I
t’s been nearly two years since the embattled notion of universal healthcare was whittled down into something that could make it onto President Obama’s desk for a signature.
During that time, the Patient Protection and Affordable Care Act (PPACA) — commonly known as “ObamaCare” — has withstood some courtroom challenges and the ire of the Republican-controlled House of Representatives, which spared not one vote for its passage.
And still, the public’s literacy about the law is lacking.
“We have had efforts over the last 50-60 years to have this kind of healthcare reform, to expand coverage to the population, to lower costs, to help protect consumers, and some of the important things about the act haven’t gone into effect yet,” says Kenneth Munson, of the U.S. Department of Health and Human Services (HHS). “A lot of very important things have taken effect, but some won’t be in place until 2014.”
Late last year, Munson was appointed HHS Region V Director and now oversees Ohio, Indiana, Wisconsin, Illinois, Minnesota and Michigan.
HHS Secretary Kathleen Sebelius, a Cincinnati native, selected Munson for the appointment and has charged him with promoting the PPACA in the six-state region and helping Region V states implement the law. Munson visited Cincinnati’s Hispanic and African-American Chambers of Commerce in late December to help demystify the Act and spoke with CityBeat during the visit.
One of the prominent features of ObamaCare are the insurance exchanges, one-stop virtual kiosks at which people will be able to learn about their options for insurance. Ideally, one can click on a state-run website or call an 800-number and learn all they need to know about how one plan stacks up against another.
This is designed to cut through obtuse industry jargon and make it simpler to choose insurance, which will help level the playing field and drive down prices. Many of these exchanges will be functional this year with the rest slated to be online by 2014, the year that all U.S. citizens are required to secure health insurance or face a fine, pending a constitutional challenge before the U.S. Supreme Court.
Although Ohio voters last fall approved opting out of the law’s provisions by a 2-to-1 margin, the decision essentially is meaningless. As even conservative columnist Charles Krauthammer has noted, “this ballot measure has no practical effect, federal law being supreme.”
While the exchanges are yet to come, some aspects of the law are already quietly in place.
“It’s like the bell that didn’t ring — you don’t know what’s happened if you haven’t heard about it or haven’t been affected by it,” Munson says. No longer can insurance companies ban children with preexisting conditions from coverage. Previously, even a common condition such as asthma could have blocked a child from coverage. This protection extends to adults in 2014.
“Recissions” — or the retroactive cancelling of coverage — also are now illegal.
Munson explains: “A woman has an insurance policy. She’s been insured for five years. She’s diagnosed with breast cancer. The insurance company looks back at when she applied for the policy and let’s say she was asked, ‘Is there anything we should know about that can help us understand your health-care needs?’ and she forgot to mention she had two counseling sessions for stress a couple of years ago. Insurance companies have barred coverage for that breast cancer treatment because of that failing to list those two counseling sessions. Some of the largest insurance companies in the country have had computer programs they’d run to try and find those kind of things.”
Munson also addressed Sebelius’ recent controversial decision to overturn the Food and Drug Administration’s recommendation that would’ve allowed the Plan B “morning after pill” to be sold to girls younger than 17 without a prescription. Plan B can prevent pregnancy if taken within 72 hours after unprotected sex and is different from RU-486, commonly known as the “abortion pill.”
“She believed that for the youngest group of childbearing age, young women or children — depending on your definition — that the scientific evidence supporting the recommendation that was made by the FDA panel and the FDA commissioner was not sufficient to support an expansion of over-the-counter access,” he says.
Critics, however, including Planned Parenthood, have argued that the decision was a political one, with Obama hoping to sidestep a thorny issue in an election year. The group believes increased availability would reduce the demand for abortions.
Meanwhile, a little-known beneficiary of ObamaCare could be Cincinnati’s health clinics, which are a point of contention in city budget negotiations nearly every year. The PPACA allocates $1.5 billion to support and expand community health centers. Of that, $16.2 million has recently been disbursed to Ohio for this purpose.
“Especially going into 2014, where the Medicaid eligibility is going to be broader, the community health center is going to be an increasingly important place for people getting their health care,” Munson says.
Reducing infant deaths is another of the law’s goals. This is especially important in Hamilton County, where the infant mortality rate has, in recent years, been significantly higher than the national average.
“Where infant mortality rates are at their highest, and this is often minority communities, you have the highest rates of un-insurance or under-insurance or lack of insurance,” he says. “So, first there’s the big picture, expanding Medicaid eligibility and expanding third-party insurance has an effect because people have medical homes to get treatment. They won’t be waiting until it’s too late for treatment. Then, you have a prevention agenda. People don’t get the diagnostic screening or early detection they should get often because of the cost of co-pays.
“One of the things the ACA does is it bans those co-pays from a set of diagnostic screenings,” Munson adds. “For women specifically, in 2012, there’s a whole range of services including well baby care, well woman care, screening for gestational diabetes, STD screenings — a variety of things that would help those women be healthier and would reduce those negative birth outcomes.” ©
