The Affordable Care Act: What It Does for You.

The Affordable Care Act: What It Does for You.

By Dr. Alan Koslow

In May of 2010, Congress passed the Affordable Care Act or as some call it Obama Care. There has been much said about this but very little about how you will benefit from the plan as individuals. Many have heard that there are Death Panels in this plan (there aren't) and you will be forced to change your insurance or doctor (you won't). This article will review the benefits you will get from this plan.

First I want to state some facts that many Americans don't realize. We essentially have national health insurance but it is not universal. About half of all people in the USA have government funded health insurance. This includes all those on Medicare, Medicaid, Veterans, Active Military and Social Security Disability. Private companies pay 34% of the nation’s insurance, and 15% of the people are uninsured. The average private insurance company pays 30% toward overhead and only 70% towards caring for patients. The most cost effective health insurance is Medicare which has a 3% overhead. The best financially run hospital system in the USA are the Veterans Hospital system and the Military Medical System. We spend $17 out of every hundred on health care, while the country spending the next most spends only $13. Despite spending more per person and as a fraction of GDP we are in the middle of the pack in terms of outcome. Would you go to the most expensive auto repair shop if their results were only mediocre? Finally, sixty-six percent of all bankruptcies in the USA are due to medical bills. These are facts and facts are non-partisan.


Among the greatest fears of Americans about their health insurance is losing it, not being able to get or afford it because of pre-existing conditions and having an uncovered condition. The Affordable Care Act eliminates all of these concerns by making it against the law for you to be denied coverage because of pre-existing conditions. It bans a lifetime maximum on most benefits so if you have a condition that costs hundreds of thousands of dollars to treat you cannot be cut off in the middle of your treatment, as happens often now. If you lose your insurance from an employer you can easily get it from the medical insurance exchange that the Act forms in each state. These laws already apply to children under 19 and as of 2014 they will be protections all Americans will have. If you have a child under 26, even if that child doesn't live with you and is married, he/she must be covered by your insurance carrier if your policy was issued after March 23, 2010 and by all policies after 2014.


Another big concern of many is what to do if payment for your care is denied. The Act mandates that your appeal is reviewed and acted on within 72 hours for an urgent care issue and 30 days for a non-urgent issue. Your insurer must also provide translation services if you need them and want to appeal.

Insurance providers are already required to cover many preventive services including cancer screening, counseling on quitting smoking, weight loss, eating healthy, treating depression and reducing alcohol use. Routine vaccines, flu and pneumonia shots must be covered. All well baby and well child care up to age 21 must be covered. These and other benefits may not need to be covered until 2014, by your insurer if your policy was issued before March 23, 2010. Any policy issued after that date must have all these features.


To make insurance more affordable the Act mandates that 80% of premiums be spent on your benefits and any rate increase of more than 10% must be approved. The Dept of Health and Human Services this week announced the removal of over 500 regulations which will save the entire system billions of dollars.

The major complaint against the Act has been that it mandates that everyone get insurance. This is not an editorial so I will not get into this debate in this column. However, it is important to know what benefits you will obtain under this Act. These benefits will go to all Americans whether you have government insurance, private insurance from your employer, individual insurance or ultimately buy insurance from the exchange.