This is part four of a series by RMHP President and CEO Steve ErkenBrack about Connect for Health Colorado. Be sure to read Part One: What did October 1 Bring? Part Two: How Does it Work? and Part Three: Where did it Come From?
With all of the discussion, focus, and interest that surround the Affordable Care Act (ACA), I have heard a few things that are not quite accurate. Perhaps this is not surprising for a law that was more than two thousand pages long, with thousands additional pages of regulations.
Given the importance of health care to each of us, I wanted to clarify a few of the more critical misconceptions.
#1: Health Care Reform is NOT socialized medicine, nor a federal takeover.
The ACA – in its simplest form – guarantees every American the right to buy health insurance and creates Marketplaces (or Exchanges) to make that purchase more understandable and more affordable. Socialized Medicine is a system in which the government is the “single payer”, controlling all the participants of the health care system. For example, in England, physicians are employees of the government and hospitals are owned by the government.
This is not the structure of the ACA. In fact, Congress insisted that reform needed to take place within the existing American health care delivery system. Doctors can still practice in independent offices. Hospitals are still generally private institutions, often associated with a religious group or church. For-profit insurance companies still answer to their shareholders, and not-for-profit insurance companies (like RMHP) still answer to their community boards of directors.
There is no federal takeover. To be sure, the federal government has a role. The ACA is, after all, an Act of Congress. But this is no “one-size-fits-all-states” system. For example, look at the health insurance Marketplaces. States chose whether to build their own Marketplace or have the Department of Health and Human Services run their Marketplace. This was a decision made by each state, not by Washington, D.C.
About a third of the states chose to build and run their own Marketplace using a variety of models.
Colorado built our Marketplace to give consumers as much choice as possible. California made different choices in how they built their model. Wyoming chose to have the federal government run their Marketplace. Different states made different choices. That is not a federal takeover; that’s how our American system has always worked.
#2: Health Care Reform will NOT immediately lower everyone’s insurance premiums … or raise everyone’s insurance premiums.
This misconception goes both ways. Some folks say everyone will pay less; some say everyone will pay more. The truth is more complicated.
Under the ACA, for the first time ever, every American who wants health coverage will be able to get it. No one can be rejected because they are already sick or have a condition. In addition, there are ten categories of Essential Health Benefits that must be included in every policy. This means more people will be covered, and more benefits will be provided. Obviously someone has to pay for that, right?
But, also for the first time ever, many people will be eligible for a tax credit toward their insurance premiums. So some people who get tax credits may pay less for coverage than they did before the ACA. Others, especially those who don’t get tax credits, may pay more for coverage.
#3: The Health Insurance Marketplace is NOT the only choice for Americans.
Some folks have told us they believe that they have to buy through the Marketplace. This is not true. You can purchase directly from your favorite insurer. Many employers will continue to provide health insurance as a benefit, too. There are a variety of options, and the Marketplace is one, but it is not the only one.
It is true, however, that the tax credits are available only through the Marketplace.
#4: Penalties for not buying insurance under the ACA do NOT include jail.
The Supreme Court upheld the ACA, stating that Congress has the right to impose reasonable taxation, and the assessment of a penalty for failing to buy a policy is tantamount to a tax. But failing to buy insurance is not a criminal act, so jail time is not a possible punishment for refusing to pay.
#5: The ACA does NOT cut Medicare benefits or create federal panels to make end-of-life decisions.
The ACA did adjust payment to Medicare Advantage plans offered by private health insurance companies, but it did not reduce the benefits provided through the Government run Medicare program. In fact, the ACA provided some additional benefits to Medicare beneficiaries, including full coverage for many preventive services.
As to the creation of “death panels” … these are simply not reality. It is a perhaps well-meaning but clearly wrong-headed consequence of political passions in both parties. Those of us who, like me, have gone through end-of-life decisions with our parents know that the process is logistically, ethically and medically complex. The government has no role in it. A health insurance company has no role in it. The ACA does not change that.
The ACA is not perfect. Improvements are needed, but change should not be made on the basis of misconceptions. There is important work to do for people on both sides of the political aisle in order to build a better health system. We need to work together.
Coming soon, I will wrap up these series of comments on the ACA with a look ahead: what’s the future of health care reform?
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