[Peace-discuss] Fw: Beyond the spin, some facts about the Affordable Care Act

[David Johnson]

----- Original Message ----- 
From: David Johnson 
Sent: Wednesday, October 16, 2013 9:42 AM
Subject: Beyond the spin, some facts about the Affordable Care Act


" What we are hearing in the US is fear-mongering from extreme right-wing groups, 
who have gone so far as to shut down our government in their attempt to remove 
funding for the health law, and deceptions from Democrats and their front groups 
about the virtues of the ACA. 
In fact, the ACA was 
born in a right-wing think tank, the Heritage Foundation, and is only supported 
by "progressives" because it was passed by a Democratic president. "

Beyond the spin, some facts about the Affordable Care Act

The ACA will actually hinder efforts towards adopting a single-payer system, 
writes health care reform advocate.

By Dr. Margaret Flowers
Al Jazeera, October 14, 2013


On the first day that the new health insurance exchanges went into effect as 
part of the new health law, the Affordable Care Act (ACA), I was caught off 
guard by a question asked by Bruce Dixon of the Black Agenda Report. 

I was prepared to detail the complexities of the ACA, but Dixon's only question was:

"What would it be like if this was the first day of a single-payer health 
system?"

Most media outlets in the US are solely focused on the ACA - either promoting it as a positive step or calling for its repeal.  This limited debate 
misses the facts that a single payer health system, also called Medicare for 
all, would both resolve the fundamental failings of our current system and is 
the solution favored by most Americans.

What we are hearing in the US is fear-mongering from extreme right-wing groups, 
who have gone so far as to shut down our government in their attempt to remove 
funding for the health law, and deceptions from Democrats and their front groups 
about the virtues of the ACA. This is what happens when a basic issue such as 
health care is determined by politics instead of policy. In fact, the ACA was 
born in a right-wing think tank, the Heritage Foundation, and is only supported 
by "progressives" because it was passed by a Democratic president.

I suspect this manufactured confusion may sort itself out over time as more 
people discover that having health insurance in the US doesn't guarantee access 
to necessary care. In the meantime, I will try to cut through the spin and 
hyperbole to explain why the ACA is not a step in the right direction and what 
health care would look like if we implemented a publicly-financed "Medicare for 
All".

Here are the top three facts that need to be addressed:

. The rise of health care costs are slowing, but not because of the ACA.

. More people will have health insurance but that doesn't mean they will have 
access to health care.

. The ACA further privatises our health care system, which is the opposite of 
single payer.

White House spokesperson Jay Carney stated numerous times recently that the 
slowing of the rise of health care spending in the United States is a result of 
the Affordable Care Act. In fact, the slowing of total health care spending 
actually began after the economic crisis of 2008, which was prior to the ACA 
being signed into law in 2010. As I wrote earlier this year, the slowing of 
health care spending was due to self-rationing. As more of the cost of health 
care is shifted onto the individual, we see less utilisation of health services.

For example, a recent report found that low-income workers with health plans 
that required high out-of-pocket payments in Massachusetts did not go to the 
emergency department for serious medical conditions because of the costs. They 
had 25 to 30 percent fewer visits, whereas high income workers with similar 
plans did not reduce their visits. A health survey from 2012 found significant 
increases in the number of people who did not get care because of the cost (80 
million total), who had difficulty paying medical bills (75 million) and who 
went into bankruptcy as a result (4 million over 2 years).

It is not likely that the ACA will have a positive effect on health care 
spending, by which I mean making health care more affordable. As economist Dean 
Baker writes, we will continue to pay high prices for medications, medical 
devices and physicians. Although there are proven methods to control health care 
costs such as simplified administration, global budgets and negotiating bulk 
prices, none of them were included in the ACA. In fact, the ACA increases our 
already enormous administrative costs by adding new levels of administration to 
our health system.

While it is true that because of the ACA more people will have health insurance 
in the US, what is not discussed is that tens of millions of people will still 
be without health insurance of any kind. There are 48 million people without 
insurance and that number is expected to fall to 31 million in 2019. Although 
historically in the US, estimates of new coverage are always overblown. At the 
state level, similar new programs that were predicted to lead to universal 
coverage fell far short of their goals and ultimately failed completely. Even 
though, because of the ACA, young adults up to the age of 26 can stay on their 
parent's health plans, this has had only a tepid effect. The percentage of 19 to 
26 year olds without insurance has fallen from 48 to 41.

Health insurance does not equate to healthcare

In the US, having health insurance does not guarantee access to necessary health 
care. The ACA will increase the number of people who have inadequate insurance 
which requires high out-of-pocket costs and does not cover all necessary 
services. This trend towards underinsurance has been growing steadily over the 
past decade so that currently about one-third of employer-based health insurance 
and half of individual plans are high-deductible plans. It is expected that in 
2014, 44 percent of major US companies will only offer high-deductible health 
plans.

The ACA has significantly lowered the bar for what is considered to be adequate 
health insurance coverage. On the new health insurance exchanges, plans are 
offered based on four tiers. The Platinum plans will pay for 90 percent of 
covered care and Bronze plans, the lowest tier, will pay for 60 percent of 
covered services. It is important to distinguish that these levels are only for 
covered services because people don't usually understand that they will have to 
pay for uncovered services and out-of-network services. Unfortunately, the use 
of out-of-network services is often involuntary and occurs without being known 
at the time of care, especially in emergency situations.

Subsidies are being offered to help people purchase insurance. These exist on a 
sliding scale for people who earn 133 to 400 percent of the Federal Poverty 
Level (FPL). If an uninsured person earns below 133 percent of the FPL and lives 
in one of the 26 states that did not expand their Medicaid programs, that person 
is likely to be out of luck. And the subsidies only apply to the Silver plans, 
which cover 70 percent, or to higher level plans. Because the subsidies are 
believed to be inadequate, it is expected that many people will choose the least 
expensive Silver or Bronze plans.

Subsidies can only be used to purchase plans in the state or federal exchanges. 
Employees will not qualify for subsidies to purchase insurance offered by their 
employer; but if what their employer offers costs above a certain percentage of 
their income, they can purchase insurance on the exchange and possibly receive a 
subsidy. Some employers will stop offering insurance and will instead provide 
what is called premium support, or funds that can be used for buying insurance. 
And some employers will decrease their employee's hours below the 30-hour per 
week threshold that relieves them from the mandate to provide insurance or pay a 
penalty. These actions will push more people into the exchanges.

Pre-existing caveats

Insurance companies have a long history in the US of skirting regulations that 
interfere with profits. So, while insurers can't exclude sick people, they can 
avoid areas where there are sick people. For example, several of the large 
insurance companies are selling plans on only a small number of exchanges, 
preferring to sell plans mostly to businesses instead. And companies that sell 
plans on the exchanges are restricting their networks. They avoid hospitals that 
care for complicated patients and keep the number of doctors in their plans low, 
making it more likely that people will have to go out of network and pay more of 
the costs of care.

And while companies can't charge more to people with health problems as 
individuals, they can charge up to three times more based on age and can charge 
more in geographic areas where the population has more health problems or the 
costs of care are higher. It is expected that if a company finds they can't make 
enough profit in a particular area, they can just pull their plans from that 
area. These are some of the most obvious ways that insurers will game the 
system. The largest insurance companies assisted with writing the law and then 
with the regulations that accompanied it, so we will see what other tactics they 
employ as time goes on.

The new health system is complex by design because that inhibits transparency 
and accountability. Imagine what we would be seeing right now if instead of the 
ACA, we had passed HR 676, also known as Expanded and Improved Medicare for All. 
This would have created a single publicly funded non-profit universal and 
comprehensive national health insurance. Overnight, everyone living in the US 
would be eligible for care without financial barriers. Any person who showed up 
to a health facility for care would be admitted because they would be 
automatically enrolled. Every person would have the right to receive the care 
they need rather than the care they can afford.

Some people believe that the ACA is a step towards a Medicare for all health 
system, but it actually takes us towards greater privatisation of our health 
system which is the opposite direction. Over a trillion dollars of public funds 
will go directly to private insurance companies to subsidise the purchase of 
inadequate health plans. Nothing was done to stem the tide of large health 
corporations that are acquiring and consolidating health facilities. And since 
the ACA was passed in 2010, our public insurances, Medicaid and Medicare, have 
become more privatised. Private Managed Care organisations are taking over 
Medicaid plans. And Medicare Advantage plans, private insurance plans that are 
more expensive than traditional Medicare, were supposed to be curtailed by the 
ACA but have actually grown by more than 30 percent.

We have not changed the fundamental problem with the health care system in the 
US: that health care is treated as a commodity to be bought on the market rather 
than as a good that all people need. In fact, the dominant message in the mass 
media is that the ACA has created a health insurance marketplace as if this is a 
good thing for patients. The United States is the only industrialised nation 
that uses a market-based health system and it has clearly failed. The US spends 
the most by far on health care and has low life expectancies and poor health 
outcomes to show for it. I often say that if our health system was a medical 
experiment, it would have to be stopped for ethical reasons.

Perhaps television comedian Jon Stewart summed it up the best when he recently 
said, "I don't understand the idea of staying with a market-based solution for a 
problem where people can't be smart consumers. There are too many externalities 
in health care that I honestly don't understand, why businesses would jump at 
the chance to decouple health insurance from their responsibility, and why the 
government wouldn't jump at the chance to create a single-payer that simplifies 
this whole gobbledegook and creates the program that I think America deserves."

Only a single payer, Medicare for all health system will begin to correct the 
many problems with the health care system in the United States. Grassroots 
groups across the country continue to organise support for Medicare for all. And 
just as similar groups did in Canada and Mexico, we believe that one day we will 
succeed as well. We aspire to join the ranks of civilised countries who 
understand that a healthy population makes a better society and is best achieved 
through national health insurance.


Margaret Flowers, MD, served as Congressional Fellow for Physicians for a 
National Health Programand is on the board of Healthcare-Now. She is co-director 
of It's Our Economy and co-host of Clearing the FOG Radio Show.
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