Tuesday, August 27, 2013
Posted in
Health
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Politics
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I've always hated the term "ObamaCare" since it is an attempt to denigrate the new health-care law by suggesting that it is something the President foisted on us. It isn't, of course. The country has 50,000,000+ uninsured citizens, uninsured because they can't afford coverage or they have pre-existing conditions. Millions more are under-insured, having insurance policies with huge deductibles, low payout limits, or other restrictions that make the policies largely useless. Before ObamaCare was enacted, opinion polls showed that the nation wanted a health-care law. After all, almost every industrialized country but ours has one (Canada's plan is great, despite what those 1990s commercials said).
Before I continue, let me give you the real name of ObamaCare: The Patient Protection and Affordable Care Act, or "ACA" for short.
When Obama pushed for a health-care law early in his first term, he left it up to Congress (which was Democratic at the time) to decide what would be in the law. There were basically two options: a single-payer system similar to Medicare (the most economical plan), or a plan with an insurance mandate, requiring citizens to buy insurance (the less economical plan because insurance companies keep part of the insurance premiums as profits, which Medicare doesn't). The concept of forcing citizens to buy insurance was dreamed up by the Heritage Foundation, a conservative Republican organization. The Democrats in Congress decided to go with an insurance mandate because they thought that some Republicans in Congress might support it. What they didn't count on was the total resistance to Obama that Republicans would display, due in part to his being a Democrat but also due to his race.
Because of this total dislike of Obama, the Republicans have resisted the ACA from the beginning, even though it is basically a Republican plan. At the time of this post, the resistance to Obama and the ACA is so intense that the Republicans are contemplating shutting down the government instead of legislating the funds to support it (actually, most of the funds for the ACA have already been legislated). Republicans in conservative states are also refusing to implement their parts of the plans, which include an expansion of Medicaid (for the poor) and insurance exchanges (where the middle-class can find affordable insurance).
The refusal to expand Medicaid in conservative "red" states will leave the poorest of the poor without health coverage, so much so, in fact, that one has to wonder: Why do Republicans hate the poor? Here in Rhode Island, where Medicaid is being expanded, I'll be getting my health-care for free because my income is under 138% of the povery line. In red states where Medicaid is not being expanded, poor people will have to buy insurance (although much of their premiums will be refunded by the federal government). Even so, buying insurance will be outside the ability of many poor people, since they will have to pay for it upfront and won't receive refunds until the following year (when they file their taxes). As a poor person, I certainly don't have the money to lay out $9,000 in any given year, which I would then have to wait for the government to refund in the middle of the following year.
As for my contention that Republicans hate the poor, that becomes more plausible when you look at what is happening in the red states. Some of them have raised taxes on the poor (!) while they lowered taxes on the rich, and some of them have scaled back Unemployment Insurance benefits. Many have also scaled back various other state benefits provided to the poor.
As I said above, there are only two basic types of health-care systems: A single-payer system in which the government pays for all medical services using payroll taxes (the liberal option), or one in which the law mandates that citizens buy insurance (the conservative option). Those are the choices. Since the Democrats chose the conservative option, the Republicans essentially have nothing else to offer but band-aid fixes, e.g., allowing insurance companies to sell insurance across state lines. The recent battle cry of the Republicans has been "Repeal and Replace", but really all they can do is "Repeal" -- and that would leave us where we started, with 50,000,000 people uninsured.
The Republicans, however, have been very good at turning the public against the ACA -- at least, until people learn about all its good points. I myself don't like the idea of an insurance mandate. However, the law provides for people who can't afford it. When I first heard of the insurance mandate, I thought, how can I pay hundreds of dollars a month for insurance? But the law provides for that: single people who make less than about $46,000 will have some of their insurance premiums refunded by the government -- and that's a pretty good income for a single person! For a family of four, the cut-off is around $95,000. That means that if you have a family of four and have no insurance from your job, the federal government will refund part of your insurance premiums if you earn even $1,000 less than that. Does that sound so bad? (Of course, the closer you make to that amount, the less they will refund. A family of four making $50,000 will get more of a refund than a family making $90,000 -- but that's reasonable.)
There are other many good things about the Affordable Care Act. Here's a short list:
* A great deal of preventive medicine is paid for entirely, with no co-pays.
* Birth control is paid for entirely, with no co-pays.
* Children up to 26 years old can stay on their parents' insurance plan.
* You cannot be denied insurance because of pre-existing conditions.
* Insurance rates will go up only if the cost of medical care goes up; this is because insurance companies cannot spend less than 80% of the premiums they collect on actual health care. In contrast, Medicare spends only 5% of premiums on administrative costs. Hopefully, Congress will eventually force insurance companies to pay out more than 80% of their premiums.
* Insurance companies cannot cancel your policy for frivolous reasons -- fore example, for making a mistake on your application (but they can cancel your policy for lying on your application about your health).
* There are no coverage limits. Your insurance payments cannot be cut off at $25,000 or $50,000 or $100,000, etc.
* People who earn less than 138% of the poverty level essentially get their health-care free (but not in the red states that have not expanded Medicaid).
* People who earn less than 400% of the poverty level will have some or most of their insurance premiums refunded by the government.
Improvements are definitely needed to the ACA. Allowing insurance companies to keep so much profit is not good. Also, Congress needs to give the government the power to directly control health-care costs. For example, I recently read that one medical-devices manufacturer is charging $9,000 for a hip-replacement device that costs $350 to manufacture. There are also drug companies that charge dollars for each dose of medication, though the medication may cost only pennies to manufacture. Those abuses need to stop. However, Republicans are currently refusing to pass any laws to fix some of the problems in the ACA. They are hoping that the ACA will fail if it doesn't function well. Personally, I think that's a cynical and irresponsible way to govern.
Before I continue, let me give you the real name of ObamaCare: The Patient Protection and Affordable Care Act, or "ACA" for short.
When Obama pushed for a health-care law early in his first term, he left it up to Congress (which was Democratic at the time) to decide what would be in the law. There were basically two options: a single-payer system similar to Medicare (the most economical plan), or a plan with an insurance mandate, requiring citizens to buy insurance (the less economical plan because insurance companies keep part of the insurance premiums as profits, which Medicare doesn't). The concept of forcing citizens to buy insurance was dreamed up by the Heritage Foundation, a conservative Republican organization. The Democrats in Congress decided to go with an insurance mandate because they thought that some Republicans in Congress might support it. What they didn't count on was the total resistance to Obama that Republicans would display, due in part to his being a Democrat but also due to his race.
Because of this total dislike of Obama, the Republicans have resisted the ACA from the beginning, even though it is basically a Republican plan. At the time of this post, the resistance to Obama and the ACA is so intense that the Republicans are contemplating shutting down the government instead of legislating the funds to support it (actually, most of the funds for the ACA have already been legislated). Republicans in conservative states are also refusing to implement their parts of the plans, which include an expansion of Medicaid (for the poor) and insurance exchanges (where the middle-class can find affordable insurance).
The refusal to expand Medicaid in conservative "red" states will leave the poorest of the poor without health coverage, so much so, in fact, that one has to wonder: Why do Republicans hate the poor? Here in Rhode Island, where Medicaid is being expanded, I'll be getting my health-care for free because my income is under 138% of the povery line. In red states where Medicaid is not being expanded, poor people will have to buy insurance (although much of their premiums will be refunded by the federal government). Even so, buying insurance will be outside the ability of many poor people, since they will have to pay for it upfront and won't receive refunds until the following year (when they file their taxes). As a poor person, I certainly don't have the money to lay out $9,000 in any given year, which I would then have to wait for the government to refund in the middle of the following year.
As for my contention that Republicans hate the poor, that becomes more plausible when you look at what is happening in the red states. Some of them have raised taxes on the poor (!) while they lowered taxes on the rich, and some of them have scaled back Unemployment Insurance benefits. Many have also scaled back various other state benefits provided to the poor.
As I said above, there are only two basic types of health-care systems: A single-payer system in which the government pays for all medical services using payroll taxes (the liberal option), or one in which the law mandates that citizens buy insurance (the conservative option). Those are the choices. Since the Democrats chose the conservative option, the Republicans essentially have nothing else to offer but band-aid fixes, e.g., allowing insurance companies to sell insurance across state lines. The recent battle cry of the Republicans has been "Repeal and Replace", but really all they can do is "Repeal" -- and that would leave us where we started, with 50,000,000 people uninsured.
The Republicans, however, have been very good at turning the public against the ACA -- at least, until people learn about all its good points. I myself don't like the idea of an insurance mandate. However, the law provides for people who can't afford it. When I first heard of the insurance mandate, I thought, how can I pay hundreds of dollars a month for insurance? But the law provides for that: single people who make less than about $46,000 will have some of their insurance premiums refunded by the government -- and that's a pretty good income for a single person! For a family of four, the cut-off is around $95,000. That means that if you have a family of four and have no insurance from your job, the federal government will refund part of your insurance premiums if you earn even $1,000 less than that. Does that sound so bad? (Of course, the closer you make to that amount, the less they will refund. A family of four making $50,000 will get more of a refund than a family making $90,000 -- but that's reasonable.)
There are other many good things about the Affordable Care Act. Here's a short list:
* A great deal of preventive medicine is paid for entirely, with no co-pays.
* Birth control is paid for entirely, with no co-pays.
* Children up to 26 years old can stay on their parents' insurance plan.
* You cannot be denied insurance because of pre-existing conditions.
* Insurance rates will go up only if the cost of medical care goes up; this is because insurance companies cannot spend less than 80% of the premiums they collect on actual health care. In contrast, Medicare spends only 5% of premiums on administrative costs. Hopefully, Congress will eventually force insurance companies to pay out more than 80% of their premiums.
* Insurance companies cannot cancel your policy for frivolous reasons -- fore example, for making a mistake on your application (but they can cancel your policy for lying on your application about your health).
* There are no coverage limits. Your insurance payments cannot be cut off at $25,000 or $50,000 or $100,000, etc.
* People who earn less than 138% of the poverty level essentially get their health-care free (but not in the red states that have not expanded Medicaid).
* People who earn less than 400% of the poverty level will have some or most of their insurance premiums refunded by the government.
Improvements are definitely needed to the ACA. Allowing insurance companies to keep so much profit is not good. Also, Congress needs to give the government the power to directly control health-care costs. For example, I recently read that one medical-devices manufacturer is charging $9,000 for a hip-replacement device that costs $350 to manufacture. There are also drug companies that charge dollars for each dose of medication, though the medication may cost only pennies to manufacture. Those abuses need to stop. However, Republicans are currently refusing to pass any laws to fix some of the problems in the ACA. They are hoping that the ACA will fail if it doesn't function well. Personally, I think that's a cynical and irresponsible way to govern.
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