Obamacare: More Than Just Insurance

As an Insurance Specialist serving at Health Center #6 with the Philadelphia Department of Public Health, it’s safe to say that the parts of the Affordable Care Act (ACA) that I interact with most, and that are most well known to the American public, are the sections that establish a health insurance marketplace, or what most people know as “Obamacare.” While this section makes up the majority of the law and is responsible for decreasing the uninsured rate in the US from 15.7% to 9.2% in the 6 years since it was signed[1], I think some of the most interesting ACA regulations are the ones unrelated to healthcare.gov. There are many, lesser known regulations which are still being enacted to improve healthcare access and quality in the US.

One of the biggest changes passed by the ACA is the attempt to reform the American healthcare system toward a preventative model and away from one that relies on the use of emergency services. In order to truly improve healthcare for American families and alleviate the cost of healthcare to taxpayers, the Act is attempting to transition from a system that primarily treats the sick to one that keeps Americans healthy throughout their lives. This goal is accomplished by increasing the benefits that all insurance companies are required to provide to consumers, at little or no cost.


This aspect of the law is one that I try to reinforce to my patients after applying for and enrolling in Medicaid or an Obamacare plan. Without insurance, people avoid going to see a doctor regularly and wind up in the emergency room when it’s too late to find a simple fix to many of their health concerns. After being discharged from the hospital, they find themselves with a bill that they can’t possibly pay which puts even more pressure on taxpayers and contributes to making the American healthcare system the most expensive in the world[2].

After my patients are approved for Medicaid or enrolled in a plan from healthcare.gov, I try to ensure they have at least a basic understanding of how to use their new insurance, because for so many of them, this is their first experience with it. I encourage them to take advantage of the preventative services that are now covered by the ACA, often without copays, like annual wellness visits, immunizations, and screenings like mammograms[3]. In my opinion, providing this education is equally, if not more important to helping the patients get insurance.

In addition to drastically changing the way Americans interact with the healthcare system, the ACA includes many other regulations. Some of these include increasing healthcare services in rural areas, helping seniors on Medicare to afford their prescriptions when they couldn’t before, and providing incentives to healthcare institutions and professionals to improve the quality and reduce the quantity of care to patients.

Just last week, the Department of Health and Human Services announced that it would fund, with money provided by the ACA, a pilot study to determine if screening Medicaid and Medicare beneficiaries for health-related social needs and helping them navigate the community-based services would improve the quality and affordability of Medicare and Medicaid[4]. This announcement is a huge step in recognizing that what happens inside a doctor’s office only accounts for a very small portion of a patient’s health outcomes. Connecting patients to housing, transportation, and food can greatly improve their health and make programs like Medicare and Medicaid run more efficiently.

Serving lower income patients for the past four months, I have seen how hard it can be for patients to prioritize or utilize their doctors when they have many other, more salient concerns, like getting food on the table for their kids or picking up over-time shifts at work to help make ends meet. A study like this could impact the way that millions around the US are able to better make use of the services provided to them.

As somewhat of a healthcare geek when it comes to these kinds of things, it’s incredibly exciting to be able to work at Health Center #6 as all of these changes are coming to life. Just as I’m understanding more and more about the healthcare system in the US, I have the opportunity to serve and see firsthand the patients who are greatly impacted and benefiting from these changes of quality and access to care.

[1] http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201508.pdf
[2] http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirro...
[3] http://obamacarefacts.com/obamacare-preventive-care/
[4] http://www.hhs.gov/about/news/2016/01/05/first-ever-cms-innovation-cente...
 

This blog post was written by NHC Philadelphia member Michelle Fedorowicz.
Michelle serves as an Insurance Specialist at Philadelphia Department of Public Health-Ambulatory Health Services: Health Center 6.