The Affordable Care Act (Obamacare) is a big bill. I was one of the nerds that read the entire bill and posted the text at my website. I must admit it was not fun and took several days to read. To be clear, because of the manner in which bills are written where it must reference other laws, reading any bill is daunting and error prone. One would imagine that for those exact reasons within any bill there are unintended consequences that must be subsequently fixed.
The employer mandate was delayed one year likely for political reasons as well as to give employers who have been dragging their heels more time to adapt. They may have thought the GOP would be successful in their attempt to take over the Whitehouse and kill the law. Insurance companies will be allowed caps for one more year, likely for political reasons as well as to keep rates lower in particular markets. Of course the excuse was computer system incompatibilities.
For the record, I support this bill only because it was the best attainable compromise in a political system owned and paid for by a corporatocracy. It is a mathematical fact that only a single payer system (Medicare for all) can attain maximal efficiencies. I discussed this at some length in the article “Immorality Of Health Insurance”.
Even after years of lies and misinformation as well as the above mentioned hiccups, Obamacare is marching forward. Many have already benefitted from those preventative screenings (colonoscopies, breast exams, etc.) that must be part of every plan at no additional cost. Many with pre-existing conditions will find insurance in the exchanges on October 1st at costs no different than their neighbors or major employers. All pregnant mothers will finally get the pre-natal care they do not currently receive. America will no longer be at the bottom of the list in childbirth mortality. Parents with kids in school or searching for jobs can keep their loved ones on their health insurance policies till they are 26.
Paul Krugman latest New York Times article “One Reform, Indivisible” lays out the why of how Obamacare was written.
There’s no way he would undermine the reform at this late date.
Republican leaders seem to get this, even if the base doesn’t. What they don’t seem to get, however, is the integral nature of the reform. So let me help out by explaining, one more time, why Obamacare looks the way it does.
Start with the goal that almost everyone at least pretends to support: giving Americans with pre-existing medical conditions access to health insurance. Governments can, if they choose, require that insurance companies issue policies without regard to an individual’s medical history, “community rating,” and some states, including New York, have done just that. But we know what happens next: many healthy people don’t buy insurance, leaving a relatively bad risk pool, leading to high premiums that drive out even more healthy people.
To avoid this downward spiral, you need to induce healthy Americans to buy in; hence, the individual mandate, with a penalty for those who don’t purchase insurance. Finally, since buying insurance could be a hardship for lower-income Americans, you need subsidies to make insurance affordable for all.
So there you have it: health reform is a three-legged stool resting on community rating, individual mandates and subsidies. It requires all three legs.
Krugman then explains that it is working and why those opposing the bill will pay a price for not being on board.
I guess that after all the years of vilification it was predictable that Republican leaders would still fail to understand the principles behind health reform and that this would hamper their ability to craft an effective political response as the reform’s implementation draws near. But their rudest shock is yet to come. You see, this thing isn’t going to be the often-predicted “train wreck.” On the contrary, it’s going to work.
Moreover, all the early indications are that the law will, in fact, give millions of Americans who currently lack access to health insurance the coverage they need, while giving millions more a big break in their health care costs. And because so many people will see clear benefits, health reform will prove irreversible.
This achievement will represent a huge defeat for the conservative agenda of weakening the safety net. And Republicans who deluded their supporters into believing that none of this would happen will probably pay a large personal price. But as I said, they have nobody but themselves to blame.
Health insurance exchanges open on October 1st. As a last ditch effort, many Right Wing and Conservative organizations are spending millions to convince Americans not to sign up hoping that that would cause the program’s failure. That is an immoral act but one that is expected as to those folks ideology trump American’s well-being or basic humanity. Every American must disregard the deception and visit http://healthcare.gov for factual information. Remember, if you are uninsured or underinsured, October 1st is the day you reclaim your healthcare rights.