Theresa Hamilton: Affordable Care Act will improve community's health

The Supreme Court's recent decision upholding the Affordable Care Act caused pundits to pontificate, partisans to parry and health-care providers to heave a huge sigh of relief. While not a complete panacea for our nation's complex and burdened system, the Patient Protection and Affordable Care Act of 2010 brings accessible and affordable health care to millions more Americans, many of them right here in our community.

The Fremont-Rideout Health Group operates Yuba-Sutter's only full service acute-care hospital, emergency department and trauma center as well as a dozen other facilities offering primary and specialty medicine, surgery and other health services. So clinicians throughout our system see firsthand the many ways in which a lack of medical insurance can adversely affect the health of individuals and, indeed, entire families. Our mission is "to provide compassionate and superior health care to everyone in our community and region," regardless of financial circumstances. In 2011 alone, we provided $ 49.8 million in health care services to uninsured or under-insured patients. But the need is even greater, and efficiency can stretch operating budgets only so far.

Rideout Memorial's Emergency Department receives nearly 55,000 visits a year, and for many of these patients, it's the only medical attention they have received in some time. Studies show that the uninsured are far more likely to put off doctor visits and routine screening tests, so by the time they get to the emergency department, many of them are already quite ill.Getting well then takes more time and more resources.

A May Gallup poll put the cost of health care first among 10 economic concerns of Americans. In recent years, more and more found themselves uninsured, through job loss, aging out of a parent's policy, denial of individual coverage due to a previous medical condition or rising premiums that made coverage simply unaffordable for them or their employers.

The Affordable Care Act removes many of these barriers to good coverage and better health. But a Kaiser Family Foundation Health Tracking Poll released in March showed that 59 percent of respondents felt they did not have enough information to understand how the Affordable Care Act benefitted them personally. So for those 59 percent, here are some of the key elements of the act that are already in effect:

• Insurance companies may no longer deny coverage to children under 19 because of pre-existing conditions.

• A Pre-existing Condition Insurance Plan provides coverage options for affected adults.

• Young adults are allowed to remain on their parents' plan until they turn 26.

• Insurance companies may no longer deny payments due to a technical mistake or error on a patient's application.

• Insurance companies may no longer impose lifetime limits on coverage for essential benefits, such as hospital stays.

• Restrictions on how insurance companies may impose annual dollar limits on essential benefits; (as of 2014, there will be no dollar limits).

• Tax credits for small businesses (fewer than 25 employees) and nonprofits to help them provide coverage for their staff. (At least 90% of all Yuba-Sutter businesses are small enough to qualify.)

• Tax-free rebate checks of $250 to seniors as they reach the "donut hole" in prescription coverage, and 50 percent discount on certain brand-name drugs (then expanded in 2014).

• Free wellness visits and preventive care for seniors on Medicare.

• All new health plans must cover preventive services such as colonoscopies and mammograms, with no deductible or co-pay.

• Insurance companies must spend at least 80 percent of premiums on benefits and quality improvement or give rebates to policyholders, and must justify premium increases.

Additional benefits such as prohibiting insurance companies from refusing coverage and from charging higher rates based on gender or health status, ensuring coverage for patients being treated in clinical trials, increasing tax credits for small businesses and extending credits to individuals will take effect in 2014.

The Affordable Care Act is already benefitting millions of Californians, including many in Yuba-Sutter. To help the public learn more about the act's benefits, we've posted a page of links to official information sources at www.frhg.org/Affordable-Care-Act.aspx.