New Health Law: More Doctors, Better Prevention, Lower Costs, Shorter Lines

New Health Law: More Doctors, Better Prevention, Lower Costs, Shorter Lines

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OAKLAND, Calif.—When a 35-year-old uninsured Korean American was told by personnel at Highland Hospital here that he would have to wait six months for a screening test to determine the cause of a lump on his neck, he promptly caught a flight to his homeland to get the test done there.

A battery of tests at Seoul National University’s medical school revealed that the man had thyroid cancer.

With the results in hand, the man returned to Highland and told doctors there to begin his treatment.

“Had he waited for six months, he might have died,” observed Dr. Nick Nelson, a primary-care resident in internal medicine at Highland, who declined to identify the man. “He did a wise thing going back to Korea for screening.”

Like millions of uninsured people in California and around the United States, the Korean man could not afford preventative care, including regular checkups and screenings that might have detected his cancer earlier. And, when he did finally seek medical attention at Highland, a county hospital that treats the uninsured, he encountered another all-too-familiar problem with the current U.S. medical system: a shortage of primary-care physicians—the doctors who oversee the bulk of preventative checkups and routine tests.

Such situations could soon be a thing of the past, when important provisions in the Patient Protection and Affordable Care Act (PPACA)—the health care reform law passed this year—kick in, starting this fall.

The Act requires that all U.S. citizens and legal residents have health insurance by 2014. Currently, 46.3 million Americans under the age of 65 are uninsured; in California, the figure is 8.2 million people, or a quarter of the state’s population.

To avoid creating even worse doctor shortages as millions of new people flow into the health care system, a provision in the new law will support the training and development of more than 16,000 new primary-care providers over the next five years, beginning in 2011. To encourage more people to enter the field, the new law provides for low-interest student loans and scholarships.

“Increasing the number of primary-care professionals will allow us to place an increased emphasis on preventive care and wellness—something I’ve devoted my life to as a public-health nurse— making this country healthier in the long run,” U.S. Representative Lois Capps, a Democrat who represents California’s Central Coast, said in a press release issued when the landmark law was signed in March.

Additionally, the law earmarks some $11 billion in new funding for community health centers over five years, beginning October 2011. Of that amount, $9.5 billion is for health centers to expand their operations so that new patients can be served.

Just as important are provisions in the law that will increase access to preventive-care services while decreasing the costs to consumers.

Currently, “most insurance plans, especially if they are employer-based, offer preventive-care services, often at no cost to the plan participant,” said Steven E. Wojcik, vice president for public policy at the Washington, D.C.–based National Business Group on Health.

But starting this September, all insurers will be required to offer new health plans that cover such services at no additional cost. For instance, many patients who now fork over a $20 co-payment for a cholesterol test or a CT scan won’t have to do so when the provision takes effect on Sept. 23.

Preventive-services covered by this provision will include vaccines and flu shots for kids and adults; colorectal cancer screening for adults over 50; hepatitis B screening and tobacco counseling for pregnant women; depression screening for adults and adolescents; HIV screening for adults at high risk; and obesity screening and counseling for adults and children. Mammograms for women over 40 will also be covered.

The administration is working with an outside panel of experts to develop a series of other preventive services for women.

“Offering primary-care services and preventive care is the most cost-effective way” to run a health care system, asserted Anthony Wright, executive director for Health Access, a statewide health care consumer advocacy coalition headquartered in Sacramento.

But there is a catch. The preventive-care requirement provision applies to new insurance policies only. “Old plans are grandfathered,” Wright said.

This means that, at least at first, only people who switch to a different policy, or buy a new one, will be entitled to preventive services at no additional cost. (Health-care advocacy groups are hoping for removal of the grandfather clause in the final rules being written by the Department of Health and Human Services.)

One exception is Medicare. “Medicare gets switched to the new rules on preventive care” on Jan. 1, 2011, Wright noted. So all Medicare enrollees—even if they do not change insurance plans— will be entitled to a free annual checkup and such free screenings as colonoscopies and mammograms.

Numerous studies have suggested that early detection of disease, as well as intervention to address such unhealthy habits as smoking and overeating, can save hundreds of thousands of dollars in medical costs per patient in the long run.

“There are people who have chronic medical conditions like hypertension and diabetes who put off coming to our clinic because they don’t have insurance and they don’t like the long wait, ” Nelson observed, adding: “If you let [those diseases] run their course, it can be devastating. Instead of one medicine to treat hypertension or diabetes, they could end up in the intensive care unit with a heart condition or needing dialysis.”

For patients like the Korean immigrant, who will have to get some form of insurance by 2014, either through an employer or from the state-managed “exchange,” the Affordable Care Act would be just what the doctor ordered.

“Hopefully, people won’t have to fly half-way across the world for a screening,” Nelson said.