Who In Their Right Mind Could Possibly Be Against Obamacare?

The first thing I’d like to note is, the number of people who are against The Patient Protection and Affordable Care Act, known simply as the ACA or “Obamacare,” because of what’s actually in it, is actually pitifully small. But dammit, they’re loud, and frankly, I’m tired of hearing them. Forty-two times Republicans in the House of Representatives have voted to kill this law, even though Democrats in the Senate will never vote to repeal it and no one has the votes to override a certain presidential veto. They’re messing with you, Obama-haters – no one can repeal this law. If you haven’t figured that out after FORTY-TWO TIMES, no wonder you’re dumb enough to want to kill the ACA. Also, they’ll never defund it, because most of the changes the ACA makes are not dependent on government funding.

While Republicans of fond of claiming that Democrats passed it without reading it, but let’s get real here. Based on the “arguments” coming from their side, it’s clear they haven’t read it themselves. For example:

    • There are not now, nor have their ever been “death panels” in the ACA.
    • The ACA is not “socialized medicine.” In fact, it barely addresses the medical side of the debate, except to provide financial incentives to doctors and hospitals for quality care.
    • Most of what Obamacare does is to regulate the health insurance industry and most of the costs are borne by the same people who have always borne the costs of the system: those who pay for insurance.

Given the moral bankruptcy of our old system of health insurance, it’s just impossible to believe that anyone rational could be against the ACA. Most people didn’t know their insurance policy sucked, because insurance companies were happy to use your own money to pay most routine or basic doctor bills and basic prescription drugs. Most families were paying an average of $1200 per month for health insurance; if you cost the carrier less than $100 a month, you were fine. But their goal was to spend as little of your money as possible. So as long as you were healthy, your insurance company was happy to have you and loved you.

But God help you if you actually needed medical care. Our system was set up so that insurance companies only covered healthy people and if you got sick or injured you were dropped and then tagged with a large red “P” for “pre-existing condition” and you couldn’t get insurance anywhere else, either. In other words, those who needed the most expensive care were not allowed to pay into the system, so when they became sick or injured, and needed a lot of medical care, everyone else paid for them.

That’s the system the Republican Party wants to go back to. They insist on characterizing health care as a market-based product, when it is most certainly not. We can’t choose when or how much we’ll need or what it will cost. Health care is not the same as buying a house or a car.

Beginning October 1, people will begin signing up for health insurance under the Affordable Care Act, and what scares Republicans the most isn’t that it won’t work, but that it will. While the ACA is not perfect legislation, it makes health insurance work better for everyone. More people will be paying premiums into the system, more bills will be paid, administrative costs and bureaucratic hassles will sink to almost nothing, and over time, premiums will stabilize.

Republicans want to focus on the cost only, but the fact of the matter is, most of what the ACA does is to reform how health insurance companies work. At least 80% of the law goes to making sure insurance is market- and consumer-friendly for the first time ever. Republicans want to kill it all, however. They haven’t offered an alternative; they operate under a fantasy that the entire health insurance system will just revert back to what it was. It won’t. But suppose it could; look at what Republicans want to take away from you:

  • Your children can be on your health insurance plan until they turn 26, which means they’re covered while in college, and while they’re out looking for a good-paying job with insurance coverage. Nearly 3 million 2.5 million adults benefit from this already.
  • There are no longer lifetime monetary limits on health care coverage.
  • Annual spending caps are prohibited, which means It’s no longer possible to lose coverage because you become “too sick.”
  • There are no more deductibles and co-pays. If you need a doctor, you just go and your insurance pays the bill..
  • All plans include full coverage for all vaccines, and well-baby and pediatric visits. All preventive care for women is covered, as is screening for gestational diabetes and HPV.
  • Screening and counseling for HIV is also covered, as is contraception.
  • Insurance companies have the burden of proof in showing that a claim is invalid, and must provide for a quick and painless appeal process.
  • Beginning with the new policy, insurance companies can no longer deny coverage or claims based on pre-existing conditions.
  • The ACA establishes a special  health insurance program to provide benefits for early retirees aged 55-64.
  • Insurance companies will no longer be able to charge women higher premiums than men.
  • Beginning in 2015, payments to doctors will be based on the quality of care, not volume.

I know many still manage to complain about the lack of a “public option” in the ACA, but a number of provisions in the law will likely have insurance companies clamoring for one. For example:

  • Medicaid expands to cover all individuals with income up to 133% of the poverty line, which means everyone making up to about $30,000 will be eligible for that, and the exchanges will provide subsidies, in the form of tax credits, for those making up to about 400% of poverty line wages. (As an aside, these are about the only parts of the ACA that the GOP could defund. Which means people will still be signing up for the subsidized insurance, then told by the GOP they can’t have their tax credit. Now you know why so many Republicans are nervous about this.)
  • For-profit Insurance companies are now required to spend at least 80% of premium revenue on health care, with any excess returned to individual policyholders in the form of a rebate. Non-profit health insurers like Blue Cross don’t escape scrutiny, have to spend at least 85% of premiums on health care. If they don’t spend enough, they have to rebate the difference to policyholders.

Insurance companies live and die based on risk pools. The greater the risk, the harder it is to make a profit. Before the ACA, they maximized profits by denying coverage to those who might actually need health care. Now, they have to accept everyone and they can’t cut anyone off when they get sick. At the same time, they must spend 80%-85% of premiums on health care, which means they have to limit administrative costs (including executive bonuses) to record a product. Higher risk pools and limited  profit means it’s just a matter of time before they demand a “public option.”

By the way, if you’re in favor of repealing Obamacare, you’re actually against strengthening Medicare:

  • The ACA closes the donut hole until it disappears in 2020. In 2011 alone, 3.6 million Medicare beneficiaries saved an average of $600 per person.
  • The ban on deductibles and co-pays extends to Medicare for most vital health care services now, and by 2018, it will ban them altogether. In other words, you pay a premium, you go to the doctor, the bill is paid. No more choices between buying groceries or paying the co-pay.
  • Under the ACA, Medicare beneficiaries to annual wellness visits, so that patients and doctors can develop a health plan based on current health and risk factors.
  • The ACA extends Medicare coverage to health care facilities with a small number of Medicare patients, such as hospitals and clinics in rural areas.
  • The ACA toughens sentencing guidelines for Medicare fraud, and it allows for the suspension of payments to providers suspected for fraud.
  • New screening procedures, similar to those undertaken by credit card companies to combat fraud, will be implemented to combat abuse and waste in all health insurance programs.
  • As I said, there are no death panels. What the ACA provides is coverage for end-of-life consultations with medical professionals, not just for Medicare recipients, but to anyone. They don’t tell you when or how to die; they counsel you as to the best way to do it in dignity and comfort.

What is it about any of the above that is so bad, you feel like it has to go away? How can anyone argue that any of the above makes the health insurance system worse. Insurance companies still get to skim 15-20% of your money off the top to pay salaries and dividends; it’s not like they’ll go broke. And since they’re not really providing a service, other than paying your medical bills for you, why should they get more? You pay agents or your waitress about 15-20% most of the time, why should your insurance company get more?

While most of the ACA regulates insurance companies, there are a few things the law does that could improve health care for everyone. These would be the most severely affected by “defunding.” Killing which of these sounds like a good idea?

  • Are you in favor of killing a temporary tax credit of up to $1 billion to encourage investment in new therapies for disease prevention and treatment?
  • Or perhaps you’re in favor of denying funds to the National Health Care Workforce Commission, a National Center for Health Care Workforce Analysis,  and a State Health Care Workforce Development Grant Program, all of which were created by the ACA to create a comprehensive system to recruit more health care professionals and to direct those caregivers to those areas with the greatest need, such as rural hospitals and clinics. Why would Republicans want to deny doctors to red areas with the greatest need?
  • Do you want to kill the small business tax credits, for businesses with fewer than 50 employees, who are scheduled to receive up to 50% of employee premiums? Once again, they’ll eventually have to sign employees up; Republicans are basically threatening to raise their taxes.

You have to be absolutely crazy to want to kill the Patient Protection and Affordable Care Act. While the ACA isn’t perfect – no bill ever is – but it improves our health insurance system enough that all we’ll need to do going forward is to tweak it to make it better.

What about any of the above is so offensive and horrible that you feel like it has to go? This opposition doesn’t make sense; not even a little.  The year before the ACA was passed, total health care costs were $2.7 trillion. The ACA will stabilize and then eventually lower that amount by a wide margin. Eliminating the ACA guarantees that number will continue to rise. So, where’s the savings the GOP is promising?

Republicans are crazy, and they’re lying to you. Don’t fall for it.

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