What progressives should know (and be able to explain) about the new law
Last week marked the six month anniversary of the passage of the "Patient Protection and Affordable Care Act" (aka the "health care reform law"). Now, as we look back on that incredibly difficult debate and begin to see some of the new consumer protections take effect, it's increasingly clear that national leaders did the right thing. Despite its many imperfections and all of the politically motivated distortions propagated by politicians and ideologues on the far right, the new law takes several critical steps in the right direction to improve the lives of average Americans.
Unfortunately, there's no getting around the fact that the law is complicated. Short of a simple, straightforward, "Medicare for all" system that would have simply placed all Americans in one big pool (or, in the alternative, a totally unregulated, "every man for himself" system as proposed by the far right), it's simply impossible to design a system that isn't complicated. Indeed, given that health care represents over 17% of the American economy, perhaps a 1,000 page law isn't really all that long.
Whatever the reason for (and necessity of) the bill being so complex, however, it seems certain that confusion and misinformation are at the root of many of its "P.R." problems. This is especially true given the concerted disinformation campaign put together by far right groups and politicians.
Help is available
Fortunately, grasping the basics of health care reform is not impossible. With just a little bit of work, average folks can understand the main provisions of the new law and maybe even explain it to friends and loved ones.
To watch a very effective, balanced, "just the facts, ma'am" summary entitled "Health Reform Hits Main Street," click here and you'll be connected to an interesting nine minute cartoon produced by the folks at the Kaiser Family Foundation. It explores things like the explosion in costs and numerous holes in coverage that afflict our current system and several of the things the new law will and won't do about these and other problems.
The Kaiser site also has a very helpful timeline that provides a short summary of dozens of provisions and when they'll become effective. There are, for instance, 25 separate changes in 2010 alone.
A useful "cheat sheet"
Of course, videos and virtual timelines are nice, but sometimes it's also useful to have a brief and handy list that one can refer to when discussing the issue with friends, colleagues and under-informed relatives. Here, therefore, are 10 key things to know about this important achievement in American public policy making:
#1 – Law is being phased in gradually – Though it was enacted in March, the health care reform law will take several years to fully implement. Right now, we're still just getting started. It will undoubtedly take years to have its full impact. Still, several important improvements have been implemented already. These include, among many others, numbers two through six below:
#2 – Pre-existing conditions – As of last week, insurance plans may no longer deny children coverage based on pre-existing medical conditions or include pre-existing condition exclusions for children. For adults, this protection becomes effective 1/1/14. Until then, there will be "high-risk pools" that will provide at least some coverage to folks with pre-existing conditions.
#3 – No more lifetime limits – As of last week, individual and group health plans are now prohibited from placing lifetime limits on the dollar value of coverage or rescinding coverage except in cases of fraud. Annual limits have also been restricted and will be eliminated in 2014.
#4 – Dependent coverage raised to age 26 - As of last week, all insurance plans must now allow young adults to remain on their parents' health insurance up to age 26.
#5 – Improved Medicare and Medicaid drug coverage – The new law provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010. Further subsidies and discounts that ultimately close the coverage gap begin in 2011. It also ups rebate percentages for a variety of drugs under Medicaid.
#6 – Several other changes are already being implemented – These include new small business tax credits, several improvements to Medicare and Medicaid, and improvements to prevention and medical effectiveness.
#7 – January 1, 2014 is the big day – Though changes and reform will continue to be implemented in 2011 through 2013, 2014 is the year in which the final big changes take effect. These include numbers 8 through 10 below.
# 8 – The individual mandate – This is the biggest, most controversial and most important change. As of the January 1, 2014, all U.S. citizens must have qualifying health coverage or face a tax penalty. The premise behind the mandate is simple: If insurers are going to be required to serve everyone (that is, the law will now say that there will be no more denying coverage to anyone) and place no dollar limits on coverage, it's only fair that people not be allowed to wait until they get sick to buy in.
So long as we're going to have a system funded through insurance premiums paid to private insurers rather than a tax-funded system, everyone must be in the "pool." Otherwise, of course, people would have an enormous incentive to simply wait until they get sick to buy. In other words, the individual mandate is the price we pay for retaining a private insurance company-based system rather than following the lead of so many other advanced democracies and simply covering everyone in a unified, taxpayer-funded system.
#9 – Health "exchanges" and subsidies – The new law will take several steps to make it possible for all Americans to comply with the individual mandate. Two, however, stand out: a) the new law will create state-based "exchanges," administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. Exchanges will have a single form for applying for health programs, including coverage through the Exchanges and Medicaid and CHIP programs; b) the law will also provide refundable and "advanceable" tax credits and cost sharing subsidies to eligible individuals. Premium subsidies are available to families with incomes between 133-400% of the federal poverty level to purchase insurance through the exchanges, while cost sharing subsidies are available to those with incomes up to 250% of the poverty level.
#10 – Medicaid expanded dramatically – Finally, the new law expands Medicaid to all individuals not eligible for Medicare under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% of the federal poverty limit and provides enhanced federal matching payments for new "eligibles."
Going forward
While this list is far from comprehensive (there are dozens of other consumer protections, insurance company regulations, tax changes, wellness incentives, quality and efficiency improvements, etc…) it should provide the average layperson with a useful list for review and handy reference. Perhaps even more importantly, it should also provide a reminder of just how painstaking the process was to produce this long list of improvements, how far we've come and how utterly disastrous it would be if we were to back away from following through on full implementation.
To receive continuing updates on health care reform and its implementation, be sure to subscribe to NC Health Report, the newsletter of the North Carolina Justice Center's Health Access Coalition. You can subscribe by clicking here.
