Politico recently summed up the president’s recent sales pitch for Obamacare this way: “Make the big sell by talking small.” And indeed, in a mid-July address, the president tried to assure Americans that all was going according plan, Politico reported, by painting “an optimistic picture of how Obamacare is putting money back into the pockets of consumers who will soon see new competition drive down insurance rates.” While the president has been focusing on some early small victories—like the rebates some people are getting due to a provision in the law—at its core the Affordable Care Act is about insurance.
When it passed, it was about giving some 30 million of the 50 million people uninsured at the time, in 2010, a chance to get insurance—for some, to buy it with help from subsidies from the federal government, and for some others, getting it through Medicaid, via an extension of the existing federal/state program for the poor. A secondary goal was to get rid of some of the worst practices in the so-called individual market, which prevented sick people from obtaining coverage and well people from affording it. There was also talk that the law would slow down the rise in the cost of US medical care, though it arguably did not contain teeth strong enough to make that happen. Forces that could actually raise healthcare costs—like consolidation in the insurance and hospital markets—would have continued with or without Obamacare. It is within this context that the Affordable Care Act to date must be scored. In Part 1 we examined what parts of the original law have been implemented, what parts are on hold, and what parts are gone. In this, Part 2, we assess the law as it stands so far—its hits and its misses, as well as the parts that get mixed reviews.
THE HITS
Coverage for young adults.
According to the 2012 Biennial Health Insurance Survey, from 2010 to 2012 about 3.4 million young adults up to age 26 gained coverage under their parents’ insurance policies, thanks to Obamacare. While some states and some employers already permitted young adult coverage, this popular provision has helped many young people who are starting their working lives.
No lifetime limits on insurance coverage.
Anyone who has experienced a catastrophic illness or accident and found that their insurance stopped paying the bills because the costs exceeded the policy limits knows how important this provision can be. While most people never reach those limits, they could mean financial ruin to those who did. Now, insurance companies can no longer impose lifetime dollar limits on coverage, a provision the White House says http://www.whitehouse.gov/healthreform/myths-and-facts has already affected 105 million Americans with individual or group coverage. Annual limits, too, will be entirely phased out by 2014. Insurers, however, are still allowed to limit the number of physician visits or treatments. Whether a policy comes with such limits will be a factor of the premium and the cost sharing a policyholder will pay. But the overall dollar limits for healthcare benefits—a factor when serious illness or accidents occur—will be a thing of the past.
Prescription drug savings for seniors.
Early on, the government sent a $250 rebate check to Medicare beneficiaries who had high drug expenses—those who in 2010 had reached the so-called “donut hole,” where the Medicare prescription drug law, passed in 2003, provides no benefits. The Affordable Care Act closed the donut hole gap, thanks to a deal the administration made with the drug companies. The companies helped fund some coverage for brand name drugs needed by consumers whose expenses were high enough to reach the coverage gap. That, of course, gave them entrée to new customers for those drugs. In 2011, the White House says, seniors saved, on average, $604 per person.
Preventive care benefits.
The law requires most health plans to cover core preventive services recommended by the US Preventive Services Task Force—with no cost sharing on the part of the patient. These include such services as immunizations and blood pressure screenings. Other services are aimed at women, such as well-woman visits and gestational diabetes screening, are also covered without cost sharing.
The biggest mistake giving the states 100% reimbursement for Medicaid (for those below the poverty line) the first few years and then only 90% beginning in 2020.
That would have created a hardship for many state budgets.
When the Supreme Court ruled that states could elect NOT to fund the Medicaid expansion but they like, Republicans and other opponents did exactly what you’d expected they’d do. So far 21 states have decided not to participate and 6 are on the bubble.
Poor people below 100% of the poverty line are out of luck.
We should have passed Medicare for All rather than allowing insurance companies to make billions are middlemen. But failing that, Obama should have had the federal government cover 100% of the cost forever. Not doing that either was going to hurt some states OR as it turned out, allow opponents in some state to not cover the poor.
This is shameful (for both sides).
#1 Posted by William Du Bois, CJR on Tue 30 Jul 2013 at 03:32 PM
It should be noted that the Center for Advancing Health seems to funded by the usual pro-corporate suspects promoting the tired trope that individual choice [neoliberalism] will set us free:
"While advances in medical knowledge have been responsible for steady increases in the length and quality of life of Americans [unless you're black or poor], the potential of health care to improve individual and population health in the future rests increasingly in the hands of individuals. Whether we are sick or well, we will not benefit from the expertise of health professionals and the technologies they deploy unless we participate actively and knowledgably in our own care."
http://www.cfah.org/about/funders
Well, I guess we get these neoliberal solutions with Obamacare; we get fake choices, fake free markets, corporate welfare, and we are tricked into bickering amongst ourselves when the inevitable bad results hit. After the corporate terrorists come for health care the only targets left will be public education and Social Security/retirement benefits.
Why won't our corporate press discuss the obvious benefits of socialized health care and/or single payer health care and why oh why are we subjected to this propaganda about "individual choice?" Just try wading through the various policies and changes described in the two parts in this series! It's a mess (not necessarily the writer's doing) and the obfuscation hides the real agenda. . . austerity, privatization, and corporate welfare!
#2 Posted by Walter W., CJR on Tue 30 Jul 2013 at 04:59 PM
I live in Massahusetts.I have Medicare and a B/C B/S supplement. I recently found out why my doctor no longer give checkups, questions what other doctors suggested my primary physician do, but having her tell me it was up to me to make that decision. I was having a UTI that was not attended to properly, and after a bad episode, I was again on antibiotics. An article I read explained that doctors make more money if their patients can reduce the costs of treatments, and office visits should be kept to five minutes up to twenty minutes. What ever happened to PREVENTIVE MEDICINE? It seems the answer to medicare problems is a "do it yourself."
#3 Posted by Bunni Roberts, CJR on Wed 31 Jul 2013 at 08:18 PM