Monday, December 9, 2013
So, what is this thing called Obamacare?
The Affordable Care Act will allow Americans who are uninsured or who buy individual policies – about 15 percent of the population – to participate in the new health insurance exchanges.
That was the question posed by Maine Sen. Angus King in a floor speech in Washington last week that followed a 21-hour oration by Texan Ted Cruz. In about 21 minutes, King answered his own question, dispelling five years of smokescreen and horror stories that Cruz and the anti-Obamacare forces have been churning up to derail a much-needed reform to a torn part of our social fabric.
Anyone who thinks that he is no closer to understanding what the law will do for him -- or to him -- after hearing all the debate would be well-served by looking up King's speech and receiving a clear and concise summation of what's really going on. As the new health insurance exchanges open for business this week, millions of uninsured Americans will find out that the law makes health care more available and affordable. And they will see that what's really driving Cruz and the others to keep this day from coming has been the fear that Americans will like Obamacare -- not the fear that it will ruin our economy or the quality of our health care system.
In his speech last Wednesday, King explained what Obamacare is by first saying what it is not -- a government takeover of the health care industry. About half of the people in the country currently receive private health insurance through an employer, and they will not be affected. Another 22 percent are on Medicare and 7 percent on Medicaid; they will not see any change, either.
Only those Americans who are uninsured or who buy individual policies -- about 15 percent of the U.S. population -- will be participating in the new system, which is a market built on the concept that group purchasing and competition will spread risk, create efficiencies and lower rates.
NO GOVERNMENT TAKEOVER
"This idea that somehow Obamacare is taking over the health care industry in this country is just nonsense," King said. "There is no place in America you can go and sign up for Obamacare. If you go onto an exchange ... you get insurance coverage from private insurance companies, just as we have done in this country (for decades)."
The effect of the law for more people, King said, would be the way it cleans up some of the worst practices of the health insurance industry.
There are no more lifetime caps on benefits. No one can be refused coverage because of a pre-existing condition -- which is why everyone is required to participate by buying insurance. Otherwise, King said, people would wait to pay until they got sick, which would be like letting you sign up for fire insurance after the flames started licking your roof.
And in the many pages of the law called Obamacare, there are pilot programs designed to develop different ways of paying for health care than the inefficient and medically ineffective fee-for-service system through which most care is delivered in this country.
Payment reform could bring down costs while providing better care. That includes an emphasis on preventive care, which, King said, saved his own life when he developed skin cancer as a young man. Without health insurance, he said, he probably would not have visited the doctor who identified the disease in time.
There are about 50 million uninsured Americans, and an estimated 25,000 of them die each year of conditions that could have been avoided with timely care. Another 700,000 people are bankrupted by medical bills every year, King said. This is the only country in the industrialized world where that could happen.
Starting Tuesday, uninsured Americans will be able to buy health insurance on the state exchanges, in many cases receiving federal subsidies making high-quality insurance coverage affordable to them for the first time. Opponents of the law have done everything they could to stop this day from coming, including taking their case to the U.S. Supreme Court and losing.
MAINE AMONG THE HOLDOUTS
Maine is one of 22 states that have refused federally funded Medicaid for people with incomes just over the poverty line, because of our governor's obsessive hatred of government programs that help people in need.
Now Obamacare opponents in Congress threaten to shut down the government if they can't defund the law, but even then they will not be able to stop it: If the government shuts down, the president decides which programs are essential. As long as the president is named Obama, Obamacare will be on the list.
Former House Speaker Nancy Pelosi will go down in history for saying that Congress would have to pass the Affordable Care Act before members could know what was in it. The quote may be famous, but that's not what she said.
Speaking in 2010 to an association of people who work in county governments, Pelosi complained about how unfounded criticism of the bill had eclipsed real discussion of its merits.
"I know you've heard about the controversies within the bill," she said. "But I don't know if you've heard that it is legislation for the future. That it's not just about health care for America but about a healthier America. ... It's going to be very, very exciting. So we have to pass the bill so that you can see what's in it, away from the fog of the controversy."
Three years later, the fog of controversy still hovers, but it's about to lift. We are sure to find areas where the Affordable Care Act needs to be stronger, or where it creates unintended negative consequences -- no piece of legislation is perfect.
But we should also see that this is a law that will make health care affordable to millions and save lives. And as Sen. King explained so well, it's nothing to be afraid of.