Prescription for a GOP Disaster: ACA Exchanges

StethoscopePerhaps one of the most intriguing narratives out there in Media-Land is that the Affordable Care Act is just taking effect as of October 1, 2013.  Not quite true.  The exchange marketplaces are the feature coming on line soon.  On October 1 Nevadans who don’t have health care insurance can select from plans offered by insurance companies participating on the exchanges (markets).   Health.gov explains:

“If you live in Nevada, the Nevada Health Link is the Health Insurance Marketplace to serve you. Instead of HealthCare.gov, you’ll use the Nevada Health Link website to apply for coverage, compare plans, and enroll. You can apply as early as October 1, 2013. Visit the Nevada Health Link now to learn more.”

For more information about how the Affordable Care Act helps Nevadans there’s a summary  from the NRDC, which notes the provisions already assisting our citizens, and RabbitRancher, who explains some basic points about the fundamentals.   For a quick and concise debunking of some of the recent GOP fearmongering about the Affordable Care Act click over to Politico for David Nather’s mythbusting.

Meanwhile, GOP efforts to repeal, sabotage, or otherwise obstruct the implementation of the Affordable Care Act are relying on ever more bizarre, generalized, and antiquated arguments.   It seems too many people have discovered that the reality of the Affordable Care Act isn’t as dismal as the mythology expounded by the radical right.

Senior citizens have discovered that the ACA extends the life of the Medicare Hospital Insurance Trust Fund, provides preventative care and health screenings without out of pocket expenses, and reduces prescription drug expenses.  They’ve found out that those preventative care/screening benefits include mammograms, colonoscopies, and immunizations — all without co-pays and deductibles.   [AmProg] Thus much for the old Death Panels.

Families have discovered the ACA prevents insurance corporations from refusing to offer coverage to those with pre-existing medical conditions.  They’ve also discovered they could possibly get some assistance paying for the premiums:

“For families making less than 400 percent of the poverty line, premiums are capped. So, between 150% and 200% of the poverty line, for instance, families won’t have to pay more than 6.3 percent of their income in premiums. Between 300 percent and 400 percent, they won’t have to pay more than 9.5 percent. This calculator from the Kaiser Family Foundation will let you see the subsidies and the caps for different families at different income levels.” [WaPo]

In short, the more provisions of the ACA implemented, the more people like the reforms in our health insurance system.  However, this has been the case from the beginning — while polling showed opposition to “Obamacare” in general, when people were asked about the individual elements they liked what they saw.

Obamacare popular

Thus the highly generalized, over-wrought, objections from right wing are still out there in Media-Land but a few isolated incidents may indicate the GOP is realizing its worst fears — the act will end up being popular.  Case in point, we have Senate Minority Leader McConnell (R-KY) sputtering out that there are a “handful of things” in the ACA which are “probably OK,” then Senator McConnell lapsed back into generalities, “I mean, there are a handful of things in the 2,700 page bill that probably are OK,” he told the Kentucky TV station WYMT. “But that doesn’t warrant a 2,700 page takeover of all American health care.”

What’s In A Handful?

Memo to Senate Minority Leader McConnell: There is NO 2,700 page takeover of all American health care.

For better, or worse, the Affordable Care Act is primarily concerned with health care insurance — not health care in general.  The idea was to promote more comprehensive health care insurance to more people, to wit — the marketplace exchanges:

“When you use the Health Insurance Marketplace, you’ll fill out an application and see all of the health plans available in your area. You’ll find out if you can get lower costs on your monthly premiums for private insurance plans. You’ll learn if you qualify for lower out-of-pocket costs.”

Therefore, if the law is primarily about reforming health care insurance,  what is in those ten major sections in the Affordable Care Act?

Title I includes improvements in health care insurance coverage,  establishes the insurance marketplaces, and the preservation of the right to maintain existing coverage.

“It also reduces what families will have to pay for health care by capping out-of-pocket expenses and requiring preventive care to be fully covered without any out-of-pocket expense. For Americans with insurance coverage who like what they have, they can keep it. Nothing in this act or anywhere in the bill forces anyone to change the insurance they have, period.”

Title II “extends Medicaid while treating all States equally.  It preserves CHIP, the successful children’s insurance plan, and simplifies enrollment for individuals and families.”

Title III concerns Medicare to ” protect and preserve Medicare as a commitment to America’s seniors.  It will save thousands of dollars in drug costs for Medicare beneficiaries by closing the coverage gap called the “donut hole.”  Doctors, nurses and hospitals will be incentivized to improve care and reduce unnecessary errors that harm patients.  And beneficiaries in rural America will benefit as the Act enhances access to health care services in underserved areas.”

Title IV “…empowers families by giving them tools to find the best science-based nutrition information, and it makes prevention and screenings a priority by waiving co-payments for America’s seniors on Medicare.”   This is the part wherein elderly Americans get those cancer screenings and immunizations without breaking the piggy bank.

Title VThe Act funds scholarships and loan repayment programs to increase the number of primary care physicians, nurses, physician assistants, mental health providers, and dentists in the areas of the country that need them most.”   So, how does increasing scholarships and loan repayment assistance for young people training to be health care providers constitute a “takeover” of the health care system?

Title VI provides access to physicians to cutting edge medical research and “promotes nursing home safety by encouraging self corrections of errors, requiring background checks for employees who provide direct care and by encouraging innovative programs that prevent and eliminate elder abuse.”  Further, it addresses reining in waste, fraud, and abuse.   Promoting medical research and  nursing home safety just might be included in that “handful?”

Title VII It “…extends drug discounts to hospitals and communities that serve low-income patients. And it creates a pathway for the creation of generic versions of biological drugs so that doctors and patients have access to effective and lower cost alternatives.”  What do we want? More expensive prescription drugs?

Title VIII  establishes “a self-funded and voluntary long-term care insurance choice. Workers will pay in premiums in order to receive a daily cash benefit if they develop a disability. Need will be based on difficulty in performing basic activities such as bathing or dressing.  The benefit is flexible: it could be used for a range of community support services, from respite care to home care.”  (emphasis added) So, we’re not in favor of developing long term disability insurance plans for those who need assisted living?

Title IX  Includes the great GOP panacea for  all ailments — tax cuts. “The Act makes health care more affordable for families and small business owners by providing the largest middle class tax cuts for health care in American history.  Tens of millions of families will benefit from new tax credits which will help them reduce their premium costs and purchase insurance. Families making less than $250,000 will see their taxes cut by hundreds of billions of dollars.” Check me, but didn’t the House vote some 40 times to repeal a tax cut?

Title XThe Act reauthorizes the Indian Health Care Improvement Act (ICHIA) which provides health care services to American Indians and Alaskan Natives. It will modernize the Indian health care system and improve health care for 1.9 million American Indians and Alaska Natives.”  Who wants to defund the Indian Health Service?

And therefore we have a handful of beneficial things for  American citizens — insurance policy market exchanges, more support for Medicare, support for Medicaid and CHIP, screenings and preventative services for the elderly, help for young people entering the health care field, promotion of nursing home safety and medical research, drug discounts, self funded long term disability insurance plans, tax cuts, and and extension of IHS services.

Meet the Public

Perhaps in future sessions with constituents Republican members of Congress might want to answer a few questions — Are you willing to jeopardize the financial standing of the United States in order to prevent Americans from being able to shop for family health care policies in a competitive marketplace?

Are you willing to shut down the U.S. government in order to make senior citizens pay for annual flu shots?  To pay for cancer screenings?  Are you willing to shut down portions of the U.S. government in order to prevent more young people from qualifying for scholarships and loans to continue their medical education?  Are you willing to shut down government in order to bring a halt to efforts to make nursing homes safer? Should we shut down the government to render it harder for physicians to access the results of medical research?   Is shutting down the U.S. government necessary in order to insure senior citizens pay more for their prescription drugs?

And, the answer is …..?  “Freedom…Socialism…Takeover…Benghazi….

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