Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
Americans for Prosperity is out with a new $1 million anti-health law advertising buy. Titled "Questions," the spot features a mother named Julie asking, unsurprisingly, questions about Obamacare.
Luckily, Wonkblog is in the business of providing Obamacare answers! Every now and then, I take reader questions about how the Affordable Care Act will affect them. Julie's questions in the advertisement, about what Obamacare means for her 2-year-old son, are perfect for a format like this one.
If we can't pick our own doctor, how do I know my family is going to get the care they need?
This question sets up a bit of a false hypothetical, given that the health-care law doesn't really stop people from picking their own doctors.
Instead, it's pretty much up to each individual to pick a health insurance plan that they feel meets their needs. In my discussions with state marketplace officials, nearly all say they plan to have links to lists of which doctors work with which health insurance carriers. That means that shoppers could check which health plans cover visits to the doctors they prefer.
To be comprehensive though, there is one way that the new marketplaces could cut patients off from the doctors they currently see. At least in California, the health insurance marketplace has been populated with plans with relatively narrow networks, meaning they include fewer doctors and hospitals in their health plan. In those situations, there is the possibility of having trouble finding a plan that covers a family's current doctor.
What am I getting in exchange for higher premiums and a smaller paycheck?
Excellent question! For the 14 million people who purchase health insurance in the individual market, some will see their premiums increase in 2014. For a 25-year-old man who wants to buy coverage, the price tag will likely be more under Obamacare than it is right now.
So, what do consumers get in return? For one thing, insurance companies will have to accept their enrollment no matter what. An applicant with a preexisting condition, for example, gets to sign up for a plan that they might not currently qualify for. Older Americans get limits on how much insurers can charge them; women will no longer get charged a higher premium than men. There are certain benefits, too, that health insurance plans are required to cover.
Princeton economist Uwe Reinhardt has termed this idea of enhanced benefits under the Affordable Care Act as "premium joy," an analogue to the better known "premium shock."
"Many such people simply could not afford the high, medically underwritten premiums they were quoted in the traditional nongroup market," he wrote in a recent blog post. "This joy will be shared by high-risk applicants who were refused coverage by the insurer, along with people now in high-risk pools.
Can I really trust the folks in Washington with my family's health care?
Unclear! But the question just isn't that relevant to the Affordable Care Act. Health insurance coverage under the Affordable Care Act will work pretty much like it does right now, with the Aetnas and Uniteds of the world deciding which claims get covered and which get denied. There is no panel in Washington, however, deciding who gets what type of coverage under the health-care law. We don't know whether Julie can trust the folks in Washington with her family's health care - but, for the purposes of the Affordable Care Act, we really don't need to.
KLIFF NOTES: Top health policy reads from around the Web.
Connecticut is struggling to get Obamacare off the ground. "Facing tight deadlines and daunting workloads, states across the country are scaling back ambitions for implementing the Affordable Care Act. At a monthly board meeting of Connecticut’s health insurance exchange, members of the standing-room-only crowd got a reminder that they, too, were behind schedule. The insurance marketplace they were working on nights and weekends won’t be completely ready on time." Sarah Kliff in The Washington Post.
Former Clinton health aide Chris Jennings is headed to the White House. "Mr. Jennings, 52, was President Clinton’s chief health policy adviser from 1995 to January 2001. He is known and trusted by Obama administration officials and has close ties to Democrats and some Republicans in Congress. In 2001, he established a lobbying and consulting concern, Jennings Policy Strategies. Current and former clients include the A.F.L.-C.I.O., the Bipartisan Policy Center, the Federation of American Hospitals, General Motors and the Generic Pharmaceutical Association." Robert Pear in The New York Times.
The White House's newest target in the Obamacare rollout: Moms. "They are collaborating with Elle and Cosmopolitan magazines, organizing mom-oriented wine-and-cheese parties and preparing commercials that will run during shows popular with mothers, such as “Good Morning America.” And soon, they plan to deploy first lady Michelle Obama, the nation’s mother in chief, who has already put her stamp on health-care with her anti-obesity “Let’s Move!” campaign." Sandhya Somashekhar in The Washington Post.