Sunday, July 1, 2012

Affordable Care Act: Still a BFD

So the Supreme Court says the Affordable Care Act, otherwise known as "Obamacare," is constitutional. As soon as the news broke, you probably noticed quite a bit of activity in your Facebook or Twitter newsfeed. I was as guilty as anyone, but I felt like my quick Facebook status update was somewhat appropriate seeing as how I only posted what NPR described as the "money quote" from the court's decision: "Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it." Aside from a sassy "mmm-hmmm" I didn't post any of my own thoughts or fact I started this blog so I could vent without flooding my friends' and frenemies' social media feeds, and at the same time force myself to stretch my thoughts beyond a 140-character rant.

My status update prompted a few questions and issues, from the right and the left, that I hadn't thought about in quite some time. Let's discuss!

The first topic that came up was the idea that the government "owns" you with the implementation of the ACA. I would be more on board with this logic if we were implementing universal health care. What we're really doing with the individual mandate, which I believe is the source of many people's Obamacare concerns, is balancing out the economics that allow insurance to function. See my previous post on health care from December 28. Currently, pretty much everyone receives some level of health care, but only some of us pay into the system. The individual mandate says that everyone will receive health care and everyone will pay into the system. So, while we as a population are probably going to be providing more health care services, we're also going to be taking in more money. 

People don't like this because they think their money is going to pay for treatment for some lowlife who doesn't deserve health care. There are two things I hate about this reasoning: one, all human beings deserve basic care especially in a resource-rich country like the Unite States, and two, that "lowlife" could be any one of us if our luck changes. When more people pay into the health care system, there are fewer unpaid medical bills (in general) and therefore costs go down for everyone. People have a hard time with this, and rightfully so, because providing and paying for health care is very complicated and you won't see a benefit to the individual mandate immediately or clearly. The benefit could be that health care costs only rise two percent per year, as opposed to seven percent. That's not very sexy politics, but it is a likely valuable outcome of the individual mandate and the complete ACA.

Please keep in mind: the government is not taking over the delivery of health care services. They are becoming more involved in the payment of such services. In this regard, the federal government is not doing anything more than your for-profit health insurance provider already does for you.

Another thing that came up was being tied to your employer under current conditions so you can have health care insurance. I made this point because I am no more "scared" of the government making health care payment choices than I am of the insurance companies. The insurance companies need to be reigned in; I love the idea of capitalism but I do not love companies who put profits ahead of people's health and lives. (Why are people afraid of the government but not an insurance company whose primary responsibility is to shareholders?) First, I think it's good for capitalism and entrepreneurship if you are free of the health insurance issue to switch to a new job or start your own company. Second, I have a little personal story about health insurance and switching jobs...

To my knowledge, I have only been without health insurance for a few months of my entire life, most memorably in July 2010. In June of that year, I left a wonderful job in Chicago to move to Denver and take an even better job with a different company. I am so fortunate to have survived the recession and the earliest stages of my career without any involuntary unemployment. My last day on the job in Chicago was a Thursday, and my new job in Denver started the following Monday, June 21. I would be unemployed for only one business day. However, my health insurance at the new company would not start until August 1. A typical delay when starting with a new employer. So, I applied for COBRA insurance to cover the gap. COBRA is slightly expensive, but it's better than paying for health insurance completely on your own. I didn't think twice about this arrangement until two weeks into my Denver residency, when I received a letter from the health insurance company. They regretted to inform me that they would be unable to insure me. It turns out that I had failed to complete a minor procedure a doctor had recommended prior to my insurance application. (I canceled the appointment for that procedure because the movers showed up a day early, the day of the appointment.)

Instead of charging me a higher amount for my "pre-existing condition," they just flat-out denied me coverage. My pre-existing condition was something that a majority of women experience in their lifetimes and usually requires a simple fix. I did not have cancer, a congenital heart defect, AIDS...I had a common condition, but I was un-insurable. I was out of luck, through no fault of my own, except perhaps making the mistake of telling the truth on my insurance application. And, OK, I suppose you can fault me for canceling the original doctor's appointment, but the movers were showing up to take my stuff to a new city where I was pro-actively moving to get a bigger and better job. Call me a lowlife, it was my fault I was un-insurable! I survived this short period of being without health insurance, but what would have happened if I had been in a hit-and-run accident, or I had been brutally mugged, or caught in a fire? I would either be dead or bankrupt.

As usual, I urge you to please leave comments if you find holes in my arguments or think that I am just plain making things up. Given my Ivy League degree, the legal studies classes I've taken and the countless nights spent arguing with some of the smartest people on the planet during my college years, I should be good at making my case...but I still have a long way to go before I reach Maddow-level logic and well-researched arguments.