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Monday Jul 07, 2014

Inside the Affordable Care Act: One Patient's Story

Whether folks thought it was a good piece of legislation or not, the Patient Protection and Affordable Care Act (ACA) is the law of the land. And recent polls show that roughly two-thirds of Americans favor retaining and, perhaps, modifying the health care reform law rather than repealing or replacing it.

A Bloomberg National News poll published in June found that 66 percent of respondents favored letting the law stand or retaining it with modifications. A month earlier, a Kaiser Health poll found similar results with 59 percent favoring keeping and improving the law.

By far, most people who responded to the Kaiser poll (60 percent) said the law had no direct impact on them, while 24 percent said the law had hurt them, and 14 percent said it had helped them. Nearly one-third said they knew a previously uninsured person who was able to get insurance because of the ACA, while less than one-quarter said they knew someone who had lost coverage.

I'd like to share the story of one of my patients -- we'll call him John -- who was helped greatly by the ACA.

John was a healthy child growing up in my hometown in Nebraska before he contracted polio at age 3 in 1952 (three years before the polio vaccine was introduced). The disease left him temporarily paralyzed from the neck down, and his parents were told that he would never walk again.

John proved the physicians wrong, and he did walk. But he has suffered for decades from an array of complications, including severe scoliosis, muscle wasting and restrictive lung disease.

As an adult, John could easily have qualified for disability, but he learned a trade, opened his own business and raised a family. His health insurance costs were high, but manageable, and he looked forward to saving more money for his retirement once his children were grown and out of the house. But John's health care insurance costs increased dramatically in the 1990s, and he suffered the consequences, at times, of not being able to afford coverage. In the past 20 years, John has paid more than $200,000 in premiums alone.

Before the health insurance exchanges opened this year, his deductible was $6,000, and his premium was more than $1,300 a month. When the exchanges opened, John went online and found a plan that cost him $32 a month. His deductible dropped to $450.

"It completely changed my life," he told me.

John's new plan was through CoOpportunity Health, one of nearly two dozen Consumer Operated and Oriented Plans set up nationwide under the ACA; this particular health care cooperative started in Iowa and Nebraska with funding provided through HHS. The Iowa AFP and Nebraska AFP were instrumental in securing that funding and making the plan available through the health care exchange.

The new plan lowered John's costs for medications and treatments, including the oxygen he uses at night. In addition to me, John has a respiratory specialist in another town. His out-of-pocket cost to see that physician had soared to $400 per visit on his old plan, so John hadn't seen that subspecialist in years. After he enrolled in the new plan, John made a long-overdue (and affordable) visit to that doctor and found out about new tips to help his breathing that he could have learned a lot sooner if he'd had ready access to affordable care.

The ACA may be far from perfect, but this one example shows its potential. The Academy is working to support the provisions of the act that help family physicians and their patients and is continuing to advocate for change where it's needed.

As for John, he's in his 60s and still running his business, but the money he is saving on insurance will allow him to finally start saving, in earnest, for a well-deserved retirement. John tells me that he feels as though a huge burden has been lifted from him, and the new insurance plan is literally helping him breathe easier.

Robert Wergin, M.D.,  is president-elect of the AAFP.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.