Health Reform Act Already Saving Lives Of Many Americans
Is the health care reform law a good deal for Americans, or is it so badly flawed that Congress should repeal it? Now that the measure is one year old — President Obama signed the Patient Protection and Affordable Care Act to law on March 23, 2010 — I humbly suggest we attempt an unbiased assessment of what the law really means to us, and where we need to go from here.
To do that in a meaningful way, we must remind ourselves why reform was necessary in the first place. I believe the heated rhetoric we’ve been exposed to since the reform debate began has obscured the harsh realities of a health care system that failed to meet the needs of an ever-growing number of Americans.
Among them: seven-year-old Thomas Wilkes of Littleton, Colorado, who was born with severe hemophilia. You would never know it to meet Thomas because he looks and acts like any other little boy his age, but to stay alive, he needs expensive treatments that over time will cost hundreds of thousands of dollars. Thomas’s parents were terrified before the law was passed because the family’s health insurance policy had a $1 million lifetime cap. Thanks to a provision in the law that makes lifetime caps a thing of the past, they can sleep easier at night.
Another person who faced the real possibility of not being able to pay for needed medical care is Robin Beaton of Waxahachie, Texas. Her insurance company notified her the day before a scheduled mastectomy two years ago that it was canceling her coverage. Why? Because Robin had forgotten to note when she applied for insurance that she had previously been treated for acne.
So Beaton – who told her story to a congressional committee — was a victim not only of breast cancer but of “rescission,” a once-prevalent practice in the insurance industry. The congressional panel — the House Energy and Commerce Committee — discovered that just three insurers had rescinded the policies of 20,000 people over the course of a five-year period, confirming for lawmakers that the practice was widespread and growing. By rescinding those 20,000 policies, the three companies avoided paying for more than $300 million worth of medical care, much of it for critically ill people. Thanks to the Affordable Care Act, Beaton and the rest of us will no longer have to worry that our insurance policies will be canceled when we need them most because of innocent omissions on applications.
Reform Will End Common Insurance Company Abuses
That same congressional committee discovered during another investigation that the four largest U.S. insurance companies had refused to sell coverage to more than 600,000 people with pre-existing conditions over a three-year period. Thanks to the Affordable Care Act, insurers can no longer deny coverage to children with pre-existing conditions. The law will apply to all of us by 2014.
In addition, young people who have not been able to find jobs that offer health care benefits can now stay on their parents’ policies until they are 26. Young adults, many of whom haven’t been able to find jobs, or who work for firms that don’t provide coverage, comprise the largest portion of the nearly 51 million Americans who are uninsured.
The new law also eliminates copayments for preventive services and requires insurers to establish appeals procedures for denied coverage or claims. And the law has additionally begun to close the infamous “doughnut hole” in the Medicare prescription drug program. Medicare beneficiaries are also now getting better coverage for preventive care. And small-business owners who provide benefits to their employees are being helped by tax credits available for the first time.
Another important provision of the new law requires insurers to spend most of what we pay them in premiums on medical care. In 1993, insurers on average were spending 95 percent of our premiums paying medical claims. That average has dropped steadily ever since. In many cases, especially in the individual and small-group markets, insurers have been spending as little as 50 percent on medical care. The law requires insurers to spend at least 80 percent (85 percent in the large-group market) on health care services or quality improvement activities. Those that don’t will have to pay rebates to their policyholders.
Coming Phases of Reform Will Help Control Costs
Other helpful parts of the law will be phased in. By 2014, for example, states will have to set up health insurance exchanges, which should help control costs. Between 2000 and 2010, American families saw annual premiums increase 114 percent on average from $6,438 to $13,770, according to the Kaiser Family Foundation. While employers often still pay the lion’s share of health insurance premiums, workers are seeing their portion increase every year. During the last decade, worker contributions to health care premiums increased 147 percent. The exchanges, if implemented as Congress intended, should bring down the cost of premiums by fostering competition among insurers. The exchanges will also require insurers to provide data that will enable us to make apples-to-apples comparisons among various benefit plans.
Even after the law is fully implemented, there will be much to do. While an estimated 30 million Americans will be brought into coverage, more than 20 million others will still be uninsured. There’s also still work to be done on addressing the underlying costs of health care in the United States.
But the Affordable Care Act is a start. Let’s consider it just that — a start — and an important one on our shared journey toward a health care system that works better for all of us. If we stop to think for a moment about what needed to be fixed, about why the health care system in the world’s richest country was failing an ever-growing number of Americans, I believe we will want to continue the journey.
By: Wendel Potter, Op-Ed Columnist, Center for Media and Democracy, March 24, 2011
The Affordable Care Act, One Year Later
A year ago this week, Capitol Hill was full of noise as the House of Representatives debated, and then voted, on the Affordable Care Act. But one of the most vivid memories of that experience for me was an extended moment of silence.
It came very late on Sunday evening–after the floor speeches, the votes, and the press conferences had ended. The galleries had long since emptied and the Capitol building itself was virtually unoccupied, so that it was possible to walk the entire length of the building, on the ground floor hallway that stretches from the House all the way to the Senate, without hearing so much as a single conversation.
It felt more than silent. It felt peaceful and, yes, satisfying. A prolonged, difficult debate had finally ended. It was time to move on.
Except that we haven’t moved on. We are still having arguments about health care reform. In fact, we are still having the same arguments about health care reform. The Affordable Care Act is law of the land now, yes, but its critics are determined to change that. And while the prospects of repealing it legislatively remain relatively slim, the prospects of repealing at least part of it judicially seem far more realistic than they did in the spring of 2010.
So perhaps it is worth taking a step back, just for a moment, and remembering how we got to this point–why this debate started in the first place and why it led to the enactment of this law.
It’s really not that complicated. Around one-fifth of the non-elderly population, or somewhere in the neighborhood of 50 million people, have no health insurance. Many millions more have insurance with major gaps or limitations, leaving them at risk of financial or medical catastrophe. Notwithstanding legitimate debates over exactly how many people go bankrupt or suffer physical hardship because they can’t pay their medical bills, virtually nobody denies that the human toll is real and significant.
These problems are the product, in part, a dysfunctional health insurance system that evolved haphazardly during the 20th Century. They also the product of a medical system as inefficient as it is costly. The United States pays more–far, far more–for health care than any other developed nation. But the care does not seem to be better overall, to say nothing of the fact that it is patently less available.
The goal of reform was really two-fold: In the short term, to make sure everybody can afford to pay for medical bills without financial distress; it the long term, to make the health care system as a whole more efficient, so that it no longer applied such a crushing financial burden on society. A single-payer system, like the ones in France or Taiwan, would have accomplished this. So would a scheme that turned health insurance into a regulated utility, as the Dutch and Swiss governments have done.
Political compromises, dating back to the earliest days of the 2008 presidential campaign, left the U.S. with a second-best–or, more accurately, a third- or fourth-best solution. It bolsters two existing insurance arrangements: Employer-sponsored coverage for workers in most companies, Medicaid for the very poor. It creates a new, regulated marketplace–insurance “exchanges”–for everybody else. Then, through a combination of tax changes and alterations to Medicare, it tries to reengineer medical care itself, wringing out administrative waste and focusing resources on the treatments, and care styles, that provide the most bang for the buck.
It’s easy to find the flaws–and to figure out who’s responsible for them. Doctors, hospitals, drug manufacturers, and device makers fought changes in the delivery of medical care that might affect their incomes; unions lobbied against tax reforms designed to discourage overly generous insurance; everyday Americans resisted changes to plans they already had. All of this blunted the Affordable Care Act’s efforts at cost control, which explains why, ten years from now, the best projections suggest we’ll have spent roughly as much on health care–as a government and as a country–as we would have if the law never passed.
At the same time, political conservatives fought to limit the bill’s expanse, demanding that the new outlays not exceed a $1 trillion, give or take. They had extra power, thanks to the filibuster, and were able to make the demand stick. As a result, the expansion of insurance coverage–via Medicaid and subsidies for private insurance–will not begin until 2014. Even then, somewhere around 20 million people, or 8 percent of the total population, will remain uninsured. And for some of the insured, the coverage will remain meager.
But the law’s shortcomings should not tarnish its many virtues. Eight percent uninsured means 92 percent insured, or around 95 of residents here legally. Or, to put it another way, more than 30 million additional people will have health insurance because of this law. The coverage, if not always as generous as it should be, will be enough to keep many if not most of the newly insured out of bankruptcy–and it will be available to almost everybody, regardless of pre-existing condition or insurance status.
The cost picture is also encouraging. The official projections suggest that, as of 2021, government spending (and, apparently, the country’s total spending) on health care will not be rising as fast as it is now. This is the critical distinction, because it’s the long-term burden of health care that threatens to bankrupt us. Critics doubt that officials will enforce planned changes to health care financing, but today’s lawmakers have no way to force action by their counterparts in the future. All they can do is put laws on the books–and that’s what they have done.
Are there better alternatives? Of course. But the loudest critics of the law, from the right, don’t have them. For all of their screaming, they have yet to put forward a credible plan that can do as much, let alone more, for less money. Their plans, stripped of misleading rhetoric, generally involve covering far fewer people, dramatically reducing the coverage that people have, or some combination of the two. Their dispute is not with the means Democrats have used to make health care affordable to all. It’s with the goal itself.
No, the way to improve the law is to build upon it–to bolster the insurance coverage, reach those Americans the law as written will not reach, and to strengthen the experiments in cost control that work. The best analysis of the law remains the one Senator Tom Harkin gave: The Affordable Care Act is not a mansion. It’s a starter home. But it’s got a solid foundation, a sturdy roof, and room for expansion.
A year from now, the presidential campaign will be well underway and the debate about the Affordable Care Act will likely be, if anything, more acrimonious than it is now. But perhaps after the election and, hopefully, after 2014, the country really will move on.
By: Jonathan Cohn, The New Republic, March 23, 2022
The Anniversary of the Affordable Care Act: A Year Later, The False Attacks Continue
Conservatives often push myths and misconceptions of the Affordable Care Act of 2010 as a way to increase opposition. During the debate in Congress in the run-up to passage of the new health reform law, conservatives pushed wild accusations that the law would be a “government takeover” and establish “death panels,” claims that were labeled “the lie of the year.” Now, a year after the Affordable Care Act was signed into law, inaccurate claims and mistruths against the law continue.
Conservatives continue to make false claims against the law as a way to repeal it, undermine consumer protections, and put insurance companies back in charge of our health system. The reason these false statements endure is clear: There are those who would rather take us back to the way our health system was before when insurance companies were in charge rather than move forward and protect our care.
This issue brief is a response to recent false attacks conservatives have made against the law. As we will demonstrate, the Affordable Care Act will create jobs, lower health care costs for families, help small businesses provide health insurance to their employees while maintaining the private sector’s key role in health insurance, and ensure we provide quality health care to all Americans at a lower cost to them and American taxpayers.
The Affordable Care Act will help create jobs
The Affordable Care Act helps our economic recovery by bringing health costs under control, freeing businesses to use that money to invest in job creation. The real threat to job creation is the conservative push to take us back to the old health system where costs were on an unsustainable path. Harvard University professor and Center for American Progress Senior Fellow David Cutler found that repealing the Affordable Care Act—and going back to the unsustainable costs—would cost up to 400,000 jobs annually over the next decade.
To push this “job destroying” argument, conservatives cite the nonpartisan Congressional Budget Office’s estimates that the law will reduce the labor supply (although conservatives dismiss CBO reports when they conclude the law will cut the deficit and reduce premiums). Yet conservatives fail to recognize that one reason for this reduction is that older workers, now forced to hold on to jobs to get health insurance, will now be able to retire—with insurance—when they choose.
The Affordable Care Act lowers premiums and costs for families
The Affordable Care Act takes steps to get our health costs under control and lowers costs for families. The real threat to costs is the conservative push to repeal the law. Cutler found that repealing the Affordable Care Act would increase total health spending by $125 billion and raise family premiums by nearly $2,000.
More small businesses are providing health coverage to their employees, thanks in part to the Affordable Care Act
Conservatives try to downplay the impact of the small business tax credits to provide health insurance to their employees. The truth is that last year, more than 4 million small businesses were eligible to receive a tax credit to make health coverage more affordable. According to the Los Angeles Times, “major insurers around the country are reporting that a growing number of small businesses are signing up to give their workers health benefits,” adding that an “important selling point” was the small business tax credits.
The Affordable Care Act keeps the employer-based health system intact
Conservatives claim the Affordable Care Act will undermine the employer-sponsored health coverage that millions of Americans enjoy when the state health insurance market exchanges become functional. This is not true. According to Mercer’s recent “National Survey of Employer-Sponsored Health Plans,” the vast majority of employers, particularly large employers, will continue to offer their employees health coverage. Indeed, the survey notes that if the Affordable Care Act follows the Massachusetts health law, “few employers of any size” will choose to drop coverage.
The Affordable Care Act ensures quality care and has flexibility for states
The Affordable Care Act provides states with considerable flexibility. Each state gets to decide how to set up their own marketplace of health options for consumers to choose which plan suits them best. States have flexibility in how they implement insurance reforms and consumer protections. The law encourages state innovation by allowing them to obtain waivers from some requirements provided the alternative proposal provides comparable coverage and affordability. President Obama recently endorsed legislation from Sens. Ron Wyden (D-OR) and Scott Brown (R-MA) that would move the start date for those waivers by three years.
At the same time, conservatives argue there is not enough flexibility in the Affordable Care Act. They criticize the Obama administration for granting too many waivers on so-called “mini med” plans that have a low annual limit. Since many of the consumer protections and mechanisms to increase patient choice—such as the state marketplaces—are not operational until 2014, the administration has in some instances granted waivers from the law’s early requirements, to avoid leaving people with nothing. CAP Senior Fellow Judy Feder told Congress that until the law is fully implemented, the goal should be to “make matters better, without making them worse.”
States can save money from the Medicaid reforms under the law
Medicaid is a federal-state health program that provides health coverage to predominantly lower-income families, elderly people, and people with disabilities. The federal government matches state funding on the program. For people made newly eligible for Medicaid by the Affordable Care Act, the federal government will pay 100 percent of costs in the early implementation of the Affordable Care Act. In the later years, states will have to pay only 10 percent.
Conservatives charge that the Affordable Care Act will increase state Medicaid spending by $118 billion. An Urban Institute study, however, found that states will save between $40.6 billion and $131.9 billion from 2014-2019 by replacing state and local spending for uncompensated care and mental health with federal Medicaid funds and by replacing federal Medicaid funding for adults with incomes over 133 percent of the federal poverty level with federal subsidies in the marketplaces.
There is no secret $105 billion hidden in the law
Conservatives such as Reps. Michele Bachmann (R-MN) and Steve King (R-IA) claim that $105 billion of mandatory funding was secretly put in the law unbeknownst to members of Congress. This is false. The Washington Post’s Fact Checker said this claim is “bordering on ridiculous” and “does not have credibility.” The truth is there was a considerable amount of transparency before the Congress approved the Affordable Care Act. In the House alone, there were: 79 bipartisan hearings, totaling 100 hours; 181 witnesses; and 239 amendments considered. The House bill was posted online 30 days before committee markup.
The law keeps Medicare solvent and cuts the deficit
Conservatives argue that the Obama administration “double counted” the Medicare savings for the law, arguing it went to save the Medicare Trust Fund and cut the deficit. The facts are these: The law cuts the deficit by $1 trillion over the next two decades and keeps Medicare solvent until 2029—12 years longer than before the law was passed. The Center on Budget and Policy Priorities explained how this works before the House Budget Committee:
There’s no double-counting involved in recognizing that Medicare savings improve the status of both the federal budget and the Medicare trust funds. In the same way, when a baseball player hits a homer, it both adds one run to his team’s score and also improves his batting average. Neither situation involves double-counting.
Conclusion
The conservative false attacks are meant to repeal the Affordable Care Act and bring our health system back to the time when insurance companies could discriminate because of a pre-existing condition. Despite these false attacks, the facts are clear: Millions of families, small business owners, and seniors are seeing the benefits of the Affordable Care Act. More than 4 million small businesses are eligible to receive tax credits to make health coverage more affordable. As many as 4 million seniors received help to make their prescription drugs more affordable. Already this year, more than 150,000 seniors with Medicare had a free wellness exam. And children with pre-existing conditions can no longer be excluded from insurance plans. We should move forward with this law and tell those who want to repeal it that we won’t go back.
By: Tony Carrk, Center For American Progress, March 21, 2011
School of Glock-Get Your Graduate Degree Here
It’s been nearly nine weeks since that tragic shooting in Tucson, and you may be wondering whether there’s been any gun legislation proposed in the aftermath.
Well, in Florida, a state representative has introduced a bill that would impose fines of up to $5 million on any doctor who asks a patient whether he or she owns a gun. This is certainly a new and interesting concept, but I don’t think we can classify it as a response to Tucson. Jason Brodeur, the Republican who thought it up, says it’s a response to the health care reform act.
A sizable chunk of this country seems to feel as though there is nothing so secure that it can’t be endangered by Obamacare. It’s only a matter of time before somebody discovers that giving everyone access to health insurance poses a terrible threat to the armed forces, or the soybean crop, or poodles.
Brodeur’s is one of many, many gun bills floating around state legislatures these days. Virtually all of them seem to be based on the proposition that one of the really big problems we have in this country is a lack of weaponry. His nightmare scenario is that thanks to the “overreaching federal government,” insurance companies would learn who has guns from the doctors and use the information to raise the owners’ rates.
However, it turns out that the health care law has a provision that specifically prohibits insurers from reducing any coverage or benefits because of gun ownership. A St. Petersburg Times reporter, Aaron Sharockman, looked this up. I had no idea, did you? Apparently Senate Majority Leader Harry Reid himself stuck this in to make the gun-lobby folks happy.
Which they really aren’t. The gun lobby will never be happy, unless the health care law specifically requires every American to have a pistol on his or her person at all times.
Great idea! thought State Representative Hal Wick of South Dakota, who tossed in a bill this year requiring every adult citizen to purchase a gun. Actually, even Wick admitted this one wasn’t going anywhere. It was mainly a symbolic protest against the you-know-what law.
Actual responses to the Tucson shooting — that is, something that might actually stop similar tragedies in the future or reduce the carnage — seem to be limited to a proposal in Congress to ban the sale of the kind of ammunition clip that allowed the gunman to fire 31 shots in 15 seconds. That bill is stalled at the gate. Perhaps Congress has been too busy repeatedly voting on bills to repeal the health care law to think about anything else. But, so far, the gun-clip ban has zero Republican supporters, which is a problem given the matter of the Republicans being in the House majority.
Meanwhile in the states, legislation to get more guns in more places (public libraries, college campuses) is getting a more enthusiastic reception.
The nation’s state legislators seem to be troubled by a shortage of things they can do to make the National Rifle Association happy. Once you’ve voted to allow people to carry guns into bars (Georgia), eliminated the need for getting a permit to carry a concealed weapon (Arizona) and designated your own official state gun (Utah — awaiting the governor’s signature), it gets hard to come up with new ideas.
This may be why so many states are now considering laws that would prohibit colleges and universities from barring guns on campus.
“It’s about people having the right to personal protection,” said Daniel Crocker, the southwest regional director for Students for Concealed Carry on Campus.
Concealed Carry on Campus is a national organization of students dedicated to opening up schools to more weaponry. Every spring it holds a national Empty Holster Protest “symbolizing that disarming all law-abiding citizens creates defense-free zones, which are attractive targets for criminals.”
And you thought the youth of America had lost its idealism. Hang your head.
The core of the great national gun divide comes down to this: On one side, people’s sense of public safety goes up as the number of guns goes down; the other side responds to every gun tragedy by reflecting that this might have been averted if only more legally armed citizens had been on the scene.
I am on the first side simply because I believe that in a time of crisis, there is no such thing as a good shot.
“Police, on average, for every 10 rounds fired, I think, actually strike something once or twice, and they are highly trained,” said Bill Bratton, the former New York City police commissioner.
Concealed Carry on Campus envisions a female student being saved from an armed assailant by a freshman with a concealed weapon permit. I see a well-intentioned kid with a pistol trying to intervene in a scary situation and accidentally shooting the victim.
And, somehow, it’ll all turn out to be the health care reform law’s fault.
By: Gail Collins, Op-Ed Columnist, The New York Times, March 9, 2011
Health Reform-If Not Now, When?
Yesterday, Sen Ben Nelson of Nebraska indicated that he was throwing his support behind the Senate reform package, in effect providing the 60th vote to keep the reform process going forward. With Nelson’s announcement followed by the press conference of Majority Leader Harry Reid, it did not take very long for the “diarrhea of the mouth” to begin flowing. One would have thought that all of the teens had just scaled the chain link fence at the local reform school and were now running through the streets yelling and screaming in a state of complete chaos. And yes, the Party of No surfaced in their usual choreographed splendor, foaming and seething at the mouth. Over the last couple of months, just about everyone on the planet has griped and moaned about not getting exactly what they wanted. Progressives are unhappy, anti-abortionists are unhappy, pro-choice groups are unhappy, those for gay rights are unhappy, Ed Schultz is unhappy, Keith Olbermann is unhappy, Racheal Maddow is unhappy and republications…well, they are just themselves…Mitch McConnell, Tom Coburn, John McCain. Theodore Roosevelt aptly noted that “Every reform movement has a lunatic fringe”.
This morning I watched the usual television pundits join the fray. There was George Will, Joe Scarborough, John Kyle, Tavis Smiley, David Gregory, George Stephanopoulos, the cast of CNN and the buffoons over at Fox. The interesting thing in all of this is that everyone seems to have forgotten that we are suppose to be talking about health reform, the same topic that we have been talking about for at least the last forty years. No wonder everyone is so up in arms.
Today, Maine Senators Snowe and Collins went on record indicating their non-support for the Senate bill. In her press release today, Sen Snowe stated that “ I deeply regret that I cannot support the pending Senate legislation as it currently stands, given my continued concerns with the measure and an artificial and arbitrary deadline of completing the bill before Christmas that is shortchanging the process on this monumental and trans-generational effort”. “There is absolutely no reason to be hurtling headlong to a Christmas deadline”. Sen Collins , god bless her, noted in her press statement “That is why I am so disappointed that the partisan legislation before the Senate falls far short of what should be the goals of reform.” It is unfair that republicans were allowed to offer only seven amendments to a bill that affects every single citizen and one-sixth of our nation’s economy.” She went on to say that “The health legislation before the Senate has enormous consequences for our economy and our society. The Senate missed the opportunity to produce true, bipartisan health reform.”
Reform…a very interesting word, a transitive verb that means 1) to put or change into an improved form or condition 2) to amend or improve by change of form or removal of faults or abuses 3) to induce or cause to abandon evil ways. As one who has been for a public option from the start and thus far not getting exactly what I wanted either, I venture to believe that the current Senate bill is about reform. The bill establishes a framework of exchanges that will go a long way for many who cannot afford health insurance by making billions of dollars available in federal help to allow people to buy coverage through these exchanges and through expanded Medicaid. The bill also places new regulations on private insurers that reduces their ability to discriminate against the sick while at the same time, preventing the insurers from undermining the security of these same people. Additionally, insurers will be required to spend more of their premium revenues on clinical services and quality activities. There will be an immediate ban on pre-existing condition exclusions for children, patient protections for choice of doctors, restrictions on annual limits of benefits and accountability for excessive rate increases. By definition, this is reform…a change to improve.
Unfortunately Senators Snowe and Collins, you are on the wrong side of this issue. You both are intelligent and learned people. Sen Snowe, how many more generations must pass before you feel you have had enough time to make an informed decision. Are 40 plus years not enough? It’s not as though you are a first time Senator. And Senator Collins, the words “unfair, true reform, and bipartisan health reform” are just not going to cut it. Health and costs go hand-in-hand. Fixing healthcare goes a long way towards fixing the economy. At every turn, the “process” has been bastardized by your Republican party. I am far more interested in results than in process. I am certain that all of those people who do not have health insurance, all of those who are under-insured, all of those who are paying extortion- like insurance premiums, all of those who are paying exorbitant out-of -pocket expenses, and all of those who are being denied insurance because of pre-existing conditions would like to see their nightmare come to an end. The consequences of your “No” is the continuation of fear and insecurity for millions and millions of Americans.
As in triage, the goal of reform is to do the greatest good for the greatest number. So I ask you, if not health reform now, when?
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