Thursday, November 14, 2013

Healthcare 101

Obamacare i.e. The Affordable Care Act i.e. The ACA

Here are the facts:
  • Almost 50 million Americans are currently uninsured.
  • Starting next year, all Americans will be required to have health insurance. If they are not already covered through a job or government program, they have the option to buy a policy through an insurance marketplace (also known as an exchange).
  •  The marketplace is an online system where people can view, compare, shop, and purchase insurance plans (as if you would shop online on
  • Although each insurance plan listed in the marketplace is offered by private companies, the online marketplace, itself, is run by either your state government or the federal government. Specifically, states can choose to manage the exchanges themselves or hand the task over entirely to the federal government.  
  • As of today, 16 states have opted to run their own marketplace programs, and 27 have handed over the responsibility to the federal government.

Here are 2 most recent, and most publicized, problems:
  • FIRST - Some individuals have had their private insurance plans cancelled as a direct result of the ACA
  • SECOND - Fewer than expected have signed-up online for coverage

The ACA has set new standards for health insurance plans, in the same way that the Department of Transportation has set standards that require every vehicle to have adequate brakes, working tail lights, and functioning seat-belts.

As such, those health insurance companies that do not meet the new standards (and continue to have plans that offer little coverage and impose substantial out-of-pocket costs) are forced to either improve their policies or cancel them all together. However, those Americans who have such plans cancelled are STILL able to enroll themselves in the online marketplace and shop for better, cheaper, and more adequate plans.

In short, the law is forcing the health-insurance industry to improve, in the same way that laws and federal regulations have forced the automotive industry to improve.

Additionally, the law has made significant changes that would also not have been possible without its existence:
  • Your insurance company can no longer drop your coverage if you become sick
  • Your insurance company can no longer limit the coverage you receive over your lifetime
  • Your insurance company can no longer deny coverage if you have a pre-existing condition
  • Your insurance company is now required to spend at least 80% of your premium payments on medical care, instead of on administrative costs such as advertising and executive salaries.
  • By 2014, everyone will be required to have health insurance. This means that more people will have access to preventive care, instead of waiting until they have to go to the emergency room. With the average emergency room visit costing hospitals $1,000, these costs will no longer be transferred to taxpayers.
  • According to the American Journal of Medicine, medical debt due to lack or loss of health insurance accounts for almost 60% of all bankruptcies. With the ACA, gaps in coverage are either reduced or improved, ensuring access to affordable and quality healthcare for every American.

Americans want affordable and quality healthcare. It is a demand that, until recently, had very insufficient supply. However, without the proper knowledge and access to enrollment, people will continue to face obstacles with the marketplace exchanges.

Yes, the federal marketplace website needs to be repaired quickly. But the major problem with the enrollment process goes far beyond a simple website. It stems from the fact that Republican leaders are refusing to cooperate or assist in the process.

The Affordable Care Act is a very bipartisan law.
  • Major provisions of Obamacare have been closely modeled after Republican ideas - a private-sector, free-market system.
  •  It is not a government-run, single-payer system, but one that creates competition in the health insurance market. It gives the uninsured, under-insured, and insured the choice of choosing multiple insurance companies, who will now compete for these people’s business. 
  • It also gives states the full opportunity to run each marketplace exchange themselves, removing the federal government from the enrollment process.
Ironically, 22 of the 27 states opting for federally-managed exchanges are run by Republican governors. More problematic, however, is that these leaders have become obstructionists. They have only attempted to repeal and defund the ACA; tried to invalidate the law by going to the Supreme Court; refused to set up their own state-based exchanges; encouraged residents not to enroll; and have misled consumers about the benefits of the law.

In states that have accepted the law for what it is and have worked with its requirements (like California and Kentucky), the enrollment process has been fairly optimistic. However, with most of the uninsured living in Republican states, the only way to ensure the program works as it was intended is to truly put politics aside and work together.