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article imageOp-Ed: Obamacare: No Cure, but worth fighting for

By Michael Terron     Aug 14, 2013 in Politics
Obamacare has been hailed as one of the most expansive transformations of the American health care system since the 1960s. However, if legislation sponsored by several U.S. senators passes, it will be defunded before it effectively gets off the ground.
Surely, there are very credible criticisms of Obamacare; officially known as the Patient Protection and Affordable Care Act (PPACA). However, there are incredible misconceptions of what the measure actually entails. Since the act was divided into ten parts, to be phased-in over a period of ten years, let me, first of all, list a few of those provisions which have already been enacted:
- The FDA is authorized to approve generic versions of biologic drugs
- The Indian Health Care Improvement Act has been reauthorized and amended
- Adults with preexisting medical conditions cannot be denied health care coverage
- Young people, up to age 26, are permitted to remain on their parents health care
insurance plans
- All new insurance plans must cover preventive care and screenings without co-
payments, co-insurance or deductibles
- Insurers cannot cancel policies because of sickness
- Insurers must provide detailed information about administrative and executive
- Health care providers must spend at least 80% of premium dollars on health care costs
and claims; if not, the policy holder must receive a rebate
- New health care plans must cover mammograms and colonoscopies without charging a
deductible, co-pay or co-insurance
- Medicaid is expanded to citizens with income up to 133% of the federally-established
poverty line. However, as a result of the Supreme Court ruling on "National Federation of
Independent Businesses v. Sebelius (2012) individual states have the right to opt out of
Medicaid expansion. (As of this writing, at least fifteen states have chosen to do so)
Perhaps, the most important provision of Obamacare are the "health care insurance exchanges" which will go into effect on October 1, 2013. At that time, barring 'defunding',
insurance exchanges will be " established and subsidies for premiums are given to individuals who buy a plan from an exchange and have a household income between 133% and 400% of the poverty line. Section 1401 (36B) of PPACA explains that each subsidy will be provided as an advancable, refundable tax credit and gives a formula for its calculation. A refundable tax credit is a way to provide government benefits to individuals who may have no tax liability (such as Earned Income Tax Credit) . . .To qualify for the subsidy the beneficiaries cannot be eligible for other acceptable insurance coverage.
The IRS and the Department of Health and Human Services issued rules on May 23, 2013 that would regulate the health care insurance exchanges. In addition, individuals who are not covered by an acceptable insurance policy will be charged an annual penalty of $95, or up to 1% of income over the filing minimum, whatever is greater; this will rise to a minimum of $695 ($2,085 for families) or 2.5% of income over the filing minimum, by 2016. Exemptions are permitted for religious reasons, members of health care sharing ministries or for those for whom the least expensive policy would exceed 8% of their income." In the language of the law, "a taxpayer" who fails to pay the penalty shall not be subject to any criminal prosecution or penalty and cannot have liens or levies placed on their property, but the IRS will be able to withhold future tax refunds from them.
In July of this year the Obama administration gave businesses a one-year delay - until 2015 - before they are required to provide health care coverage for their workers, or face fines. Citing the 'complexity' of the law and 'complaints' from businesses, Assistant Treasury Secretary, Mark Mazur, announced that the administration recognized the need to give businesses more time. "Under the law, companies with 50 or more workers must provide affordable coverage to their full-time employees - redefined as 30hrs or more - or risk a series of escalating tax penalties if just one worker ends up getting government-subsidized insurance.
Of course, funding for Obamacare involves a variety of taxes and offsets. The principal sources of revenue will include 1) an expanded Medicare tax on incomes over $200,000 for individual filers, and $250,000 for joint filers 2) a 40% tax on 'Cadillac' or expensive insurance policies. Pharmaceuticals, certain high-cost diagnostic equipment and indoor tanning facilities will also be taxed. Over the next ten years projected spending offsets are to come from: reduced home health care payments and Medicare hospital payments. The taxes and offsets are estimated to amount to over 500 billion dollars.
When the contemporary national debate began around reforming our dysfunctional health care system public opinion was generally favorable. As specific plans emerged and the congressional haggling became nightly t.v. news, Americans tended to split along ideological lines. Progressives tended to support reform while Libertarians and Conservatives generally opposed it. There was even an 'age' divide, with most people under forty, for it; those over forty, against it. Bitter contention, duplicitous pronouncements and 'backroom' deals - all tended to turn off many Americans to the effort. By the time of the presidential signing, most Americans polled had soured on the proposition for different reasons.
"What this bill does is not only permit the commercial insurance industry to remain in place, but it actually expands and cements their position as the lynch pin of health care reform. And these companies profit by denying health care, not providing health care. And they will be able to charge whatever they like. So if they're regulated in some way and it cuts into their profits all they have to do is just raise their premiums. And they'll do that.", says Marcia Angell, Senior Lecturer in the Department of Social Medicine at Harvard University Medical School.
Many progressives, including myself, tend to agree with Professor Angell. We would prefer a 'Single Payer' system; one, in which President Obama reneged on after launching his first presidential campaign. Under this kind of health care plan the government would collect all health care fees and pay out all health care costs. "Hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the government to cover operating expenses . . . Doctors would have three options for payment: fee-for-service, salaried positions in hospitals and salaried positions within group practices or HMOs . . .The need for private insurance would be eliminated." Now, more than twenty health care related organizations in the U.S. endorse a Single Payer system. They include: the American Public Health Association, the American Medical Women's Association, the National Medical Association, the Islamic Medical Association and National Nurses United.
In my opinion, sufficient public and congressional support for a Single Payer system is not likely to materialize in the near future. Full-throttled opposition from the for-profit health care, insurance and pharmaceutical industries, coupled with a sizable percentage of the population uninformed about the benefits of Single Payer, will make efforts to bring it about, in the short-run, futile. It should remain, nevertheless, a part of a long-range goal. We must keep in mind that Obamacare, with all of its flaws and inefficiencies, continues to be fought 'tooth-n-nail', even though it remains well within the clutches of the private sector. Is Obamacare worth fighting for, and why? My answer is - yes, for two important reasons. It has: 1)provided real access to comprehensive health care for millions of American citizens who, otherwise, would not have it 2) further defined the concept, through legislation and judicial ruling, that health care is not a 'privilege', but a 'right'. No, Obamacare is not the cure; however, to oppose it is dead wrong. . .
This opinion article was written by an independent writer. The opinions and views expressed herein are those of the author and are not necessarily intended to reflect those of
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