Barkingdoc's Blog

   It has been two years since the rollout of the Affordable Care Act, and almost half of its provisions are already in effect. For example, two years has been enough time to establish protective measures that prevent insurance companies from denying coverage for pre-existing conditions, to let young people remain on their parents’ plans through age 26, and to provide annual preventive health visits and screening to an insured patients without added out-of-pocket expense.    It has also been enough time for foes of the law to bring their legal challenges to the U.S. Supreme Court, which is expected to rule as early as this week on the constitutionality of individual mandates, interstate insurance exchanges and federal involvement in Medicaid expansion. But however the court rules, there is no turning back on health-care reform.    Election-year rhetoric notwithstanding, slashing such existing programs as Medicare and Medicaid is not a reasonable alternative to substantive reform. That’s like deciding not to fix a leaky roof so that your household budget looks more flush. You’ll just keep buying buckets until you finally have to take out a loan to replace the whole rotten roof. With health care as with roofs, it’s about maintenance and prevention.    This is the ACA’s track record so far in the Ocean State.    As of 2011, over 7,500 young people in Rhode Island (and over 2.6 million nationally) who previously would have had no way to afford health insurance, through employers or otherwise, were able to remain enrolled in their parents’ plans. That is thousands fewer people clogging emergency rooms because they had no access to timely, affordable primary care.    In 2010 alone, more than 15,000 Rhode Island Medicare recipients who fell into the prescription-drug “doughnut hole” received rebates to help with the costs, and in 2011 almost the same number of Rhode Island seniors got 50 percent discounts on prescriptions when they reached the doughnut hole, saving them more than $8 million.    In 2011 nearly 130,000 Rhode Island Medicare recipients, and another 200,000 of us on private insurance plans, received free preventive services, including wellness exams, mammograms and colonoscopies, with no cost-sharing. People who were delaying these services because they hadn’t met their deductibles or their insurance didn’t cover them now have fewer obstacles to these life-saving, cost-effective screens.    The ACA put into place protections against unreasonable premium-rate hikes by insurers, and Rhode Island has received $4.7 million to fight these kinds of practices. This is only a temporizing measure — plugging up those leaks until we have more rational payment systems in place — but it offers some immediate relief to employers and individuals struggling with rising premiums.    The ACA has removed lifetime limits on health benefits to those with chronic illness. No longer do seriously ill people have to watch in horror as their benefits dry up. So far 374,000 Rhode Islanders have come under this protection, including 89,000 children.    Rhode Island has received $64.7 million in grants under the ACA to develop and implement state insurance exchanges that will let individuals and employers shop around for the most affordable coverage.    Some $14 million has gone to expand Rhode Island’s community-health centers, and there have been grants to our state for school-based health centers, Medicare outreach, maternal and early-childhood home visits, and other programs that promote wellness. Look to these kinds of settings for the sort of innovations that will move our health-care system into the future: emphasis on prevention and health maintenance, payment models that incentivize quality of outcome rather than quantity of procedures, and a broad commitment to cost-effectiveness.    Thanks to the ACA, we are all getting our first glimpse at what smart, cost-effective health care looks like when it puts the needs of patients first. But there is so much more that we need to do. Regardless of how the Supreme Court rules, health-care reform is already working. We simply cannot afford to turn back.    Maggie Kozel, M.D., is a pediatrician from Jamestown, a member of Doctors for America, a liberal group, and the author of “The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine.”