The Appeal of the Affordable Care Act
In an extraordinary article in The New Republic, Jonathan Cohn offers perhaps the most coherent and easily digestible explanation of the “vision” that Mitt Romney and his conservative allies have for the American health care system, and what they would do if they took control of our government. The bottom line is that up to 58 million Americans will lose health care coverage via the repeal of the Affordable Care Act (“ACA,” or, as Republicans derogatorily refer to it, “Obamacare”) and the virtual dismemberment (under guise of “reorganization”) of Medicare and Medicaid. Romney and his allies will brand this as a return to “small government,” an homage to “States’ rights,” and a defense of the free market. In actuality, it is a defense of industry interests and a continuation of the Republican assault on non-military domestic spending. This cannot work, and will not work.
The American health care system has some of the highest costs and lowest returns of any industrialized nation on Earth. The ACA was designed to break the insurance industry’s stranglehold on health coverage, increase access to health care and Medicaid, reign in premium costs, and encourage streamlining and accountability in the health care delivery system. Fueled by donations from powerful lobbyists, and corporate interests, Republicans would eliminate these important reforms, roll back longstanding Federal insurance programs, and drastically reshape the nature of health care in our country through a radical legislative agenda that would benefit no one other than their political allies. The average American will be left by the wayside: at age 21, with cancer, you will be told that you are uninsurable. At age 42, having lost your job, you will be told that unfortunately you can’t afford coverage for your family, and that there is no longer a Federal option to fall back on. At age 85, you will be told to go shopping for your own health care plan and to navigate the insurance process entirely on your own, despite the fact that you’ve never used a computer. This cannot stand. Under the ACA, it is not allowed to stand. Under Romney’s plan, it will once again, and to an unfathomable extent, be the status quo.
I am a health care lawyer, and have worked extensively on regulations implementing various provisions in the ACA and on tailoring our clients’ health care programs based on new rules and opportunities. While political compromising and legislative gerrymandering have rendered the ACA inadequate in many ways, and while the law and is dense and wildly complicated even to health care professionals, the ACA is nevertheless one of the most important pieces of legislation passed in the United States in decades. Our health care system is broken. Beset by wild procedural prices and medically unnecessary services, lack of preventive care, skyrocketing premium costs, and an insurance industry that systematically denies coverage to those with preexisting conditions, America spends more per capita on health care than any other nation. Our treatment may be the best, but only for those who can afford premiums and copayments, do not have chronic or preexisting conditions, and who have access to employer-based health care. Increasingly, fewer and fewer can and do.
The ACA has and will continue to extended coverage to tens of millions of previously uninsured Americans, while helping reduce budget deficits. Through the creation of State and Federal health insurance exchanges, marketplaces for individuals and businesses to compare, choose, and buy affordable health insurance for high quality care, the ACA will make health care easier to navigate for consumers and small businesses. It contains provisions encouraging collaboration between providers in order to increase transparency and coordinate patient care, reducing duplicitous services and promoting a holistic approach to health care. In a shattered job market where high school and college graduates struggle to find employment and obtain their own health care, the ACA prevents insurance companies from removing children from their parents’ insurance until age 26. It creates opportunities to combat the outrageous health care disparities facing Native Americans. It fights fraud and abuse in the health care system. While still in its infancy and beset by previously unforeseen problems regarding administration and implementation, the ACA is at a net one of the most remarkably beneficial and, as of now, successful Federal programs in decades.
But, listening to Republican talking points, they will tell you that the ACA increased regulations, increased taxes, killed jobs, and was an unwarranted intrusion into an individual’s choice of health care options. This is rather remarkable given that Republicans invented the idea of a public option and that the universal healthcare plan Romney enacted in Massachussetts is incredibly similar to the ACA (and, in fact was in large part the ACA’s inspiration). There may be a kernel of truth to certain Republican claims, and obviously such an overhaul of the system will have its ups and downs. But the vast majority of the coordinated Republican opposition to the ACA is a calculated web of lies and misinformation that is divorced from reality and has been repeatedly proven to be purposefully dishonest (remember “death panels”?).
What motivates this Republican vitriol? In part, it’s their insistence to simply oppose anything that Obama does on principle (making me wish that Obama would nominate the Koch brothers to the Supreme Court and move to rename the United States “Ronald Reagan and Jesus World,” just to see what would happen). More important is the fact that health insurance companies are increasingly heaping cash to Republicans to help maintain their hideous stranglehold on American health care. They resent being told that they can no longer callously tell the sick that they will just have to die rather than receive subsidized treatment. They are wrong.
The ACA is not perfect. It is not a nationwide panacea. But it is an astounding first step toward truly ensuring that the American health care delivery system can provide outstanding levels of health coverage without bankrupting individuals who happen to be sick because they live downstream from a factory, or were born with diabetes, or developed cancer as a child. It has been, and will be, a success. All we need is time. Let’s make sure we have it.