As the GOP aligns their membership to repeal the Affordable Care Act (ACA), now is a good time to consider some of the problems it was intended to address.
Prior to enactment of the ACA, poor and indigent folks relied upon community clinics and emergency rooms for health services. The cost of their treatment was covered by states, charities, local communities and Medicaid. Uninsured folks with moderate income sometimes incurred large medical debt that could overshadow other concerns for years.
The number of uninsured non-elderly dropped by more than 13 million after the enactment of the ACA. This number could have been higher if 19 GOP-controlled states did not refuse to accept federal dollars to expand their Medicaid programs. The result of their refusal is that millions of otherwise-eligible Americans did not qualify for Medicaid and thus continue to find health insurance too expensive for their budgets.
By refusing federal assistance, 19 states assured that health insurance would remain too expensive for many of their elderly, fixed-income and low-income wage-earners whose employers did not offer health-insurance benefits. States that refused Medicaid expansion dollars have seen the lowest drop in number of uninsured.
The ACA includes a mandate for individual coverage. A modest but increasing fine is levied against those who do not sign up. The mandate is a controversial feature but it is the linchpin that makes other beneficial features possible. Without a mandate for coverage, insurers would not have enough younger, healthier people on their rolls to ensure an adequate base of premiums to cover the sick and elderly.
Under the ACA, there is no exclusion for pre-existing conditions, lifetime benefit caps are eliminated, preventative services and immunizations are covered at zero or low co-pay, parents can keep children on their plan up to age 26, coverage for substance abuse and mental health counselling is mandated, the so-called “doughnut hole” in Medicare coverage would be eliminated by 2020, and finally, the ACA is projected to reduce the federal deficit by 143 billion over 10 years by shifting costs to health-care providers, pharmacies and raising taxes on the wealthy.
Health-care providers frequently charge the uninsured higher rates for service than those negotiated with an insurance provider. Going without health insurance has the effect of raising rates for everyone, just as an uninsured motorist transfers their property damage and medical care liability to those that buy coverage. We need the mandate for coverage in health care for the same reason it’s mandated for motorists.
Please write your elected representatives to express your personal experience with health care and your point of view on the impending repeal of “Obamacare” and the associated effort to privatize Medicare.