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About the ACA

October 26, 2016

 

Most of today’s Affordable Care Act coverage is driving me nuts. Some basics:

 

Obamacare is not a thing. It’s a nickname for the Affordable Care Act (ACA) – a comprehensive law passed in 2010 that did a lot of good things, including making it illegal for insurance companies to deny coverage based on pre-exisiting conditions they themselves defined. That’s important. Before this law, if you were a freelancer or contract worker or lost your job or didn’t have a job that offered health insurance, you had to try to buy a plan on your own as an individual. Unless you were a 21-yr-old male who never had seen a doctor for any reason ever, it was almost impossible to find coverage. Not just affordable coverage. ANY coverage. You see, insurance companies can offer affordable insurance to companies because grouping people together mitigates risk. But one lone person… not so much. So insurance companies would decide most normal people weren’t worth the risk and refuse to sell them a plan. I know because this happened to me and a lot of arguably very healthy people I know. Then if you were lucky enough to find an affordable plan, it likely had an obscene deductible. Or even better. If you tried to use the coverage for anything substantive, the insurance company would fight tooth and nail to avoid paying. No excuse was too ridiculous for the insurer to use to attempt to weasel out of giving you the coverage you’d paid for. Thanks to the ACA, this no longer happens with regularity.

 

Did I mention Obamacare is not a thing? Because it’s also not a health insurance plan. The ACA required the states to set up marketplaces (or exchanges) where people can comparison shop for private health insurance plans. Did you catch that? Private insurance plans. Not government-run health care. Private companies selling private plans. 14 states have their own marketplaces. 36 states use Healthcare.gov because Republican governors and legislators refused to work with the Obama Administration and do their part to set up something on their own. The ACA accounted for this possibility by saying if you don’t do it, the federal government will. So no matter whether you go to a state site like CoveredCalifornia.com or bewellnm.com or Healthcare.gov, you now can comparison shop for an individual plan – a private health insurance plan – which is something you couldn’t do before the law passed.

 

“But it’s so expensive!” Is it? Well, for me, it’s not cheap because my income fluctuates year to year, and I cannot claim I make under 400% of the poverty level so I have to pay full price. BUT… if you make less than 400% of the poverty level, you can get help paying for your health insurance. Obamacarefacts.com explains this well:

 

Americans making under 400% of the Federal Poverty Level (FPL) may qualify for cost assistance through the marketplace.  Cost assistance includes: reduced premiums via tax credits for those making between 100% – 400% FPL, out-of-pocket cost assistance (on Silver plans only) for those making between 100% – 250% FPL, and Medicaid for those making under 138% FPL (if their State has implemented Medicaid expansion).

 

“Costs keep going up!” Yes, yes they do. But they always have, and they actually are going up at a slower rate now than before we passed the ACA. Cost control is a big part of why we needed national health care reform so badly. Unfortunately, getting reform through Congress was tough (I know because I was there), and one of the great mechanisms for cost control – the public option – died in the process. Having a government-run health insurance plan as one choice in the marketplace (think Medicare) would have forced the private insurance companies to offer competitive prices and reasonable networks. Instead, they continue to operate mostly unchecked, and they set the prices as high as they think they can go. Access to health care is not like a regular consumer good. If you get sick, you have to see a doctor or get medical care. Insurance companies are the gatekeepers to care in this country. They know this and take advantage by charging whatever the market will bear. So where the ACA fell short was in not including the cost control mechanism we needed most.

 

HOWEVER… this does not mean you scrap the law that has a lot of other great parts to it and start from scratch. You get in there and make it better. You build on the good parts and improve on the ones that need fixing.

 

“But, Jacki,” you’re thinking, “I’m still really mad about my costs going up. I’m angry. And it’s called Obamacare so I blame Obama.”

 

Congratulations. You’ve been manipulated by the insurance industry… twice. They control costs. No one else. There is no government-run health insurance plan. If anything, the government doesn’t have the muscle to go far enough and stop the insurance industry from taking advantage of you. Oh, and insurers LOVE that it’s now called Obamacare because they want you to blame the President. It lets them off the hook.

 

Health care policy isn’t easy to understand and plenty of stakeholders are glad you won’t have the time to dig into it. But if you do, you will learn that the ACA was a good first step in the right direction, and the key now is to harness that frustration and use it to continue to fight the injustice.

 

Just make sure you’re aiming in the right direction.

 

 

 

 

 

 

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