Author Archives: Sarah Fontenot

Twenty-Five Things You May Not Know Are In Obamacare

The Parts of the Affordable Care Act that Meet the Press

There are a handful of key issues that are central to the current Republican debate within the House of Representatives and the Senate on how to fulfill the GOP’s 7-year-long promise to “Replace and Repeal” Obamacare.

The main issues for GOP members of Congress (as of today) are:

  1. how to offer affordable, guaranteed access insurance to people with a pre-existing condition (I discuss the original ACA plan for this in Fontenotes No. 8);
  2. the continuation and funding of the expansion of Medicaid (see Fontenotes No. 14);
  3. the mandate that all Americans must be insured, and how to increase the size of the pool of insured Americans without it (to lower costs, see Fontenotes No 41);
  4. repealing the taxes in the law that supported much of the costs created;
  5. how much assistance the poor should receive as subsidies to purchase insurance (if any);
  6. how much the elderly should pay for insurance compared to the “Young Invisibles”;
  7. how many requirements the government (state or federal) should be able to put on the quality of insurance policies sold; and
  8. how to provide adequate funding to fight the opioid crisis that is consuming all quarters of our country.

These debates are all important, and they do represent core principles of the law.

Not coincidentally, these are also the parts of the ACA that have garnered the most attention (in particular by the media) since the law was signed in March 2010.

The “Silent” Parts of the Affordable Care Act

However, there is so, so much more to the ACA than what we hear on the floors of Congress or from the talking heads on TV.

Here is a selection of 25 Obamacare rights, programs, and possibilities I thought might interest you:

  1. Student loans for doctors, mental health personnel, nurses, pediatric mental health professionals, dentists, dental hygienists, public health students and allied health (O.T., P.T., etc.) – with a focus on primary care;
  2. More transparency for Nursing Homes, including ownership, compliance, ethics policies, quality monitoring, and consistent enforcement of safety regulations;
  3. No lifetime Caps within private insurance companies, which prohibits companies from denying further coverage if your needs exceed a certain amount (usually a million dollars) regardless of your good history of paying your monthly premium (I addressed this in Fontenotes No. 32);
  4. Training for personal home health aides, standardization of that training, and a nursing aid registry to monitor those who are good (and more importantly) those who are not;
  5. Funding for projects aimed to increase independence at home for the elderly (“Aging in Place”);
  6. Limits on the total out-of-pocket expenditures a person can have (or family) in a year (For more on the costs of health care see Fontenotes No. 41);
  7. Increasing financial support for hospitals, especially rural hospitals and those meeting the needs of underserved populations (such as in the heart of our cities);
  8. Coverage (at no out-of-pocket expense to you) for preventive screening ordered by your providers, such as mammograms, colonoscopies, and blood work) (For more see Fontenotes No. 7);
  9. Maternal/child home visitation grants- to bring better post-partum care to new mothers and babies in their homes, as is common in many other industrialized countries;
  10. The Medical Loss Ratio (also known as the 80/20 Rule) which requires Insurance Companies to invest at least 80% of the money they receive in premiums back into the health of their covered population (For more- I wrote about this in Fontenotes No. 9);
  11. Closing “the donut hole”- an aberration of Medicare Part D that opens Medicare beneficiaries to exposure for drug costs in the middle of a scale between entry level and more catastrophic expenses;
  12. Tax breaks for investments in therapeutic discoveries;
  13. Increased transparency under “The Sunshine Act” that requires public disclosure of money being given by pharmaceutical and DME companies to physicians and teaching hospitals (For more- I wrote about this in Fontenotes No. 5);
  14. Medicaid for former foster care children to help them with the transition when they “age-out” of Child Protective Services when they are 18;
  15. Providing reimbursement to your physician so they can spend more time with you to discuss how you want to deal with terminal disease and end-of-life decisions (see Fontenotes No. 24);
  16. Allowances and calculations to coordinate federal assistance with Medicaid to provide disaster relief for states recovering from a major calamity for up to 7 years;
  17. Provisions allowing insurance plans to be offered in more than one state, and “regional compacts” with state control/option to opt-out (this was part of Donald Trump’s platform as a candidate– see Fontenotes No. 19);
  18. Outreach to notify people who may not be aware of their rights/availability of Medicaid, CHIP, as well as subsidies to purchase insurance on the Exchanges;
  19. Financial support for innovative medical therapies, including biologics and biosimilars, and more affordable drugs, especially for the poor and for poor children;
  20. Support for “Medical Homes,” requiring a team approach to a patient’s health care and coordination around the patient, rather than the patient having to act as the messenger between all their physicians and providers (see Fontenotes No. 29);
  21. Posting calorie counts on items you order from chain restaurants and fast-food counters (see Fontenotes No. 16);
  22. Financial support for nursing students, nursing faculty support, and advance practice education for nurses- all intended to increase the number of nurses available in both hospitals and community settings;
  23. Adult protective services and “Elder Justice” with enhanced penalties and requirements for reporting injuries in long-term care, and protection of protection of employees who report elderly abuse at nursing homes and skilled nursing facilities,
  24. Funding and development of demonstration projects focused on health promotion, wellness, and disease prevention;
  25. Enhanced funding, stricter rules and increased penalties for people who fraudulently make millions of dollars while pretending to deliver care– i.e. going after the people who are stealing our tax dollars (we should all be able to agree on that one!).

And there is so much more! This list is only the beginning.

Yet, most Americans will not even know about their rights (and opportunities for their own health) that they could lose this Summer.

Our politicians certainly do not acknowledge what is at stake when they treat us to daily talk of “Repealing Obamacare.”

This law is so much more than the political circus around it. 

That is the biggest shame of all.

Want To Know More?

If you have not read all of the Affordable Care Act- and are now interested in doing so- you can get your very own copy by clicking here. Happy Reading!

While you are at it, please also consider reading the American Health Care Act passed by the House of Representatives (here) and the pending “Better Care Reconciliation Act” from the Senate… Actually, I could not find one. But here is the CBO summary of the Bill and estimates of the impact of the Bill as currently drafted.