Keeping Healthy: Health Care Reform 101
By: Elsa Gillis
Updated: September 20, 2012
Passed by Congress in March of 2010, the Affordable Care Act seeks to
expand coverage, provide consumer protections, and create marketplaces,
or exchanges, to allow people to compare and buy their health care
plans. It's expected that it will expand coverage to 32 million more
Americans.
"In new york state 2.6 million is the number right now of people who are uninsured, and they're hoping that decreases to 1.2 million," says Regional President for Excellus Blue Cross Blue Shield Eve van del Wal. "There's going to be changes to health care. Some of these changes have already occurred, for example the dependent coverage up to 26, the women's health mandate has gone intro effect, no pre-existing for people up to age 19 and will expand to adults a few years down the line, but the real changes are going to occur in 2014."
That major change lies in the individual mandate - either buy insurance, or pay a penalty. The penalty will start low and increase over time, to encourage Americans to get coverage.
"For people who can't afford to buy insurance on the exchange, there will be some assistance for them, but there's certain criteria that need to be met," she says.
Van de Wal says Medicare will not be affected, but Medicaid is being left up to the states - and in New York, the program is being expanded - with the goal of getting more people insured. Van de Wal explains the the ideology behind getting insurance - and says its important to have access for preventative services.
"If someone has a cold and a sore throat, if they have a primary care doctor they can actually call up, see them get taken care of, if they wait and it continues to get worse and it goes into pneumonia - now they have to go to the emergency room. They're going to have chest x-rays, and services that may have been able to have been prevented."
A concern that has been brought up with this plan is that there's already a shortage of primary care physicians - and with more people forced to get insurance - the shortage is expected to increase.
"I think what we're going to see is more mid-level, more physician assistants, more nurse practitioners," she says.
Van de Wal says she knows of community based initiatives to train and encourage people to become doctors, and there are provisions in the affordable care act to do the same. Most of the controversy however lies in the individual mandate - which was recently ruled constitutional by the supreme court. And where most of the confusion is "the exchange" - where people, whether your company covers your insurance or not, have the power and more options in choosing their health insurance plan.
"In new york state 2.6 million is the number right now of people who are uninsured, and they're hoping that decreases to 1.2 million," says Regional President for Excellus Blue Cross Blue Shield Eve van del Wal. "There's going to be changes to health care. Some of these changes have already occurred, for example the dependent coverage up to 26, the women's health mandate has gone intro effect, no pre-existing for people up to age 19 and will expand to adults a few years down the line, but the real changes are going to occur in 2014."
That major change lies in the individual mandate - either buy insurance, or pay a penalty. The penalty will start low and increase over time, to encourage Americans to get coverage.
"For people who can't afford to buy insurance on the exchange, there will be some assistance for them, but there's certain criteria that need to be met," she says.
Van de Wal says Medicare will not be affected, but Medicaid is being left up to the states - and in New York, the program is being expanded - with the goal of getting more people insured. Van de Wal explains the the ideology behind getting insurance - and says its important to have access for preventative services.
"If someone has a cold and a sore throat, if they have a primary care doctor they can actually call up, see them get taken care of, if they wait and it continues to get worse and it goes into pneumonia - now they have to go to the emergency room. They're going to have chest x-rays, and services that may have been able to have been prevented."
A concern that has been brought up with this plan is that there's already a shortage of primary care physicians - and with more people forced to get insurance - the shortage is expected to increase.
"I think what we're going to see is more mid-level, more physician assistants, more nurse practitioners," she says.
Van de Wal says she knows of community based initiatives to train and encourage people to become doctors, and there are provisions in the affordable care act to do the same. Most of the controversy however lies in the individual mandate - which was recently ruled constitutional by the supreme court. And where most of the confusion is "the exchange" - where people, whether your company covers your insurance or not, have the power and more options in choosing their health insurance plan.
