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ACA Coverage and the New Year



Whitney McFadden
AMSA Health Policy Chair

As medical students, what should we expect for our healthcare system this year?

The Department of Health and Human Services is closely tracking the number of people signing up for health insurance. This year’s resolution will be to follow how Obamacare is improving the health of our nation. First, 2.1 million Americans have signed up for private insurance in the exchanges and a new 3.9 million were found to be able to access coverage through medicaid. We do not know how many people had to change their current insurance, and how this coverage will affect doctor patient visits. In the end, we want to understand how these changes improve the health of our nation.

How we prioritize and evaluate the measure of our national health will be a significant issue this year. Obamacare is covering more individuals and in order to measure its success, many are searching for ways to see the impact on healthcare. The National Bureau of Economic Research studied the Oregon Health Insurance Experiment published in 2011 to investigate how health insurance improves health care and outcomes. The study measured health care utilization, out-of-pocket medical expenditures, medical debt, and self-reported physical and mental health in randomly chosen low-income participants who qualified for coverage. The study found that those with coverage had statistically significant changes in their health. Participants were likely to have more healthcare utilization (hospitalizations, outpatient visits, prescription medications), less expenses, and better self-reported health. It seems these will be a few of the outcomes to follow after the ACA is in full swing.

Listed are some of the noteworthy changes for the 2014 year:
  1. Insurance coverage will not be withheld for individuals with pre-existing conditions or premiums elevated based on age or gender.
  2. Insurance companies must share pricing and benefit information with consumers in a comparative way. 
  3. Private exchanges might be used more in the workplace.
  4. Employer mandate set for 2015 will give small companies time to prepare for covering their employees. 
  5. Price transparency. 
  6. Likely more regulations imparted by HHS.
  7. Insurance companies will begin to limit the number of healthcare providers they cover based better rates. 
  8. States will have the most impact on local price structure (i.e. Medicaid expansion). 
We will likely see some great improvements in care as individuals access more preventive services, get connected with primary care physicians, and pay less for healthcare. However, some changes remain to be seen. Emergency room visits are not likely to drop off if we use the OHSE as a model, and some insurance plans have already increase their premiums to existing customers covering lost costs for sicker people. Following the progress of our healthcare system over the next few years will be essential to improving our health as a nation. As medical students we can help patients be aware of these changes and the effects on our overall healthcare.

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