Since its inception, the Affordable Care Act (ACA) has fallen under intense scrutiny. Contrary to popular belief, it is essentially insurance reform, not health care reform. The law is complicated. It has multiple interlinking components that all rely on one another for it to be successful. The ACA is supposed to provide a larger safety net for Americans. Two major aspects of the ACA are the Medicaid expansion, which includes more funding for the federal Children’s Health Insurance Program (CHIP), and closing the doughnut hole left by Medicare part D. For most Americans, particularly those who purchase their own insurance, it’s off to the exchanges. However, with its rollout and the fact that many states refused to work with this administration, it has been far from stellar. One of ACA’s basic reforms is allowing children to stay on their parent’s policy until the age of 26; unfortunately, this does not include grandchildren. However, in the states that accepted money to expand Medicaid, CHIP will help fill that void.Policies can no longer be denied, or worse, canceled when coverage is needed on the basis of a preexisting condition, such as being born female. And now, there is a minimum threshold of coverage to which insurers must adhere.
In order to comply with the ACA, insurance companies can no longer sell “junk health insurance” or “mini-meds” to the general public. However, that fact appeared to be in direct opposition to the president’s statement that, “If you like your plan, you can keep it,” which has landed him in the hot seat. So was the president lying? The answer is not so simple. The ACA is complicated and it’s impossible to discern the president’s intent with any level of certainty. However, there are some common-sense questions one may ask:
Q: Would Americans knowingly want to keep junk insurance that doesn’t offer medical coverage when they need it most?
A: Perhaps. There may be some people who don’t mind propping up the insurance industry.
Q: If the ACA were not passed, would insurance companies have canceled any policies, or changed any policies based on market projections, company financial objectives, plan restructuring, and/or a change in their network providers?
A: This is a far more likely scenario and has been how insurance companies have operated for decades.
Q: Would an insurance company cancel or change a policy, blame the ACA, and then try to sell something more expensive in its place?
A: This exemplifies how the insurance industry typically behaves. It has a history of and still is actively misleading consumers. Recently, LifeWise of Washington got caught in the act. A 57-year-old Seattle resident received a cancelation letter, but it also indicated that they identified an alternative similar policy (more than likely with superior coverage). If she did nothing, they would automatically enroll and lock her into the alternative plan. The new policy was an additional $300 per month. Moreover, they didn’t indicate that the same plan could be purchased through the exchanges for less. She went to an exchange and received a similar policy; with tax credits, she paid $1000 less per month than what LifeWise was offering.
The ACA is a political lightning rod. It has been constantly under attack and mired in controversy. Since 2009, hardly a day goes by without partisan rhetoric that muddies the waters. It has become so murky that collectively we’ve lost sight of why this law was necessary in the first place.
A Call for Reform
In 1944, during his State of the Union speech, President Franklin Roosevelt spoke about a second Bill of Rights. He recognized that the strength of our country was its people and the freedoms given to them under the first Bill of Rights. He also recognized that the first Bill of Rights provided inadequate protection to its citizens:
“As our nation has grown in size and stature, however-as our industrial economy expanded-these political rights proved inadequate to assure us equality in the pursuit of happiness.
We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence. Necessitous men are not free men. People who are hungry and out of a job are the stuff of which dictatorships are made.”
FDR wanted to expand our constitutional freedoms. He envisioned a United States where everyone was free from the tyranny and oppression that poverty, hunger, a poor education, and poor health can cause. Unfortunately, his second Bill of Rights was never realized. Since Roosevelt, every president has recognized that our health care system is extremely flawed.
On 2 separate occasions, President Truman tried to create a national health insurance fund for all Americans but was thwarted by big pharma and the AMA. After learning that 56% of Americans over 65 had no health insurance, President Kennedy attempted to create a national health program for seniors, essentially Medicare. He too was out-flanked by big pharma, the AMA, and a complicit congress. After his death, the torch was passed to Lyndon Johnson, and this time the nation was ready despite industry-sponsored ads claiming Medicare was the first step to socialism. On July 30, 1965, Medicare became law. Of course, one may look at this group of presidents and conclude that nationalized health care is a liberal or progressive endeavor, but they would be wrong. Richard Nixon recognized that heath care costs have a deleterious effect on our nation’s economy and proposed a form of universal health care. Again, the usual rhetoric lambasting it as a socialist/communist plot quickly derailed any movement on this front. However, in 1972, legislation was passed that expanded Medicare to include disabled persons under the age of 65, and since then, Medicaid has allowed millions of Americans, especially children, access to health care. In the 1990s, the Clintons tried to take up the torch again, but many of the familiar faces came out, and like so many times before, universal health care didn’t make it out of the gate. For about a century, we have seen health care costs grow, and the number of Americans who are uninsured or under-insured skyrocket alongside that growth.
Today, there are additional and unusual groups who oppose any kind of reform, such as those funded by David and Charles Koch, billionaires who inherited an energy empire from their father. Among many of the unsavory actions that they and their company are associated with, one is the hijacking of a true grassroots movement, the Tea Party. Over the past few years, they have funded many Tea Party subgroups, including the Tea Party Express. The Tea Party Express is a bus that drives paid activists (the term is used lightly) from state to state denouncing the ACA. Recently, they went to new lows. A group called Generation Opportunity (GO), funded by the Koch brothers, is traveling to college campuses to throw keg parties. It is their hope that they can persuade students to not buy health insurance or at least not from the exchanges. The Koch brothers have bankrolled GO to the tune of $5.04 million and the “Opt Out” tour is scheduled to stop at 20 college towns and throw these drunken fests. The calculus here is that by stopping young people from getting insurance through the exchanges, it may derail the entire program.
A Need for Reform
In 2010, there were 50 million uninsured Americans. The number of under-insured Americans is estimated to be around 25.2 million, and some of the most heartbreaking stories come from that group. A study in 2007 found that 62% of all bankruptcies resulted from medical debt. At the time of illness, 77.9% of those people had medical insurance. And of those insured, 77.4% had private insurance. Before the economic downturn in 2007, an American family filed for bankruptcy every 90 seconds because of medical bills. Of those bankruptcies, 92% were directly related to medical debt and out-of-pocket expenses. Many people who thought they were covered really weren’t because of junk insurance. Other families had tremendous out-of-pocket expenses because their policies were canceled. Many of these families received insurance through an employer, but once they became too debilitated to work, about half of their employers dropped their policies either immediately or within a year. Within 5 years, 66.4% of the families who filed for bankruptcy because of medical debt also lost their homes.
The United States Stands Alone in the Modern World
Virtually every industrialized nation in the world provides some form of universal health care for their citizens. However, in the United States, we hold on to an archaic delivery system that benefits the few at the cost of the many. The pre-ACA system couldn’t even manage to keep per capita spending lower than other nations. Health care spending in the US has nearly doubled since 1980, rising from 9% to roughly 18% of GDP. According to the World Health Organization, the US ranks 37th overall in health care performance but we are number 1 in overall per capita spending. On average, 13% of all revenue is spent on billing and insurance costs. To put this in perspective, Canada spends 6.6% on similar services and achieves an overall ranking of 30 (As a side note, Canada is ranked 10th in health care spending.). In virtually every measurable metric, the US has fallen when compared to its cohort nations. Since the 1980s, we have seen all-cause mortality and infant mortality rates decline more slowly and longevity figures slump. Some argue that these measures are not reliable, particularly infant mortality because there is no standardization of measurement. This point is true. However, it is the same standard that existed in 1980 and now other countries fare better than we do. Excluding infant mortality, nearly every other measure is poor: all-cause mortality, longevity, and morbidity across multiple diseases and infectious states have diverged too. In general, as a country, we are growing sicker than our industrialized counterparts, while spending more on health care than they do.
Misconceptions, Falsehoods, and Outright Lies
With respect to health care and health care insurance, the status quo wasn’t working for millions of Americans, and that number was exploding. More Americans were under-insured, more Americans lost their insurance, and more Americans were confronted with crippling debt because of illness. It is also noteworthy that since the passage of the ACA, health care spending has grown at the slowest rate ever recorded. Also, just as before, much of the modern-day rhetoric is at best misleading and in many instances is patently untrue. Death panels were weekly stories on almost every network. They gripped our attention and nearly all the coverage on them was wrong. They are essentially a right, not previously provided, for patients to have insurance-covered end-of-life discussions with their doctors. Other outright lies include a 3.8% tax being levied on all home sales, unions not having to comply with the law, how eliminating the ACA will save nearly $100 billion a year, how it’s a job killer, and of course, “it’s a government takeover of health care”;again, it’s insurance reform. This last aspect is puzzling because in no way does the federal government have any stake in these insurance companies from which Americans will buy their insurance. The ACA merely sets up regulations to which insurers must adhere.
Many health insurance companies have grown due to a multitude of illegal practices. Insurers such as UnitedHealth have stolen market share by refusing claims, limiting reimbursements to doctors, forcing higher out-of-pocket expenses, refusing policies based on preexisting conditions, offering inadequate protection, and selling what can only be deemed as unnecessary policies to one of the most vulnerable segments of our society, the elderly. Out of the 10 worst insurance companies in America, health care insurers take spots 5, 6, and 8. They are in good company. AIG, a central figure in the recent financial meltdown, came in at number 3. The rhetoric against the ACA will inevitably continue, but what’s disheartening is the fact that journalism seems to only be interested in sensationalism. Every day, there’s another heart-wrenching story of how someone lost their insurance because of the ACA; however, not mentioned is that in many instances, that person can find a better, cheaper policy through the exchanges, especially in those states that participated in the Medicaid expansion. Unfortunately, it is rare to hear stories where the law has positively changed a person’s life, such as with Gail Roach. Per a local Pittsburgh news station, at age 57, Gail Roach was paying $509 a month for health insurance that she received from a retirement plan. She had type 2 diabetes and a limited income. She turned to the exchanges and found a similar policy for $70 per month, and with tax credits, her monthly out-of-pocket cost dropped to about $1.
Few people know the story of Gail Roach because it doesn’t fit into many of the national media’s storyline for the ACA, including the talking point that most Americans are against the ACA by a margin of 51% to 43%. However, when you look into those numbers, a different picture emerges. Results from a CNN poll in May 2013 demonstrate that 43% are in favor of the ACA, 16% don’t think it goes far enough, while only 35% are opposed to it.
For a select few, health insurance has been a very profitable proposition. For the vast majority, however, it has been an ever-increasing financial burden, with rising out-of-pocket expenses and lifetime caps that have brought many Americans to financial ruin. A simple common-sense approach is that a healthier workforce is a more productive workforce, and a more productive workforce spurs on economic prosperity and greater freedom. Is the ACA the first step to some form of socialized medicine? Perhaps, but what is wrong with creating a floor of health coverage for all Americans, a foundation that enables everyone to receive basic preventative health care? And preventative medicine is far cheaper than emergency medicine, for which Americans essentially already pay in the form of higher deductibles and taxes. Medicare has such a foundation and premium plans if more coverage is desired. Where is the outrage for that form of socialized medicine?
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