Deciphering the Indecipherable Affordable Care Act

Published March 27, 2015

Health Care Made Easy: Answers to All of Your Healthcare Questions Under the Affordable Care Act, Michelle Katz, Adams Media: Avon, MA, December 2014, 240 pages; ISBN-10: 1440580197

For anybody concerned about health, who has health insurance or is planning to buy it, or who wants to understand the Affordable Care Act (ACA), this book is a must-read.

Author and nurse Michelle Katz currently works as a health care advocate on ABC World News, and she proves herself here to be an amazing interpreter of a program that for most of us is all but indecipherable. Her objective explanations of all aspects of the new insurance programs established by the ACA are succinct and comprehensive.

This 230-page narrative is presented almost entirely in a question-and-answer format that simplifies the reader’s search for specific questions. The book is divided into four sections. The first explains the Affordable Care Act, better known as Obamacare; the second explains how to choose a health plan; the third describes how to use your benefits; and the fourth explains how to control health costs.

That all sounds dry and sterile, but Katz does a wonderful job of making the book read as if it were written by a favorite uncle giving solid advice. It seems that Katz is the kind of person who is capable of deciphering any unreadable contract.

Key Questions Answered

The author starts off by briefly describing the 10 essential health benefits of all plans: ambulatory services, emergency services, hospitalization, maternity, mental health, rehabilitation, laboratory services, wellness, pediatrics, and prescriptions. Katz describes the bronze, silver, gold, and platinum health plans Obamacare forces all insurance plans to conform to, and she simplifies topics ranging from exemptions in coverage to the rare cases where old plans can be grandfathered in and retained.

Of far greater interest to this reader was the alphabet soup of healthcare programs, including HMOs, PPOs, EPOs, FSAs, HSAs, and POSs, and the 17 pages that answer the 15 questions that will enable the reader to choose the very best option for health coverage using the government’s exchange.

I think the strongest portion of the book is Katz’ advice on selecting a doctor to attend to all your health care needs before those needs become evident. She notes that in this day and age, patients can research any doctor on the Internet in addition to asking for a recommendation from an insurance provider, so there’s nothing stopping you from finding a quality physician.

There is an old joke that drives her point home: What do you call a medical student who graduates with a C-minus average? The answer, of course, is “doctor.”

Selecting a Doctor

Katz explains the credentials, training, internships, residencies, postdoctoral training, and publications you might look for in helping to select a doctor.

In her segment titled “What are some questions I can ask before making a final decision about a doctor?” she describes the obvious things most people rarely research, including, “Consider what’s important to you, such as weekend office hours or quick response to calls. You might also want to ask who covers for the doctor when he or she is not available. Does the doctor have policies regarding how appointments are canceled? How long does it take to get an appointment? Does that change if your problem is urgent?”

Katz advises scheduling a visit with a new doctor to learn if the doctor allows patients to ask questions, closely listens and provides answers in understandable terms, asks questions and shows respect, makes the patient comfortable, spends enough time with each patient, describes alternative treatments, and is open to discussion. 

Most people are too intimidated by doctors to consider these things fully, but Katz might just be able to give you the backbone to do so.

The book abounds in simple gems, such as a single-page explanation of relevant laws and pros and cons governing money-saving drugs from Canada and Mexico. She even provides a lovely pep talk on saving money by living a healthier life through diet and exercise.

It simply would not be possible to read this book and regret the small amount of time and money it takes to access the tremendous wealth of information provided by Katz.

Jay Lehr ([email protected]) is science director at The Heartland Institute.