I am seeing and reading a lot about the Affordable Care Act (ACA), or Obamacare. It is frustrating, because I witness people whom I believe to be intelligent, echo what are clearly (if you’re familiar with the law, or paid attention to the supreme court) words that are simply wrong. I see this as a symptom of our current political status; ideology trumpeted by talking heads and sound bites crafted by decidedly partisan speechwriters become the “facts” that are debated as either being good or bad for America. What is so frustrating is that this law (it is a law, despite the current rhetoric) is imperfect and needs to be amended, adjusted or perhaps implemented in a better way, but we will never get there if we continue to allow the political extremes not only to control the conversation but also our very understanding of what ACA really is.
Now we have a partial government shutdown (about 750k-800k workers out of a government workforce of about 3.3M) and its collateral impact (not to be interpreted as unimportant) for things like the Head Start Program that receive government funding. This, because a faction of the Republican Party is behaving as if the ACA is still in committee, being hammered out by the two houses of Congress. I understand that they do not like the law. But, it is a law. A law vetted by the (Conservative leaning) Supreme Court. Shutting down the government in an effort to renegotiate on law is a bad precedent.
Rather than engaging in a productive review of the (now being realized, perhaps previously anticipated) implications of the ACA and proposing appropriate changes, the move is to simply de-fund the entire thing, good and bad equally hit. This sounds like the sequester we got hit with this year because, again, our Congress cannot figure out how to work together and ends up resorting the non-decision. They are afraid to prioritize, make a decision and stand up for it. As long as they push things to the extreme, they can simply blame the ‘other side’ for not compromising. Both sides are guilty.
In the case of the ACA, the Republicans are entrench in an anti-ACA crusade. This time it is on them. During the budget debate that lead to the Sequester, I believe the Democrats were intransigent, not willing to entertain (in any serious way) real reforms and cuts to our spending. Okay, Republicans were also extreme in not being willing to entertain tax increases. But, if you don’t know how much you really need to spend, how can you determine how much revenue you need to raise. In my view, the Dems wanted to see how much they could be raise & borrow, and then figure out what we can spend it on. The Republicans wanted to figure out how much we need to spend, and then determine the funding for doing so.
Any way, a bit off course….
As you hear things, and feel a need to pass on or share a quote, video our op-ed story, fact check it. Even if it is a pundit you like and a general position you agree with, check the underlying facts of their arguments.
Somethings are just funny. I’ve seen medical doctors. deriding the ACA in a way that cracked me up, and see Jon Stewart clips that are equally funny. But they are entertaining, not educating. Share this stuff in fun. But, base arguments in facts.
So, a few things I am seeing that are not actually true, or at least uncertain at this point:
1) Health Care Plan – No. Compelled insurance participation – Yes, sort of.
Often, the ACA / Obamacare is referred to as a healthcare plan that we have to participate in. It is not. Not by a long shot. At its core, the ACA is a law that compels people to have health insurance. Employers must offer it, or pay a fine (about $2k / worker / year to start ). People must get health insurance or face tax penalties (roughly up to 2K+ for a family, or a 1% of HHI to start.).
Here is the thing. 80% of the people are not impacted by this. (I touch on the cost issue later).
Why? Because they are already covered by some type of healthcare insurance. The ACA does not change that. It does not force them to do anything differently than they currently do. (http://www.washingtonpost.com/blogs/wonkblog/wp/2013/09/30/%3Fp%3D63297/)
Personal exemptions – the “sort of” part of compelled..
If buying healthcare insurance costs more the 9.5% of your income, you are exempt. While the government is going to kick in some cash, not everyone will get enough. So, mostly, these folks will depend on the state in which they live and the level of Medicaid that state makes available.
When it is done, everyone will be covered by some kind of insurance, right? Wrong.
The Congressional Budget Office estimates that roughly 26 million Americans will not be covered after the rollout is complete (2016 – 2020). So, we will go from about 48 million uninsured / not-covered down to 26 million. The remaining uncovered will be made up mostly of the poor, between 18 – 44 years old.
That is about 20 million people for whom the coverage status will change under the ACA. That’s about 6% of the population. About 8% will remain uncovered. There balance will / should be covered by the expansion of Medicaid.
Keep in mind, the actual percentages / number vary based on assumptions. However, the basic premise (80% stays the same) does not change.
2) Congress and the President are exempt.
No, they are not. I don’t know how this got so distorted. But, the exact opposite is true. In fact, the Republicans forced an amendment to ensure this (though, by default, Congress was not exempt anyway):
“Notwithstanding any other provision of the law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and Congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are — (I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an Amendment made by this Act).”
The President maintains the same coverage as always (just like the other 80% of Americans). The President is not exempt.
Some more on this point.
Just as all those covered by employer insurance, Congress and the President have been and will continue to be covered.
3. Doctors are going to get paid too little to participate.
There is an issue for Medicaid participation. But, this is a long standing issue and not part of ACA particularly. For years, the federal government has been scaling back the funds, and as such, the States (which actually pay the doctors) have also been getting stingy, and in some cases late, in paying doctors and facilities. This is one of those issues that must be addressed, but not because of ACA. In fact, the argument over ACA has been a distraction from addressing fair and timely compensation for Medicaid doctors.
The issues are impacted by the Federal funding, but set at the State level. For Illinois, the Department of Healthcare & Family Services is responsible. Rate reform information for IL.
4. All our costs are going to increase
Yes. This is true, kind of. The fact is, those newly covered people are likely less affluent with lower education levels. On average, their health issues tend to become more acute before they are addressed and as a result, more costly.
What is not being addressed in this discussion is the hidden cost currently imposed. These same people are treated (eventually) and the costs are buried in the hospitals, only to be recouped by getting more from other patients who can pay. Or so the argument goes.
The fact is, the answer is unknown. People started pointing to increases in insurance policies last year and claimed it was because of the ACA. But, that was just an excuse. Insurance rates have gone up every year, and disproportionate to inflation (which has been relatively non-existent).
According to some, it is too early to tell, and if there is an increase, it will be nominal.
Others are predicting a doubling of insurance cost for individuals.
It is important to note that the relative cost of pre-ACA and post-ACA as a blanket statement is irrelevant. It is too greatly influence by State, status and demographics. Take a look at this from the State of California:
Essentially, for lower income families, the cost will decrease due to subsidies. But, that price has to be paid by others (taxes). If you limit your view to the individual cost, you may think the situation is better (or worse) than if you look at the marco-view. The fact is, no one truly knows yet.
A word of caution: When you see the “average increase” statements, be weary. We can take slices of the new, compare them to slices of the old, and make it look how ever we want – good or bad. Before you quote specific “studies”, be sure to understand the detail and scope of the comparisons. You may be surprised at how biased they can be.
Those are some of the things I see and hear. You see more I’m sure. Please check before you parrot.
The ACA has more to it. There are taxes on equipment, increases in government oversight, new regulations on insurance companies and healthcare providers. We’ve also seen some other aspects already implemented, such as no disqualification for pre-existing conditions, coverage for children up to 26 years of age, and more. The issues most commonly debated are above. Many need to be reviewed and perhaps amended. But, there is good mixed in with the bad, and we need to address this thoughtfully.
In Closing (imaginative, huh?)
Finally, and take this however you wish, we are a nation of morals. We don’t let people die or suffer without trying to help. We’ve sent food, equipment and people all over the world to help others. At home in America, we have decided that if someone needs emergency medical attention they will get it. We’ll figure out how to pay for it later. We’ve honored this and codified it with the Emergency Medical Treatment and Active Labor Act in 1986. As our poor population delays their medical care due to lack of access, they end up at the emergency room which must by law (and should) treat them.
From a practical perspective, this means the cost is already being incurred. The question for us is how we gain visibility into the costs, pay for it, and manage it. Whether the ACA is the vehicle to accomplish this or not, it inevitably has to be done.