Apr 172014

Who among us has not been inundated with the news and commentary regarding the Patient Protection and Affordable Care Act (also known as Obamacare)? We were all privy to Supreme Court decisions surrounding its legality, a botched roll-out of the much-anticipated Healthcare.gov website (until Accenture saved it), countless arguments back and forth from elected officials, industry lobbyist groups, talk shows, and just about anybody who cared to voice an opinion. We cannot recall a policy issue that has generated such intense, and often heated, debate regarding a government policy’s purpose, intent, legality or cost.

Is all of the intense scrutiny a sign of a more informed and involved electorate? Or is it the result of an over-zealous reach by all parties concerned to use our easy and instantaneous access to information as a way to influence policy and create a following? We have never before had a law that has inspired such intense fervor to weigh-in. Folks either love affordable care or hate the Affordable Care Act. Furthermore, folks are anxious to tell others about it, especially across social media. Regardless of the passions held, a lot of people have widespread misinformation or limited knowledge of the law, largely due to the over 900-page complexity of the law and the impending thousands of pages of new regulations. Many more additional regulations are planned going forward. Whether they are indeed affordable or not.

Protecting Patients and Families for Affordable Care

The intent of the Affordable Care Act is for all Americans to have healthcare insurance coverage so that all Americans can have affordable healthcare. We can debate whether or not such affordability will indeed be achieved. We may even wonder whether the law was intended for that. Clearly, healthcare is costly and becoming costlier in the future with increased demand for access to advanced healthcare technologies.

The ‘individual mandate’ requiring all Americans to obtain health insurance is supposed to address such access in the face of rising healthcare costs. If we get sick or injured and we do not have healthcare insurance, then we do not get the affordable care we need. Or, we get the care that we need, but the price may be non-affordable to others, as the cost of care is passed along to other folks who require care.

People of all walks in life on both sides of the debate continue to argue the structural question regarding should or should not the federal government require folks to purchase insurance of any kind, especially if folks cannot afford it. For people who do not have a job that provides adequate healthcare coverage, the federal government has established a ‘marketplace’ of private insurers to provide coverage. Large employers are required in 2015 to provide employees with affordable health insurance coverage, or pay a penalty to the Internal Revenue Service that may or may not be used to help pay for coverage. A big piece of affordable care is removal of insurer pre-approval constraints on ‘pre-existing conditions’ and ‘limitations on benefits and auxiliary costs of care’ to patients and families. Insurers have naturally responded by raising premium costs, causing ‘sticker price shock’ to consumers engaging the government marketplace.

Economics of Affordable Care Access

The economic impact of affordable healthcare is immense. We have already seen ‘knee-jerk’ reactions from businesses designed to find a loop-hole in the law that reduces or eliminates any requirements they might have to pay more. Businesses are resorting to anything from reducing the hours employees are required to work, or reducing the number of employees altogether, to meet certain thresholds. All such business policies have been ‘out there’ for us to see and react to.

CIOs have to lead the charge in how a company connects to the state exchanges, in any technology spending related to healthcare and in how the healthcare policies are implemented in IT.”“5 Ways CIOs Need to Prepare for Obamacare” at CIO.com

We have seen different reactions from various states, pro and against the plan, primarily based on the political leanings of the governors of these states. In addition to the obvious political overtones, the healthcare reform measures also reflect economic uncertainty. As I have commented in The Christian Science Monitor, “States are scared to death they cannot afford it, on top of their burgeoning social security and Medicare entitlement cost loads already on their insolvent books.” And now as we begin to run full-steam ahead into a 2014 mid-term election cycle, we are beginning to get a glimpse of how support or disdain for the affordable care law is being used to craft campaign strategies. The talking points are already beginning to take shape.

We have seen the impassioned accounts of ‘real people,’ whose lives have been impacted by their lack of insurance, their having insurance, and of course, those who have lost their insurance – that they were once assured they would be able to keep. We have also seen numerous studies and projections from a variety of ‘think-tanks’ trying to sort it all out. We are at a point where this is the law. So, talks of repealing the law are no longer grabbing the headlines. So, what’s next?

You must keep up on health insurance premiums and allocate 20 percent of your family budget to these expenses.”“7 Budget Cuts You Should Never Make” at Care.com

We cannot imagine anyone who would not want Americans to live healthy lives and receive the medical care and medicines they need when they are sick. All we have now are concerns of just how affordable is affordable care, as a social, technological, economic, and political issue across the country. This issue is pressing down upon us hard, moving forward in the 21st century age of demography shift and heightened engagement.

Questions Remain that Need Answers

Is it really just the cost that has so many people up in arms over this law? Or, is it the forced way the Affordable Care Act was rolled out, when it was clear there really could not be a compromise among the political parties. So, each side drew a ‘line-in-the-sand’ and refused to budge. Or, is it something else?

Are we using affordable care to continue to perpetuate a hidden class system in our country between ‘the haves’ and ‘the have-nots’?

Will my ability to get quality healthcare be diminished, because there are now, all of a sudden, so many ‘other people’ who have now entered the healthcare system?

What about the future of social security and Medicare in the face of Affordable Care and its expanding law? Have medical care resources across the board become overly-strained now?

Has anyone really looked more deeply at the impact of affordable care on healthcare education?

Have we done sufficient workforce planning to determine if enough healthcare professionals will be there to treat all of the folks who are now in the system and so many more forthcoming in future?

Will hospital emergency rooms now become less hectic and more focused on ‘real’ emergencies now that those who previously went to the emergency room on a regular basis are living healthier lives, because they now practice preventative care?

What is the future affordability of ‘prevention-based care’ or ‘patient-based care’ or ‘population-based care’ or ‘community-based care’ or ‘universally-managed-care’ or ‘university health-sciences-based care’?

How do we afford such universal emergency medical care during the next ‘Hurricane Katrina’ or ‘Hurricane Sandy’, or ‘man-made 9-11’ disaster recovery and aftermath?

There are so many more questions than answers, more speculation than facts, and more or less irrational thought than intelligent discourse about this topic. Will we ever get to a point where we can all get on the same page and objectively and rationally look at what works, assess what does not work, and perhaps fix those things that can be improved upon? It is only when we get to this point that we will indeed be able to quantify the impact of quality affordable care and determine if it is indeed affordable.

What do you think?

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