Last week, we took a look at the ARRA (the American Recovery and Reinvestment Act) which has been characterized as “the failed stimulus bill.” It has not been a failure at all, according to the Congressional Budget Office (CBO). In fact, it has resulted in millions (between 5-25 million) of jobs both saved and created in the public and private sectors. It is one of the many positive things that the President has done, or taken leadership to see accomplished, in his three years in office. In fact, according to several writers and pundits, President Obama accomplished more in his first two years than any other President in history. Republicans will keep trying to characterize his tenure as an abject failure, but their rhetoric is nothing but lies and distortions that cannot be backed up by facts (which they tend to ignore in any political “debate”).
This week, let us take a closer look at the Patient Protection and Affordable Care Act (PPACA), which Republicans and conservatives try hard to characterize as a failure, and as “government controlled”, and even as “socialism,” derisively referring to it as “Obamacare.” As a matter of fact, it is less of a government-controlled system then is their own health care insurance, which is entirely organized, managed, and overseen by the OPM (Office of Personnel Management). To go a step further, the extra health care benefits available to members of Congress includes clinical care on-site operated by naval personnel, and they have access to taxpayer-subsidized surgical/hospital care at Walter Reed Army Medical Center in Washington DC, and the National Naval Medical Center in Bethesda, Maryland. (Senate Minority Leader Mitch McConnell had heart surgery there in 2003).
So let’s say, first, that the PPACA legislation does not contain a public option; that, under its provisions, the government does not provide services, nor does it control from where you get your health insurance. You are free under this Act to continue choosing from a number of private insurance companies for your coverage. The Act does have a provision for state-based Health Exchanges through which individuals and small businesses with up to 100 employees, could purchase qualified coverage, but these Exchanges can be administered by either a state agency or a non-profit organization; presumably, the states can make that choice. States can also opt in 2017 to set up Regional Exchanges or allow other state Exchanges to operate within a given state. In addition, the OPM will contract with private insurers to offer at least two multi-state plans in each Exchange. Going a step further, the Act allows for the creation of non-profit, member-run health insurance companies in all 50 states and DC to offer qualified health plans.
Are there some requirements in the Act that would involve government implementation and management? Of course; but that doesn’t make it “socialism” or “government-run.” There is a federal requirement that everyone be covered, backed up by certain penalties for those who fail to comply. That is controversial, and will be addressed by the Supreme Court. Some lesser courts have supported its constitutionality and others have not. Other restrictions are placed on what can be offered by insurers and what cannot be included. But, in my opinion, this is no different than many pieces of legislation that require certain actions, programs, restrictions and innovations that result in changes in administration or management in the public and/or private sector. One example: the ADA - the Americans with Disabilities Act. If the Court rules that the federal government cannot require all people to purchase health insurance then surely logic would say that government cannot require compliance with adaptive measures for all public and private facilities and programs. In my opinion, it is ridiculous to say that the federal government cannot require certain actions on the part of all citizens when it clearly benefits all, or a major portion of, the citizenry. We shall see…
Second, let’s take a closer look at the PPACA, and see what it has actually done for consumers in a positive way:
- allows adult children up to age 26 to be on their parents’ healthcare insurance; has already extended insurance coverage to 2.3 million young adults under age 26
- prohibits insurers from citing pre-existing conditions for denial of coverage;
- provides portability between employers;
- expands Medicaid to certain eligible citizens under age 65;
- extends funding for the Children’s Health Insurance Program through 2015;
- provides for a tax credit for eligible small employers (under 25 employees with annual average wages less than $50,000) that purchase health insurance for employees;
- establishes a national, voluntary, insurance program for purchasing community living assistance services and supports (CLASS)
- prohibits lifetime limits on coverage
Here are some more positives that will occur in the near future:
- will provide refundable and advance premium credits to eligible individuals and families to purchase insurance plans through the State Exchanges
- will require Exchanges to maintain a call center for customer service, and to use a single form for application that can be filed in person, by mail or online;
- will create a temporary insurance program for employers providing health insurance coverage to retirees over age 55 but not eligible for Medicare
- will create an essential health benefits package which is the minimum that must be offered by all health care plans;
- will establish a temporary national high-risk pool to provide coverage to individuals with pre-existing conditions along with subsidized premiums;
And administratively, there are these helpful provisions:
- establish a process for reviewing increases in health plan premiums and require justifications for increases; provide grants to states to support these efforts
- adopt standards for financial and administrative transactions to promote simplification of administration, thus saving money
- impose same insurance market regulations in all markets and exchanges
- establish the Health Insurance Reform Implementation Fund to implement health reform policies
- permit states to create a Basic Health Plan for uninsured individuals in lieu of premium subsidies
- simplify health insurance administration by adopting a single set of operating rules; non-compliance will bring a penalty
- establishes a Council, a Fund, and a grant program to spur prevention, wellness and public health programs
- will require skilled nursing facilities to disclose information regarding ownership, accountability requirements, and expenditures and will publish results on a website so Medicare enrollees can compare facilities
- improve workforce training and development, much of which is focused on graduate medical training, nurse training and retention, and increasing both through scholarships and loans
- impose additional requirements on non-profit hospitals to conduct a community needs assessment every three years and adopt an implementation plan to meet identified needs
And finally, here are some consumer-based reforms that will improve health care insurance and health care delivery:
- will expand Medicaid coverage to all non-Medicare eligible individuals under age 65
- require qualified health plans in Exchanges to meet marketing requirements and will require reporting of information in certain areas of operation, including enrollee rights
- require all new policies offered through, and outside of, Exchanges to comply with one of four benefit categories
- develop internet site to help people identify coverage options
- develop standards for insurers in providing information on coverage and benefits
- establish an office of health insurance consumer assistance or an ombudsman program to serve as an advocate for people with private coverage
- establish an independent Payment Advisory Board to submit legislative proposals with recommendations to reduce the per capita rate of growth in Medicare spending when spending exceeds a certain target rate, and to slow the growth in national health expenditures
- improve care coordination for enrollees with both Medicare and Medicaid
- create an Independence at Home demonstration project to provide high-need Medicare beneficiaries with primary care services at home
- improve access to community care by increasing funding for community health centers, and for the National Health Service Corps, plus support for school-based health centers
This brief summary does not even include all the reforms to Medicare and Medicaid contained in this Act simply because we have discussed those elsewhere. So, in essence, I have just skimmed what I presume are some of the more important reforms in the Act.
What can we say, then, to the radical Republicans in Congress, and running for President, who want to repeal this entire piece of important legislation? I suppose, first of all, we could say, “Do you even know what is in the Act?” Second, we might ask, “Do you care at all for what ordinary people would give up or lose by your ill-advised action?” Third, we might point to a letter from the CBO, dated May 26, 2011, and written to Congressman Henry Waxman, ranking member of the Committee on Energy and Commerce, in which there is some discussion of the consequences of repealing this legislation, or more precisely, of permanently preventing the use of appropriated funds to implement the Act. Here are some of the CBO points for your consideration:
1) would result in a significant loss of revenues, particularly from certain fees and taxes that would be collected by the IRS: e.g. 40% excise tax on insurance plans above certain thresholds for persons with incomes above 250k, and certain insurance industry and pharmaceutical industry fees
2) would significantly alter the effects of many provisions of the ACT, including changes to Medicare and Medicaid; the establishment of health care exchanges, tax credits, and cost-sharing subsidies designed to increase the number of Americans with health insurance
3) would reduce the number of people with health insurance coverage compared with what would occur if the health care laws are fully implemented
4) could prevent CMS from modifying Medicare payment rates on an annual basis; preclude CMS from engaging in the rate-setting process and signing contracts with private insurers that offer Medicare Advantage and Part D (prescription drug) plans; the possible result - no Medicare Advantage plans and no more Part D plans for Medicare beneficiaries!
5) preclude the Secretary of HHS from implementing recommendations of the Independent Payment Advisory Board aimed at limiting Medicare costs
6) prevent federal government from setting up insurance exchanges if states chose not to
7) prevent CMS from assessing and collecting its share of higher rebates from pharmaceutical companies for drugs dispensed to Medicaid beneficiaries
8) payment to doctors would be affected because the calculation of annual rates by CMS would be affected and rates would remain at current levels, and Medicare spending would increase in 2012 and 2013
9) mandated demonstrations and pilot projects designed to improve efficiency and quality of care would increase spending in some cases
10) in the absence of mandates for insurance coverage, the number of families and individuals covered would be lower than under current law
11) grants to states for setting up exchanges and subsidies for cost sharing would not be available, putting states in a further bind as to health care support
12) CMS would probably be prevented from providing assistance and guidance to states as to their Medicaid and CHIP programs
13) provisions to reduce waste fraud and abuse would be undercut, as would provisions to improve quality of care to enrollees
The Patient Protection and Affordable Care Act of 2010 is not the failure that many conservative Republicans would have you believe. There are many, many provisions that will not only reform our health insurance provisions, but that will go a long way toward reforming our health care delivery system into one in which quality is primary and preventive care and wellness are of the utmost importance. Those who want to destroy the most important health care legislation since establishment of Medicare under Lyndon Johnson, are simply deluded. It is time to praise this major accomplishment of the Obama administration, and to seek to implement those positive aspects that are pending between now and 2019. “Obamacares” is an apt title for this major piece of effective legislation.
As with most of the programs (and agencies) that the Republicans want to cripple or destroy, there are real people -- millions of them -- who are in need of the assistance and subsidies which such programs provide. It is not just a matter of how many positions can be cut, how much money we can save, how big the deficit is. For every number, there is a face, a life, a story and a person being threatened with the loss of something that for them constitutes a net of safety and assurance.
Congressmen and presidential candidates who spew the kind of venom that tells “hippies” of OWS to get a job; that says that poor kids need to learn a work ethic and to hell with child labor laws; or who despises union workers and especially government union workers (and takes their collective bargaining rights away). They want to send “illegals” back to where they came without opportunity for citizenship or for their children‘s education. They want to deny quality health care insurance help to seniors and children and persons with disabilities. These same people want, above all, to maintain and support the excesses and power of the richest among us. It’s past time that we call them out, and ask: do you even know the people about whom you speak; the people you threaten with a torn safety net (denying help even with home repairs or heating subsidies or food stamps)? Do you ever meet with them one-on-one or in small groups to discuss their concerns? Do you care to become acquainted with them and their life stories? I hope the coalitions they are forming across this country begin to occupy your neighborhoods, and your offices, and even your properties. The time is coming when you will have to begin to respect the needs of the middle class and the working poor and those who have little or nothing, including a home.
President Obama has shown by his accomplishments that people matter. He is our best hope for greater accomplishments in health care and further advances in the welfare of the 99% who do not have a million dollars or more to insulate themselves from real life problems, exigencies and difficulties. It is past time to laud him for his targeted actions and his many attempts to make our lives and our nation better than the mess left behind by a certain Texas cowboy. More next time…
