The Republican Congress tried to stop it too many times to count. They even shut down the federal government and threatened to destroy our nation’s credit rating by refusing to allow the government to sell debt instruments or raise taxes to cover the deficit. All this was done for one purpose. To stop the Affordable Care Act from doing what it was designed to do: expand healthcare coverage to millions of Americans without it, and to make it harder for insurance companies to deny coverage to Americans.
Even the New York Times is forced to admit that, despite all the obstacles placed in its path by Republican politicians, despite the difficulties in rolling out the first ever federal program to expand health care coverage to millions of Americans, despite the incredible stupidity and or evil intentions of Republican governors to refuse to accept federal dollars to expand Medicaid coverage to the most vulnerable and most in need of health care in their states, the Affordable Care Act will improve the lives of millions of Americans starting today.
WASHINGTON — Millions of Americans will begin receiving health insurance coverage under the Affordable Care Act on Wednesday after years of contention and a rollout hobbled by delays and technical problems. The decisively new moment in the effort to overhaul the country’s health care system will test the law’s central premise: that extending coverage to far more Americans will improve the nation’s health and help many avoid crippling medical bills.
Starting Wednesday, health insurance companies can no longer deny coverage to people with pre-existing conditions and cannot charge higher premiums to women than to men for the same coverage. In most cases, insurers must provide a standard set of benefits prescribed by federal law and regulations. And they cannot set dollar limits on what they spend on “essential health benefits” for a policyholder.
Will everything go perfectly? Of course not. Then again, for years things have gone horribly wrong for so many people because our government, alone among the developed world, refused to adopt rational policies to expand health care coverage and decrease rising health care costs. Policies in place in countries as different as Japan, France, Sweden, Germany, Canada, and yes, Cuba. As a result we had millions of individual bankruptcies caused by medical bills for which families lacking adequate coverage could afford. We had the highest rate of infant mortality in the developed world. We had millions of people whom were essentially un-insurable because they had a “pre-existing” condition. We had a private sector which spent more money for “administrative costs as opposed to payment for medical claims than any other health care system in the developed world. We had the ignominy opf health insurance executives making obscene salaries even as their insurance companies denied claims that destroyed the lives of millions of their “policy-holders” not to mention the lives of their families.
The Affordable Care Act is far from perfect. But so was Social Security and Medicare when they were first introduced. Over time, as people learned of the benefits from those programs they demanded improvements, and improvements were made. The Affordable Care Act is a good beginning. Five years ago I didn’t believe anything even half as good would ever be passed through Congress. Ever. So today we should celebrate. Then tomorrow, we should get to work, advocating for new laws and reforms to improve the ACA. The effort to improve health care for “we, the people” is far from over, but it has finally begun.
Thank you, President Obama, Nancy Pelosi, Harry Reid, and every current and former Senator and House Member who voted for passage of the ACA. Now get back to work making it better.
And, for all of you here, please take the time to let your Congressional Representatives, regardless of party affiliation, know that you support the ACA, but that you also expect them to work to make it better – to cover more people, to offer more benefits, to work more efficiently – and to stop trying to make it fail. Let them know you are watching them. Like a hawk.
My husband and I have been without regular health insurance coverage for decades. He was let go from his job with a small company twenty years ago because our son’s leukemia treatment had caused the insurance plan to rise across the board. We never had decent coverage since.
We signed up for the new coverage and we will finally be able to get care and preventative care as needed. My only concern now is making that monthly payment. We are going to be basically making the equivalent of another house payment to do this, and things are going to be very, very tight. If we went with a lower monthly payment, though, the deductables would have been too high. That’s the frustrating part for us.
The What If site has a good article up on how the Silver Plan can actually be a ‘almost’ gold plan because of a little known subsidy. The site has really helped my family discover the ins and outs of the new plans. Maybe it can help you.
My niece has been on the WA state site for over 2 weeks daily trying to get on. The phone number was so overloaded that it would just hang up on her rather than putting her into a cue. Last night she got through only to find out that her app had been duplicated making it look like an identity theft issue. Throughout the whole thing she hasn’t waivered because the promise of getting insurance for her and her husband for the first time in 15 years is worth every frustration.
There are so many people who have had limited access, if at all, to health care it’s also a learning process for them to discover preventative care. Up until now the answer was always just ‘suck it up’. Now there seems to be a building awareness that the aches, pains and crippling chronic ailments may actually be fixable. People had grown so accustomed to sucking it up that the idea of being fixable is truly an American dream come true.
So yes, thank you Pres Obama and Dems!
My grandson in Eatonville was a bit daunted by the web site and the requirements. He saw a Navigator who was signing people up at the public library and she straightened everything out.
I was on the WA state site when it first came up, it was far more robust and well-planned than healthcare.gov. Apparently, it is being overwhelmed too.
Yes, pat the dear little self-important politicians on the back, else they never will do anything for you again.
And then tell them in no uncertain terms that it is time to end deductibles and co-pays in health care. Folks are paying in their premiums; they don’t need to pay again and again and again. Moreover, they don’t need to be sacrificed in disputes between big insurance and big medicine and left holding the bag.
“Yes, pat the dear little self-important politicians on the back, else they never will do anything for you again.”
Your “self-important politician” is getting calls, lots of them, every single day, from people bringing imaginary, ideological, extremely nasty complaints about the ACA along with the legitimate ones. If the 15% of Americans who answer polls saying they oppose the ACA from the left sit on the sidelines right now, or do nothing but call their Congressional representatives and criticize the law, then it is very likely that the law will be repealed or crippled, and nothing will take its place. Those who think that a teardown of the ACA would bring on a single-payer system are wrong, dead wrong, and they’ll kill and harm many people with their searing political stupidity.
Yes, criticize and work to improve Congress. But I’d encourage people to take time to recognize progress when it is provided to you by “self-important politicians” who are swimming in a sea of lies right now. You may despise their self-importance, but they’re human beings just like you, and if you tell them their vote for the ACA was worthless, then they won’t consider health care reform worth protecting.
I’m not going to tell them their vote for ACA was worthless. (One of the Senators voted against it.) I’m going to tell them that now they have to eliminate deductibles and co-pays if they are going to expect to see health care costs go down.
But the rising cost of health care in the U.S. has gone down in each of the last two years since the ACA’s passage. I agree we have to do more, but please know that that HAS happened.
That in part is because people who were excluded from insurance before and could afford premiums at any price are getting coverage and large bills for their procedures are now being paid to providers.
And the rate of increase in costs has slowed, not the increase in costs–which in 2009 were twice per person of the best single-payer plan. There is about $1 trillion of costs in the system that are not going to help people be healthy. But the system keeps trying to put those inflated costs back on the patient through deductibles, co-pays, and balance billing. The pressure to lower costs needs to be on the insurers and providers, not the patients. Because the patient response is to not seek needed health care, which winds up costing more as health conditions worsen.
I know pretty much what has happened, but my neighbors haven’t recognized it yet. And the political impact comes when Republican voters are demonstrably better off and can see that.
There are cost-control measures on insurers in the ACA. My favorite is the requirement to spend at least 80% of the money cumulatively paid by policyholders on actual health care. The penalty mechanism for this policy requires insurers to send their policyholders a rebate check if they spend more than 20% on overhead. Some insured people have already received those checks, and the insurer has been made to send a letter with the check which explains why they are sending the rebate.
That insurers have actually been forced to do these things is very important, because it shows that portion of the law is enforceable. It’s also a much better enforcement mechanism to force insurers to reimburse policyholders. If the insurer paid a big fine to the government, the benefit of this policy wouldn’t be personally felt by people. Hell, most of the policyholders wouldn’t even hear about a big payment to the government, but people know about the check they got in the mail thanks to the ACA. And, of course, this is embarrassing to the insurer, which gives them a powerful incentive to get over that 80% level.
The ACA requires insurance plans to offer a significant list of basic preventative services with no co-pays, for the very reason you note here. It is much cheaper in the mid and long run to cover preventative care for free, since it makes it more likely the patient can avoid catastrophic medical conditions and costs later.
“And the rate of increase in costs has slowed, not the increase in costs–which in 2009 were twice per person of the best single-payer plan.”
Agreed; single payer is a more effective way to manage costs, and a properly integrated and managed public health care system can also provide better health care services as well. But hear this:
Per year total cost increases for health care in the U.S. have been around 4% in each of the last two years. These increases had been around 8% per year for the previous decade or so. If you’re wanting to set the standard for success in controlling health care costs as a need for them to decrease, that’s totally unachievable; in fact, as you note, costs increase on a yearly basis for countries with well-run single-payer systems as well.
This unfair “costs are still rising!!” standard is what the right wing is using against the ACA right now. It makes sense as a criticism if you forget about such simple concepts as population increase, an aging population, and inflation. That’s why I encourage our side to understand that 4% figure as a BIG win, not a loss.
The ACA has to survive and be improved for us to get to single-payer.
Deductibles and co-pays are perfectly justifiable. They act as an incentive against overuse of medical services. A big problem with our health care system is overuse of medical services that have no significant impact on actual health.
You may think that co-pays and deductibles should be smaller or should be targeted better, but getting rid of them entirely is a bad idea.
I haven’t seen any evidence that statement is true.
Nor I. What they do is intimidate lower income policyholders into ignoring problems. Feeling a little tired and light-headed? Well, you’re not going to waste money with a minor complaint, are you? Just fatigue, probably. Why be a baby and spend all that money, maybe a hundred dollars. Then you collapse at O’Hare Airport with a blood sugar over 1000, never knowing that you are diabetic.
That’s a true case that I am personally acquainted with. Seeing a doctor and having a routine blood chemistry screen would have avoided all that by simple dietary changes. But the system is geared to save money on guys like him, while executives have the private doctor come to the office for every headache.
Skin in the game has done nothing to restrict health care costs. Deductibles and copays do one thing and one thig only: restrict access to the poor and lower to mid range middle class. Study after study shows we use health care and go to the doctor LESS than UHC countries despite deductibles and copays.
I’d link to stuff but I’m on vacation atm. Greetings from Mexico, BooTribers. And happy new year.
Sorry, the point is that going to the doctor less — which is what deductibles and copays accomplish — has done nothing toward lowering cost. It’s only limited access to those unfortunate souls. Tax me more so they can go! But stop the nonsense that we need deductibles and copays.
Deductibles are a good thing in Auto and Home insurance to keep down small claims that can be easily afforded by the policyholder. Co-pays make the policyholder decide whether he really needs the Chrome replaced with new or if the roofing can be replaced instead of repaired.
While a car can be fine with a dent and house with a broken shutter, human bodies demand a different calculus.
I lived in a world with good insurance and no co-pays. It did not mean that I went to the doctor more frequently. It did mean that I got better preventive care.
The idea that deductibles and co-pays reduced costs was introduced by the Reagan Republicans who were trying to sabotage Medicare.
At least 3 people we know are now getting coverage through the ACA. A couple friends in Louisiana fall into the medicaid gap. I get insurance through my wife’s employer – there is some uncertainty about her job in the future, and the ACA gives us some security there. This is a big F’n deal. I just hope we can elect another Dem for Prez in ’16 so that necessary improvements can be made and no rollbacks are threatened by R’s.
My cost went from 740 down to 201. My wife’s went from 680 down to 160. She was supplying her brother in law (don’t ask) at 600, he is now 100. A person I autocross with went from 1400 a month to 450. A person I work with got parkinson last year and had no coverage and now does. Even the conservative coocoo birds I know are signing up. I live in California and it all worked from day one (my wife was looking through options 2 hours after the California site went live).
So when republicans talk about ‘ending Obamacare’ they are actually saying they want to take thousands of dollars out of our pockets. And there are MILLIONS scattered all over the country saving money.
The politics are simple… in 2016 the republicans will never nominate a candidate for president who does not have to stridently advocate taking thousands of dollars out of hundreds of thousands of peoples pockets in all sorts of different states. Races for the Senate will play out the same, but on a smaller scale. The House, not so much, but at least a few seats will be lost by republicans in the south on this.
Stridently advocating taking thousands of dollars out of people’s pockets is entirely consistent with winning elections, depending on what else you promise.
People don’t vote their economic self-interest, not entirely, or even mainly, or there wouldn’t be a GOP incumbent anywhere in the country except Fairfield county, CT and a few other places.
Presidential voters vote party, race, and religion — or lack of it. They vote age, gender, and — maybe — narrative. They vote like their neighbors do. They vote like their parents did. They vote depending on the general health of the economy.
What are Democrats doing to make those factors work in their favor? Economic determinism is not going to deliver the White House.
the problem with the ACA originates with the evil ass GOP Governors that:
Who the hell thought that the federal government would have to be responsible for exchanges for half the states of this country?
Come on, now.
Of my descendants, one lives in an enlightened state (WA) and is benefiting from the Medicaid expansion. One lives in a corrupt and confused state (IL) but will stay on my policy for three more years thanks to the ACA. And two live in a third world hellhole (AL) and have no coverage at all.
Who the hell thought that the federal government would have to be responsible for exchanges for half the states of this country?
Plenty of us did. Especially those that know Rusty Limpballs runs the GOP. Do you not remember, before even Obama’s first term began, when Yertle the Turtle(aka Mitch McConnell) said his one, and only priority, was making Obama a one-term president? Did you think Mitchie-poo was joking?
Mitch is not a Governor or State Legislator; he is unable to control whether States set up their own exchanges. I’d concede that his “one-term president” expression matched the view of his awful political party, though. It’s worth remembering that the 2010 mid-term created more GOP Govs and State Legs than we had when the ACA was passed. It’s even more important to remember that the ACA originally prevented States from refusing Medicaid expansions; we have Chief Justice Roberts to blame for that turd in the punchbowl.
Been having a discussion for the better part of today with a well to do friend who is complaining that his premiums are going up to $1,200 a month. First, that rate is for a platinum plan so no tears from me.
But it’s occurred to me along the way that hearing the complaints of rising premiums from those who are well off, and I’m talking well over $100,000 a year income, makes me want to point out that health care taking a larger bite out of one’s paycheck is actually leveling down or equalizing the % that the smaller incomed people have faced. Duh. But really, I’m not going to feel sorry for someone who is receiving the care of a great plan and then paying what they should have been paying for all along to receive it.
I’ve had conversations with a couple of progressives with healthy incomes that know their annual premium is going up $3,000 or so. They aren’t happy about having to pay that, yet they are all for it because they know how this saves lives. True progressives IMHO.
But then there are still lower income folks for whom even partially subsidized ACA plans are not affordable.
We have so much more to improve for the future on this. I look forward to seeing how it rolls out. And there are so many ways to expand and improve the law.
I’ve known people who have been stuck at dead-end jobs for decades because they had a sick child and were pinned down due to “pre-existing conditions”. DECADES.
I never thought that barrier would go away in my lifetime.
Now we have money that used to go directly to hospitals via the disproportionate hospital share payments, going to people in the expansion of Medicaid. They have the chance now to get seen by a doctor early in an illness rather than late (or sadly “too late”) in an emergency room.
The 1% are getting some of their investment income taxed for Medicare. For the first time ever income other than wages is fair game for Medicare funding. If that isn’t progressive I don’t know what is.
So I think costs will go down and premium costs will improve. Longer term there are so many ways to go. Will single payer get rolled out state by state following Vermont’s lead? Or will the Medicare age of eligibility get lowered? Or will Medicaid eligibility get raised?
Personally I think a few laws could be passed that would make it easier for single payer to move forward state by state. Once California goes for it, the future is set. The red states? If citizens there can’t see it, tough. A lot of people in red states will move or finally vote for their interest.