Health care. Is it a basic human right or a for profit industry? What is ObamaCare? What is Medicaid? How have things changed since the start of the coronavirus pandemic?
Affordable Care Act (Obamacare)
The Patient Protection and Affordable Care Act (PPACA) more commonly called the Affordable Care Act (ACA) or Obamacare was the most significant overhaul of the U.S. healthcare system since the introduction of Medicaid & Medicare in 1965. It was signed into law by Barack Obama on March 23, 2010. It was a major part of Obama’s candidacy platform for presidency. It was intended to increase the quality and affordability of health care insurance and to lower the uninsured number.
Here were some of the more significant changes introduced by the law:
Protections for policyholders:
- Insurers could no longer deny coverage to patients due to pre-existing conditions.
- Insurers could no longer impose lifetime dollar amounts on essential benefits, such as hospital stays.
- Insurers could no longer drop policyholders when they get sick.
- It established minimum standards for health care policies.
- Plans had to cover preventative care and medical screenings and couldn’t charge co-pays or deductibles for these services.
Expanded protections:
- It expanded Medicaid eligibility.
- It allowed children to stay on their parents insurance until their 26th birthday.
Streamlined Services:
- Introduced health insurance exchanges as an on-line avenue where individuals and small businesses could compare plans before purchasing during open enrollment.
- Reformed and streamlined the payments system through Medicare.
Penalties for Non-Compliance:
- It mandated insurance coverage unless an individual experienced financial hardship or was a member of a protected religious sect. Subsidies were available to help low income individuals.
- It enacted tax penalties for businesses (with 50 or more employees) who didn’t offer coverage for full-time employees but received tax deductions for such a purpose.
- Penalized hospitals with a higher than expected readmission rate due to the costs they incur to Medicare by decreasing their Medicare reimbursement rate.
Why people love it.
Most Americans benefit from the Affordable Care Act. The inability of an insurance company to refuse people with pre-existing conditions has been life changing for many. A member of my own family paid $800 a month due to a pre-existing heart condition because no insurance company would take him except the state. The Affordable Care Act changed that. For those that were sick, Obamacare is a really big deal. For over 100 million people with a pre-existing condition, not enrolled in public programs like Medicaid or Medicare, they no longer had to face higher premiums or significant out of pocket expenses. Insurance companies used to be able to deny coverage or charge more, now they couldn’t. Insurance companies used to be able to put lifetime limits on coverage. Now they couldn’t.
The end to lifetime limits was another big deal. I’ve been moved by numerous stories over the years about people, especially children, who have had to endure horrific illness from cancer to brain tumors and the end to lifetime limits has saved their families from financial ruin.
The requirement of preventive care and minimum requirements drove costs down by preventing people from getting sick down the road when the expense rises.
The uninsured rate went down considerably due to the affordability and accessibility. 20 million more people gained health care coverage because of the Affordable Care Act. Medicaid and CHIP coverage also expanded. Businesses had to offer coverage for their employees. Basically, people got taken care of in ways they didn’t before. More people had health care than ever before.
But, why the mandate?
Granted, all of this additional coverage cost insurance companies a lot more money. The sicker a patient is, the more money this is going to cost insurance companies. This is why insurance companies traditionally denied those with pre-existing conditions or dropped them when they became sick. Enter the mandate. If insurance companies have to cover more, they need more policy holders which is part of why all people, even the traditionally healthy, had to purchase insurance. Otherwise, people would just wait until they got sick to purchase insurance which would truly “break the bank.” The mandate was originally introduced in 1989 by the Heritage Foundation and was championed by conservative economists and Republican senators.
Why people hate it.
For some, it didn’t go far enough to prevent the rise in health care costs which surpassed income growth for years. While ObamaCare had slowed the rise in healthcare costs and premiums weren’t rising at the rate anticipated, they continued to rise and they were expensive! It turns out that quality plans that meet minimum requirements cost more than plans that could drop you when you got sick or kick you out of the hospital.
To pay for the program, it raised taxes on high earners (the 2% making more than $250,000/year) and the healthcare industry. People don’t like the mandate because they don’t like being told what to do, especially the young and healthy who could go without and now had to pay for insurance.
Some called it a job killer because companies would force their employees to part-time to avoid paying health care costs.
Smaller government advocates said it was an overreach of the government into people’s lives.
The biggest myths about ObamaCare:
Myth: ObamaCare was causing premiums to increase.
Fact: Health insurance premiums had been increasing at outrageous rates for years, long before
ObamaCare. ObamaCare did a lot to curb premiums, like using the Health Insurance Marketplace to shop around for insurance. As mentioned earlier, insurance companies raised their rates as a result of offering quality plans that meet minimum requirements.
Myth: ObamaCare killed jobs and increased the deficit.
Facts: The Affordable Care Act actually paid for itself through tax increases on insurance companies and high earners and spending reduction. It led to a deficit reduction. As cited in my post on the economy, the deficit had shrunk every year Obama had been in office. There is no evidence from the Bureau of Labor Statistics that that the law had an impact on part-time workers seeking full-time work.
ObamaCare Today
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| Source: https://www.insurancejournal.com/news/national/2020/01/03/553270.htm |
On Thursday, June 25th, 2020, the Trump administration filed a late-night court filing to the Supreme Court, urging them to overturn the Affordable Care Act. The whole thing: coverage for pre-existing conditions, the prohibition on lifetime limits, the requirement of preventative care, allowing children to stay on their parent’s health insurance until 26, everything. This was the same day that the government had reported that 500,000 who had lost their health coverage due to job loss during the coronavirus had secured it through the Affordable Care Act. 20 million people could lose their health care coverage if the law is overturned. There is currently no replacement plan and a significant replacement has not been proposed in the last 10 years since the bill became law.
Medicaid:
What is Medicaid? Medicaid is the government insurance program for people whose incomes are insufficient to pay for health insurance. ObamaCare expanded Medicaid coverage to families whose incomes were up to 133% of the federal poverty level. This would have covered about 15 million more families. But, 14 states actually rejected that expansion denying access to 4.9 million adults. Over half of the nation’s uninsured population lived in the states that did not adopt Medicaid expansion.
Why did they reject it? The federal government subsidized 100% of of the expansion through 2016, but that subsidy tapered to 90% by 2020. The states that rejected it say that their 10% of their responsibility does not work within their budgets. Studies have shown that rejecting the expansion actually cost states more due to increased spending on uncompensated emergency care that would have otherwise been covered by Medicaid.
Medicaid is the only option for many low-income Americans. And, the truth is many people don’t want to use tax dollars to pay for those who can’t afford insurance. But, the flip side of that is that taxpayers are responsible for tens of millions of dollars in unpaid medical bills for those who can’t afford insurance and turn to emergency rooms for care when they are out of options.
Here are the candidate positions. Click on their name to be taken to their campaign positions related to healthcare on their website.
Joe Biden: Unlike some of the more liberal candidates in the original Democratic pool for president, Biden does not support getting rid of private insurance in favor of starting from scratch with a Medicare for all type plan. Instead he has a plan to build on the current Affordable Care Act. He will
- create a public option like Medicare for those who are unsatisfied with their current insurance.
- increase the value of tax credits in order to lower premiums and extend coverage to more working Americans. He will remove caps in order to make sure that no family has to pay more than 8.5% of their income on health insurance.
- offer a premium free option for the 4.9 million individuals uninsured in states that didn’t expand Medicaid.
- automatically enroll those making below 138% of the poverty line when they interact with certain institutions such as public schools and SNAP.
- bar health care providers from charging patients out-of-network rates (that usually show up as surprise bills) when a patient doesn’t have control over which provider a patient sees, such as during a hospitalization.
- repeal the exception that allows drug companies to avoid negotiating with Medicare.
- impose a tax penalty on drug manufacturers that increase costs over the general inflation rate.
- allow consumers to buy prescription drugs from other countries as long as the U.S. has certified them as safe.
- terminate pharmaceutical corporations’ tax breaks for advertisement spending.
- improve the supply of quality generics.
- reinstate the Obama era policy rolled back by Trump that protected LGBTQ patients from discrimination in healthcare.
- double investment in community health centers.
- expand access to mental health care.
- pay for his plan by getting rid of the capital gains tax loopholes for the super wealthy.
Donald Trump: Again, Trump’s website focuses on his record, not his plans for the future. So, here is what his administration has done.
- Provided more than $1 billion in fiscal year 2017 to be used to improve access to healthcare for 2.5 million in rural communities.
- Expanded access to Associated Health Plans (AHPs) so that small businesses could pool risk across states.
- Repealed the individual mandate in the Affordable Care Act.
- Signed a 6 year extension for CHIP to fund healthcare for 9 million.
- Approved the largest number of generic drugs in history through the FDA causing year-end drug prices to fall for the first time in 50 years in December of 2018.
- His Center for Medicare and Medicaid Services instated a new policy meant to support states in requiring work as a condition for Medicaid eligibility.
- Created a Conscience and Religious Freedom Division within the Department of Health and Human Services dedicated to investigating concerns by health care workers who feel they are being forced to violate their consciences by providing services such as abortion, sterilization, and assisted suicide.
- Rolled out MyHealthEData to increase access to health data by patients.
- Passed Right-to-Try to give critically ill patients access to experimental treatments that have not been approved by the FDA.
- Signed bill to extend Veterans Choice Health Care.
- Launched initiative to end HIV/AIDS by 2030.
- Pushed Congress to end surprise medical billing.
- Finalized rule to expand Health Reimbursement Arrangements (HRAs).
- Launched a program to provide the HIV drug PrEP to uninsured patients for free.
- Signed legislation raising the age to purchase tobacco and vaping products from 18 to 21.
- Announced plan to lower drug prices.
- Rolled back patient protections for LGBTQ people on the anniversary of the Pulse nightclub shooting.
- Asked that the Supreme Court overturn ObamaCare.
