To The Daily Sun,
Since the presidential election it has become a foregone conclusion that the Affordable Care Act will be either repealed or replaced. The question is, will the resulting program be better than or cost less? Time will tell.
How did this most maligned of laws come into being? Who's idea was it, Anyhow? Well, in answer, its not a new idea. Many countries have their version of universal health care. Hilary Clinton lobbied for it while Bill was in office. Congress wasn't interested. As a matter of fact, they were downright rude to her, as I recall.
Later the state of Massachusetts came up with a workable version of universal health care and made it a reality. It wasn't universally liked by the insured, but it solved most of the health care problems that existed in the state. One of the hardest problems to solve involved the emergency rooms of their hospitals. The ER's were becoming clinics for the uninsured. The were treating everything from coughs to cuts. The hospitals were being forced to absorb the cost of unpaid bills run up by an uninsured indigent population. Costs were negatively affecting the bottom line of most of the hospitals. Trauma centers were failing to deliver high quality service to the real emergencies. Part of the Massachusetts plan provided for wellness clinics. The clinics were, in part, a solution the ER crisis. Not only were they cheaper, they were much less chaotic. Everyone profited; even the state. The state budget looked better after the initial start-up costs were absorbed.
When Obama came to Washington, he was primed to get some things done. Once he got the mess that Bush handed off to him back from the brink of disaster, he had a little time to attack some other problems. Teddy Kennedy was making a concerted effort to get some attention given to health care. Being from Massachusetts, he suggested the Obama administration put forth a similar program for the nation. And so, the Affordable Care Act was conceived but not yet born. They knew that it should probably be signed into law before the mid-term elections because evidence was building that Carl Rove had plans for his version of the House of Representatives.
Vast amounts of paper were generated to create a framework that was introduced as bill to Congress. Many of the opponents of the bill complained that they were being asked to vote on summaries of the bill because of its size. Wrangling over the future shape of the bill took place in 2009. The Republican minority were unified in its opposition to the bill. Finally a conference committee of the House and Senate reported the bill out for a vote. Prior to the vote, Senator Kennedy died and Scott Brown, a Republican won the election to replace him. Ten democrats had to make sure the independents were voting for the bill before it was brought to the Senate floor for a vote. Passage was achieved by the slimmest of margins and sent to the president for his signature in the spring of 2010.
It was immediately challenged in court. Eventually the Supreme Court confirmed the constitutionality of the act. Republicans in congress have endeavored to rescind the law or at least obstruct the orderly introduction by the Obama administration. Moving forward in the face of the negative Republican maneuvers was difficult but progress was made. Procedures required to enroll those in need of affordable health insurance were created. Because some states refused to set up exchanges, the federal administration had to implement and manage programs in those states. Many of the potential insurers were reluctant to commit to the program because of the on-going battle between the Democrats and the Republicans in congress.
Several features of the act were highly desired by the insured under the plan. Coverage of young adults to the age of twenty-six, the ending of the exclusion due to preexisting conditions and the adding guarantees of the appeal of any arbitrary withdrawal of coverage were the most popular.
In reference to costs, the ending of lifetime limits on coverage caused a few headaches because insurers were being asked to take on added risks. Because all increases of premium must be justified as reasonable, some insurers decided not to participate. Another feature that made the insures unhappy was the ruling that premium dollars be spent primarily on healthcare, not administrative fees demanded by insurers in an effort to guarantee an attractive bottom line for their corporation.
The act endeavored to provide preventive care options, allowing primary care doctor choices and the ability to seek emergency care outside the plans network. Many users of the plan especially appreciated that feature.
So, whatever replaces the current plan must include the list already enumerated. In addition there must be a well understood method of payment for services. All involved; the insurers, the doctors and the patients must have the same understanding of how the payment system works. Focus should on the improving health care delivery, the managing and sharing the personal data while observing HIPPA rules.
One of the concerns expressed by the Republicans has been the cost of plans available to small businesses. Even before the advent of the Affordable Care Act that was a offered as an excuse for some small businesses to not offer health care plans to their employees. Any improvement in that area will have to be focused toward insurers and providers of service. High deductibles are placed on covered services. This practice is one of the sore points that keeps on irritating the premium payer because of the out-of-pocket cost that pile up before the plan pays anything. It is like paying the premium twice. So, can plans be developed to lower the deductibles without causing premiums to soar? Are there lessons that can be learned from the Medicare system? What are the state and federal responsibilities to those below the poverty level. These are some of the questions to be answered before we revert to what existed before the ACA.