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Setting the Stage for the ACA’s Second Anniversary

Posted by Mark Ryan, MD March 13, 2012 at 8:00 AM

In one week, the Patient Protection and Affordable Care Act (PPACA, or ACA for short) will attain its second anniversary.  In preparation for the media attention this milestone will attract, it is necessary to set the stage regarding the ACA’s achievements and popularity.

First, a review of what the reforms already in place as a result of the ACA:  this timeline provides a good summary, as does this timeline.   A review of these timelines shows that the ACA has already led to the following changes:

  • Young adults can stay on parents’ insurance policies until age 26.
  • People with preexisting medical conditions who have been uninsured for at least 6 months can access care via Preexisting Condition Insurance Plans.
  • Insurance companies can no longer rescind patients insurance, and have eliminated lifetime caps on insurance benefits.
  • Children can no longer be denied medical care due to preexisting medical conditions.
  • Seniors have received discounts and rebates on their medication costs via Medicare Part D.
  • Patients can receive many preventive care services without paying co-pays.
  • Funding has been increased for community health centers and for the National Health Service Corps.
  • Increased targeting of healthcare fraud.
  • Insurance companies will be held accountable for unreasonable premium rate increases, and are being required to spend at least 80-85% of the premiums they receive on providing necessary medical services to beneficiaries.

These are among the ACA’s reforms that are favored by individuals on both sides of the political spectrum (pdf link).  Even before the ACA’s major reforms become active in 2014, the law is already improving the status of healthcare in America.

It can be anticipated that there will be a great deal of critical commentary about how the ACA represents a governmental overreach and that Americans resent this supposed power grab.  However, in the most recent Kaiser Family Foundation Health Tracking poll (pdf), 35% of Americans would like to see the law expanded, while 19% would like to see the law kept in its current form.  When 54% of the nation would like to leave the law as is or expand its reforms, it is hard to argue that most Americans oppose the ACA in the way that the law’s opponents would have us believe: they might highlight that 72% of Americans oppose keeping the ACA in its current form, but 1/2 of that number want the law expanded.  This underlines the disingenuous nature of the claims made against the ACA: the law’s opponents highlight those bits of data that can be presented as supporting their claims, but conveniently omit the details that undercut their claims.

Opponents of the ACA also have chosen not to propose any replacement for the law any time soon, despite the fact that the House of Representatives actually voted to repeal the law in 2011.  While the Republican Party delays action, 1/3 of Americans are struggling to pay their medical bills.  This statistic illustrates the reasons that the ACA’s reforms were so badly needed: Americans cannot easily afford necessary medical care.  The law will address this directly as the health benefits exchanges come online in 2014, but the reforms noted above stand to improve this statistic.

We will certainly hear more and more reasons that the ACA was unconstitutional, especially as the Supreme Court will be hearing arguments on the law’s constitutionality the week following the law’s anniversary.  One of the major arguments against the ACA focuses on the law’s mandate that individuals purchase health insurance or face paying a penalty.  This article nicely encapsulates arguments as to how and why the ACA and its individual mandate are both constitutional and necessary.

This is where we stand: the ACA is already benefiting Americans, many of whom are in favor of the law’s reforms or who would have preferred more expansive reforms.  The need for reform is clearly evident, and the ACA’s opponents have not proposed any meaningful answer to the current crisis in healthcare access and affordability.  Despite the law’s opponents’ fervent claims and beliefs, the law’s constitutionality can be supported in a number of ways.

If you support the ACA’s healthcare reforms, get ready, be vocal, and stand tall.  The week of March 19-23 promises to be quite active.

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