September 30th, 2013

th-13Tomorrow, October 1, is the first day of open enrollment for Americans who need health insurance coverage for themselves and their families.  Under the Affordable Care Act (otherwise known — neutrally, disparingingly, or affirmatively, depending on your apolitical or political persuasion — as Obamacare), Americans will have a brand new way to obtain health insurance coverage.  If you believe, as I do, that every American should be insured for catastrophic medical conditions (at a minimum), then the desired result of the ACA — more people insured — should be realized.

So what does this mean for you and your family?  What do you need to do beginning tomorrow?  Jeffrey Young has some simple answers:

If you’re one of the roughly 80 percent of Americans who already has health insurance through an employer or is enrolled in a government program like Medicare, the answer is: probably nothing.

 

For the nearly 171 million Americans who already have coverage through their work and the nearly 102 million who have insurance through public, government programs — Medicare, Medicaid, and the public plans government workers (including our politicians) have — not a whole lot changes.  But that doesn’t mean nothing will change.  If you have coverage through your employer, you can keep your kids on your plan until they are 26 years old and, if you change jobs or your life’s circumstances change, you can’t be denied coverage based on a pre-existing condition.

So 80% of Americans don’t have to do anything.  For the other 20%, this is the time to get with the program.  If you live in Pennsylvania, you will be enrolling in a health plan through a nationwide exchange (along with states that, like PA, didn’t have the political will or foresight to create their own state-run marketplaces).  One problem for Pennsylvanians is the fact that the state government decided (on purpose!) not to expand Medicaid (public health insurance) coverage for our family, friends, and neighbors with low or no income.  Recently, there have been signs that Governor Corbett is finally coming around with a plan to do just that, but passage of his plan (which has not been made available to read online) by the state legislature is not a done deal by any means.

A BIG problem I see is that learning about the Affordable Care Act and enrolling in an insurance plan through the health insurance marketplace requires consumers to be computer-literate.  For those of you who read this blog, that’s not a problem.  But one thing I’ve learned as a pediatrician — by adopting electronic health records (EHR) in our offices, implementing an online patient portal (NextMD), participating in the Pennsylvania Statewide Immunization Information System (PA-SIIS), forging ahead with creating a path to one of the most important “superhighways” of online health information sharing (the health information exchange or HIE), and, writing this blog — is there are a lot of people that really don’t use computers efficiently, if at all.  There are two websites that should be helpful to those who want or need to understand how to move forward to get insurance coverage on their own. One site is from the Kaiser Family Foundation and the other is the government’s own site, HealthCare.gov.  Consumers will be able to enroll by phone (and I’m sure there will be paper forms available somewhere), but being swift with the internet will be the most efficient way to gather information.

Will the Affordable Care Act be a success?  We’re about to find out.

 

(Yahoo! Images)

3 Responses to The Wait Is Over

  1. Nicely done Dr. Ketyer! Thanks for the nicely presented and easily understood information.

  2. Thank you for calling it what it is…the Affordable Care Act. Healthcare is a right, not a privilege.

  3. Just saw this stat from Pew and thought of your post from yesterday. Definitely a problem that people aren’t talking about.

    http://www.pewresearch.org/fact-tank/2013/10/01/21-of-americans-without-health-insurance-do-not-use-the-internet/

  • MEET THE EDITOR

    Ned Ketyer, M.D.

    Ned Ketyer, M.D.

    Dr. Ketyer has special interests in developmental pediatrics and preventative medicine, specifically how nutrition and the environment affect health. He earned his bachelor’s degree from the University of Vermont and his medical degree from Northwestern University Medical School. He completed his residency at Children’s Hospital of Pittsburgh.

    As one of the founding physicians of Pediatric Alliance, PC, Dr. Ketyer served as its president from 1997-2004. He has been practicing general pediatrics at Pediatric Alliance since 1990. Dr. Ketyer and his wife have three boys and live in Pittsburgh's South Hills. 



  • Note: The information included in these posts is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

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