The Truth about Obamacare

The Truth about Obamacare.

Well, I can see it’s going to be a bad six weeks. I just heard a paid TV advertisement for people to call their Congressman and urge him to oppose funding Obamacare, because the President is exempt. I expect to see a lot more of these misleading ads, and if past is any indication there won’t be much response from Democrats. They are not nearly as loud and insistent as Republicans and I’ve never understood why.

Is the President exempt? I guess so, depending on how you define exempt. Anybody who already has medical insurance is exempt. I’m with Aetna, so I’m exempt. If you are over 65 and are on Medicare, you are exempt. If you are in the military, you are exempt. If you are a veteran with VA coverage, you’re exempt. If you are a member of a Native American tribe, you are exempt.

The President, Vice President, Cabinet Secretaries and all Executive branch employees are covered by the Federal Employees Health Benefits Program. They can stay on that plan, just like anyone can who is already covered. 

Interestingly, Congress and their staff will have to leave the FEHBP and sign up for coverage under the Affordable Care Act. That amendment was added to the bill by Sen. Chuck Grassley, Republican from Iowa, probably as a “poison pill” amendment to make it harder for some members to vote for it. (That’s just my opinion, by the way.) Congress swallowed the pill. Some of the vehement opposition from Congress now is because they will lose their present top of the line coverage and be covered by the lower quality “MedicAid Plus” plan of the Obamacare exchanges 

However, some changes will affect everybody. If your medical insurance had a lifetime limit, it’s gone. If your plan had an exclusion for pre-existing conditions, that’s gone. If you have a child under 26 they can stay on your plan. Plus, all plans now must include preventive screenings, such as mammograms, and routine medical checkups at least once a year.

Obamacare, or the Affordable Care Act, is for people who don’t have or cannot afford medical insurance. Up until now, when an uninsured person got sick, their only option in most areas of the country was to go to the emergency room, where the hospital was required to treat them. That is a very expensive way to provide medical care. Many hospitals were going under because conditions that would have been easy and cheap to treat or prevent early became expensive later on, and hospitals, even with help from the taxpayers, couldn’t make ends meet.

Healthcare costs in the USA were double the costs in every other country, and some method had to be found to cut the cost of heath care, as well as provide coverage to those who had no insurance coverage. The cost of medical insurance was skyrocketing, and we were reaching the point where almost nobody would have been able to afford coverage. 

So the object of a national health care plan was threefold:

1. To cut the cost of health care by providing more competition between insurance providers.
2. To cut the cost of health care by encouraging more preventive care, and enabling visits to the doctor rather than the hospital emergency room.
3. To increase the number of people covered by insurance to include as many as possible, especially young families and children.

Several different options were available to achieve these goals. The first would have been Socialized Medicine. This was never even considered by the administration. Under socialized health care, the government would take over all hospitals and clinics. All doctors and nurses would get a salary from the government. There would be no charge for the patients. No one would be allowed to make a profit from anybody’s pain or injury. I had this coverage in the US Army when I was on active duty back in 1965. All the military and VA hospital coverage was socialized then. As I understand it now, any active duty service member on Tri-Care Prime and getting health care at a Military Treatment Facility is still receiving socialized medicine. Anyone who contends that Obamacare is socialism is displaying his ignorance or his duplicity.

Another option would have been a Single Payer plan. The hospitals remain private, for profit  institutions and the doctors are independent, for profit providers. But all insurance would be handled by the government on a non profit basis. Medicare is such a plan. Premium payments come out of payroll taxes, and the patient chooses among doctors and hospitals who accept the insurance coverage. President Obama never even brought it to the table, probably because he saw the insurance company lobbyists loading for bear. Some Liberals and Progressives felt betrayed, because Barack Obama spoke of this as he campaigned for the presidency.

A third plan was called the Public Option. This would involve for profit hospitals, doctors, and insurance companies, but would include a federal government run non profit insurance option competing with the insurance companies to force their premiums lower. Bill Clinton proposed a similar plan in 1993, but due to a concerted effort by insurance companies and conservative organizations, he and Hillary could not get it through Congress. This idea didn’t last very long during the negotiations for the Affordable Care Act, either.

So the Affordable Care Act became a collage of compromises to get all the health care actors on board so they would call off their lobbyists. Insurance companies don’t have to compete with a federal insurance plan, because Obamacare agreed to just subsidize the states to increase their state run Medicaid programs with expanded coverage for poor people. 

Insurance companies agreed to provide coverage nationwide instead of statewide as long as the law made coverage mandatory, so they get more customers. Most states will get more companies competing for their business, so prices should come down. 

Big Pharmaceutical companies agreed to go along if the law prohibited the government from negotiating for lower drug prices. So we still have to go to Canada or Mexico if we want drugs for 1/10th the cost. But the gap in Medicare Part D coverage for drugs (The Donut Hole) will be reduced each year until it disappears in 2020.

Doctors got changes to their billing practices, including being paid by the patient rather than the procedure. That’s supposed to reduce the number of unnecessary and redundant procedures and save costs. Eventually they are supposed to go to standardized medical records on computer, for easier access, reduction of errors and lower costs.

Since Obamacare is expected to greatly increase the number of people receiving health care, hospitals immediately got money to expand and renovate. If your local hospital has a new wing or even a new facility in the last few years, it’s probably funded by Obamacare.

By co-opting every group who had opposed universal health care in the past, Democrats were barely able to get the bill passed by one vote. By not having all the changes happen in the first year, they gave themselves time to get it implemented. And as snags have come up they have made revisions and postponed some of the deadlines.

This is a big and complicated bill, to deal with a big and complicated problem. The writers knew it would not be perfect, and so there is flexibility written into it to allow for fixing problems as they arise. 

Here in Nevada, the health care exchange goes by the name of Nevada Health Link. There are actually two exchanges in Nevada, one for Individuals and one for Employers. The one for employers is called the Small business Health Options Program, or SHOP. (Don’t you just love acronyms?) The Exchange Board set up by Governor Sandoval adopted a ”Free Market Facilitator” model to ensure “the maximum participation by insurers and the widest choice for consumers.” No mistaking this for Socialism. 

The Nevada Exchange Board has signed a Tribal consultation agreement with the Indian Health Board of Nevada to include a zero cost sharing plan for Native Americans from every insurance carrier in the exchange.

Each carrier must offer one Gold level Qualified Health Plan and one Silver level QHP in either or both the Individual and SHOP exchanges, up to a maximum of five plans in each. They also must offer the afore mentioned Native American plan, as well as coverage for child only plans at coverage levels comparable to other plans in the exchange. Catastrophic plans may be offered only to individuals under thirty or individuals with a hardship exemption in the Individual Exchange only 

Already some people are noticing the elimination of their lifetime limits and their pre-existing condition clauses going away. Some have been able to keep their kids on the policy longer, which is a lot cheaper than having to buy a second policy. Some people have gotten rebate checks back. because insurance companies are now required to give money back if 80% of the premiums are not spent on health care, but on overhead or salaries.

As more and more people start to experience the benefits of having affordable health care, they may begin to understand and appreciate what they have received. For the first time they do not have to live in fear and dread of a medical condition devastating their lifetime savings.

Republicans know this and some have said as much. They are desperate to find some way--any way--to stop the Affordable Care Act from being fully funded and implemented. They fear that voters will remember who helped them when they needed help, much as people remembered for two generations which party got them Social Security, and which party fought it tooth and nail.

Some states with Republican governors and legislatures have decided to refuse the federal funds intended to set up the insurance exchanges and expand their Medicaid coverage, hoping to somehow stymie Obamacare. It will be interesting to see when they figure out that they are handing control over to the federal government to set up the exchanges and provide low cost federal insurance instead of locally controlled Medicaid programs. They are enabling the public option some of us preferred in the first place.

After decades of people losing their savings and their houses, being forced into bankruptcy when struck by cancer or some other medical disaster, finally we are catching up to the rest of the civilized world!

And today I just heard a TV ad for Obamacare with a number to call for information and application forms! Maybe they are going to start selling this thing after all! 

Don Rogers

August 18, 2013