Cincinnati Enquirer...
Health care users must understand reform 
January 15, 2012 

One thing is for certain about the world of health care: It is constantly changing. Unfortunately, that doesn’t make life easy for those who have to navigate their way through the health maze each day. 

It’s important for all of us to understand how all these changes affect our access to quality health care. 

Health reform is not a political gimmick, nor is it just about insurance companies, hospitals or clinicians. It is about us, our employers and our communities. We must ask ourselves: What are we doing to live a healthier lifestyle? How are we engaged in the care we are receiving? Do we know its actual cost? Are these services necessary to improve our quality of life? 

One major development in health care is the linkage between state Medicaid programs and managed care. Ohio already has that linkage in place, while Kentucky is transitioning to it. Meanwhile, all of us will start seeing more aspects of reform as the Affordable Care Act, the federal health care reform legislation, is implemented. 

A key goal is that patient access to care is improved, and not jeopardized. That is why consumer advocates have identified several focus areas: new health care exchanges (“shopping malls” for individual and small-business health plans); increased focus on preventative services; greater transparency for consumers on coverage and costs; and maintaining access to quality care.

Standardizing the language used by plans and insurance companies is important for consumers to be able to compare plans and purchase health coverage. Consumers also need to be active participants in the care they pay for and receive, studying their personal health information and understanding how their care is paid for. 

Insurance plans are often referred to as payers of care. This is a misnomer. Individuals and employers are really the payers of care, through premiums paid to insurance companies which are then used to reimburse providers. The ACA requires that 80 percent of premiums paid be used to pay for medical services and quality improvements, and not on marketing, administration, commissions, profits and executive salaries. Health reforms must promote fairness and provide security to families while allowing consumers and small businesses to compare health plans and buy affordable coverage. 

Health reform presents many interesting challenges to policymakers as they build health insurance exchanges to make it easier for individuals to shop for coverage. It also poses challenges in the expansion of state Medicaid programs, required to cover individuals with incomes up to 133 percent of the federal poverty level. 

For reforms to succeed, all Americans becoming newly eligible for coverage must take it up. And all of us, as health care consumers, need to become more familiar with what health care reforms offer. 

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