Changes In Health Insurance from the Affordable Care Act

The Supreme Court upheld almost all of the Affordable Care Act, yesterday.  This law is a push towards innovation and quality outcomes in health care.  It is a move towards greater cost efficiency and effectiveness.  It makes sense.

If you already have health insurance, you keep your health insurance.  Frankly, those of us who are employers purchasing health insurance for employees have seen annual double digit cost increases in health insurance premiums year after year, even as we reluctantly scaled back coverage, increased deductibles and co-pays for our employees.  Politics aside, this law brings much needed change, and makes health insurance more secure and more affordable for those of us already paying for it.

The Supreme Court also upheld the principle that people who can afford health insurance should take the responsibility to buy health insurance.  This is important for two key reasons:

First, when people who have chosen not to purchase health insurance show up at the hospital emergency room for health care, the rest of us end up paying for their care in the form of more costly health insurance premiums. They not only are not paying for the services they are receiving, they are going to the most expensive place you can go to get their  medical or other needs met. It's a double whammy for the rest of us who are footing the bill in our more expensive health insurance premiums.

Second, if you require insurance companies to cover people with pre-existing conditions, but don't require people who can afford it to buy their own health insurance, a percentage of people will wait until they are sick or have a health problem before they buy the care they need.  This just drives up everyone else's health insurance premium costs.  Insurance companies depend upon you paying your premiums when you are healthy in order to be able to cover the catastrophic costs you unexpectly incur when you do need major medical services.

Insurance companies can no longer impose lifetime limits on the amount of care you receive.  They can no longer discriminate against children with preexisting conditions.  They can no longer drop your coverage if you get sick.  They can no longer dramatically increase your premiums without reason.

We have already seen and experienced some of the good changes in the Affordable Care Act:  young adults under the age of 26 are able to stay on their parent's health care plans - a provision that has already helped many of our kids.  Seniors, like our parents, who often have multiple prescription medications to help with their health, receive a discount on their prescription costs.

For people who do not yet have health insurance, starting in 2014 there will be a menu of affordable health insurance plans to choose from.  Each state, like Michigan, will design their own menu of alternatives, and if we can come up with even better ways of covering more people at the same quality and cost, the law allows that.  Once these health insurance "exchanges" are set up, insurance companies will no longer be able to discriminate against people with pre-existing conditions, charge women a higher cost because they are women, or bill people into bankrupcy.

Simply put, this is a good step in the right direction.

We Are At A Fork In The Road

We are at a fork in the road.  In the 37 years that I have been an adult voter with a professional interest in social policy I have never seen the kind of dismantling of essential "people" services as we are now witnessing.  Children, seniors, people with disability or illness, and others who depend upon help from a caring community are at risk.  Over recent years, teachers, police, firemen, helping professionals of all kinds, are being dismissed from providing their services as a result of public policy and budget decisions that give priority to tax cuts and austerity budgets.  We continue to experience fast rising costs for health insurance premiums (in the private sector marketplace!) year after year, and increasingly employers have no choice but to pass the higher costs on their employees.  Revenues to the budget are reduced due to lower taxes.

I am all for lower taxes.  I do my best each April like every other red blooded American to pay the legitimately least amount of taxes that I am entitled to.  But I do pay what I owe and understand that is my responsibility as someone privileged to be a citizen of this country.  But, somewhere along the way we got lost. We got cynical.  Our moral compass started acting erratically.  We felt taken advantage of one too many times and we became vulnerable to the simple messages that just aren't true.  When it comes to public policy and politics, sometimes simple is easier than true.  "Tax cuts will balance the budget."  Really? Do the math.  Actually tax cuts have reduced the revenue available to government at Federal, State and local levels, resulting in larger deficits, dramatically lower levels of public services, and the erosion or elimination of help services aimed at protecting and supporting our society's most vulnerable citizens.  Consequences include higher unemployment because we are laying off all those teachers, police, firemen, and people whose jobs were funded by those dollars.  Those people who don't have their jobs anymore don't have much money to spend in our local community economy anymore.

There is a different issue, however, which is accountability. Regardless of whether you consider yourself a liberal or a conservative, a middle-of-the-roader, a libertarian, or if you just don't care about politics; you should care about getting value for each tax dollar.  Are we getting value from the tax dollars that are being spent?  That is the conversation that should be taking place.  What is it worth us to educate a child to grow up to be a productive contributing citizen? What is it worth to provide health care that keeps someone out of the Emergency Room at the hospital, and/or provide mental health services or substance abuse treatment that helps an individual stay out of jail?  What is it worth to keep someone in a prison?  What would it be worth to keep someone out of prison?  What is it worth to give a business or a corporation a tax break?  Is that value different with or without the promise of new jobs?  What is it worth to us to not have to witness child abuse?  What is it worth to us to be a community that does not neglect its elderly or disabled persons? What is the value we get and what is the price we are willing to pay to have a war with another country? What is it worth to us in this country to take care of the veterans of that war when they return home, or to take care of their family when they don't come home? What is it worth us to not to have to send any soldiers into a war? As a citizen, voter and taxpayer, I want my tax dollars be used effectively.