The Most Important Obamacare Benefit: Preventative Care
December 15, 2014Uncategorized
Love it or hate it, there’s no denying that the Affordable Care Act (ACA, a.k.a. “Obamacare”) did much to address the drastic need for better preventative medical care in the United States. Under the ACA, all health insurance plans — even those one would buy off-exchange — must fully cover certain preventative care measures without charging the policyholder a co-pay or co-insurance fee. That’s critically important, because lack of access to care for avoidable illnesses has been one of the largest stressors on the American healthcare system.
ER visits are expensive, and most of them are unnecessary.
A 2013 study, published by Truven Analytics, found that 71% of all visits to US emergency rooms are either preventable or unneeded. According to the authors, 42% of ER visits could safely be treated by primary care doctors, 24% do not require immediate attention and 6% could have been avoided altogether with proper preventative care.
Given that the average charge for an emergency room visit in the United States is $2,598 (although costs widely vary by diagnosis, facility, provider, ED course and state — indeed, as Time noted, an ER visit amounts to a financial “crapshoot”), the need for consumers to shift away from on-demand care and back toward traditional primary care is urgent.
Diabetes, as a case study.
Most emergency room doctors will tell you that they see a number of patients with acute problems resulting from diabetes, or its secondary complications. Many of these patients either do not know they are diabetic (because they have not been properly screened) or are non-compliant with their diet and insulin regimen, resulting in costly, often life-threatening illnesses.
Although little can be done, other than preventative screening, to get ahead of Type I (juvenile) diabetes, the vast majority of diabetes cases (over 90%) are acquired, also known as Type II, and thus preventable with diet and lifestyle changes. Type II diabetes is strongly linked with chronic obesity and lack of physical fitness; it could be characterized, in fact, as end-stagemetabolic syndrome.
Every year, complications from diabetes — whether through lack of patients’ awareness that they have it, non-compliance attributable to financial stress, or willful non-compliance — cost the American healthcare system an estimated $116 billion (that’s billion — with a “B”), with a further $58 billion drained from the economy due to lost work time, preventable disability payments and premature death). A more proactive approach was desperately needed.
The ACA seeks to rein in healthcare costs by giving people increased access to preventative care.
As such, it requires that plans provide full coverage for many basic screening and health counseling services, with no out-of-pocket cost to you. For adults, these include:
Abdominal Aortic Aneurysm (AAA) one-time screening for men with risk factors
Alcohol abuse screening and counseling
Aspirin therapy to prevent cardiovascular disease for men and women of certain ages
Blood pressure screening for all adults
Cholesterol screening for adults of certain ages or at higher risk
Colorectal Cancer screening for adults over 50
Depression screening for adults
Diabetes (Type II) screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
HIV screening for everyone ages 15 to 65, and other ages at increased risk
Immunizations for adults, including:
Human Papillomavirus (HPV, or “genital warts,” a major cancer risk factor)
Influenza (the “flu shot”)
Measles, Mumps and Rubella
Meningococcal (bacterial meningitis)
Pneumococcal (the “pneumonia vaccine”)
Tetanus, Diphtheria, Pertussis (“Whooping Cough”)
Obesity screening and counseling for all adults
Sexually Transmitted Disease (STD) prevention counseling for adults at higher risk
Syphilis screening for all adults at higher risk
Tobacco abuse screening for all adults and tobacco cessation measures
Additionally, some women’s services are covered in full, including:
Well-woman visits (i.e., annual check-up by gynecologist)
Gestational diabetes screening in pregnancy
Human papillomavirus (HPV) testing
Contraception (except for those women covered through faith-based employers’ plans)
Breastfeeding support, supplies, and counseling
Interpersonal and domestic violence screening and counseling
The deadline to sign up for coverage with a January 1st, 2015, start date is today.
That said, if you miss the December 15th deadline to purchase coverage, you can still purchase by January 15th and avoid a tax penalty for 2015. Go to healthcare.gov and fill out an application to determine whether or not you are eligible for a subsidy. Then, talk with a health insurance agent to find a plan — on-exchange or off — that will fit your coverage needs in the New Year.
Once your covered, schedule a visit with your primary care doctor (your plan will be able to help you find one if you don’t already have a family doctor) and take advantage of the potentially life-saving preventative care that your new insurance will cover.