Affordable Care Act: Progress and Anticipation

The Affordable Care Act (ACA), commonly referred to as “Obamacare,” is less than three months away from entering its next phase. On October 1, 2013, certain consumers, including those who don’t receive insurance from their employers, can seek coverage through healthcare insurance exchanges in the Health Insurance Marketplace. Coverage could begin as early as January 1, 2014.

ACA advocates maintain that the legislation, upheld in 2012 by the Supreme Court, will improve the lives of the middle class and the working poor by expanding access to affordable insurance options. New York State made national news last week when Governor Andrew Cuomo’s office announced a revised rate structure from participating providers that could lower insurance rates by 50 percent for some plans.

Reaction to ACA, nationally, however, remains mixed. A CNN poll out this week shows that 39 percent of Americans—the highest percentage ever—want the act repealed.

We wanted to take the pulse of researchers and clinicians in the Einstein community to get their take on the recent New York State rate-structure announcement and the potential implications of the ACA rollout overall. What do you think about the Affordable Care Act? Let us know by leaving a comment below.

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Lots of promising news this week for Obamacare, from reduced insurance premiums to initial success for accountable care (with our clinical partner, Montefiore Medical Center, playing a leading role in the latter). leading role in the latter). What’s amazing to me is how the shrill and unsubstantiated jeers from the Republicans—“It’s a disaster!” “It must be repealed!”—continue unabated. I wish I could say I knew for certain that the Obamacare reforms will be successful; while I can’t, here’s something I do know: that the “system” (such as it is) that we have is dysfunctional and unsustainable. “Repealing Obamacare” means endorsing our current failing system, which is simply not a good option. We need to see what reforms will work, and revise the program to maximize the advantages. Thankfully, we have some encouraging early signs

Paul Marantz, M.D., M.P.H.
Associate Dean for Clinical Research Education and Director of the Center for Public Health Sciences, Albert Einstein College of Medicine

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Politics, ethics and human decency have converged on this major flowering of the Affordable Care Act that has been both derisively and respectfully called “Obamacare.” The middle class, which will benefit most from the reduction in insurance premiums engendered by market forces responding to a government program, deserves the highest level of medical care that can be provided, as do all Americans. The middle class’s specific contribution to the economy and the tax base is so critical that it is a particular joy that it will finally reap a major plum from the president’s and Congress’ initiative.

Edward R. Burns, M.D.
Executive Dean, Albert Einstein College of Medicine

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In the next six months, New York State will take a big step forward in healthcare reform via voluntary participation in accordance with recent legislation to extend health insurance coverage to the uninsured and to permit those with limited coverage to get more for their money. According to the Urban Institute’s Health Policy Center’s estimate, projected in a March 2012 research report, “the number of New Yorkers with insurance coverage increases by roughly 1 million people, with the share of the population uninsured falling from 16 percent to 10 percent.” The Empire State’s exchange, following the Massachusetts model, will be moving us in the right direction. As was true with the advent of prescription coverage via Part D, states with large populations, such as New York, could have considerable choice among commercially initiated plans. The extensive list of choices has helped reduce the premiums for individuals purchasing coverage through the purchasing exchanges.

Unfortunately, the ACA never permitted the establishment of nonprofit health plans, known as “the public option,” which could have served as benchmarks in each state against which profit-making companies could be measured when it came to looking at performance and consumer satisfaction. States that have agreed to establish an exchange will receive substantial federal assistance to create a method for identifying eligible consumers and to develop an education program, staffed by a small army of facilitators known as “navigators,” for those individuals considered to be in the small-group or uncovered individual market. The Empire State will be able not only to find people eligible to purchase coverage on the exchange, but also to determine whether it allows them to receive a subsidy; navigators also will discuss with consumers what plans are available from which insurance companies and how much it would cost to receive the high, medium, or low levels of coverage. The most expensive (platinum) plans will command the lowest levels of deductibles, a situation similar to what is available to those in the workforce who already have the opportunity to pick a plan. Finally, affordability will mean more demand for services; multispecialty practices, in particular, will have to find ways to deliver primary care via the use of either physicians or nurse practitioners.

Arnold Birenbaum, Ph.D.
Professor of Pediatrics, Albert Einstein College of Medicine

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What a relief! For those of us on the front lines providing care for the people of the Bronx, the ACA represents a breath of fresh air. Historically, at Einstein’s Children’s Evaluation and Rehabilitation Center, about 10 percent of our clients come to us with no means of paying for the services they receive. These are the working poor, members of our community who earn too much money to qualify for Medicaid but whose jobs don’t offer health insurance and who don’t have the resources to buy insurance on their own. Caring for this segment of the population has always been a challenge. The availability of health insurance for all will meet that challenge and ease their burden.

Robert Marion, M.D.
Chief, Genetics and Developmental Medicine; Department of Pediatrics,
Albert Einstein College of Medicine and The Children’s Hospital at Montefiore Medical Center