“The Affordable Care Act”: A Mother’s Day Gift For Moms Throughout The United States
People always say good health is the greatest gift, so let’s make health a priority this Mother’s Day. Now that I am a mother myself, I am even more appreciative that I have health insurance that covers the care I need. All moms deserve the kind of quality, affordable care that I was lucky enough to receive while pregnant and postpartum, and Obamacare is working to make that dream a reality.
While pregnant, what did I need the most—that is, besides a foot massage? Maternity care, of course. My prenatal visits reassured me that my pregnancy was progressing as it should and my insurance allowed me to use the provider of my choosing, labor in the setting I wanted, and get the emergency care I ultimately needed. Unfortunately, only 12 percent of plans in the individual health insurance market currently offer maternity coverage. Thankfully, starting in 2014, Obamacare will require all new health plans to cover maternity care as the essential health service that it is.
Needing an emergency C-section was the first sign that I was no longer calling the shots. It’s fine if my son has his own plans, but not the insurance industry. Insurers currently can deny women coverage for specific health services or entire plans due to gender-related “pre-existing conditions” such as Cesarean sections, breast cancer, domestic violence, and sexual assault. The idea that my surgery could disqualify me from obtaining coverage on the open insurance market is both absurd and deeply offensive. But this discriminatory practice becomes illegal under Obamacare in 2014.
After my son was born, my pediatrician’s office began to feel like a second home with the amount of time I had to spend there his first year. I am lucky enough to have a low co-pay that I can afford, but for far too many families those co-pays are not just a minor inconvenience. Obamacare ensures that families can afford to bring their children in for vaccinations and other routine visits by eliminating cost sharing, such as co-pays or deductibles, for well-baby and well-child care.
Whoever said breastfeeding comes naturally? Like so many of my peers, I was surprised to encounter all sorts of difficulties with nursing. I relied heavily on my local breastfeeding center to help me diagnose and address the problems I had, an expensive but incredibly helpful service. Had I not been able to afford those hefty out-of-pocket fees, there is no way I could have continued nursing my son, providing him with valuable antibodies and nutrients and strengthening the mother-child bond. The good news is that this August, nursing mothers in new health insurance plans will receive no-cost coverage for lactation supports that include counseling and equipment.
Nursing moms who return to work also will benefit, as I did, from the requirement that large employers provide breaks and a private space for expressing breast milk. I was very thankful for this provision, especially when I heard the horror stories of women who were forced to pump in a bathroom stall or in their cars—or those who were fired for requesting pumping breaks. With such obstacles in place, it is no wonder that only 36 percent of U.S. infants are breastfed past six months, even though the American Academy of Pediatrics recommends nursing through the first year. Obamacare should help that rate finally improve.
Despite these amazing benefits and more, the health reform law is under siege. It risks being overturned by the Supreme Court or repealed by conservative politicians. This Mother’s Day, let’s give moms a gift that is truly important and will really last. Let’s do everything we can to make sure Obamacare is fully implemented and remains the law of the land.
By: Jessica Arons, Center For American Progress, May 11, 2012
“Clouded By Misperceptions”: Five Myths About The Health-Care Law
The Supreme Court will hear three days of arguments starting Monday on whether President Obama’s Affordable Care Act is constitutional. Twenty-six states have filed challenges to the health-care reform law. The main issue, on which the lower courts have split, is whether Congress had the power to pass this law under the Constitution’s commerce clause. The answers to that and other questions are clouded by misperceptions about the law itself. Let’s debunk them.
1. The “individual mandate” forces everyone to buy health insurance.
The law states that, beginning in 2014, individuals must ensure that they and their dependents are covered by health insurance. Taxpayers who do not meet this requirement will have to pay a penalty that the law calls a “shared responsibility payment.” It begins at $95 for the first year and never exceeds 21/2 percent of anyone’s annual taxable income.
A large majority of Americans, of course, have health insurance through their employers, Medicare or Medicaid and are already in compliance with this requirement. Given the relatively modest payment required of those who choose not to maintain insurance, no one is being forced to buy a product they don’t want.
The challengers argue that the mandate is a binding requirement that makes anyone who goes without insurance a lawbreaker. The government has determined, however, that those who pay the penalty, like those who are exempt from the penalty, are not lawbreakers. As a practical matter, the so-called mandate is just a relatively modest financial incentive to have health insurance.
2. Only the individual mandate is at stake in the Supreme Court case.
The mandate is not a stand-alone provision that can be invalidated without affecting the rest of the law. In fact, it is merely an ancillary measure that makes two more-fundamental provisions of the law workable: “guaranteed issue” and “community rating.”
A significant problem with our nation’s health-care system has been that insurance companies can reject applicants who have had health problems, including minor ones. The guaranteed issue provision prevents companies from turning down applicants because of their medical conditions or history. The community rating measure bars insurers from charging higher premiums to those who have had illnesses or accidents.
Experience in the states has shown that if people can’t be turned down for health insurance, there must be an incentive for them to sign up for it before they have an accident or illness. The individual mandate was enacted to ensure that the central, nondiscrimination provisions can work as they were intended — to provide everyone access to affordable health care, regardless of their medical history or current conditions.
If the court were to strike down the mandate, the law’s popular provisions on preexisting conditions would fall as well.
3. If the court upholds the health-care law, it means Congress has the power to require Americans to purchase any product.
The health-care case is a test of Congress’s power under the Constitution to regulate commerce among the states. One way to defend the law is simply to say that a requirement to purchase insurance or any other product sold in interstate commerce is obviously a regulation of that commerce. President Ronald Reagan’s solicitor general, Charles Fried, and conservative judge Laurence Silberman have adopted this view.
The Obama administration is not relying upon such a sweeping argument, however, and its more limited claim would not justify any law that required Americans to buy products such as cars or broccoli.
The mandate does not force people into commerce who would otherwise remain outside it. Instead, it regulates the consumption of health care, an activity in which virtually everyone will engage. Right now, people who go without insurance often shift the costs of their health care to other patients and taxpayers. That situation is different from what happens with any other type of purchase.
Would the government’s defense of the mandate also support a law requiring Americans to buy broccoli or a car? The answer is a simple and emphatic no.
4. The law is socialist.
Actually, the opposite is true. The principal reason the Affordable Care Act has been called unprecedented is that it declines to follow the New Deal approach of having a monolithic government agency be the single provider of a good or service. Instead, the law adopts a new approach, one conservatives have long supported, of using providers in the private market to deal with social and economic problems.
In defending his “Massachusetts mandate” as a conservative model for national health-care legislation, former governor Mitt Romney editorialized in 2009 that by imposing tax penalties on people who choose to remain uninsured, an individual mandate “encourages ‘free riders’ to take responsibilities for themselves rather than pass their medical costs on to others.” And, as Romney noted, conservatives have never been inclined to favor freeloaders.
5. The law is an extraordinary intrusion into liberty.
Liberty is always said to be fatally eroded, it seems, when great advances in social legislation take place. The lawyers who urged the Supreme Court to strike down the Social Security Act of 1935 argued that if Congress could provide a retirement system for everyone 65 and older, it would have the power to set the retirement age at 30 and force the very young to support everyone else.
It was said that if Congress had the authority to create a minimum wage of $5 an hour, it would also be a regulation of commerce to set the minimum at $5,000 an hour. In 1964, critics argued that if Congress could tell restaurant owners not to discriminate on the basis of race, it could tell them what color tablecloths to use. None of these things happened.
Nothing in the health-care law tells doctors what they must say to patients or how those patients are to be treated. It only requires people to either have insurance coverage or pay a modest tax penalty.
Nearly 75 years ago, a Supreme Court dominated by appointees of conservative presidents rejected the challenge to the constitutionality of the Social Security Act. The words of Justice Benjamin Cardozo’s 1937 opinion are relevant today:
“Whether wisdom or unwisdom resides in [the statute in question] it is not for us to say. The answer to such inquiries must come from Congress, not the courts.”
By: Walter Dellinger, The Washington Post, March 23, 2012
“Mitt’s Legacy”: Health Reform Worked In Massachusetts
On February 8 the Center for American Progress hosted an event featuring Massachusetts Attorney General Martha Coakley, where she discussed the success of the Massachusetts health care reform law signed by former Gov. Mitt Romney (R) in 2006.
Attorney General Coakley discussed the framework of the law and explained how it’s played an essential role in providing unparalleled access to health care coverage for Massachusetts residents. She and CAP President Neera Tanden also discussed why the Affordable Care Act’s adoption of the Massachusetts framework fits comfortably within the United States’ constitutional authority.
In her introductory remarks, Tanden said that “the Massachusetts law, though sometimes maligned in our national debates, is actually an incredible success story, and has really demonstrated to the country how effective health care reform can be, and the Affordable Care Act can be.”
She mentioned the new CAP report “The Case for the Individual Mandate in Health Care Reform,” and said that Massachusetts’s embracing of the individual mandate in addition to its nondiscrimination over preexisting conditions has allowed its health care reform to flourish.
Flourish so much, Tanden said, that “98.1 percent of the state’s residents were insured at the end of 2010, compared to 87.5 in 2006, when the health care law started. Almost every child in the state is insured, and premiums in the individual market dropped 40 percent as the Massachusetts law was fully implemented.”
In her speech, Attorney General Coakley described the Massachusetts health care law, saying that “in some, but not all particulars, the Massachusetts Act of 2006 was really the prototype for what has become the Federal Patient Protection and Affordable Care Act.” Like the Affordable Care Act, Massachusetts’ reform includes a state-operated health insurance exchange, subsidies for low- and moderate-income individuals, and a mandate that all individuals who can afford health insurance purchase coverage, or an individual mandate.
Coakley said, “The law has resulted in the highest health care access rates in the nation, it has improved both access to and affordability of health care for hundreds of thousands of residents, while maintaining a high level of quality, and I think that’s important.
“We don’t talk about quality so much, but it’s part of what we are concerned about. Access, cost, quality: Ensuring two is relatively easy, if you want to do all three, not so much. And this has been, and is still, our challenge and our goal, and as a work in progress, I think the facts demonstrate that rather than our experiment proving a risk to the rest of the country, Massachusetts as a test laboratory has a lot to offer.”
She said, “We’ve seen significant improvements in the care of our residents. From 2006 to 2010, adults from all income groups, but in particular lower-income adults, experienced a significant decline in reported unmet health care needs due to cost. … we also have seen significant overall economic benefits for our state as a result of this.”
In terms of costs, she said, “[w]e’ve seen a sharp decline in the amount of spending on the so-called ‘free care,’ [when an uninsured person visits an ER, for example, and costs get passed on to the insured in higher rates] about $300 million, and that’s 33 percent less than we spent in 2006.” And nongroup or individual insurance premiums cost 40 percent less.
Attorney General Coakley also discussed why she believes the Supreme Court will not overturn the individual mandate. Massachusetts, she said, is giving a very positive endorsement for the mandate, and it is “a constitutional act by Congress.” It would be quite surprising if the Supreme Court overturned “the 70 years of precedent that have been set” by case law establishing what Congress has constitutional authority to regulate, including commerce such as health care.
After her speech, Attorney General Coakley spoke with Tanden about health reform. In response to an audience question about the constitutionality of the mandate, Tanden said that “when you say that people have coverage when they go to the emergency room, that immediately means that they’ll be cost-shifting, and the individual mandate is just a way in which people have the same responsibility for their own health care so they’re not shifting costs anymore.”
As Attorney General Coakley asserted, Massachusetts is an essential—and the only U.S. example—of the importance of the individual mandate in ensuring affordable access to health care for all.
By: Center for American Progress, February 27, 2012
Rick Santorum’s Cynicism: A Fine Day To Discuss The Value Of The Affordable Care Act
This morning brings some sad news, that Rick Santorum’s daughter, Bella, has been hospitalized in Philadelphia. The child has Trisomy 18, a particularly heartbreaking genetic condition.
I do not share the opinion that it is distasteful to discuss the political issues surrounding a tragedy, that there should be some kind of grace period. If you want to argue for or against gun control in the wake of a school shooting, have at it. Why should the very day an issue gets maximum media saturation be the one day we can’t discuss its political contours?
Point being, I think it’s okay to point out that under the Affordable Care Act, insurers can’t deny coverage to children with a preexisting condition or disability.
[T]he law actually prevents insurance carriers from denying coverage to individuals with pre-existing conditions (and disabilities), prohibits health plans from putting a lifetime dollar limit on benefits and offers new options for long-term care. This is why groups like the American Association of People with Disabilities, National Organization For Rare Disorders, and The Arc of the United States not only support the law, but have filed an amicus brief in its defense.
And it’s equally okay to remind voters that Santorum, in an act of startling cynicism, continues to equate the ACA with socialism, even suggesting that it would lead to the death of his daughter. His claim that he’s “fighting for Bella and other children like her” — and, by extension, proponents of the ACA are not — is spurious.
By all accounts, Santorum’s daughter has beaten the odds. She’s gotten marvelous healthcare. I have yet to encounter a decent justification from either Santorum or his fellow candidates for denying the nation’s children the same opportunity.
By: Elon Green, Washington Monthly Political Animal, January 29, 2012
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
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