As the HCR debate continues there are still some prevailing myths that prevail over the ACA law. Most myths are slanted right but key myths slant left as well.
- Batshitcrazy Right Wing Myths: Let’s get these out of the way first. There are no “death panels”, funding for abortions, socialistic healthcare rationing, criminal penalties for not buying insurance etc. These are all simply untrue and part of the Republican denial paradigms.
- Personal Mandates to Buy Private Insurance is a “Republican Idea”: No, the concept to require people to by insurance from a private entity is quite old. Germany has required their citizens to pay into privately funded “sickness funds” for decades. They are non-profit but administered by non-government entities. The Dutch and Swiss already have systems in place where citizens have to buy insurance from for profit healthcare insurers. The fact is most systems around the world are hybrid systems and for good reason. To call it a Republican idea is not understanding how universal healthcare has evolved in the world.
- Progressives Think They Will Have to Buy for Profit Healthcare Insurance: Predominantly no. What has emerged as the best part of the ACA considering the political environment is how flexible the law is when it comes to healthcare insurance providers. All states have the ability to set up their insurance exchanges with great latitude including a few non-profit options. States can provide a public option or even a single payer system like VT did. The last non-profit option includes private healthcare insurers who are non-profit now like much of BCBS for example and states also have the option to develop NGOs (non-government organizations) to deliver a not for profit option.
- I Already have Private Healthcare Insurance so the ACA Will Not Affect Me: For mostly good reasons the ACA will effect almost every American eventually because if we do get nearly everyone covered with healthcare insurance premiums and costs will not go up on the same trajectory. The biggest bang for the buck has always been expanding the risk pool to as many citizens as possible. That one principle is what makes other country’s healthcare systems better and cheaper than ours. Even the Swiss who have a very similar system to the ACA has healthcare cost that are about 70% of ours.
- The ACA is Moot Because It will be Struck Down by the SCOTUS Anyway: A small but significant part of the ACA is the only part of the law that possible could be struck down, the individual mandate. When a part of a law is struck down the immediate remedy is up to the Executive Branch unless the Congress wants to pass a new bill which would be highly unlikely. There are ways within the ACA law for HHS to make it very painful to people who want to roll the dice and game the system. A few examples are if someone does not enroll they can be deemed not eligible for subsidies, they could be required to pay back premiums if they do require healthcare insurance after the fact or even pay stiff penalties. Striking down the federal mandates still does nothing to prevent states from having personal mandates like MA has already and it could have the positive effect that more blue states could find it necessary to evolve faster into adding public options to their insurance exchanges and even going single payer faster. Like the stimulus I suspect you are going to see allot of hypocrisy over the ACA in red states.
My view may be a bit optimistic but we see more and more that States have become mini-nations in this country of late and there will be many states with good healthcare systems because of the ACA. States that do not leverage the ACA do so at their own risk. They will end up either racing to the bottom and get worse and worse care for their citizens or be pummeled by soaring healthcare costs.
There are still a few fundamental problems that still will exist in our healthcare system with the ACA. Ending the personal mandate would just add one more fundamental problem because it could result in a national healthcare system that is not near universal.
I think I’ve said it 1oo times now the only thing common with universal healthcare systems around the world that are better and much cheaper than ours is that they are universal, the various ways countries provide access to healthcare insurance is truly secondary by any measure.
Myths Expertly Pointed Out by ChoiceLady
Myth: This is just “Romneycare”. No – it’s not. The MA plan charges a small premium for healthy 30-year-olds, and that is what the state subsidizes. However, to make it affordable for MA, it imposes a $5000 deductible and $10,000 out of pocket mandate per person per year. If you have a chronic condition, that can be $15K year after year after years. What’s free? Not much. The Schwarzenegger clone eliminated only TWO things from the identical plan – childhood immunizations and Pap tests. That’s it. For too many people it has turned health insurance into catstrophic care – it does not catch and treat that PRE-cancerous polyp or mole. However, it does provide cancer coverage (minus the $10K) when you’re already sick and possibly dying. HCR has a huge list of FREE tests and treatments including colonoscopies, Paps, diabetes screening and start-up advice, mammograms, etc. The deductible is variable based on the state, but it’s somewhere around $1200 which is LESS than Kaiser charges in CA now. Also medical risk – age, residence, sex – have been controlled. Today private insurance can charge 500% more for older women than younger, and reform has kept it to a much lower figure of 200% or less.
Myth: Obama refuses to permit single payer and hates it. Wrong. He just gave Vermont an early waiver to implement single payer there in 2014 and praised it highly. Even single payer advocates in other states did not KNOW this (I saw a story, but it was pretty small). You can confirm this on Bernie Sanders’ Senate “newsroom” web site. Vermont can go for it in 2014 as their state option. http://sanders.senate.gov/newsroom/news/?id=2bdb32a3-4c32-4ecb-98cf-9642d61ef52b
Myth: Obama refuses a public option. Wrong. Right from the beginning, the High Risk Pool WAS a public option. If you were uninsured and denied coverage privately, you went into the pool. If you were poor, it was Medicaid. If you were over a certain income, it was insurance that cost a fraction – less than half – of private rates, sometimes even less than that. Anecdotal information leads us to think that although they are not “supposed” to, those covered by private insurance via employers are dropping it due to the cost, applying to private insurers who are disallowing anyone with a pre-existing condition, and then moving into the High Risk Pool. We don’t have data, but time will tell if this is creating, by fiat, a public option. It’s what we always expected, by the way.
Myth: People who are mandated to have insurance will pay through the nose. Nope – unlike the MA plan, there is not a flat rate you pay. You will be subsidized on a sliding scale, paying from 1-9 percent of your income up to 400% of the Federal Poverty Level ($88K for a family of four). Current estimates are those outside employer or group coverage are averaging 15% at the UPPER end of that scale, more at the lower ends. BTW – for reasons I cannot explain, this subsidy is EXACTLY that which appeared in the one fianance version of California’s single payer health legislation. Was it taken from that bill? I think we will never know, but it’s identical.
Myth: insurance companies will get rich and fat off private purchases. Not likely – state review boards are encouraged (CA is creating the law now – AB 52) to give rate increase review to departments of managed health care and/or insurance commissioners. All increases will have to be justified and thus can be rejected. Only states with no concern for citizens would refuse to establish a rate review process that works for all people.
Myth: we are doling out major bucks to pharmaceutical companies. Nope. The chaos of private intervention in drugs is coming to an end, and the government will by 2014 have scaled down costs, closed the “donut hole”, and forced drug companies into providing rational rates and broad generics to keep down both individual and societal costs. Pharma HATES this.
A good concise update of the court rulings on the ACA.
Unlike the MSM spotlights suggest it’s been upheld more often than not.
I don’t know about you CL but I don’t understand how people can’t comprehend the huge advantage of the subsidies in the ACA. Of course it’s not free money but a family making $50K (about half of all working families in the country make $50K or less) could literally go from paying $1,200/month on insurance premiums to less than $300/month overnight. Just think about the flexibility that would give people to work for whoever they want without having to work for insurance.
Already with the high risk pools a small group of people are starting to “get it”. For example people with preexisting conditions and these outrageous $1,200/month plus premiums like people with COBRAS are opting out of their insurance so they can buy the around $500/month high risk pool insurance. It’s far from optimum because you have to go without insurance for 6 months but some people are trying it.
Indeed, KQ – the differences are now VERY obvious to most people, even ones with subsidized insurance from employers. As more and more people have to pay larger and larger portions, the cost is now being seen for what it is. The government plan does not immediately rule out private insurance, but the self contained options are SO much less expensive! People ARE gravitating.
The ONLY ones I know who are not are a couple of acquaintances who won’t even LOOK at the healthcare.gov site to find premiums for themselves because it’s NOT single payer. So they pay MORE through a employer plan simply because they are peeved at Obama for not doing single payer. I am NOT making this up! I’ve tried to explain it to them, to no avail.
I will equally bet – without a shred of evidence – that initially some GOP folks without insurance are doing the same. But that will last as long as they don’t get a ‘keeping up with the Joneses’ bent when their friends and neighbors get cheaper coverage.
It takes time to make Americans stop being self defeating. Always has!
I believe it about single payer and that’s the hugest myth about other healthcare systems around the world. Progressives want single payer because they think that’s how healthcare works predominantly in Europe and that could be further from the truth. Single payer is about 50/50 in the developed countries and they are moving away from single payer to add competition into their systems.
I use to be a automaton, “Single Payer Only” type but once I learned more and more about healthcare I realized it would be an unmitigated disaster to try to force single payer on everyone. After the fact that a universal healthcare system has to be as universal as possible to work best, I learned that a healthcare system has to fit the culture of a country. In this country we have 50 different cultures so while single payer would work in VT soon it would be a disaster to try to implement it in a state like TX. At least all in one shot. It has to evolve there.
KQ – some of the movement toward “competition” is RW pressure, but your point is valid. Of all the developed nations, each has its own version.
I love the “fifty cultures” image – I think that’s true! We live where we live because of family, jobs, and yup – affinity. I have lived all over the country, and some places “fit” me more than others. I entirely agree – shoving single payer onto Texas would be too great a “culture shock” for them.
Is there ANYTHING we have done in the U.S. that was not gradual? OK – the Civil War. You can see how well THAT worked out. We’re still mopping up the mess.
I do not understand impatience with democracy. Mark Twain said it well: the reason not to make pigs fly is that will frustrate you, and it annoys the pig.
True the trend is coming about because Europe is shifting a bit right but I think some of the sameness of coverage does hurt single payers systems. We’ll see what happens with The Netherlands they have a “managed competition” concept. But I’m not naive competition will not make things cheaper but just give people a more specific product choice.
You are right the slow progress Americans are use to because even when we take bold steps things always seem to take a step back.
Great article KQ, and one that I’ll use over and over in my conversations with others: If I can add a post-passage postscript from Forbes?
“The provision of the law that permits young adults under 26, long the largest uninsured demographic in the country, to remain on their parents’ health insurance program resulted in at least 600,000 newly insured Americans during the first quarter of 2011.
Wellpoint, the nation’s largest publicly traded health insurer with some 34 million customers, reports adding 280,000 new members in the first three months of 2011.
Add in the results of some of the other large health insurers including Aetna, who added just short of 100,000 newly insured to their customer base, Kaiser Permanente’s additional 90,000, and Highmark’s 72,000 new customers, and we begin to sense our health insurance pools are filling up with some badly needed young blood.
The Health & Human Services Department had estimated that the changes in the law would result in about 1.2 million new enrollees in 2011. However, according to Aaron Smith, the executive director of a Washington based non-profit that advocates for the young, it now looks as if that number will be exceeded.
http://www.forbes.com/sites/rickungar/2011/05/23/more-solid-proof-that-obamacare-is-working/
Cheers I came across that article but lost the link.
AND those newly insured younger adults found, at least in CA, that the demand by Wellpoint-blue Cross for a 39% increase in rates was DENIED. It was cut waaaay back so they would not profiteer on the backs of the new enrollees.
Good move, IMHO.
Yup the benefits/premium ratio requirement in the ACA law is a big part of what is stopping these outrageous increases. No longer to HC insurance companies get a blank check.
Of course this ratio and the commission you are talking about is the real target of the GOP in the HCR law.
I was hoping for more myths involving minotaurs and semi nude goddesses but I can see why you stayed in the realm of things that are actually helpful.
Maybe this is a myth I believe in: Isn’t it true that there is no mandate to buy insurance? Aren’t we charged a fee that equals the premium of the lowest level of coverage?
Is that true?
Not yet, funk. That would have been the public option. There are penalties, and you CAN go into the pool to obtain insurance after 2014 (presuming the mandate continues)but you don’t have an ‘automatic’ fee charge for your premium. It would indeed have been tidier if that had happened.
Many of the Blue Dogs were “turnable” on public option, many were not. But this is set up so that incrementally, step by step, there ARE ways for people to move into the pool, and that would create a public option by default.
If something benefits people but is not passable, I think there is quite a lot to be said for stealth and incremental change. That IS what the Baggers fear, and they are right. Given a decent, low-cost, accessible and usable plan, gosh – people might find ways to USE it! And helping people access health care is SO much less important than preserving the insurance industry…
Yeah, Adonai – KQ and I looked long and hard for your kinds of myths and images, but we couldn’t find them. Sorry to disappoint! Would have made this MUCH more interesting, to be sure.
BTW Cheers for the assist to Kalima. Sometimes I just can’t figure how to get that damn feature image to show sometimes.
I don’t think you’re being overly optimistic KQ. I think you’re mostly right on point.
I don’t think the “personal mandate” issue will be as big a deal as some people think.
I still think free health care and not universal health insurance is the best and most affordable system but we do what we can do when we can do it.
I’m getting worried we are agreeing too much lately. 😉
There is no literally free system but I get what you mean. Healthcare is a right but with rights come responsibilities as well.
HA! It happens!
Indeed. Even with “free” health care everyone must do their part or it will crumble just as easily as every other system.
Excellent, KQ! May I add more?
Myth: This is just “Romneycare”. No – it’s not. The MA plan charges a small premium for healthy 30-year-olds, and that is what the state subsidizes. However, to make it affordable for MA, it imposes a $5000 deductible and $10,000 out of pocket mandate per person per year. If you have a chronic condition, that can be $15K year after year after years. What’s free? Not much. The Schwarzenegger clone eliminated only TWO things from the identical plan – childhood immunizations and Pap tests. That’s it. For too many people it has turned health insurance into catstrophic care – it does not catch and treat that PRE-cancerous polyp or mole. However, it does provide cancer coverage (minus the $10K) when you’re already sick and possibly dying. HCR has a huge list of FREE tests and treatments including colonoscopies, Paps, diabetes screening and start-up advice, mammograms, etc. The deductible is variable based on the state, but it’s somewhere around $1200 which is LESS than Kaiser charges in CA now. Also medical risk – age, residence, sex – have been controlled. Today private insurance can charge 500% more for older women than younger, and reform has kept it to a much lower figure of 200% or less.
Myth: Obama refuses to permit single payer and hates it. Wrong. He just gave Vermont an early waiver to implement single payer there in 2014 and praised it highly. Even single payer advocates in other states did not KNOW this (I saw a story, but it was pretty small). You can confirm this on Bernie Sanders’ Senate “newsroom” web site. Vermont can go for it in 2014 as their state option. http://sanders.senate.gov/newsroom/news/?id=2bdb32a3-4c32-4ecb-98cf-9642d61ef52b
Myth: Obama refuses a public option. Wrong. Right from the beginning, the High Risk Pool WAS a public option. If you were uninsured and denied coverage privately, you went into the pool. If you were poor, it was Medicaid. If you were over a certain income, it was insurance that cost a fraction – less than half – of private rates, sometimes even less than that. Anecdotal information leads us to think that although they are not “supposed” to, those covered by private insurance via employers are dropping it due to the cost, applying to private insurers who are disallowing anyone with a pre-existing condition, and then moving into the High Risk Pool. We don’t have data, but time will tell if this is creating, by fiat, a public option. It’s what we always expected, by the way.
Myth: People who are mandated to have insurance will pay through the nose. Nope – unlike the MA plan, there is not a flat rate you pay. You will be subsidized on a sliding scale, paying from 1-9 percent of your income up to 400% of the Federal Poverty Level ($88K for a family of four). Current estimates are those outside employer or group coverage are averaging 15% at the UPPER end of that scale, more at the lower ends. BTW – for reasons I cannot explain, this subsidy is EXACTLY that which appeared in the one fianance version of California’s single payer health legislation. Was it taken from that bill? I think we will never know, but it’s identical.
Myth: insurance companies will get rich and fat off private purchases. Not likely – state review boards are encouraged (CA is creating the law now – AB 52) to give rate increase review to departments of managed health care and/or insurance commissioners. All increases will have to be justified and thus can be rejected. Only states with no concern for citizens would refuse to establish a rate review process that works for all people.
Myth: we are doling out major bucks to pharmaceutical companies. Nope. The chaos of private intervention in drugs is coming to an end, and the government will by 2014 have scaled down costs, closed the “donut hole”, and forced drug companies into providing rational rates and broad generics to keep down both individual and societal costs. Pharma HATES this.
These are some of the things that make the Affordable Health Care Act work and work well. It has laid the ground, as they did in France, Germany, Switzerland, for single payer based on private insurance AND on government mediation of payments.
Perfect? Nope. But a GREAT start nonetheless.
Excellent excellent points CL.
Actually I’ll do one better and combine your points in the main post. 😉
Aren’t you nice! Thank you! Co-authorship with the man who “brung me” to the Planet is a real honor!!
When I saw your post KQ, I was thinking C’Lady will add to this! She knows the law better than most and has actually read it. understands it and can explain it!
Absolutely I gladly deffer to CL on the specifics of the law. Most of the information I’ve gathered on the HC issue is general and I try to learn about other HC systems around the world to see how they evolve.
And your summation was BOFFO, KQ!!!
I just have one small goal in life: I NEVER want to read another health care bill as long as I live. My reasons for wishing the survival of ACA boil down to that. DON’T MAKE ME READ ANYTHING ELSE!!!!!!
You may resume your regular programming.
You are a trooper by any definition. I read the House version ONCE and that was enough for me.
Good and informative post KQ. Bending the cost curve will take time and as you stated with more participants within the ACA the costs will go down, it will take time, but they should go down. There are many changes in the Medicare payment systems that can be done to reduce costs for everyone.
I do wonder what the long term effects of the “race to the bottom” with some states refusing their grant monies to help set up the exchanges while other states are moving quickly forward.
How does the myths get dispelled, not with the the MSM maintaining their idea of having people on for 3 minutes and what they say never gets challenged. Did Bachmann get challenged today with her myth of what the S&P report said, I didn’t see it.
It means that Alabama residents might FINALLY vote the troglodytes OUT of office. When they see what other people can have that they don’t, I think they will demand it. People are funny – they won’t just lie down and die. Those states where politicians have put ideology ahead of care may finally emerge into the light. And if they don’t, it’s really something they will have to deal with.
Great point and I finally hope it gives “blue states” a huge advantage when it comes to attracting businesses, especially young entrepreneurial high tech businesses. Because small businesses will no longer have to worry about competing with big business and their healthcare benefits in states with good healthcare systems.
: )
Indeed.
Hope so C’Lady, when a small business, and their employees, in a state that has no exchanges, like Kansas, who just turned down their grant, and see a state that has them with reduced costs, there will be a penalty to pay for some pols. Setting up ACA may be the best way to dispel the myths.
Looking at the tweets and links from HealthCare CA, CA seems to be really moving along on their work of instituting ACA
Yes – we’re going great guns indeed. Right now the big issue is AB 52 which gives the Dpt. of Manged Health Care and the Commissioner of Insurance the right to demand PROOF of impending rate hikes and the right to deny them if no proof is forthcoming. That is HUGE. Several other states (it’s Sunday – don’t ask me to name them, please) are doing similar things. We have the Exchange pretty much in place and ready to go right on time, 2014.
I really think, as long as I’ve been pumping single payer in CA, that we have to face the fact that we are a diverse body of people and that what gets done is always creakingly slow in the eyes of people who can clearly tell how the story will end, and why can’t you SPEED IT UP?
Franbkly, that, more than anything else, may be what IS “American Exceptionalism” no matter what the Fundies want you to believe about being “called by God”. Nope – held back by caution. That’s us. That’s the U.S.