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.