One Week Into the Heart of the ACA

09 Jan

The Affordable Care Act was enacted all the way back in 2010. But, even before then, critics were asserting that this new law would more or less destroy the American economy, insert Uncle Sam squarely between patients and providers, and initiate the end of freedom as it ushered in socialized medicine. That was nearly 4 years–and 40 repeal attempts–ago, and yet, the sky remains intact above us.

Sure, there have been some major bumps in the road along the way. No one, including perhaps most of all the President, was thrilled to receive cancellation notices in the mail from their insurers after being told they could keep their plans if they liked them. Others, particularly if they–or those they work with–are young and healthy, have seen some increases in their insurance premiums, and have attributed those increases to the new law, as if insurance premiums weren’t on a steady upward trajectory well before anyone ever heard the name Barack Obama. And, of course, the infamous website was a tremendous embarrassment in the early days, threatening to derail enrollment efforts critical to the functioning of the new health insurance exchanges. Most of this has been, or is currently being, addressed by the Obama administration. And, it is helpful to keep in mind that this new law represents an enormous undertaking. Health care represents 18% of the American economy. Changing something that large takes time and is certainly prone to mistakes along the way. Similar efforts, like the implementation of Social Security and Medicare were also beset with more than their fare share of problems.

But now that we’re one week into the real heart of the ACA, with the most key provisions now implemented as of January 1, 2014, what has really changed? Has the government prevented you from seeing any doctor you wish? Have your taxes gone up exponentially? Are you now paying more for health care and getting less? Has a “death panel” convened to decide your fate? Or has life, somehow, gone on much as it did before? Some of you may say, “Yes, my taxes increased.” or “Yes, my health insurance premiums have increased.” For some, that is inevitably true, and I would not disagree.

But, for others, the world is a much brighter place as of January 1, 2014. The phrase “pre-existing condition” is no longer a part of insurance companies’ vocabulary. That means that the middle-aged woman with breast cancer who was unable to buy insurance because she was already sick, is now able to get covered and receive the care she desperately needs. In many states, Medicaid has been expanded to everyone with incomes up to 138% of the federal poverty level. That means that the childless adult who works full-time for minimum wage is now able to have health insurance for the first time. And, across the country, the health insurance exchanges are open for business and subsidies are available for those with incomes between 100% and 400% of poverty. That means that a father or mother with a family of four, who works for a small business that doesn’t offer insurance benefits, can get federal assistance to buy insurance as long as they earn less than $94,200. These changes are real and they are positive. And, I would contend, not only has the sky not fallen, but for many it also looks to be a brighter shade of blue. But, we are just getting started, and 2014 is full of new opportunities and challenges, as these experts predict.


Posted by on January 9, 2014 in Uncategorized


6 responses to “One Week Into the Heart of the ACA

  1. Ramona

    January 10, 2014 at 6:38 pm

    Excellent column and great way to start the new year!

  2. Shirie Leng, MD

    January 13, 2014 at 9:43 am

    Hmm. Bob Hackey gives statistics that suggest most people “don’t like” the ACA. I have a hard time figuring out if it’s the ACA people don’t like or Obama. Or Democrats. Or the Yankees. Maybe the people who are benefitting are not speaking up?

  3. Brad Wright, PhD

    January 13, 2014 at 11:32 am

    I would say that, to start with, our health care system, and the changes the ACA is making, are very complex. For most people, it is far easier to jump to a conclusion one way or the other without actually understanding what the law does. When Jimmy Kimmel put together a segment asking people whether they preferred the “Affordable Care Act” or “Obamacare” most of them said they preferred the ACA. They were shocked to learn that they are one and the same.

    I’ve had people tell me that the reason the IRS is now requiring the value of benefits to be listed on W-2s is because they are planning on taxing them (as opposed to helping people understand how much of their total compensation comes from very expensive insurance products). Moreover, the amount of misinformation out there is staggering, so even those who want to educate themselves about it are confronted with a bunch of non-sense to wade through.

    You can bet that there are plenty of people who don’t like the ACA because they don’t like Obama. You can also bet that most people don’t understand much about the ACA. That’s why that Kaiser poll showing that people dislike the ACA but love all of its components is so revealing. If people knew what this law did, and why it needed to do it, the support would be much more widespread. Instead, fear has had ample room to intrude where information was lacking.

  4. Janice Hendrix

    January 17, 2014 at 11:27 am

    As always Brad, an excellent article. I agree the biggest hurdle that the ACA faces is a misinformed or uninformed public.


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