 18 and 24 months
Immunization vaccines for children and adults
Mammography screenings every one to two years for women older than 40. Pap smears for cervical cancer prevention
HIV screening for all adults at higher risk
Blood pressure, diabetes, and cholesterol tests
Cancer screenings
Counseling on smoking cessation, weight loss, healthy eating, depression treatments, and reduction of alcohol use
Screening, vaccines, and counseling for healthy pregnancies. Well-baby and well-child visits up to the age of 21, as well as vision and hearing, developmental assessments, and body mass index (BMI) screenings for obesity
The new regulations represent a fundamental shift in how health care is addressed, DeParle says. "We are shifting form health care coverage meaning coverage for the sick to meaning coverage to keep you well."
The aim, she says, is "to create a healthier country."
''Chronic disease such as heart disease, cancer, diabetes and others are responsible for seven of 10 deaths among American each year and account for 75% of the nation's health care spending," Cutter says.
The co-pays and other out-of-pocket costs to help prevent these problems are a stumbling block, Cutter and DeParle say. For instance, Cutter says, "12% of children have not had a doctor's visit within the last year and receive recommended care less than half the time."
Prevention = bending the cost curve. In a big way. And the government estimates that between now and 2013, these provisions are estimated to extend preventive care to 88 million Americans. There are so many intertwined elements and working parts of PPACA; it's really not possible to get a sense of its impact from examining one piece of it at a time.