Health care reform – hope and reality.

(Health care reform.  What I hope will happen.  What I think will actually happen.  That is the topic presented to us for next week’s ChronicBabe Blog Carnival.  What a loaded topic this time around!  Please note, I have enlisted the help of the informative website established by the government, http://www.healthcare.gov, throughout this post.)

Hope

If all goes well, we should start seeing the impact of health care reform soon enough.  Those with a pre-existing condition but without health insurance are already beginning to receive access to the high-risk pools.  On September 23, new rules will also:

stop insurance companies from imposing pre-existing condition exclusions on your children; prohibit insurers from rescinding or taking away your coverage based on an unintentional mistake on an application; ban insurers from setting lifetime limits on your coverage; and restrict their use of annual limits on coverage.

Tax credits for small businesses employing fewer than 25 employees will be put into place – up to 35% of the cost of insuring employees.

For people with chronic illness (or parents of children with chronic illness), all of this is good news.  Many of us are self-employed, underemployed, or unemployed.  Some of us in such a position are lucky enough to have a spouse working for an employer that does provide excellent benefits, though for the ones who do not, this provides another option for children with pre-existing conditions now and for the rest of us in 2014.  No one should go broke because they are sick or become sick.

Also on September 23, young adults will be allowed coverage up until age 26 on their parents’ health insurance.  To me, this is huge for children and young adults with chronic illness.  It does not limit them to only college before losing the good coverage their parents may have and it means they may pursue dreams of furthering their education without fear of racking up huge medical bills in the process.  Student health insurance is often not enough to avoid financial disasters.  Who knows, perhaps some of these young adults will find better treatments (or even a cure!) for their condition by pursuing research or become stronger chronic illness advocates through careers in social work or the law.

Easier access will be made to preventative care on September 23 as well – not just your typical annual physical and pregnancy care, but also to cancer, heart disease, and diabetes screenings.  Most important to me, having regular physicals and regular blood screenings allows both prevention and earlier diagnosis of type 2 diabetes, which can make all the difference in a person’s life.

The act also ensures that more primary care providers will be available for underserved communities:

The Affordable Care Act expands the health care workforce and increases funding for community health centers, which provide comprehensive health care for everyone no matter how much they are able to pay. Health centers serve an estimated one in three low-income people and one in four low-income minority residents.  The new resources will enable health centers to double the number of patients they serve. Combined with investments made by the American Recovery and Reinvestment Act, the new law will support 16,000 new primary care providers.

In 2014, health care exchanges will be created, ensuring that even in the event of job switching, job loss, or illness, affordable quality health care will be available to all.

Reality

While I will try to refrain from beating a political dead horse, it is without question that the 2010 mid-term elections (and beyond) could change the way health care reform looks right now – and not in a good way.  Fear is being put into people’s minds about socialism and big government when it comes to health care, while I (and many others) fear what happens if the changes are not made.  This is especially true in states that are trying to block health care reform, either in its entirety by challenging the federal law or in bits and pieces by passing legislation against certain aspects of the law.

But enough about politics.

One of the biggest barriers to preventative care is whether allowing affordable access to it will actually move people to go to their primary care provider.  We all know people who go for years and years without seeing a doctor, not because they cannot afford it, but because they do not want to do so or fear some aspect of a routine physical.  How do we remove these mental blocks of these people to healthier lives, or should we even expect them to change?

Along the same lines, and more specifically to my expertise, not everyone with diabetes sees the health care providers necessary to fight complications of the condition.  Sure, early diagnosis of type 2 diabetes might spur people to stay as healthy as possible, though for every person (type 1 or type 2) who is vigilant about diabetes care, there is another who either is filled with denial and/or fear.   How do we remove these mental blocks to better lives with diabetes, or should we even expect them to change?

Speaking of mental health, I worry that not enough is being done to ensure mental health coverage is just as important as physical health coverage.  There is no question that physical health worries can lead to mental health issues (and vice versa) – keeping the mind healthy can impact recovery from acute health worries and in maintaining the best physical condition possible with chronic health worries.

Fortunately, there is an organization called the Collaborative Care Research Network examining “the clinical, financial, and operational impact of behavioral health on primary care and health outcomes”.   Hopefully some of this research will come in handy as health care reform moves forward.

If it moves forward.