Pixel Tracker

Tuesday, February 19 , 2019, 11:19 am | Fair 54º

 
 
 
 

Karen Telleen-Lawton: The New Medical Paradigm Under the Affordable Care Act

Health care is both a heart-stopping and heart-warming topic. There are patients who have to fight for covered reimbursement and uninsureds who free-ride on payers when their health turns south. There are doctors and nurses who provide care no matter their patients’ ability to pay, and those who order tests and procedures with hidden financial incentives.

That’s now. What will transpire after Jan. 1, 2014, when the Affordable Care Act kicks in?

The pessimist in me listens to John Bridgeland and Peter Orszag, former policy and budget wonks under President George W. Bush and President Barack Obama. In their recent Atlantic article, “Can Government Play Moneyball?” they estimate that “less than $1 out of every $100 of government spending is backed by even the most basic evidence that the money is being spent wisely.”

In health care particularly, which accounts for about one-quarter of federal government spending, they write that decisions are based on “good intentions, inertia, hunches, partisan politics and personal relationships.” That doesn’t sound like a recipe for effective health-care decisions.

On the other hand, there are now six years worth of evidence from Massachusett’s “Romneycare,” the model for Obamacare, in place since 2006. June’s Money Magazine laid out the most significant results of this experiment, offering clues to what we all can expect. Among them:

» 1. More of us will be insured. The proportion of uninsured shrank from 8 percent to 3 percent under Romneycare. The U.S. estimate is that 10 percent will go without, vs. 16 percent now. More insureds means fewer free-riders and more people who get preventive treatment instead of costly emergency procedures.

» 2. Most employers won’t drop coverage, as was feared. Only 5 percent of Massachusetts private firms are paying the fine rather than covering employees. Premiums have risen one-third less since 2006 than in 2000-06. Small businesses have found coverage more expensive, but in the next year or two employers will be able to provide a budget so employees can pick from policies on a state exchange, which should abate costs in long run.

» 3. Buying insurance independently will likely be cheaper, using online insurance exchanges. Bonus for older buyers: We can’t be charged more than three times younger buyers, vs. the current 5-to-1 or 7-to-1 cost differential.

» 4. There will be more “advanced practitioners,” such as physician assistants and nurse practitioners, reserving physician involvement for diagnoses and complications. Also, there will be increasing emphasis on providing care for good health vs. expensive tests.

For instance, more than 250 hospitals and physician groups have signed up to join Obamacare’s accountable care organization (ACO). Under this agreement, hospitals and insurers share the financial risk of keeping patients healthy. For example, insurers can give doctors a budget for a group of patients. If the medical organization meets certain standards of care and health, and the treatment costs less than budget, doctors can earn a share of savings.

» 5. Federal costs will continue to be a concern for the foreseeable future, but the focus will remain on costs savings while improving health care. Starting in 2018, there will be a tax on high-end health plans designed to slow spending by paring costly benefits.

The Institute of Medicine estimates that more than half of treatments provided to patients lack clear evidence of being effective. That’s now. The good news for all of us is, there is plenty of low-hanging fruit to pick on the medical cost reduction tree.

— Karen Telleen-Lawton’s column is a mélange of observations spanning sustainability from the environment to finance, economics and justice issues. She is a fee-only financial advisor (www.DecisivePath.com) and a freelance writer (www.CanyonVoices.com). Click here to read previous columns. The opinions expressed are her own.

Talk to Us!

Please take Noozhawk's audience survey to help us understand what you expect — and want — from us. It'll take you just a few minutes. Thank you!

Get Started >

Support Noozhawk Today

You are an important ally in our mission to deliver clear, objective, high-quality professional news reporting for Santa Barbara, Goleta and the rest of Santa Barbara County. Join the Hawks Club today to help keep Noozhawk soaring.

We offer four membership levels: $5 a month, $10 a month, $25 a month or $1 a week. Payments can be made using a credit card, Apple Pay or Google Pay, or click here for information on recurring credit-card payments and a mailing address for checks.

Thank you for your vital support.

Become a Noozhawk Supporter

First name
Last name
Email
Select your monthly membership
Or choose an annual membership
×

Payment Information

Membership Subscription

You are enrolling in . Thank you for joining the Hawks Club.

Payment Method

Pay by Credit Card:

Mastercard, Visa, American Express, Discover
One click only, please!

Pay with Apple Pay or Google Pay:

Noozhawk partners with Stripe to provide secure invoicing and payments processing.
You may cancel your membership at any time by sending an email to .(JavaScript must be enabled to view this email address).

  • Ask
  • Vote
  • Investigate
  • Answer

Noozhawk Asks: What’s Your Question?

Welcome to Noozhawk Asks, a new feature in which you ask the questions, you help decide what Noozhawk investigates, and you work with us to find the answers.

Here’s how it works: You share your questions with us in the nearby box. In some cases, we may work with you to find the answers. In others, we may ask you to vote on your top choices to help us narrow the scope. And we’ll be regularly asking you for your feedback on a specific issue or topic.

We also expect to work together with the reader who asked the winning questions to find the answer together. Noozhawk’s objective is to come at questions from a place of curiosity and openness, and we believe a transparent collaboration is the key to achieve it.

The results of our investigation will be published here in this Noozhawk Asks section. Once or twice a month, we plan to do a review of what was asked and answered.

Thanks for asking!

Click Here to Get Started >

Reader Comments

Noozhawk is no longer accepting reader comments on our articles. Click here for the announcement. Readers are instead invited to submit letters to the editor by emailing them to [email protected]. Please provide your full name and community, as well as contact information for verification purposes only.

Daily Noozhawk

Subscribe to Noozhawk's A.M. Report, our free e-Bulletin sent out every day at 4:15 a.m. with Noozhawk's top stories, hand-picked by the editors.

Sign Up Now >