THE AFFORDABLE CARE ACT PART I

ABSTRACT: As implementation of another key piece of the Affordable Care Act (ACA) (also known as Obama Care) approaches, the information and disinformation in the media and from the opposition builds. On January 1, 2014, the “exchanges” – where individuals can purchase health insurance if they don’t have it – will begin operation. On October 1, 2013, individuals can beginning selecting the health insurance plans they want to enroll in.

No one disputes that if the ACA is implemented as intended roughly 30 million Americans will have health insurance who don’t have it now. From a worldwide perspective, the US has the most expensive health care system but ranks 37^th in overall health outcomes. Nearly 45,000 deaths annually are associated with not having health insurance.

From the first days of the Congressional debate on the ACA, its supporters have done a horrible job of presenting its benefits: millions already have better health insurance, $7 billion has been saved by those with health insurance, lifetime caps on benefits are prohibited, and denying coverage for pre-existing conditions will be banned.

The primary target of the opposition has been the individual mandate, which originally was promoted by the conservative Heritage Foundation and Republicans as part of personal responsibility. However, once Obama adopted the individual mandate as part of the ACA, it became anathema to Republicans. The Republicans’ focus on repealing, obstructing, and undermining the ACA has been described by Norm Ornstein, a long-time political scientist at the conservative American Enterprise Institute, as “monomaniacal.” He went on to write, “What is going on now to sabotage Obamacare is not treasonous – just sharply beneath any reasonable standards of elected officials with the fiduciary responsibility of governing.”

FULL POST: As implementation of another key piece of the Affordable Care Act (ACA) (also known as Obama Care) approaches, the information and disinformation in the media and from the opposition builds. On January 1, 2014, the “exchanges” – where individuals can purchase health insurance if they don’t have it – will begin operation. On October 1, 2013, individuals can beginning selecting the health insurance plans they want to enroll in.

There has been good news on the cost of the new plans to be offered through the exchanges: so far 5 states’ plans will cost less than expected. Where the plans cost more than current options, it is often because they provide more comprehensive coverage than current insurance, where coverage has often been narrowed to reduce costs and increase profits.

To put all of this in some context, no one disputes that if the ACA is implemented as intended roughly 30 million Americans will have health insurance who don’t have it now. Further, many of us who have health insurance will get better and, in many cases, more affordable coverage. From a worldwide perspective, the US has the most expensive health care system (at over $8,300 per person) but ranks 37^th in overall health outcomes, and worse for infant mortality and life expectancy. And we have the most people without health insurance. In the US, nearly 45,000 deaths annually are associated with not having health insurance. [This estimate takes into account the effects of the education level, income, health behaviors (for example smoking and drinking), and baseline health (for example, obesity) of those who don’t have insurance.] [1]

From the first days of the Congressional debate on the ACA, its supporters have done a horrible job of presenting its benefits, including: [2]

• 3 million young adults up to age 26 have had health insurance because they could continue to be covered by their parents’ health insurance
• 13 million Americans with insurance have received $1 billion in rebates because their insurance companies spent more than is allowed under the ACA on expenses other than health care (for example, administration and advertising)
• 54 million Americans have gotten free access to preventive services, such as checkups and cancer screenings
• 6 million seniors have saved over $6 billion on their prescription drugs
• Lifetime caps on benefits are prohibited (Isn’t the whole purpose of insurance to cover catastrophic losses? At least that used to be the case before the profit motive took over.)
• Denying coverage for pre-existing conditions or denying renewal of an insurance policy when a health condition or accident occurs will be banned

The primary target of the opposition, particularly from the Tea Party types, has been the individual mandate – the requirement that everyone have health insurance or pay a penalty. Historically, the individual mandate was promoted by the conservative Heritage Foundation and Republicans as part of personal responsibility, i.e., being self-reliant and not depending on government or others for support. Democrats and progressives were cool to the idea because they were concerned that it would pose a burden on lower income families and individuals. The individual mandate was a centerpiece of the Republican alternative to the universal health care proposed by President and Hillary Clinton. And it was the centerpiece of Massachusetts’ universal health care law that Republican Governor Mitt Romney spearheaded and was so proud of (when he was Governor).

However, once Obama adopted the individual mandate as part of the ACA, it became anathema to Republicans. Ironically, as the Tea Party holds town hall forums and rallies today, the headline speaker against the ACA and the individual mandate is often Jim DeMint, the President of the Heritage Foundation, despite it having been the original promoter of the individual mandate. [3]

The Republicans’ focus on repealing, obstructing, and undermining the ACA has been described by Norm Ornstein, a long-time political scientist at the conservative American Enterprise Institute, as “monomaniacal.” The US House has voted 40 times to cut funding or repeal all or part of the ACA, knowing full well that it was a waste of time and effort given that the Senate would never pass such legislation and that the President would veto it and there weren’t the votes to override a veto. (This is one reason why Congress over the last 2 ½ years has been the least productive it’s been in the 75 years that records have been kept.)

Ornstein notes the contrast with President George W. Bush’s Medicare prescription drug plan. The Democrats, led by Senator Ted Kennedy, negotiated a compromise bill with the President. (Something Republicans refused to do with Obama on the ACA.) Then Republicans in Congress removed all of the provisions Kennedy and the Democrats had negotiated for and passed the stripped down legislation. Nonetheless, Democrats worked with Republicans and the Bush administration to make the law work.

In contrast, to undermine the ACA, Republicans refused for 3 years to confirm anyone to head the Center for Medicare and Medicaid Services, which was responsible for implementing the ACA, as it had been for the Bush Medicare drug plan. In addition, they have worked to discourage states from participating in the Medicaid expansion and the exchanges where the uninsured would obtain insurance. They are now threatening to shut down the entire government on September 30 when the fiscal year ends unless Obama stops all implementation of the ACA.

Ornstein went on to write, “What is going on now to sabotage Obamacare is not treasonous – just sharply beneath any reasonable standards of elected officials with the fiduciary responsibility of governing.” [4]