For all that has been written, spoken, screamed, and whispered about the Affordable Care Act, there is still a lot of confusion and lack of knowledge among the public. No wonder, I suppose. Republicans continue to attack it as if it were a scourge from hell. Democrats are desperate to tout it. Meanwhile, it keeps changing, as portions are altered, fixed, or dropped. Maybe it’s a good moment to take stock. For starters, after all those changes, what is Obamacare, exactly? What is out, what is on hold, and what is still standing in this large and controversial law? And what have been Obamacare’s plusses and minuses so far? Here’s the first of a two-part scorecard.
WHAT’S STILL STANDING?
The individual mandate.
This is the heart of the law—the requirement that everyone carry insurance or face penalties, and it is still scheduled to take effect January 1, with enrollment in the state health exchanges beginning October 1. Most Americans—about 160 million of them—are insured through their workplace, but some 50 million have no insurance at all. Many of those who have no coverage now will be able to shop in the state exchanges set up by the ACA and, depending on their income, receive a subsidy to help pay the premiums. Those with incomes up to 150 percent of the poverty level ($17,235 for individuals and $35,325 for a family of four) will get further help by having their out-of-pocket costs cut by as much as two-thirds. And if people have pre-existing conditions, they won’t be turned down for coverage.
An important wrinkle: Workers with employer coverage who pay more than 9.5 percent of their income for that insurance can shop in the exchange and receive subsidies for themselves or their families. But because of the way the Treasury Department has interpreted this provision, if the worker’s contribution to an individual policy is less than 9.5 percent of income but the contribution to a family policy is more than that, family members are out of luck when it comes to getting subsidies.
Medicaid expansion.
One of the pillars of reform, Medicaid expansion, is sort of in and sort of out, thanks to the Supreme Court and several reluctant GOP-led states. Obamacare was supposed to bring coverage to some 15 million people through the expansion by raising the eligibility limit to 138 percent of the federal poverty level—or to about $32,500 for a family of four and $15,000 for a single person. The Supreme Court ruled that states had the option of dropping out of his expansion, however. By early July 19 states said they would not expand their Medicaid programs, 23 plus the District of Columbia said yes they would, while five were undecided and three were considering another kind of expansion. As a result, people with incomes below the poverty line—the poorest of the poor—are stuck if they live in states that have chosen not to expand. These people have almost no coverage options. They have little money to buy insurance on their own, and because of the way the law was written, they are barred from shopping in the exchanges and receiving subsidies.
Hospital penalties and bonuses.
These carrots and sticks aimed at encouraging better care remain in effect—despite grumbles and complaints from hospital officials. Medicare now penalizes hospitals for readmitting too many patients, though there have been fits and starts implementing the program. Medicare made some mistakes in calculating penalties and had to reduce them a bit, but so far has penalized about 2,200 hospitals. Hospitals also get bonuses or penalties if they meet or don’t meet certain targets that measure quality of care. One example of good care: giving beta blockers to patients who’ve had heart surgery. Hospitals scoring the highest were not necessarily the ones with brand name reputations.
WHAT’S OUT?
Setting aside the fact that this article has nothing to do with journalism, it's amusing that Lieberman simply passes along the administration's press-release terminology about "system limitations" and "operational barriers" without even attempting to explain what's really happening. This just emphasizes that the goal here is to publicize the administration's spin on events, and not to look behind it.
#1 Posted by Tom T., CJR on Tue 30 Jul 2013 at 07:12 AM
All of the confusion could be avoided with a Medicare-for-All plan, 100% funded by the federal government.
And for all those who believe our Monetarily Sovereign government "can't afford" to fund Medicare for every man, woman and child in American, look up the meaning of Monetary Sovereignty at http://mythfighter.com/2013/07/27/i-just-thought-you-should-know-lunch-really-can-be-free/
#2 Posted by Rodger Malcolm Mitchell, CJR on Tue 30 Jul 2013 at 09:38 AM
The Republican v. Democrat angle is a diversion. Both parties and the entire corporate elite support the austerity Obamacare will usher in (not to mention more corporate welfare).
One concrete example of the sleight of hand: how many media sources reported spouses can now be dropped by employers under Obamacare? Very few. This change in the law will be of huge importance to families, especially during the next downturn when employers use the "exchanges," er "marketplace" (or whatever PR tested word they go with), as an excuse to drop spouses.
Dropping spouses will have a much larger effect on households than allowing a 21 year old to stay on his parents' policy, which is one of the "good" changes in Obamacare (i.e. 21 year olds will not use or need health care coverage like a 55 year old spouse will).
And of course the media plays up the R v. D angle re spousal coverage by pushing the lie that the Democrats overlooked the change when they passed Obamacare and now they really, really, (really!) want to change the law but the meany Republicans won't allow them to.
The media gets an F for complicity in my book. This austerity and corporate welfare is being foisted upon us by a corrupt political process and media.
#3 Posted by Walter W., CJR on Tue 30 Jul 2013 at 02:42 PM
As to subsidies for out-of-pocket costs, be sure to read the fine print. It is my understanding that the subsidy will be available to holders of silver plans--not the cheaper bronze plans.
Oh--for single payer Medicare for all. Everybody In--nobody out--no meed to read the fine print.
Today 7/30 in DC, Physicians for a National Health Program (pnhp.org), Public Citizen, Rep. John Conyers and Sen Bernie Sanders will discuss single-payer and how it could be funded.
#4 Posted by Harriette Seiler, CJR on Tue 30 Jul 2013 at 03:01 PM
"For starters, after all those changes, what is Obamacare, exactly?"
Unfortunately, I don't think this article answers the question.
Here's my attempt (sorry for the length but I'm trying to be concise while describing the change in law and it is a complicated subject):
Obamacare is a bipartisan neoliberal approach that putatively provides near-universal health insurance coverage to citizens. The individual mandate requires citizens to purchase a bare minimum insurance policy from an industry that still enjoys exemption from anti-trust laws and is largely exempt from other consumer protection laws (like bad faith torts per ERISA). Citizens that do not purchase insurance will be fined by the government and millions will still go without insurance under this near "universal" system. Employers will have to pay a small fine for not providing benefits for full time employees but will still enjoy huge tax breaks on the insurance they do provide.
The insurance companies get substantial subsidies based on a citizen's ability to pay. But the citizen is responsible for predicting his income, and therefore his subsidy, under pain of penalty, as well as theoretically choosing the best product in a confusing "marketplace" that is sponsored by the government (but run mostly by private contractors). In exchange for this captured market share insurance companies will be forced to provide basic policies (how basic is in flux but it looks pretty meager--if you get seriously sick you still go bankrupt). Insurance companies will be forced to provide wellness visits, cover children of insureds under 25 years of age, and not be allowed to deny coverage based on pre-existing conditions (but the ability to rescind policies based on "fraud" remains). Health insurance companies, drug companies, and hospital stocks are all rising in anticipation of the huge profits to be gained. The U.S. health care system will most likely continue to be the most expensive in the world while offering middling results to its citizens in terms of health care (despite the misnomer, "Affordable" in the title of the legislation).
Also, Medicaid will be expanded under Obamacare, but on a practical level it looks like many states will cut back on Medicaid benefits and coverage--so more citizens may qualify for Medicare but those already on it may be worse off than before (not to mention the other services states are cutting because of increased Medicaid expenses). Another practical effect of Obamacare is that employers are cutting employee hours to under 30 hours to avoid health care coverage requirements. Also, employers will now have an incentive to hire undocumented immigrants as they will not be required to provide the same medical coverage benefits as for citizen employees.
All in all, austerity will increase health care costs, raise profits for insurance companies, drug companies, and hospitals, while still not covering all citizens. Most other citizens will have to pay more for a shoddy product and will still go bankrupt if they ever get seriously sick on their basic coverage.
#5 Posted by Walter W., CJR on Tue 30 Jul 2013 at 03:24 PM