Experts in public health use the apt phrase “silent killer” to refer to hypertension, or high blood pressure, because there are often no symptoms of this dangerous condition that affects millions globally. High blood pressure is a slow killer, wreaking havoc on the body with acute manifestations such as stroke and heart failure—which present many years after a persistent elevation in blood pressure first appears. While there is debate among experts about what causes hypertension, there is widespread agreement that reducing one’s blood pressure to within normal limits is a positive step and can extend one’s life. New provisions in the Affordable Care Act (ACA), or “Obamacare,” provide hopeful signs that this slow killer can be stopped or slowed in its tracks.
As a health policy analyst, I find that current trends in healthcare costs and skyrocketing out-of-pocket expenses are analogous to slow killers of a fair public health policy—ones that disproportionately affect those with lower wages and those who work for small businesses.
According to a November 2012 Commonwealth Fund report, due to rising costs, less than half of all businesses with fewer than 50 employees now offer health insurance. In comparison, 90 percent of firms with 100 or more workers continue to offer such insurance.
Healthcare costs are particularly difficult for low-wage workers. Whether the country is moving out of the recession is debatable, but nearly 20 percent of people under age 65 spend more than one in 10 family-income dollars on healthcare, according to a November 2012 Health Affairs study. The need to choose between paying for rent and food, on the one hand, and receiving regular medical care on the other often means the latter is sacrificed. In a rocky economy, many lower-wage American families have been making fewer visits to the doctor and are putting off elective procedures.
This sharply reduces opportunities to diagnose and treat preventable or controllable conditions such as high blood pressure. Hypertension can be successfully treated with lifestyle changes and an arsenal of medications, including fairly inexpensive generic drugs. Similarly, the lethal disease type 2 diabetes is often ignored in its early stages, when patients could be receiving critical guidance and treatment regarding lowering blood sugar and losing weight.
The Affordable Care Act is steaming toward full implementation in 2014. While it’s hardly a panacea for all that ails our healthcare system, it does offer notable progress in the form of tax credits for small businesses and expanded eligibility for young adults.
For businesses with fewer than 25 workers, tax credits are available for up to 35 percent of an employer’s contribution to employee health premiums, provided that the employer picks up at least half of the total premiums.
The data are not in for the 2011 tax year, but the U.S. Department of Health and Human Services estimates that 360,000 small businesses will take the ACA tax credit in order to cover two million workers. There are plans to expand tax-credit advantages to businesses with fewer than 50 employees. And there’s more.
Health insurance “exchanges” established on a state level will also offer policies for individuals and small businesses that have burdensome healthcare costs, with some costs offset by federal subsidies.
Restructuring and increasing the efficiency of healthcare financing are key objectives of the ACA. And reforms are already producing welcome changes for young adults.
Insurance companies now permit young adults up to the age of 26 to remain on their parents’ health plans. Research reported in the December 19 Health Affairs “Web First” shows a nearly 8 percent spike in coverage among those 19 to 25 years old. Moreover, insurance has encouraged prudent behavior among this sector of the population: the study found that coverage facilitated access to care for young adults, with fewer delays and a reduced incidence of failure to seek care because of cost barriers.
The ACA has already produced major insurance reform; it recognizes that access to care is a lifelong requirement, which is in line with the judgment of medical experts.
Taken together, the extension of tax credits to small employers, the establishment of state health exchanges and the expansion of coverage for young adults to age 26 provide encouraging opportunities to reduce the impact of—or prevent—a host of silent but treatable “slow killers.”