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Talking points about the Affordable Care Act (ACA)

April 29, 2016

Tags: ACA, Affordable Care Act

Often called Obamacare, originally by its opponents), the Patient Protection and Affordable Care Act (ACA) was signed into law by President Obama on March 23, 2010. It is often described as comprehensive health reform, but as health writer Eileen Beal has pointed out
The ACA is health care insurance, not health care
It provided a means for those who could/decided to pay the premiums a way to access (increasingly expensive) health care
• It increased the number (and % of the U.S. population) seeking and getting health care services
• It DID NOT increase the number of health care providers (especially mental health care providers)
• It DID NOT include mechanisms for increasing the number of health care providers, much less the experienced health care providers that those using ACA insurance are expecting to see/be treated by.

The eight basic consumer protections the Obama White House wants health care reform to cover:
(1) No discrimination for pre-existing conditions,
(2) No exorbitant out-of-pocket expenses, deductibles or co-pays,
(3) No cost-sharing for preventive care,
(4) No dropping of coverage if you become seriously ill,
(5) No gender discrimination,
(6) No annual or lifetime caps on coverage,
(7) Extended coverage for young adults,
(8) Guaranteed insurance renewal so long as premiums are paid.
For more about the White House plans for health care, see http://www.whitehouse.gov/healthreform .

Posted below are links to articles, sites, judicial arguments, etc. that might advance intelligent discussion of the ACA.

What we know about how health insurance affects health (Carolyn Y. Johnson, WaPo, 9-8-15) "The real question now may not be how big the effect of insurance is on health, but how to structure insurance so that it gives people the best chance of staying healthy. There is also growing interest in comparing insurance coverage to other ways that money could be spent to improve health, for example by reducing poverty, which is associated with poor health outcomes, spending on food stamps, or structuring insurance plans differently. 'We know we improve health care coverage, but .... what are some of the other strategies to improve health?' Long said."

Summary of the Affordable Care Act (Kaiser Family Foundation, which has many ACA-related resources on its website). ).

Affordable Care Act (Commonwealth Fund). Many more ACA-related items.

Reports of Obamacare’s Demise Are Greatly Exaggerated (Larry Levitt, JAMA Forum, 4-26-16)

Kaiser Health Tracking Poll: The Public’s Views on the ACA (click on modifying search terms on left for difference on how Democrats, Republicans, etc. feel, blue being favorable and red unfavorable).

Wrong Prescription? The failed promise of the Affordable Care Act. (Trudy Lieberman, Harper's, July 2015) "The A.C.A. was sold to the public on the pledge of “affordable, quality health care....The A.C.A.’s greatest legacy may finally be the fulfillment of a conservative vision laid out three decades ago, which sought to transform American health care into a market-driven system. The idea was to turn patients into shoppers, who would naturally look for the best deal on care — while shifting much of the cost onto those very consumers. In other words, Rooney and his G.O.P. allies (with, it should be said, Democratic acquiescence) moved American health insurance in a direction contrary to that taken by most every other nation in the developed world. It is also contrary to the needs of those unlucky enough to get sick."

Equitable Access to Care — How the United States Ranks Internationally (Karen Davis and Jeromie Ballreich, NEJM, 10-23-14) "The United States has been unusual among industrialized countries in lacking universal health coverage. Financial barriers to care — particularly for uninsured and low-income people — have also been notably higher in the United States than in other high-income countries. As more Americans become insured as a result of the Affordable Care Act (ACA), differences in access to care between the United States and other countries — as well as among income groups within the United States — may begin to narrow."

Dead Man Walking (Michael Stillman and Monalisa Tailor, New England Journal of Medicine 2013) 'Mr. Davis had had an inkling that something was awry, but he'd been unable to pay for an evaluation. As his wife sobbed next to him in our examination room, he recounted his months of weight loss, the unbearable pain of his bowel movements, and his gnawing suspicion that he had cancer. “If we'd found it sooner,” he contended, “it would have made a difference. But now I'm just a dead man walking.”'

Mississippi, Burned (Sarah Varney, Political magazine, Nov./Dec. 2014). " In Mississippi, America’s most down-and-out state, a full 20 percent of the population doesn’t graduate from high school, 22 percent lives in poverty—and even more than that, a quarter of the state, goes without health care coverage. In a state stricken by diabetes, heart disease, obesity and the highest mortality rate in the nation, President Barack Obama’s landmark health care law has barely registered, leaving the country’s poorest and most segregated state trapped in a severe and intractable health care crisis. ...Why has the law been such a flop in a state that had so much to gain from it? ...bumbling errors and misinformation; ignorance and disorganization; a haunting racial divide; and, above all, the unyielding ideological imperative of conservative politics."

Landmark: The Inside Story of America's New Health-Care Law—The Affordable Care Act—and What It Means for Us All (Public Affairs Reports, staff of the Washington Post) " The table of contents reads like a Frequently Asked Questions list, and it covers every question you could possibly think of related to the new health-care reform.” ~Everyday Health

Preventive Services Covered by Private Health Plans under the Affordable Care Act (Kaiser Foundation 10-28-14) A key provision of the ACA is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. Full discussion.

The Great Cost Shift comes into focus (Trudy Lieberman, CJR, 12-24-14). "Consumers, even consumers who have insurance, are paying a larger share of their healthcare costs. This shift has been in the works for years, but provisions in the ACA have made it more visible."

In Need of a New Hip, but Priced Out of the U.S. (Elisabeth Rosenthal, NY Times, 8-3-13) Paying Till It Hurts: A Trip Abroad. Part of an excellent series on what's wrong with American health care.

Estimating the Potential Impact of Insurance Expansion on Undiagnosed and Uncontrolled Chronic Conditions (Daniel R. Hogan et al., Health Affairs, Sept. 2015 -- vol. 34, no. 9, pp. 1554-1562). Findings: The ACA could have significant effects on chronic disease identification and management, but policy makers need to consider the possible implications of those effects for the demand for health care services and spending for chronic disease.

Medical Device Industry Fears Health Care Law’s Tax on Sales (Barry Meier, Tracking the Affordable Care Act, NY Times, 10-1-13)

At Stake: What Repealing the Affordable Care Act Would Mean for Middle Class Families (HHS)

Frequently Asked Questions about Health Reform (Kaiser Family Foundation)

Obamacare’s Secret Success (Paul Krugman, NY Times Opinion page, 11-28-13) The law establishing Obamacare was officially titled the Patient Protection and Affordable Care Act. And the “affordable” bit wasn’t just about subsidizing premiums; it was also about “bending the curve” — slowing the seemingly inexorable rise in health costs. Follow the bending cost curve and you will find that the slowdown in health costs has been dramatic.

Obama's Deal, long, fascinating transcript of Frontline special on the deal-making that went into health care reform. You can also Watch the Frontline program. "Those deals can be pretty smelly."

Why Republicans can't come up with an Obamacare replacement (Ezra Klein, Vox, 1-16-15) Making "sure poor people have health insurance is politically popular, at least in the abstract. But the plans that achieve it tend to be in tension with both broad tenets of conservatism — it raises taxes, it redistributes wealth, and it grows the government — and with key factions of the conservative coalition....It is ironic that the law Republicans loathe most is actually based on ideas they developed, and that their most recent presidential nominee actually implemented."

Medicine’s Top Earners Are Not the M.D.s (Elisabeth Rosenthal, Sunday Review, NY Times 5-12-14) The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries. (There are more doctors than administrators, so she's talking about individual, not total, salaries for a group.)

Supreme Court Case May Be A Wake-Up Call For Republicans (Julie Rovner, KHN, 2-23-15) About Obamacare: "“Republicans are united around repeal. And they’re united around replace. But obviously they’re not united around ‘replace with what...’”

Obamacare: The Rest of the Story (Bill Keller, Opinion Page, NY Times, 10-13-13) "You realize those computer failures that have hampered sign-ups in the early days — to the smug delight of the critics — confirm that there is enormous popular demand. You have probably figured out that the real mission of the Republican extortionists and their big-money backers was to scuttle the law before most Americans recognized it as a godsend and rendered it politically untouchable. What you may not know is that the Affordable Care Act is also beginning, with little fanfare, to accomplish its second great goal: to promote reforms to our overpriced, underperforming health care system. " An interesting account of "accountable care organizations" (ACOs), which are springing up all around the country.

Medicaid Expansion in Red States (Drew Altman, WSJ's Think Tank, 12-18-14) "In the struggle between pragmatism and ideology over Medicaid expansion in red states, pragmatism may slowly be winning."

Majority Favors the Affordable Care Act’s Employer Mandate, But Opinion Can Shift When Presented With Pros and Cons (Kaiser Family Foundation, 12-18-14) Recent news stories on the health law did not attract most Americans’ attention, and many are unaware of details and implications of the developments

Three Words and the Future of the Affordable Care Act (PDF, Nicholas Bagley, draft accepted for publication in Journal of Health Politics, Policy and Law, 2014, open access)

Feds Target Health Law Loophole That Allows Large Employers To Offer Plans That Don’t Cover Hospitalization (Kaiser Health News, 11-4-14) The administration intends to disallow plans that “fail to provide substantial coverage for in-patient hospitalization services or for physician services."

Medical Loss Ratio (MLR) Information "The medical loss ratio is a calculation that divides the total dollars a plan spends on health care by the total dollars a plan receives in premiums. The result is the medical loss ratio or MLR." The ACA requires that health insurers "spend specific target amounts of the premiums they receive on payments for the health care members utilize, as well as for projects that improve the quality of care members receive. When insurance companies spend less than those target amounts, the Affordable Care Act requires that those companies refund the difference between the amount that was spent and the specific target amount."

A death blow for Obamacare? (Laurence H. Tribe, Boston Globe, 7-18-14) "The moment the Affordable Care Act was enacted in 2010, it became a litigation magnet. The lawsuits threatening to derail it were initially dismissed as ridiculous but became deadly serious by the time Chief Justice John Roberts’s decisive fifth vote two years later barely upheld the law’s individual mandate, while the Court’s decisive 7-2 vote left the health law’s Medicaid expansion in tatters. Last month, the court struck a second blow to the ACA by allowing some for-profit corporations to opt out of offering contraceptive coverage they deemed religiously offensive. And even House Speaker John Boehner is joining in the litigation..."

The Piecemeal Assault on Health Care(NY Times editorial, 11-22-14) "Now that they will dominate both houses of Congress, Republicans are planning to dismantle the Affordable Care Act piece by piece instead of trying to repeal it entirely....All of the provisions they are targeting should be retained — they were put in the reform law for good reasons."

Hospitals and health law (Opinion, NY Times, 12-7-14) "The American people aren’t the only ones who will suffer from the systematic dismantling of the Affordable Care Act. It’s also bad news for America’s hospitals."

Another Baseless Attack on Health Law (NY Times editorial, 12-12-14) A suit filed by the "Republican-dominated House aims to block another important subsidy: federal payments to insurance companies to keep deductibles, co-payments and other cost-sharing low for the poor. ... If the federal government cannot assist, a lot of other individual policyholders may have to pay more."

A closer look: Did the ACA result in more canceled plans? (Joanne Kenen, Covering Health, AHCJ, 4-29-14)

Warren: It's too soon to call Obamacare — or Obama — a failure (James Warren, Daily News, 12-1-13) There was a lot of melodrama over Saturday's 'sort-of deadline' for repairing HealthCare.gov. Though Obama's approval ratings are tanking and the Obamacare website had early missteps, the President and his health care plan shouldn't be written off so quickly.

Safety Leaders. Actor Dennis Quaid's family is joining forces with the Texas Medical Institute of Technology (TMIT) to raise public awareness about our broken medical system, to eliminate human error, and to make caregivers aware that patients have the right to know all information that could have an impact on their health and well-being, with major focus on increasing awareness of the dangers of medication errors. See also Preventable Medical Malpractice: Revisiting the Dennis Quaid Medication/Hospital Error Case (Rick Schapiro, The Legal Examiner 8-9-10).

Bringing local, national perspectives to report on ACA in rural Kentucky (Joanne Kenen, Covering Health, AHCJ, 6-17-14)

The AP downplays its Obamacare scoop (Trudy Lieberman, Columbia Journalism Review 4-11-14). AP calls "minor' a change in legislation that shifts costs to consumers by raising deductibles.

Rooting for Failure (Timothy Egan, NY Times Opinion page, 11-28-13) It's hard to remember a time when a major political party and its media arm were so actively hoping for fellow Americans to lose. Tim Egan's unvarnished take on the shamelessness of the anti-Obamacare creed.

Challenges For The New Health Insurance Exchanges (transcript for Diane Rehm show, with guests Susan Dentzer of The Robert Wood Johnson Foundation, Louise Radnofsky of The Wall Street Journal, Jon Kingsdale of the Wakely Consulting Group, who led the agency that implemented the Massachusetts health insurance exchange, and David Simas, speaking from the White House, 10-16-13).

Challenges For The New Health Insurance Exchanges (transcript for Diane Rehm show, with guests Susan Dentzer of The Robert Wood Johnson Foundation, Louise Radnofsky of The Wall Street Journal, Jon Kingsdale of the Wakely Consulting Group, who led the agency that implemented the Massachusetts health insurance exchange, and David Simas, speaking from the White House, 10-16-13).

Special Investigation: How Insurers Are Hiding Obamacare Benefits from Customers (Dylan Scott, Talking Points Memo, 11-4-13). "By warning customers that their health insurance plans are being canceled as a result of Obamacare and urging them to secure new insurance plans before the Obamacare launched on Oct. 1, these insurers put their customers at risk of enrolling in plans that were not as good or as affordable as what they could buy on the marketplaces."

Middle class families wary of higher premiums Carla K. Johnson, AP story in Portland Press Herald, 9-13-13). "The new Affordable Care Act health exchanges won't offer any bargains for higher-income families, who fear that their current health insurance policies may get more expensive under the new law's requirements. As many as nine in 10 Texans buying health insurance on the new federally run exchange will get a break on costs, according to federal health officials. Steve and Maegan Wolf won't be among them."

Questionable design blamed for healthcare website woes (Carla K. Johnson and Ricardo Alonso-Zaldivar, AP, 10-8-13) A decision by the Obama administration to require that consumers create online accounts before they can browse health overhaul insurance plans appears to have led to many of the glitches that have frustrated customers, independent experts say.

How Obamacare’s medical device tax became a top repeal target (Sarah Kliff, Wonkblog, WashPost, 9-28-13). See also:

SOME OF THE EARLY STORIES:
The Affordable Care Act Will Work (Sen. Jay Rockefeller, Reader Supported News, 10-3-13)
Where Poor and Uninsured Americans Live (interactive map, NY Times, 10-2-13). The 26 Republican-dominated states not participating in an expansion of Medicaid are home to a disproportionate share of the nation’s poorest uninsured residents. Eight million will be stranded without insurance.
Little Evidence Obamacare Is Costing Full-Time Jobs (Kaiser Health News' Daily Report, 10-23-13) Roundup of stories from WSJ, NYTimes, Reuters, Wash Post, Politico and others.
States Are Focus of Effort to Foil Health Care Law (Sheryl Gay Stolberg, NY Times, Politics, 10-18-13) In Virginia, conservative activists are pursuing a hardball campaign as they chart an alternative path to undoing “Obamacare” — through the states.
New York State of Health: The Official Health Place
Covered California, the new marketplace for affordable private health insurance
Millions of Poor Are Left Uncovered by Health Law ( Sabrina Tavernise and Robert Gebeloff, NY Times, 10-2-13)
A Nevada Health Plan -- Without The Insurance (Pauline Bartolone, Kaiser Health News, Capital Public Radio, NPR, 9-14-13) An unusual Nevada nonprofit that helps connect 12,000 uninsured residents to doctors and hospitals who are willing to accept a lower-cost, negotiated fee for their services. Giving care to the uninsured before they require urgent care helps lower costs by keeping their members out of the ER.
Health Reform D-Day? Or not for a few more months? (Joanne Kenen, Covering Health, AHCJ, 10-1-13). See also Tracking exchange activity.
Shutdown Din Obscures Health Exchange Flaws (Robert Pear, NY Times, 10-4-13)
What's in a name? Lots when it comes to Obamacare/ACA (Steve Leisman, CNBC, 9-26-13) In CNBC's third-quarter All-America Economic Survey, we asked half of the 812 poll respondents if they support Obamacare and the other half if they support the Affordable Care Act. And 30% of those polled don't know what ACA is, vs. only 12% when asked about Obamacare; 29% support Obamacare compared with 22% who support ACA; and 46% oppose Obamacare and 37% oppose ACA. "So putting Obama in the name raises the positives and the negatives." Republicans coined the term Obamacare as a pejorative, but not everyone perceives it that way.
A British Woman Spent Three Days in a U.S. Hospital. Here's What She Learned About Obamacare. (Eleanor Margolis, New Republic, 10-18-13. First appeared in New Statesman) "I begin to wonder how the Republicans have managed to convince even those in the very midst of a system that punishes the poor, that the slightest implementation of state-funded healthcare is an evil, communist conspiracy. ...As a foreigner with travel insurance, I’m lucky enough to observe American healthcare from a safe distance. But to someone fully enmeshed, like Carmen, Obamacare is a tiny drop in the murkiest of quagmires."
Health Care Reform: What It Is, Why It's Necessary, How It Works by Jonathan Gruber (clear explanations in graphic novel format of the Affordable Care Act, by an MIT economist, and one of the architects of both RomneyCare and ObamaCare). Here's YouTube version, in short.
C-Span is a good place to find various town hall discussions, hearings, wonderful links. For example: Supreme Court Determining the Constitutionality of Health Care Act and Supreme Court Hears Argument on Individual Mandate Provision
Understanding the Right’s Obamacare Obsession (Joshua Holland, What Matters Today, Moyers.com, 9-2-13) Excellent overview.
Church Insurance Improvements To Obamacare Threatened By Partisan Fighting (Sarah Pulliam Bailey, Religion News Service, 8-9-13)
The Republican party's 'defund Obamacare' disorder (Michael Cohen, The Guardian, 8-25-13) In denial of political reality thanks to its Tea Party fringe, the GOP is revving up for a debt ceiling showdown it can only lose.
How the ObamaCare defunding fight became a political showdown (Sam Baker, HealthWatch, 8-29-13)
Ten Titles: Understanding the Affordable Care Act (pdf, John McDonough, Hunter College, October 2010)