The Affordable Care Act Is Turning Five Years Old!

Over 1.1 million Oregonians now have coverage, a 64 percent increase over 2013.

OPINION -- Since President Obama signed the Affordable Care Act into law five years ago, Oregonians have sent a powerful message: The Affordable Care Act is working, and the quality health coverage offered on the Health Insurance Marketplace is a product that consumers need, want and like. They also made it clear that they don’t want this coverage taken away.

Over 112,000 Oregonians selected plans thorough the health insurance Marketplace under the Affordable Care Act. Additionally, as of December 2014, almost 1,031,000 Oregonians are enrolled in Medicaid, a 64 percent increase over enrollment in 2013!

That means over 1.1 million Oregonians will no longer need to choose between a checkup and paying a bill, or worry that an accident could plunge them into debt, or worse, bankruptcy. These numbers represent real people whose lives have changed for the better: a mom whose cancerous lump is found with enough time to intervene; a dad who can afford the prescription to keep his blood pressure in check; a son or daughter who can stay on a parent’s plan while finishing school or starting a career.

It’s not hard to figure out why Oregon consumers are enthusiastic. This year’s Marketplace offered quality insurance plans—and the financial and health security that comes with coverage—at a price they could afford. Seventy-seven percent of those who signed up on the Marketplace as of February 22 qualified for an average tax credit of $198 per month--44 percent paid $100 or less per month after tax credits.

Thousands of Oregonians who already had insurance have seen their coverage improve because they now have access to preventive services like

vaccines, cancer screenings, and yearly wellness visits. In addition, Oregonians cannot be denied or dropped from coverage because of a pre-existing condition or because they hit an annual or lifetime cap in benefits.

It’s worth putting this all in perspective. Nationwide, since the Affordable Care Act’s coverage expansion began, about over 16 million uninsured people have gained health insurance coverage. This led to largest reduction in the nation’s uninsured in nearly five decades.

The uninsured rate in Oregon is now only five percent according to a recent study. This reflects a 63% drop since the Affordable Care Act took effect.

Altogether, the Affordable Care Act is not just about a new way to buy insurance; it’s about a health system that prioritizes access, affordability and quality for everyone--the evidence shows that the Affordable Care Act is working, and families, businesses and taxpayers are better off as a result.

Happy Birthday ACA!

Susan Johnson was appointed in 2009 by President Barack Obama as Regional Director of Region 10 serving Alaska, Idaho, Oregon and Washington. As HHS Regional Director, she serves as Secretary Burwell’s primary representative and liaison to key constituencies in the Region. In this role, Susan works with federal, state, local and tribal officials on a wide range of health and social service issues.

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The more things change, the more they stay the same. Yes more people have insurance, but what is it they really need? They need healthcare and they will get more healt care than they have had in the past. There are positives, but there are also certainly negatives. From my point of view as an internist, my job is just getting more difficult and in some ways we have moved further away from achieving what we are trained to do. 

EMR's may be great for everyone else, but I am now a data entry specialist with a medical degree - the trade off is fragmented cognitive thought processes. I simply can not constantly point, click and type and also think about differential diagnoses, labs, referrals etc., in addition to what is going to get covered by insurance, what barriers patients face and educate the patient. The EMR is the predominant focus of a patient encounter - I absolutely must point, click, type, point, click, type..........f-r-a-g-m-e-n-t-a-t-i-o-n.

If the prime goal was to achieve coverage then we have clearly succeeded. If the goal was to transform the system into an effective, humane system for providers and patients, that is yet to be seen. 

Of course, my perspective may be completely off, but I just can't figure out how to change my views. I speak with other physicians at conferences and still even they don't provide any other explanation. So, how is it, if indeed the primary care workforce has roughly the same negative perceptions, is this supposed to work out for the best?  

Some would say that the joy of treating patients makes up the difference - I say, at some point, things have to get bad enough that the positives can't continue to outweigh the negatives forever. One universal truth seems to be that there must always be balance - math, chemistry, physics, and even the universe bear this out. For every negative there has to be an equal positive. 

Regarding patient centered medical homes, meaningful use and quality measures I was initially confused by these terms as they were being presented as a "new model." That's the way I was trained - how can this be new?  I now realize these are new concepts to those who aren't physicians. If physicians weren't doing these things before, why not? Was it because we didn't have EMR's, carrot and stick? No. And this is where the fundamental problem I have with the ACA - most physicians want to do these things but are constrained and the ACA has only added more burdens. EMR's don't document quality, they document verbiage and clicked boxes. We are achieiving mediocrity, which is worse than clear failure. My prognosis is that we will continue to underperform, harming patients via lack of appropriate care, yet not be able to change course. 

Hopefully this doesn't come across as too bitter or pessimistic. I have a niche and enjoy what I do. I will make the best of the situation. 

Dr. Mike Henderson

The 64% increase in coverage for Oregonians contrasts sharply with my family's 81% increase in premiums under the ACA.  The ACA is an elaborate, yet horribly inefficient, system to force those with higher incomes to pay for other people's insurance.  Now my family has to be much more frugal with the medical care we receive because more of our healthcare dollars are going toward these higher premiums.  I say that's a big FAIL for the ACA!

Jamey Dyson