Why did the U.S. healthcare system need reforming?
According to the United States Census, approximately 46 million Americans were uninsured in 2009. Health insurance was so costly that people could not afford it. Many Americans delayed seeking medical care from a primary care physician and instead relied on costly medical care from a hospital emergency room. Insurance companies denied policies and coverage to people who had pre-existing conditions such as asthma, diabetes, hypertension and kidney disease. Insurers dropped customers if they got sick. Insurance premiums for women were higher than those for men. Americans filed bankruptcy, lost their homes and drained their pensions because of a serious illness like cancer or a catastrophic medical incident such as a stroke.
After the 2008 presidential election, there was a long drawn out national debate that went on for so long that Americans experienced “healthcare reform fatigue.” You couldn’t open a newspaper, turn on the TV or listen to the radio without hearing so-called experts and everyday people debating their vision of healthcare reform. “Death squads,” “socialized medicine,” “town hall meetings,” “health care for everyone,” and “single payer health care” became everyday phrases.
Congress finally got busy drafting healthcare reform legislation and then spent many more months in congressional meetings, town hall forums and conference committees all the while engaged in political posturing. In the end, Congress passed the Patient Protection and Affordable Care Act (Affordable Care Act), which President Obama signed into law in March 2010.
The Affordable Care Act is multifaceted and complex. It is over 1,000 pages long and outlines every benefit, consumer protection, tax, credit and reform component in the bill. Some healthcare reform advocates criticized the bill for falling woefully short of truly reforming the U.S. healthcare system and argued that the bill predominantly reformed the way health insurance companies do business. Despite that criticism, the Affordable Care Act does deserve recognition for increasing the availability of and accessibility to affordable medical insurance. Adult children under the age of 26 can now remain on their parents’ insurance plan. Insurers cannot deny coverage to individuals, including children, with pre-existing conditions. All new health plans must include preventive care free of charge. Health insurance companies cannot cancel your coverage when you are sick. No longer can insurance companies raise premiums due to health status, gender, occupation, small employer size or claims history. Premiums are now based on your income, age, tobacco use, family size, where you live, and the type of plan you buy on the health insurance exchange (i.e., www.mnsure.org or www.HealthCare.gov). Without a doubt, this abbreviated list of consumer protections found in the Affordable Care Act helps countless individuals and families.
In January 2014, the Health Care Individual Mandate, a centerpiece of the Affordable Care Act, went into effect, requiring that adults over the age of 18 must have health insurance or pay a fine. A new retail marketplace would be created for some 46 million new consumers to purchase health insurance. Now consumers would be able to shop and compare among various plans. Health insurance exchanges would increase competition among insurers thereby lowering the price and simplifying the process for consumers.
Minnesota was one of 17 states to opt out of the federal health insurance exchange. Instead, Minnesota would plan, design and implement its own state-run health insurance exchange. The federal government allowed for state-run exchanges and even allocated federal grants to support the effort. As of last fall, Minnesota had received $41million in federal grants to support its state exchange called MNSure.
Five insurance companies applied and were selected by the state to sell their insurance products on MNSure. The qualified health plans include Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, PreferredOne and UCare. MNSure is also the place where people can determine their eligibility for MinnesotaCare (for Minnesotans without access to affordable health insurance) and Medical Assistance (Medicaid).
MNSure has been plagued with trouble since its rollout in October: Website glitches. Software flaws. A less than admirable executive leader (since released from her position). Long hold times for consumers. Insurance cards delayed in the mail. Premium payments in limbo. To say that MNSure is not a perfect system may be the understatement of the year. There are problems with MNSure, but when the dust finally settles we will be able to measure its success in helping Minnesotans buy affordable health insurance and assess its shortcomings.
The Affordable Care Act has helped Minneapolis residents like Gloria and George. Gloria, a 24-year-old, had a private self-pay plan with Blue Cross Blue Shield of Minnesota (BCBS) for five years. She paid BCBS a monthly premium of $150 for a plan with a $2,500 deductible, which meant she paid for her medical expenses out of her own pocket until she reached the $2,500 threshold, at which point BCBS coverage would kick in. High deductible plans force people to avoid going to the doctor because you pay for it out of pocket. Last November she used MNSure to shop for and compare plans. MNSure told her she was eligible for Medical Assistance (Medicaid) which would cover her insurance costs. Now she is thoughtful in deciding how she will use the $150 per month that she no longer pays to BCBS and has decided to invest those savings to improve her health, by taking yoga classes and shopping for organic and free range foods, for example.
George, 43, had health insurance through his employer up until three years ago when he was laid off. Since then, he has been uninsured though he admits that did not worry him until last summer when he was diagnosed with a medical condition. Without insurance, he paid out of pocket for medical expenses to see a specialist, who offered discounted rates for office visits and monthly prescriptions. Prior to the Affordable Care Act, he would have likely been denied insurance due to this pre-existing condition. That changed last October when Minnesotans could shop for and buy insurance through MNSure. He applied online in November and inadvertently completed an application for MinnesotaCare and Medical Assistance. He canceled that application and re-applied for insurance with a qualified health plan. As a self-employed handyman and freelancer in publishing, he had the means to pay for health insurance and did not want or feel he needed subsidized health insurance. George selected a platinum plan with PreferredOne that has a monthly premium of $250, a $750 deductible and allows him to continue seeing his specialist. He is quick to say the MNSure website has its problems but in the same breath he complimented the MNSure staff who handled his numerous phone calls and tried to assist him in every possible way.
President Obama’s supporters were devastated when he retreated from the idea of single payer health care (where everyone pays a tax and everyone is covered). Others felt let down by his inability to give single payer a chance to succeed or fail in the healthcare debate. Some were bewildered by his backing down on his promise to truly reform the country’s broken healthcare system. Many supporters criticized him for not playing hardball. In hindsight, perhaps the question to ask is, “Did President Obama see something his supporters could not or would not see? Did he come to the realization that some healthcare reform was better than no reform at all? That he would have some success in reforming the healthcare system but that replacing the system was not within reach?”