21 November 2012

The Affordable Care Act: Back to Reality

Nine Republican Wisconsin State legislators are threatening to arrest any federal officials who try to implement a federal health insurance exchange in the state.  This development prompted the Milwaukee Journal Sentinel editorial staff to declare, "What's next: Firing on Fort Sumter?"

Evidently that's just what the next step is intended to be.  Yet even ultra-conservative Justice Antonin Scalia knows better.  "There is no right to secede," Scalia recently wrote.

Gov. Walker finally announced his administration will not be presiding over the implementation of a health exchange for Wisconsin because for one he's against it and two it will cost Wisconsinites too much.  The specific details on how the exchange would cost Wisconsin more than not having them is unclear and diametrically opposed to what the intention of the exchanges is designed to be.  The exchanges are supposed to be designed to save buyers of insurance money by providing more choices to access.

Similar exchanges are currently used by public employees through the Employee Trust Fund (ETF) in Wisconsin. Through the ETF, public employees choose an insurance plan that fits their needs and based on the contributions they would like to make.

It seems obvious that all citizens of Wisconsin should have access to a similar exchange. 

While concern over the Patient Protection and Affordable Care Act (ACA) is understandable given the nation's inherent distrust of monarchical rule, the ACA is anything but a government takeover of health care.  In fact it is more or less a buy-in to private insurers.

A look at the finer points of the law clearly illustrate how the whole framework of the law is based on conservative and capitalist notions including the provision that everyone buys in.  The so-called individual mandate holds every citizen responsible for his/her own health insurance.  The individual mandate is an attempt to stop people from not purchasing insurance only to show up sick in an emergency room with no way of paying for care.

Although many people may dread the idea of being encouraged toward buying health insurance in lieu of a cash penalty, the people who shouldn't be complaining about the individual mandate are those who agreed with Mitt Romney that there are certain people who don't pay for services.  Likewise, emergency room professionals know all too well the sheer numbers of people who carry no insurance yet expect emergency care.  The ACA's individual mandate hopes to lessen that problem which in turn could lower health care costs.

Below I've tried to highlight some key provisions in the ACA:

Stage 1 (in effect now)
• Outlaws worst health insurance abuses including denials based on preexisting conditions for children (adults in 2014).
• New standards for insurance, such as allowing young adults to stay on parents policies until they are 26.

Stage 2 (goes into effect 2014)
• Expand BadgerCare (Medicaid) to almost all low income Wisconsinites.
• Create competitive health marketplace to guarantee coverage to everyone who does not have good insurance at work.
• Require Members of Congress to buy the same plans offered to everyone else in the new marketplace.
• Strengthen Medicare for Seniors.

 Stage 1 Reforms:
Insurance Practices Outlawed now under the Affordable Care Act
• Preexisting condition exclusions (kids now/everyone in 2014) (see below for a list of preexisting conditions)
• Lifetime limits
• Dropping coverage after a person gets sick
• Excessive insurance industry profits and overhead (80-85% of your premium dollars must be spent on medical care, not profits)

The Affordable Care Act guarantees
• Preventive care coverage (ex: Mammograms, checkups, etc) with no cost sharing (co-pays, deductibles, etc)
• Young adults can stay on parents policies until age 26
• Preventive care without cost sharing for seniors on Medicare

Health insurance companies hold the right to deny any coverage for people who may have been diagnosed under previous care with any one of the following medical conditions.  These are called Preexisting Conditions and this list is not exhaustive:
• Diabetes
• Arthritis
• Heart Disease
• Obesity
• Asthma
• Cancer
• Stroke
• High Blood Pressure
• Hypertension
• Stress disorders
• High cholesterol
• Kidney disease
• Alcohol and drug abuse
• Hepatitis
• Adjustment disorders
• Alzheimer’s
• Angina (Chest Pain)
• Chronic obstructive pulmonary disease (COPD)
• Pancreatitis
• Dermatomyositis
• Emotional disturbances
• Emphysema (Lung disease)
• Major organ transplant

Sami’s Story
“My 7-year-old son, Sami, suffers from a disease that causes tumors to grow all over his body. Sami’s treatments could not continue if we hit our insurance policy’s life time limit. Thanks to the Affordable Care Act, insurance companies can no longer impose lifetime limits or deny health coverage to children like Sami with preexisting conditions. We can’t go back to being on our own against the insurance companies.”
--Tracy, Appleton, Wisconsin

Remy’s Story
“I own a small café. Over 20 years ago I beat cancer, but ever since then no insurance company would sell me a policy because my cancer is called a preexisting condition. Starting in 2014 under the Affordable Care Act, no insurance company will be allowed to discriminate against me because I’m a cancer survivor.”
--Remy, Pepin, Wisconsin  

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