Pro & Con: Is first year of health care reform law living up to promised claims?

YES: Coverage has been added for pre-existing conditions, as have tax credits for businesses.

By Joann Yoon and Cindy Zeldin

Tomorrow marks the one-year anniversary of the enactment of the Affordable Care Act, our nation’s new health care law. Upon full implementation in 2014, purchasing affordable, usable health insurance will become a reality, and more than a million Georgians will gain coverage.

The law leaves in place and further improves upon what works well — Georgians who get private health insurance at work or through programs like Medicare or Medicaid will continue to do so — while creating new structures to address the challenges of today that leave too many consumers without insurance or with unaffordable medical bills.

Uninsured Georgians previously locked out of the insurance market due to a pre-existing condition can now purchase coverage through the Pre-Existing Condition Insurance Plan, and several hundred Georgians already have enrolled. Young adults up to age 26 who are in school or struggling to find a job that provides health benefits in this difficult economic climate can remain covered under their parents’ health plan.

Small businesses struggling with rising insurance costs have begun taking advantage of a tax credit to assist with premiums, making it easier to maintain this important benefit for their workers.

Children diagnosed with asthma, cancer, sickle cell or any other disease can no longer be denied coverage by insurance companies.

Seniors on Medicare who have been paying higher out-of-pocket costs for their prescriptions are starting to receive rebate checks from the federal government to help close the gap in prescription coverage, otherwise known as the dreaded Medicare Part D “donut hole.”

Policymakers and stakeholders remain hard at work in the background to continue strengthening the framework for our revamped health care system which will be fully operational beginning in 2014. Georgia is one of many states currently assessing the creation of a consumer-friendly, competitive marketplace, known as the “health insurance exchange,” with such planning made possible through the receipt of federal grant dollars.

Likewise, Georgia plans to take advantage of increased federal match dollars to revamp and modernize our Medicaid eligibility system. It will take a few years for these systems changes to come online and for new rules of the road for insurers, such as the inability to deny coverage based on a pre-existing condition, to be formalized.

But the end result will be a health insurance system that is more fair, more user-friendly, and that incentivizes value.

The law also makes available federal dollars to strengthen and grow our existing health care workforce. Federal grants can support workforce training to increase Georgia’s supply of health providers and to create good jobs in the burgeoning medical field. Funding will increase the capacity of community health centers across the country. The law also provides for a much needed reimbursement rate increase beginning in 2013 for primary care providers who participate in Georgia’s Medicaid program. Because this reimbursement rate increase is financed with federal dollars, Georgia physicians will benefit without burdening our strapped state budget.

We can see how in the first year alone Georgians already are benefitting from changes made under the Affordable Care Act. Each day, we move closer to a system that will improve the health of our state’s children and families for generations to come.

Joann Yoon is the associate policy director for child health at Voices for Georgia’s Children.

Cindy Zeldin is the executive director of Georgians for a Healthy Future.

NO: The law's mandates force insurers to drop plans and business to cancel coverage.

By Sally C. Pipes

In pressing his case for the overhaul, the president made several lofty promises — and assured Americans it would expand access to health care while improving quality and reducing costs.

Throughout the past year, Obamacare’s efforts to expand coverage have fallen flat — even as it has raised the cost of care for individuals and businesses.

Take the law’s effort to extend coverage to people with pre-existing conditions through a new federal high-risk pool.

The administration estimated last year that 375,000 people who had been previously shut out of the insurance market would turn to the new federal program for coverage. But enrollment has severely lagged expectations. Despite a comprehensive public-awareness campaign, only about 12,000 people have actually signed up.

That’s less than 5 percent of the initial projection.

Obamacare’s attempt to control the price of health insurance has also been an abject failure. The law foisted minimum medical loss ratios (MLRs) on insurance companies, mandating that they spend 80 percent of premium dollars from the individual and small-group markets — and 85 percent of premiums from the large-group market — on medical claims.

Officials hoped that the MLRs would force insurers to pare back their administrative costs and profits and devote more of consumers’ money to paying for care. Instead, they’ve undermined competition in insurance markets, leaving consumers to deal with fewer choices and higher prices.

For instance, the Principal Financial Group, an Iowa-based insurer, has quit the health insurance business entirely thanks to the new rules. And Aetna has left Colorado’s individual insurance market.

Several states — including Maine, Nevada, Kentucky, and New Hampshire — have asked the administration to exempt them from the MLR requirements. At least 10 other states have expressed interest in filing for a similar waiver.

Maine’s case is instructive. Only two insurers operate in the state’s individual insurance market. One of them has warned that it will cease writing policies if the new MLR rules go into effect — leaving the other with a de facto monopoly, free to charge whatever it wants.

Obamacare’s rules are also threatening many Americans’ current health insurance plans. The new law would invalidate low-cost, no-frills “mini-med” plans, which offer a minimal level of health coverage to beneficiaries, for not providing $750,000 in annual benefits. By 2014, no plan will be permitted to have a maximum benefit cap.

Firms with many low-wage, seasonal, or part-time workers often rely on mini-meds to furnish at least a modicum of health care to their workers. Without the plans, the workers would be uninsured.

As McDonald’s explained, “it would be economically prohibitive for our carrier to continue offering [mini-med plans]” if required to adhere to the MLRs.

The Obama administration wasn’t too wild about its signature achievement depriving millions of Americans of insurance coverage, so it has distributed more than 900 one-year waivers to corporations like McDonald’s, local labor unions, and even municipal governments. In theory, organizations would have to re-apply for a waiver every year through 2014, when the health-insurance exchanges go into effect.

If consumer protections were so crucial, then why has the administration been so quick to hand out waivers?