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Lost In The Rhetoric: Health Care Act Provides Crucial Consumer Protections

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The U.S. Supreme Court is taking up the question of whether Congress had the Constitutional authority to require individuals to have a minimum level of healthcare insurance, or face a tax penalty. The Supreme Court is unlikely to strike down the entire Patient Protection and Affordable Care Act (aka "Obamacare"), but that is what several candidates for the Republican nomination have vowed to do if elected President.

What gets lost in the rhetoric is the reality that there are many elements of this law that have widespread support. Already, people are finding that expanded coverage for young adults under a parent's health insurance plan is very helpful in this time of high unemployment and rising costs for higher education. There are many other ways that this law can help those who have little or no insurance coverage, as well as those who have excellent policies that they want to keep.

This law prohibits lifetime limits and unreasonable annual limits on benefits provided under eligible plans. Given the rising cost of healthcare, many people being treated for serious illnesses or traumatic injuries discover that they can burn through annual and lifetime benefits within a very short time.

Without this law, if your child is born with a serious illness or has a major injury, the annual limit could be met within weeks or months. Your child would have no insurance coverage for the rest of the year, even though the medical bills are still pouring in. Lifetime maximums of one or two million dollars may seem like a lot of money, but costs from just one serious illness or accident can meet that lifetime cap very easily. That leaves many people still living with major illness or injuries for which they have little or no financial means to pay. It is no wonder that so many of the people seeking bankruptcy are in financial crisis because of medical costs for themselves or their families. This law addresses the reality that annual and lifetime limits do not make sense given the high cost of medical care.

The law also forbids insurance companies from cancelling a person's policy unless they can show that the person engaged in fraud or intentionally lied. It has not been uncommon for a person diagnosed with a catastrophic illness to have her insurance policy cancelled, supposedly because he or she had failed to report a pre-existing condition on the policy application. Imagine being diagnosed with a skin cancer and having your insurer cancel your policy with the 'explanation' that you failed to mention on the application that you had once been treated for acne, which they conclude was a pre-existing condition. Under the Patient Protection and Affordable Care Act, we can now have some confidence that our insurance cannot be unfairly cancelled when disaster strikes and we need it most.

A major concern in the healthcare debate has been the cost of healthcare and the need for greater responsibility by consumers, healthcare providers, insurers and state and local government. Again, this law provides important standards for accountability at all levels to ensure that tax dollars are used in efficient, effective ways. Healthcare providers will be required to measure and publicly report whether care provided actually makes a positive difference in the patient's health. They must show that care being provided is safe, effective, personalized, appropriate, and timely. They must evaluate and report how well they coordinate care with other healthcare providers, so that all of the people caring for you are actually working together to help you get well. These may seem like common sense expectations, but quite often, communication and coordination between multiple specialists can be sporadic at best.

One step toward better communication among caregivers is through incentives for healthcare providers to make "meaningful use" of information technology. Paper "charts" and other documents have been problematic for many reasons. (Can you read your doctor's handwriting?) Electronic records will encourage greater efficiency, cost effectiveness, and access to vital information.

For example, suppose you injure your knee in a skiing accident and end up in the ER. You likely will have x-rays and perhaps more sophisticated (and costly) scans such as the CT or MRI. Then, you may go to a specialist, who may not have ready access to the results of those scans. There may be medical reasons for your orthopedist to order more scans, but often, new tests may be ordered because it is faster than waiting for the initial scans. Not only are those extra scans a waste of your or your insurance company's money (which is your money in the form of increased premiums), you have had additional and unnecessary exposure to radiation.

However the Supreme Court rules on the questions it considers, it will be economically and politically unwise for either Congress or the President to scrap vital elements of a healthcare law that provides such important consumer protections.

Ruth Schulenberg, an ordained minister, works in healthcare as a clinical pastoral educator, and has years of supervised clinical experience as a chaplain and educator in adult and pediatric healthcare settings. This is her first piece for Off the Bus. If you would like to contribute as a citizen journalist to The Huffington Post's coverage of American political issues, please write to us at offthebus@huffingtonpost.com.

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