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Wednesday, September 18, 2013

Blame Obamacare confusion on old system: Guest Column

Megan Salzman

Staff Writer

As full implementation of the Affordable Care Act takes shape this fall, many Americans still wonder how the health care law will affect them. Help us spread the word that the Affordable Care Act is here to stay and that new affordable health coverage options will be available starting on October 1. Check out this recent guest article featured in USA Today to learn more about the many benefits the law has to offer. 

This article originally appeared in USA Today by John R. Seffrin. 
Our old health insurance approach was deeply flawed. That's why it's being replaced.

Americans have had little understanding of the Affordable Care Act since it became law in 2010. With major provisions taking effect in January, half the country still does not know what the law does or what it means for them. While some of the confusion is no doubt due to the law's complexity and the highly charged political environment, a largely ignored but central factor is that people know little about the deeply flawed health insurance system that got us to this place.

The problem is that until now, it was nearly impossible for consumers to understand their health plan. Consumers received little useful or clear information enabling them to make informed decisions about their health coverage. Policyholders received confusing plan descriptions written in complicated, technical language. In addition, small differences in benefits made it difficult to distinguish one plan's coverage from another, and people looking for insurance on their own had no convenient place to compare health plans by quality or price.

The challenges were compounded for people who got sick. The system seemed designed to work well if you stayed healthy but crumbled at its foundation if you fell ill. Take someone diagnosed with cancer. If employed, they had to worry about whether their job-based health plan would pay for needed care, or whether they would be covered if they lost their job. If looking for insurance on their own, they and others with a pre-existing condition could be refused coverage or charged sky-high rates. If uninsured or stuck with limited coverage, they were unlikely to get appropriate care without going deep into debt.

The new law dramatically improves the health insurance system for consumers and patients. For starters, it ensures that consumers have more valuable information than ever before, such as by requiring insurers to supply anyone shopping for coverage or renewing their plan with a short, simple and standardized summary of benefits and costs. Next year, health insurance marketplaces in every state will enable people shopping for coverage on their own to make side-by-side comparisons of health plans and choose the best one for them. The new marketplaces will group plans into simple tiers – platinum, gold, silver and bronze – based on their level of coverage and cost.

The law also makes health insurance fairer for consumers. It protects people from having their coverage canceled just because they get sick, and from strict limits on the amount of care a plan will cover annually or over a person's lifetime. Patients have broad new rights to appeal denials of claims. Beginning in January, no one will be denied coverage or required to pay more because of a pre-existing condition, everyone will have a firm limit on the total out-of-pocket costs they must pay in a given year, and health plans will have to cover basic health care services needed to prevent, treat and survive a disease such as cancer.

The fact is that as Americans learn about the law, they will learn about health insurance itself -- what it covers, what it costs and how to make informed decisions about their coverage. They may not like everything they hear, but it will be important to measure the law's changes against what the old system offered -- or didn't.

For example, young and healthy people may see higher premiums next year as older and sicker people are no longer charged astronomical rates. But according to Avalere Health, two-thirds of those most likely to be charged higher premiums will be eligible for tax credits that reduce what they pay -- assistance that has never before been available, even as premiums have risen every year. And some states are reporting that, even removing tax credits from the equation, the average consumer in the individual market will pay less for health coverage than they do currently.

To take another example, state health insurance marketplaces may not offer as many choices when they go online later this year as the law's supporters expected. But in many areas of the country, any real choice will mark a substantial improvement over the status quo in which one or two insurers dominate the market.

The health care law is far from perfect. Like previous laws that created Medicare, the Children's Health Insurance Program and the Medicare prescription drug benefit, implementation will be bumpy and the law will need improvements.

But as large-scale provisions begin to take effect, Americans will have the opportunity to become more actively involved in their health coverage, and the health insurance system should work for consumers far better than it does now.

John R. Seffrin is chief executive of the American Cancer Society and its advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN). Jim Guest is president and chief executive of Consumer Reports.