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September 2, 2013 at 9:04 PMComments: 0 Faves: 0

Personal Strategies for the Coming Health Care Changes

By Jeffrey VanWingen M.D. More Blogs by This Author

If you're too young to remember, Little House on the Prairie was loosely based on the real-life diary of Laura Ingalls-Wilder. Laura and her family were homesteaders on the Great Plains of Minnesota in the latter part of the 1800's. The Ingalls' lives were rough, and there was plenty of hardship. The nearest town, Walnut Grove was tiny and yielded modest provision. As such, the family packed up their wagon maybe once or twice per year and headed to the big town of Mankato. In the face of uncertain hardship and the difficult logistics, the Ingalls family planned ahead meticulously and got exactly what they needed out of every big visit.

As I see patients daily and consider the challenges with the new era of American healthcare, I can't help but be reminded of the Ingalls family. In fact, I often share my views with those who would appreciate the analogy on what I call "Mankato medicine."

The Mandate

In March of 2010, President Obama signed The Affordable Care Act (ACA) into law. The goal of the new law is to "provide affordable, quality health care for all Americans and reduce the growth in health care spending." American health care consumers (patients) have been relatively insulated from the law's provisions thus far. This will change in the next few months, however.

The next step of the law states that all Americans will be required to have health insurance starting January 1, 2014 or pay a penalty on their tax returns. The exceptions to this new rule are those who have a household income below the threshold for filing taxes, those who are between jobs (up to three months), those who are members of a native American tribe, and those who have religious objections.

To provide for this new rule, insurance companies are asked to provide affordable insurance products for the American people. Further, insurance plan products will be posted on a government-sponsored website called the Health Insurance Marketplace. This will be available October 1, 2013. Unfortunately, "affordable" is a relative term. For most, the most affordable plan will be one with very basic coverage and likely a high deductible (the set amount of money that must be spent on health care before insurance benefits kick in), likely between two and four thousand dollars per family per year. As such, a visit to the doctor or especially the emergency room will still be costly if that deductible is not met.

Mankato Medicine

Despite a costly deductible, some plans feature complete coverage of preventative visits (yearly physicals). In other words, even if a deductible is not met, a yearly physical would be paid for by the plan, and the cost of this provision is relatively small.

Typically, a "yearly physical" is a longer visit. In my office, a physical gets 45 minutes of time whereas an episodic visit gets 15 minutes. This allows health to be covered from head to toe, diving into a person's health history, and looking at their future in regards to health risks. It also gives time to address questions and issues that have come up over the year. Doctors feel differently about this, but most feel that dealing with health issues at a physical is fair game. It does help if a doctor has a head's up at the beginning of the visit. Most will schedule extra time if they know that there are some issues to address.

Like the Ingalls family heading to Mankato, a visit to the doctor can seem much the same. Bundling issues is a way to save money and time, especially with the coming changes. I am aware that this only pertains to non-urgent health questions and issues. Letting an infection brew until you have a physical, for instance, is a bad idea.

Though it seems common sense, I still should mention that it pays to maintain your health. Proper diet, exercise, and sleep do wonders to keep the doctor away.

In Conclusion

The Affordable Care Act is about to enact one of its most wide-sweeping changes, affecting every American on some level. This poses significant challenges for health care consumers who must fund their own insurance plans. Knowing your plan in regards to coverage is important. Though high-deductible plans are the most affordable, some offer the coverage of a yearly physical. This provision is an opportunity to maintain health while dealing with non-urgent healthcare questions and issues.

Live healthy and live smart. Best wishes to you if the winds of healthcare change are blowing swiftly in your direction.

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