June 28th, 2012

lunadelcorvo: (Casavir (NWN2))
A lot of people whose opinions I respect are actually quite furious that the PPACA/Affordable Care Act/Obamacare was upheld. Their chief complaint seems to be the objection to only one thing: that the government requires individual citizens to purchase a product form a corporation, and can penalize that citizen for failure to do so.

This is also accompanied by the concern that there are no minimum standards for that product, and no protections from things like price-gouging, and corporate abuse of a 'captive market.'

Well, no, not really. There ARE standards and protections, as well as expetions and subsidies for low income Americans. There are also provisions that make employer-provided care easier for small companies to offer, and which make basic care co-pay-free and therefore far more accessible. Here's what it REALLY does:
  1. Guaranteed issue and partial community rating will require insurers to offer the same premium to all applicants of the same age and geographical location without regard to most pre-existing conditions (excluding tobacco use). This means that while all Americans are required to purchase coverage, they cannot be denied coverage for pre-existing conditions. This is HUGE.
  2. A shared responsibility requirement, commonly called an individual mandate, requires that all persons not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs, purchase and comply with an approved private insurance policy or pay a penalty, unless the applicable individual is a member of a recognized religious sect exempted by the Internal Revenue Service, or waived in cases of financial hardship. Insurers must be approved, and exemptions will exist for those in financial distress.
  3. Medicaid eligibility is expanded to include all individuals and families with incomes up to 133% of the poverty level along with a simplified CHIP enrollment process. This expanded eligibility means that many who can't afford coverage, even under the ACA, will still be covered.
  4. Health insurance exchanges will commence operation in each state, offering a marketplace where individuals and small businesses can compare policies and premiums, and buy insurance (with a government subsidy if eligible). Again, there will be assistance with coverage, and active steps toward fostering actual market competition to offer better services.
  5. Low income persons and families above the Medicaid level and up to 400% of the federal poverty level will receive federal subsidies[27] on a sliding scale if they choose to purchase insurance via an exchange (persons at 150% of the poverty level would be subsidized such that their premium cost would be of 2% of income or $50 a month for a family of 4). Can we really argue that $50 for a family of four is abusive, especially when set against the grim realities of the millions of uninsured who have no coverage at all?
  6. Minimum standards for health insurance policies are to be established and annual and lifetime coverage caps will be banned. Minimum standards, there they are. These standars mean that no, companies will not be able to offer pointless 'compliance only' policies that do not actually provide for health care. (I wish auto insurance had the same standards!)
  7. Firms employing 50 or more people but not offering health insurance will also pay a shared responsibility requirement if the government has had to subsidize an employee's health care. This will help more people get coverage through employers, reducing the number forced to purchase health coverage privately.
  8. Very small businesses will be able to get subsidies if they purchase insurance through an exchange. As above.
  9. Co-payments, co-insurance, and deductibles are to be eliminated for select health care insurance benefits considered to be part of an "essential benefits package" for Level A or Level B preventive care. It's a no brainer that basic preventive care is essential to cutting costs of lifelong health care AND improving overall health and quality of life; this will make that basic care much more easily accessible to those who need it most.
  10. Changes are enacted that allow a restructuring of Medicare reimbursement from "fee-for-service" to "bundled payments."
  11. Additional support is provided for medical research and the National Institutes of Health.
I do understand the concerns about government forcing private citizens to purchase a product, but I think that to argue that this is the first step towards any corporation or industry being able to obtain similar positioning is a massive slippery slope. The ACA is NOT the first step towards 'government mandated' purchase of sneakers, cigarettes, or anything else.

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Things I need to remember:
• Asking for help is not, as it turns out, fatal.
• Laughing is easier than pulling your hair out, and doesn't have the unfortunate side effect of making you look like a plague victim.
• Even the biggest tasks can be defeated if taken a bit at a time.
• I can write a paper the night before it's due, but the results are not all they could be.
• Be thorough, but focused.
• Trust yourself.
• Honesty, always.

Historians are the Cassandras of the Humanities

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