The Most Important Obamacare Benefit: Preventative Care

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.

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.

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.

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:

Hepatitis A

Hepatitis B

Herpes Zoster

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”)

Varicella (shingles)

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 1^st, 2015, start date is today.

That said, if you miss the December 15^th deadline to purchase coverage, you can still purchase by January 15^th 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.