Obamacare enrollment begins today, despite government shutdown

Despite House Republicans’ forty plus attempts to repeal and defund “Obamacare,” the six-month enrollment period starts today. House Republicans dead set on making sure this legislation fails have used the ACA as leverage to threaten a government shut-down. Mission accomplished. However, the President, Democrats, and some Senate Republicans are refusing to use the ACA as a bargaining chip. Good. The law was passed by Congress and upheld by the Supreme Court. Forbes.com reported yesterday that recent polling shows only 33% of Americans think the federal law should be repealed, delayed, or defunded, and the majority definitely don’t want a government shut-down over it.

The Affordable Care Act (aka Obamacare) is essentially health insurance reform. It is a far cry from the “socialized medicine” its opponents claim it to be. While the state health insurance exchanges become effective January 1, 2014, other components of the law have been postponed until a later date and therefore full implementation will not occur until 2015 or later.

If you don’t want to read about the Affordable Care Act, watch this YouToons Video for information about the law. I urge you to check it out. It’s comprehensive and easy to understand.

Opponents who make claims about ACA’s negative impact are not being honest because until it is fully implemented an accurate assessment of the legislation cannot be made. (The same can be said about those making overly optimistic statements about the law’s benefits and cost-containment.) Some people may see higher insurance premiums, others will see their costs decrease; some health care costs will be contained, others likely will not. However, what the ACA will do is bring millions of uninsured Americans into the system. It is the first serious attempt since the Clinton administration to provide affordable quality health care to all Americans, though sadly, it is estimated that 30 million Americans will still remain uncovered, for various reasons.

Over a quarter of uninsured Americans are unaware of ACA enrollment. This is a problem. One reason for this is that the Obama administration, HHS, and supporters of the ACA have only recently begun disseminating information through advertising campaigns, social media, and community networks. Another reason is that there is much misinformation out there about the ACA. Most people cannot tell you the provisions in it or the benefits they will receive, or why they hate it so much, except for the mandate that requires they must now purchase insurance coverage.

Recent polls have found that 46% of people disapprove of Obamacare, but only 37% disapprove of the Affordable Care Act. It’s one and the same. Still, Americans are largely supportive of its main provisions. There is a major disconnect between the perception of Obamacare and what it is in reality.

So what is in it? Since March 2010, pre-existing conditions for children have been eliminated; come January 2014, that will be extended to all people. Young adults can stay on their parents’ plan until they are 26 years old. Mammograms have been covered in full and will continue to be. You can read more about the benefits and provisions here on the timeline.

Full implementation of this legislation is further imperiled by GOP-led states or states where the legislatures are dominated by conservatives who have refused to set up their state exchanges (Nevada being one exception) but are deferring to the federal government do it. Some states have refused to expand Medicaid, which would allow more low-income Americans to have medical coverage, even though the federal government is paying for it initially, and by 2020 would still be responsible for 90% of state Medicaid funding.

To make matters worse, these states are obstructing the enrollment process and making it harder for navigators to assist residents in their states to access information and to enroll. This is reprehensible. Even in the reddest of states there are people who need health insurance that may save their lives—even conservative lives. This is not an ideological issue, it is a human issue. I expect the fact that these legislators are actively working to make it more difficult for their constituents to receive health coverage will at some point come back to bite them—hard—and it should.

Currently, we are seeing in states where implementation has been going on for months, the exchanges are not perfect, but they are ready for enrollment and these states are willing to assess where the challenges lie and address them on an ongoing basis. We also see that in many states premiums are coming in lower than expected. A Rand Corp analysis of 10 states and the United States overall predicts that there will be no widespread premium increase in the individual health insurance market. However, in states like FL, TX, LA where they are not expanding Medicaid under the ACA, premiums could increase 8-10%.

Arguments against the ACA include: the mandate is too coercive, it goes against our idea of “freedom,” that Obamacare is already causing insurance premiums to increase, or it is the biggest job-killer right now. First of all, the fine for foregoing insurance coverage is not highly punitive. In the first year, it is $95 or 1% of  income, whichever is higher. Furthermore, if you are too poor and still cannot afford coverage, the fine will be waived.

The penalty for not purchasing coverage should be high enough to at least make people stop for a moment and ask if it is worth the cost to not be insured. The idea of the mandate, is to increase the risk pool, including old and young and sick and healthy. Spreading the risk this way brings down/contains the cost of coverage. Right now, those of us with insurance, subsidize those who do not have it when they need medical care. That’s unfair. Furthermore, it’s the freeloader issue that conservatives are always bemoaning, so one would think this would be an element of the law they would like: everyone taking personal responsibility for their medical coverage.

Providers will offer four plan-levels in the exchanges: bronze, silver, gold, and platinum. Anyone with income up to 400% of the poverty level—$45,960 for an individual, $94,200 for a family of four—will get subsidies to help cover the cost. Disclosure: I am not eligible for subsidies. I make too much money, which isn’t a lot for the NY/NJ area, but even though I do not qualify for them, I do not begrudge those who do. I know how important it is to have decent coverage. I am a leukemia survivor and my healthcare story is a cautionary tale. I was one of the lucky ones.

The second criticism above about increased premiums that people want to assign to solely to Obamacare is also false. Think about it, health care costs have been increasing steadily over the past decades, much higher than wages. This is nothing new. From 2003 to 2011, family premiums for employer-based coverage increased 62% while average median incomes grew only 10%. Some insurers, guaranteed, are setting huge premium increases to fatten their bottom line and blaming it on Obamacare because it’s a great excuse, and most people won’t look for information to refute this subterfuge.

Not only have healthcare costs gone up over the years, but employers have also made employees share more  of those costs. Employers have also decreased pensions as well as their contributions to employee 401K plans. All these costs placed on the American worker have been happening for years, not only in healthcare. The entire system is pushing more costs onto workers.

As for the ACA being the number one job-killer in America—not so much. Read it here, here and here.

No matter what you think of Obamacare the one thing you should remember is that it gives American people choices. If you are fired, or laid off, or want to leave your job, you can do so without the fear of having no affordable health care options for you and your family. That’s liberating. People stay in jobs they hate because they need health insurance. That is ridiculous. Healthcare should not be tied to employment. Furthermore, if businesses did not have this expense they would be much more competitive, globally and domestically. Getting healthcare out of the employment equation is a positive goal because it makes American businesses more competitive and provides Americans the choice and freedom to move to a different job or to start their own business.

The ACA is far from perfect; it is not what I would have designed. However, it is a start to providing universal healthcare to the people of this country. Its implementation will not be complete until all elements of it are in place. And as stated previously, some components have been postponed. The initial enrollment period is for six months (October 1, 2013 – March 31, 2014). In subsequent years, it will be three months (October 1 – December 31).

Furthermore, if Obamacare is delayed for a year, as House Republicans want, it will never get implemented. That is their goal because they are hoping that in the near future there will be a Republican President and a Republican Congress then they can obliterate the law. Our current system is broken, it’s costly to American taxpayers, there are already “death panels” and “rationing” going on in the insurance industry, and have been for years. It’s time to try a different approach, and if that doesn’t work, try another one. The status quo is not an option; our healthcare system is unsustainable.

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SOURCE: Data from OECD, Health Data 2013, June 2013. Compiled by PGPF.

Once we see what is working and what isn’t then we can put policies in place to improve it. But trying to prevent people from accessing a system that though imperfect may help them, possibly even save their lives, is a bad strategy.

There will be obstacles and glitches initially with Obamacare, but perhaps many will be minor. We will never know how a different health care system will work if we don’t try, and even if there are problems, we can improve upon it. We’re Americans. We can meet these challenges. The Affordable Care Act will not affect the majority of Americans or their current coverage. However, if you are uninsured, enroll. The exchanges are open.

Cross-posted at The Feisty Liberal

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