Local view: Affordable Care Act offers important protections

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(Jeff Parker / Cagle Cartoons)

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The Supreme Court support of the Affordable Care Act was even more important for Northlanders than for other Americans.

The most important part of the act for the Northland is the expansion of Medicaid, which the Court specifically ruled was constitutional, although not obligatory for states. Minnesota has already joined this program, which is paid for by federal funding.

Extending Medicaid eligibility to 133 percent of poverty level income and to cover single people and childless couples affects tens of thousands of area residents. The new income guidelines potentially affect more than 20,000 households in Duluth alone, since median household income in Duluth falls very near the new Medicaid guidelines. Thousands of uninsured Northlanders will be offered coverage under the program. In addition, increases in Medicaid payments for primary care providers will improve access for Medicaid patients to family doctors and will improve the financial stability of area provider systems.

Thousands more Northlanders will benefit from the new reforms for insurance companies. Insurers can no longer exclude people with pre-existing conditions or drop insurance for people with high yearly or lifetime medical costs. Families will continue to be able to insure children younger than 26 on their family policies. With the new insurance exchanges individuals and small businesses will be able to buy insurance through buying pools that will lower costs, will be able to compare insurance costs and coverage in easy to understand charts, and will be guaranteed that important preventative services will be covered, usually with no deductibles or co-pays.

The importance of the unpopular mandate is to stabilize insurance markets to make these very popular programs financially sound. The experience of states that have passed these guarantees without a mandate raises concerns that insurers will be unable to offer plans that provide the needed coverage. That is why the conservative Heritage Foundation first proposed an insurance mandate, and why former Gov. Mitt Romney included the mandate in his Massachusetts health-care reform.

The Affordable Care Act offers a carrot to help people buy insurance as well as a stick. The law helps pay for insurance coverage through sliding credits based on income, credits that extend to the upper levels of middle class income. Individuals will receive financial assistance to make insurance affordable like employers and employees already get. Very few employees turn down employer health insurance, even if they are in good health. These incentives may encourage uninsured people to voluntarily take advantage of the act in numbers large enough to make insurance guarantees financially sound without using the mandate.

Small businesses will also benefit from financial aid to help them provide insurance for their employees and for the owners themselves, and will be able to use the exchanges to buy better insurance for less. Many employees may find that they will get new insurance through their work due to ACA incentives.

The Affordable Care Act also begins the hard task of bringing American health-care spending under control and protecting the country from economic disaster due to health-care spending. The act contains features designed to reduce costs both for private insurance and for Medicare and Medicaid, including incentives to encourage better patterns of practice for health-care providers that save money by improving care, and the creation of the Independent Price Advisory Board to research decisions about efficient scientifically based spending. That is why the Congressional Budget Office continues to predict that the act will actually decrease the deficit over time.

The long-term future of the Affordable Care Act will depend on election outcomes, but for now it continues to function and to offer Northlanders important protections and help with their health care needs.

Dr. Patrick Schoenfelder is a retired Duluth doctor who worked both for Essentia and in private practice throughout the Northland.

Tags: local view, opinion, editorials, columns, columnists, health