Tomorrow, on October 1, health insurance exchanges nationwide will begin signing up people for health insurance which will become effective in 2014. In many ways, tomorrow is a landmark day in the country’s history. Under the Affordable Care Act (ACA), passed in 2010, the federal government opened the door to tens of millions of uninsured people to gain health insurance. Currently, about 50 million Americans lack health insurance. That number will fall significantly in 2014.
A 2010 study by Families USA estimated that 61 Californians ages 25-64 die prematurely every week because they are uninsured. Nationwide, 26,000 people in this same age group die prematurely every year due to a lack of insurance. The problem of so many Americans living without insurance not only takes a heavy human toll, it exacts high financial costs as well. People without insurance tend to not receive usual preventive care measures and often end up in Emergency Departments with serious and more-expensive-to-treat illnesses which may have been avoidable. The costs of caring for the uninsured may not be immediately visible but they are real, and someone has to pay these costs. Currently, the costs of caring for the millions of people without insurance are borne by those with insurance. One would think this defines the concept “irrational.”
In California, our health insurance exchange is called Covered California. It is estimated this exchange will help 2.3 million uninsured Californians acquire health insurance. For those with limited income, premium assistance is available to offset the cost of insurance. Many people will remain uninsured even under the provisions of the Affordable Care Act, in particular those without legal papers to live in the U.S. This is a major shortcoming in the ACA, but expanding insurance for the undocumented was not politically palatable when Congress passed the law.
Most readers of this post are very aware that some forces are still battling the ACA. They object to the U.S. helping broaden health insurance coverage to more of the population. While Partnership HealthPlan is not a partisan organization, it is a stretch to imagine U.S. society would be better off continuing to have tens of millions of people uncovered by health insurance. Any look at health statistics reveals the nature of the problem. The U.S. spends a higher proportion of our GDP on health care than any other industrialized country, yet our health status lags significantly behind many other countries.
Tomorrow, we take a large step on an exciting journey forward. For primary care and specialist clinicians alike, in the near future, the number of uninsured patients we see will start dropping. For society as a whole, the cost of health care will start dropping. We will still have many more steps to take, but at least we will be on our way.
Richard Fleming, MD