What Are the Pros and Cons of the Current Healthcare Reform Act?

The current healthcare reform act, H.R.3962 - Affordable Health Care for America Act, has been passed by the House of Representatives and is now awaiting the Senate for approval.

As recent news in the media reveal, the recently passed Act prohibits abortion services from being required under an essential benefits package or under a qualified health benefits plan. Therefore, an intense debate among abortion supporters and antagonists has begun.

This summary focuses on the other aspects of the H.R. 3962 Healthcare Reform Act.

Pros for Uninsured and Retirees:

It provides temporary health insurance coverage to those who are retired and/or uninsured with pre-existing medical conditions.

It provides some protection against health insurance companies in limiting preexisting condition exclusions and prohibits discrimination based on health status factors; and

requires parity for mental health benefits.

Cons for Uninsured and Retirees:

It imposes a surtax on individuals who do not obtain health care coverage.

Pros for Pharmaceutical Companies:

It eliminates the coverage gap under Medicare Part D (Voluntary Prescription Drug Benefit Program), which means patients who historically have self rationed their pharmaceutical drugs to avoid exceeding the initial Medicare Part D coverage will now be able to remain compliant on their drug regimen.

Cons for Pharmaceutical Companies:
The government currently accounts for more than 30% of most pharmaceutical sales. Therefore, this act will further increase the dominance of the federal government as the major pharmaceutical drug purchaser in the United States. It forces pharmaceutical companies to develop a volume based business model instead of one based on higher profit margins.

Pros for Primary Care Physicians:
It expands Medicaid eligibility for low-income individuals and families. It requires coverage of additional preventive services; and increase payments for primary care services.

It places further emphasis on physical health (addresses obesity issues, attempts to increase nutritional education efforts and addresses pain management issues), mental health (expands existing mental health coverage) and women's health (establishes an Office of Women's Health).

Cons for Primary Care Physicians:
It further blurs the line between physician assistant and primary care physician responsibilities by permitting physician assistants to order post-hospital extended care services, and to provide for recognition of attending physician assistants as attending physicians to serve hospice patients.

Pros for Health Insurance Companies:
It expands the pool of patients that the government is willing to provide healthcare coverage and makes the current uninsured and retiree cohorts more financially attractive.

Cons for Health Insurance Companies:
It provides further scrutiny on how health insurance companies handle pre-existing medical conditions and limits maximum coverage. It also provides further emphasis on quality improvement and other healthcare indicators.

It provides increased competition. With a public health insurance option for individuals and employers, the government is a major purchaser of health insurance and eventually a major health insurance provider as well.

Pros for Small Business Employers
It allows a new tax credit for small business employers who provide health care coverage to their employees.

Cons for Small Business Employers
The new tax credit does not offset the administrative burden of small business owners in providing health care coverage for their employers. This will result in an increase hiring of health and human resource benefit administrators by small business owners or having such function outsourced to health care benefit companies.

Pros for Medical Device Companies
It establishes a national, voluntary disability insurance program to purchase community living assistance services and supports (CLASS program). Therefore, increasing the potential client base for medical device companies.

Cons for Medical Device Companies
It will set standards to make medical diagnostic equipment accessible to, and usable by, individuals with disabilities. Pros for State governments

Makes states eligible for federal funds under the Public Health Service Act only if they agree to be subject as an employer to the obligations under this Act.

Overall, this healthcare reform act attempts to do the following for all healthcare stakeholders:

Reduce profit margins in exchange for an increase in volume business for all healthcare related providers (pharmaceutical companies, health insurance companies, medical device companies, physicians and physician assistants).

Increase scrutiny of healthcare service practices by imposing healthcare quality standards and measurement.

Sources: www.opencongress.org/bill/111-h3200/show