With the announcement by Speaker Paul Ryan (R-WI) of the first pieces of the House plan for “repealing and replacing” the Affordable Care Act, it’s becoming clear that not only are Republicans confronting the complexities of governing vs. the simplicity of obstructing, they are also nowhere close to delivering on President Trump’s promise of “better health care for more people at a lesser cost.”
Immediately following Inauguration Day, the administration’s first step was to halt the final 10 days of consumer outreach to publicize the deadline for 2017 open enrollment, canceling public service announcements and $5 million in ads that had already been paid for! This, despite the first—and most fundamental—rule of insurance: the bigger the pool of enrollees, the more risk is spread and the greater the savings.
Now, a month later, two committee chairs, Sen. Lamar Alexander (R-TN; Health), and Sen. Orrin Hatch (R-UT; Finance), on the advice of a pollster, are leading the shift in GOP rhetoric: to “repair” (not “repeal” or “replace”) the ACA. This actually is progress. We should applaud it – while vigilantly opposing all efforts to dismantle central provisions of the ACA.
Legislative “repair” has a historical tradition: both Social Security and Medicare have needed tweaks along the way. And Republicans are now waking up not only to several provisions of the ACA that are well known and popular; they are also beginning to recognize other parts of the law that, while largely unacknowledged as ACA provisions, help everyone, whether they have employer-provided insurance, private coverage, or bought a plan on a state/federal marketplace.
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The most popular with consumers are two ACA provisions: one that prevents denial of coverage due to a pre-existing condition—this affects more than a quarter of all adults under 65—and another that allows coverage of a child under 26 on a parent’s policy.
There are a number of other important—but largely unrecognized—provisions that must be protected. For example, thanks to the ACA men and women today pay the same premiums, which now can vary only with age, geography, and smoking status.
Remember all the middle-class, employed people struggling with ruinous medical bills because their insurance covered only a fraction of the costs of a life-threatening diagnosis and the personal bankruptcies that ensued? Those caps limiting insurance policies’ lifetime, and annual, payments have been eliminated. Instead, thanks to the ACA, we now have caps on an individual’s or family’s annual health care costs.
The ACA provides that mental/behavioral health coverage be offered on par with physical health. This includes treatment for depression, addiction, and a host of other serious, yet widespread, health problems. Think of the impact on children when a parent suffers, untreated. Numerous studies confirm that healthier parents mean healthier children.
By now, the benefits of preventive care are, surely, accepted by all: emergency room care is the most expensive, least efficient way to treat preventable illnesses and conditions. The ACA requires basic, minimum coverage; and it requires that preventive care be offered without co-pays and without meeting deductibles. These include well-baby checkups, flu shots, colonoscopies, mammograms, contraception, diabetes screenings, prostate and cervical cancer screenings. And the ACA provides an important phase-out of the Medicare prescription “donut hole” by 2020, insuring that the elderly will not be forced to choose between rent and medicines.
Finally, and also little recognized, are provisions that limit what insurance companies can spend on marketing and administration, including executive compensation, and that require insurers to provide policy descriptions in a uniform format.
The ACA isn’t perfect, but it has delivered health insurance to 20 million previously uninsured people; and overall program costs are running below estimates. The challenges now are to create incentives to lower costs by focusing on outcomes rather than procedures and to further enlarge the pool (spreading the risk) by enrolling more young, healthy people and by extending coverage to those millions nationally (and an estimated 500,000 North Carolinians) who are stuck in the health care gap, too poor to qualify for ACA subsidies and ineligible for Medicaid.
Good health is necessary for a competitive, productive workforce, for a stable economy and a stable society. To make lasting “repairs,” we must vigorously defend the ACA’s central provisions and complete its original intent: making affordable, quality health care a right, not a privilege – no matter what we call it.
Kate Douglas Torrey was an ACA Certified Application Counselor from 2013-2015.