SCOTUS Rules! Now What?

Now that my heart rate has returned to normal and my inner health policy goddess has stopped doing back flips, I can try to put Thursday’s historic vote into perspective.


Oh, sorry. I guess I haven’t completely calmed down.

But my joy is tempered with fear. Fear that the Republicans will make good on their promise to repeal the law or defund it. Fear that the ruling will tilt November’s election to the Republicans, giving them the votes to throw the law out. Fear that, as I said in my earlier blog, we will return to where we were 10 years ago—which is heading off a cliff in terms of health care.< This is in no way a statement about which party should win. It is a statement about the need to continue on the path that has been set. If a political change can change hard-fought laws previously passed, what does that mean for the country? We have some serious problems to deal with beyond health care; if we can’t find a way to work together, we are doomed. Ok, enough philosophizing for one blog. Let’s get back to the Affordable Care Act (ACA). One thing I’ve read—and agree with—is that the ACA codifies the fact that health care is a right, not a privilege available only to those who can afford it. If that is, indeed, the case (and I think everyone, regardless of their political leanings can agree on that), then we need to find a way to provide quality, affordable care to every American. As I’ve said before, the ACA is not perfect; what we really need in this country is a single-payer system like nearly every other industrialized country in the world. Until we get that, though, we have to be content with the incremental change the ACA affords. To that end, here are five important things you need to know about the ACA. These are five things I think the majority of Americans don’t understand, both because supporters have not been very good about communicating them so people can understand the law; and because those opposed to the law have been able to spout untruths and, ok, let me just say it, outright lies about the law.

If you want to really understand the law, no one explains it better than the Kaiser Family Foundation. I urge you click on the link and go visit the site. For those without the time or inclination, here are five truths about the law.

1. The ACA will not bankrupt the country. The nonpartisan Congressional Budget Office (CBO) estimates the law will reduce the deficit by $143 billion over the first 10 years, $1 trillion over the next 20 years, and add 8 more years to the life of the Medicare Trust Fund. These savings come from components in the law designed to reign in healthcare costs and reduce Medicare fraud.

2. The ACA will not put an undue burden on low-and-moderate income individuals. Their cost for insurance will be based on income. When you figure in what they have to pay out of pocket today for medical services because they don’t have an insurance company negotiating lower fees or receive higher-cost care in the emergency room, they should save considerable money and not have to worry about going bankrupt if they get sick.

3. The ACA will drive insurance premiums through the roof. The ACA requires that insurance companies spend no more than about 20 percent (variable depending on the region in which it is based) on administrative and other non-medical costs. Anything over that they have to return to their customers. For comparison, Medicare spends less than 5 percent on those costs.

The Kaiser Family Foundation estimates that insurers will return approximately $1.3 billion in excess profits and administrative charges this year alone.

Reigning in administrative costs will, by definition, reduce premiums. So will providing more efficient care, as the law enables through new reimbursement models, and providing more preventive care, which the law also requires.

4. The ACA gives the federal government the right to dictate what kind of care we get. Hardly. For proof just look at the Medicare program, which most people seem to forget is a federal government program. You get Part A, which covers hospital costs, without paying any premiums if you or your spouse paid into the program while working; while Part B, which covers doctor costs, is voluntary and does carry a premium, as does Part D, which covers drugs. How many of you who oppose the ACA would like to turn in your Medicare card?

Oh, and for the record, the ACA doesn’t “decimate” Medicare. The reality is that by reducing out-of-pocket costs for Part D, it will actually put more money in your pocket. It already has through refunds. More on this in a later blog.

5. The federal government has no right to make us have or pay for healthcare. Um, the federal government already does this with Medicare. From the minute you receive your first paycheck, nearly every working American is required to pay into the Medicare program through a payroll tax. I’m not sure how that differs from the Affordable Care Act requirements.

Watch for my next blog in which I’ll list five things you probably never knew about the ACA.

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