Fasten seatbelts: Obamacare needs fixing
by Susan Estrich
April 17, 2014 12:00 AM | 640 views | 0 0 comments | 24 24 recommendations | email to a friend | print
As I walked into the pharmacy, the technician who has kept track of all of my prescriptions for years was on an endless call trying to figure out who is going to deliver her baby and where.

The good news: Her new plan, which fully complies with the Affordable Care Act, provides much more comprehensive coverage and lower co-pays than the one she used to have.

The bad news: Neither the obstetrician who has taken care of her for the past six months nor the hospital where she had planned to give birth are covered by the plan.

Ouch.

Now, this young woman is really good at dealing with insurance companies. It’s what she does all day long — getting prescriptions approved, figuring out why they aren’t being approved, going back and forth with doctors and insurance companies about what they will and will not cover. No neophyte, she.

And as I signaled her that I could wait, that she should finish her conversation, she never lost her cool. Me, I would have been a wreck if someone had told me six months into a pregnancy that the doctor with whom I had developed a close and trusting relationship or the hospital that I had always relied on were no longer on my list, and that my choices — within any reasonable geographic distance — basically came down to six doctors I’d never heard of and a hospital I’d never set foot in.

She was not a wreck. But she wasn’t happy. Who would be? Six months pregnant and interviewing doctors who are themselves overwhelmed because they are, in fact, on so many plans.

Now that the website is working and the administration is taking credit for hitting its sign-up goal and former Health and Human Services Secretary Kathleen Sebelius (who is hardly the only one at fault for all the “hiccups” or “potholes” or just plain mistakes along the way) has taken her leave, now the hard part starts.

Exactly what kind of care are people going to receive under the Affordable Care Act? And who is going to provide it?

Who knows? Certainly not most of the doctors I talk to.

I walked into one practice last week that has four doctors and there was a big sign at the front about which doctor you could see based on which plan you are on. Not surprisingly, the most senior doctor was only seeing Medicare patients and people like me, with pre-existing, employer-provided, expensive group plans.

I walked into another practice and the rule was basically pay as you go. No lines there.

At the hospital where I get tests, there was a big sign advising patients to call a toll-free number to find out whether the plans they are considering would allow them to continue using the hospital. The short answer is that many of them don’t.

Welcome to the shakedown period. Welcome to the host of problems that need to be fixed.

While Republicans keep railing against Obamacare, the reality is that it’s not going to be repealed, at least not as long as Barack Obama is in the White House. And if you ask me, not afterward, either.

I don’t know anyone with a 20-something-year-old on their plan (which you couldn’t do before) or with a pre-existing condition (and who, after a certain age, doesn’t have some pre-existing condition?) who is yearning to go back to the bad old days when gastritis, not to mention heart disease or cancer, could make you uninsurable. There are many features of the new system that most of us would agree are better than those of the old one.

But not all. The business of what doctors you can see, what hospitals you can use — very big problem. The waiting lines for doctors who accept all kinds of plans — very big problem. The confusion and expense of having a “new” plan that costs more because it covers services you don’t need and at the same time forces you to leave the doctors who know you — not so good.

“Mend it, don’t end it” used to be the Clinton administration’s slogan about affirmative action.

Obamacare should not be repealed, and it won’t be. But it needs to be fixed and that’s not a problem the IT guys and girls can solve. So fasten your seatbelts. We’re in for some rocky times, and the politicians and leaders who focus on trying to solve the problems, rather than trying to score points off of them, are the ones who deserve our support.

Susan Estrich is a law professor in Southern California and managed the 1988 presidential campaign of Michael Dukakis.
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