Keep the law — and work to improve the health system and the lives of those who benefit
Should Obamacare be repealed, replaced or left alone?
To answer this question, one must first consider the reason the Affordable Care Act was created and then examine the moral and societal implications of the health-care system of the richest country in the world unable to ensure 41 million residents have quality, affordable, accessible, comprehensive health care.
The Affordable Care Act, the most significant piece of legislation since the Civil Rights Act, promises to improve health care equity. Is this promise necessary? Consider the rising cost of health care that has been straining the wallets of American families, the balance sheets of our businesses, and the long-term health of our federal budget. Consider the growing number of uninsured: 41 million people in 2013. In Illinois, 1.8 million, or 14 percent of the population, were uninsured.
Now, consider the benefits of the ACA.
In order to achieve quality, accessible, affordable, comprehensive health care for all, the Affordable Care Act sets standards to ensure that all plans in the new health insurance exchanges cover a comprehensive set of necessary services and it offers protections for consumers.
In all states, It provides government paid health-care coverage (Medicaid) to those living at or below 100 percent of the Federal Poverty Level ($11,670 for an individual and $23,850 for a family of four). In states that expanded Medicaid, it provides that health care coverage to individuals living at or below 133 percent of the Federal Poverty Level ($15,521 for an individual and $31,721 for a family of four).
The Affordable Care Act improves the health insurance marketplace by strengthening consumer protections and providing consumers with the information they need to choose the best health care coverage for their families.
It reduces waste, fraud, and abuse saving taxpayer dollars: $143 billion over the next 10 years, and $1.2 trillion more over the following decade; thereby, protecting the health-care investments made by individuals, businesses and government.
Health-care reform makes insurance premiums more affordable and reduces out-of-pocket expenses for lower and middle income individuals and families. It provides sliding-scale tax credits for individuals and families with incomes above the Medicaid thresholds but below 400 percent of poverty. It prohibits insurers from limiting coverage for individuals or families through annual or lifetime limits. It also protects individuals and families, either self-insured or insured by their employer’s new plan, from catastrophic costs by placing a cap on total out-of-pocket spending.
Health-care reform will ensure that all Americans have access to quality, accessible, affordable, comprehensive health-care coverage through shared responsibility among individuals, businesses, and the government. Individuals will also be responsible for purchasing health insurance coverage, and most employers will be responsible for offering coverage. Individuals, employers, and the government are all responsible for contributing to the cost of coverage.
The Affordable Care Act will create state‐based Health Insurance Exchanges, for states that choose to operate their own exchanges, and a multi‐state exchange for the others. The exchanges will make health insurance more affordable and accessible for small businesses and individuals.
Reducing rising health costs and improving quality requires doctors, hospitals and other providers to work together to ensure they provide the right care to the right patient at the right time. Rather than rewarding the quantity of care, payment systems are being modernized to reward high quality care. Realigning payment incentives will reduce waste, slow the growth of health-care costs and improve health outcomes.
During the first enrollment period in 2013, approximately, 7.3 million uninsured moved to the ranks of the insured. In Illinois, the number was 670,000. Estimates for the second enrollment period, which is currently ongoing, are that those numbers will double. For taxpayers this means we are now only eight years away from realizing that $143 billion savings. Those savings are realized as covered individuals and families now make more informed and smarter choices about how they access health-care services. As a result, the health-care delivery system is forced to respond to the needs of the consumer by improving access to services, reducing costs and improving the quality of care. Additionally, these continuing improvements move the health-care focus to preventive care rather than emergency care; thus, moving us ever closer to that $143 million savings.
Now, we come to the moral and societal implications of the Affordable Care Act. Should it be repealed, replaced, or left as is? If as a society, we want to widen the gap of the “haves” and the “have nots,” then by all means repeal the law. But, do not hide behind righteous morals. Admit that, as a society, we do not want our neighbors to improve their lives by having access to the same benefits we enjoy. Admit that health care is not a priority. Admit we are content to spend the majority of our health-care dollars on chronic illness and mental illness, when they can be controlled at reduced costs with the appropriate health-care delivery systems in place. Admit a healthy community, neighborhood, state, country is of little to no value.
Repeal or replace? Neither of these should be an option. Listening to the stories of those people enrolled in the ACA by the Campaign for Better Health Care, each person is thrilled to be insured, have an affordable plan, and has been using the plan with success. Why would we want to take that away? Our energies should be spent ensuring continuous cost improvements, continuous quality improvements, and consumer education and engagement to develop a literate health care user who will hold accountable the insurance industry as well as the health-care delivery system.
Joan Sheforgen is the interim executive director of Campaign for Better Health Care, an Illinois-based coalition of health care advocacy organizations working to ensure quality, accessible, affordable, comprehensive health care for all.