Ok lets get down roll up our sleeves and get to work. We've had a long vacation taken a few good breaths but now the devil is staring us in the eyes and we need to get to work again. So to start lets talk about the Affordable Care Act (ACA) AKA Obamacare. I feel that this is a post that is just as important to republicans as it is to democrats as many not only benefit from this system but many need to know what will happen if a repeal is done without a replacement.
Lets first start with the origins of the law. Health care costs really started to go up during the Reagan Administration putting it into law that if you show up to an ER with significant health issues you would gain treatment. The actual ACA was born during the time of the Clinton administration when universal healthcare was thought to be inevitable. Hillary had her own version of health care (no it was not the ACA) that was more similar to a public option Bernie Sanders Style system. The republicans lead by Newt also decided to come up with their plan with the help of the Heritage Foundation. this plan would be rooted in Republican ethics such as hard work and personal responsibility. The idea was by making everyone participate you would have a large pool and then subsequently drive the costs down. This would also gain interest from the health insurance agencies as it would guarantee them lots of money and would further give ability to recoup the money lost through the ERs. When the public was seen to not be on board with universal healthcare yet, all parties dropped it and moved on to other issues. During the course of time enter Governor Romney of Massachusetts. He had a lot of issues on his hands and in the ACA found a way to address that need in a good conservative way. This plan was widely looked at as a success in the state and Romney himself managed to get a lot of positive accolades from the state for his work in this area (later to come back and haunt him). We finally get to the Obama Administration where universal healthcare is the center point of his work in the first year of his presidency behind his work on the economy. The original plan of Single Payer and creating a Government option appeared to be impossible. The Democrats were in power and they all decided to throw their weight around and the problem ended up being that they really didn't have anything they could agree on. During this time not only did the President have a rather difficult and rebellious group of people under him he also had a united Republican front dedicated to oppose any law or decision he would make (sounds familiar doesn't it?). The President at this time had made the pledge to be a uniter and he meant it at the time, the plan was to come up with universal healthcare that would not only be agreed on by all the Democrates in the House and Senate but also agreeable to most Republicans so it would be a solid deal immune to repeal no matter who is in the White House. After much arguing the ACA was dug up and altered a little bit to make it workable for the country at large and after he managed to reach Democratic consensus (finding that the republicans planned to vote no on anything put forward) Obamacare was born.
The first thing that Republicans did after the system was passed was what the Democrates will likely need to do when it comes to Republican planning and that is fighting it tooth and nail. They lost a major fight when the Supreme Court upheld the law but also managed to gain a major foothold in two areas. The first is that the states had been previously required to set up their own exchanges with federal dollars and the second was that the states had been required to expand Medicaid.
State Exchanges: Healthcare.gov shouldn't have been an issue in the first place as it was never intended to be the final solution. The law was supposed to function widely on the state level (remember it was originally a republican plan "states rights" was central in this). By getting rid of a state exchange the state lost a lot of leverage and health coverage possibilities went down. This is one of the reasons why choice is much higher on states that have set up their own exchanges as opposed to those that have not. Kentucky for instance has a far greater number of providers than Virginia.
Medicaid Expansion: Medicaid expansion was central to the law as it is based on healthcare subsidies. These subsidies get bigger and bigger as you have less income until it gets to a low point (poverty level) where it stops. This wasn't President Obama saying "screw those poor people" it was meant to be the point of drop off as these people were supposed to go on Medicaid and would therefore not need any subsidies. The good thing is that these people were immune from the penalty for being uninsured. By saying that States didn't have to Expand Medicaid many republican states created what was called the Medicaid GAP. This was a group of uninsured people that would normally have qualified for Medicaid under the law but due to not accepting the law have to remain uninsured and still continue to utilize the ER as their PCP.
Results: The fight against the ACA has worked to a greater extent. States that are Republican controlled have managed to work hard driving up costs, reducing the number of options and leaving a great number of people uninsured. In those states the ACA is deemed a failure and "broken" but when you compare it to states that have worked with the law such as California or Kentucky (I use this as it is a republican state) the ACA is largely effective and does most of what it says. The ACA is indeed broken in many states but it was the Republican Party at large that did the breaking.
I don't plan on dwelling a lot on this but I feel it is important to talk about weaknesses in the system at large. The ACA is not as terrible a bill as people like Rush may have you believe but it is still not without a great deal of Shortfalls and here I will outline a few.
HealthCare.Gov: This is one that was overblown for a number of reasons. I mean one of the major talking points is that "Private industry is perfect and the government is terrible see here is an example" and considering the number of crashes for sites funded by large private corporations this is not a valid one, I do have a few things to say about this botched rollout. I feel that the President at the time was greatly unprepared on many levels for the level of resistance he was going to face in the wake of this law. It was thought that this website would only be temporary and many states would quickly have exchanges in place so that traffic would be minimal at best. Unfortunately many states opted out of this and the floods rolled in. The website wasn't able to handle the traffic and then subsequently crashed. This problem was fixed quickly but the damage had been done as it was a major blow to the systems rep. This was also a very confusing site and though you had Navigators to help you through the process (I had to Navigate Medicare Part D making this rather easy for me) many people were easily confused about the process even when it worked.
Penalties: I feel that the penalties, though a good idea if the law was functioning at peak capacity ended up a curse. With rising rates and dwindling options in Red States many had to look at the options and found that the penalties sometimes ended up being less than what they may have to pay in premiums or that the couldn't afford the premiums or the tax penalties. This did the opposite of what the law promised making Healthcare pretty much unaffordable.
Keeping your Doctor: In a way this was a half-truth when the president presented this. The theory was a good one: You would gain private insurance that was as good or better than what you had before and your primary care doctor would benefit from this. Many Primary Care Physicians(PCP) saw the more complicated insurance structures and decreased rates of compensation coming and many decided that either this would be a good time to retire or that this was a great time to go to Self-Pay only. So in some cases you could keep your doctor and in some they would jump ship. This had a very negative result and was a promise that should have been reworded.
Rising Costs: One of the major issues with this law was the deal the president made with companies that he would forgo Caps on Rising costs as well as Negotiations for medications process and they would then give money that would be used towards the subsidies. This resulted in continued rises in Healthcare costs. Many will say "Continued Rises?" and I will simply encourage those of you with real healthcare coverage (not junk insurance) and you will note that Insurance Premiums have been rising constantly each year. Mine for instance would go up from 15-25% each year from the years 2003-2012 and that was pre-ACA. Medication costs would also go up at a similar rate. This failure was more a failure to fix an existing issue than an issue caused by the law itself. If you see a repeal without a replace and expect insurance rates to go down for good insurance or for medication prices to fall you will be very much disappointed.
Part-Time Cuts: This is a point that is debated. The law reduced the hours needed for employees to apply health care for their employees from 40 to 30 which then lead to many employers reducing the hours of their employees...or not. This has been debated a lot over the years. There have been many that have cut their hours due to this and there have been many that have not.
Inability to apply fixes: Every law has to really get into practice before we know what needs to be fixed and what is working well. Unfortunately we have had zero ability to alter this law to make fixes. Many of the issues caused by the law could have been fixed relatively quickly but due to our Mexican standoff that we have had since 2010 no changes could be made as when asked about change the only response would be "its repeal or nothing". Hillary Clinton ran on this as one of her platforms which alienated many of her potential supporters who are Single payer supporters and left many republicans with a bad taste in their mouths.
There are many things that the ACA does not do well but there are many things the ACA does right and a full repeal of a law that has now been in effect for 3-4 years is not going to be a good thing. Lets look at what will happen on repeal that may irk people.
Jobs: Believe it or not, healthcare is currently a booming agency. Many of the people are now seeking outpatient care where they had never done so before and many offices keep hiring more and more people. If you look at the jobs reports many of them are in this field and you can see a large connection to the ACA. If you repeal without a replacement the people will stop using outpatient clinics and many of these clinics and agencies will have to downsize leading to a flood of unemployed medical professionals (not as much doctors but those on the lower levels).
Adult Children on Insurance: Another highlight of the ACA is the extension of the time that a parent can keep their child on their insurance after reaching adulthood. This may not seem like much but it is extremely costly otherwise to have a child seek insurance through a private provider when they are likely in college or looking for employment.
Hospital Blowouts: When you have large numbers of the population now without insurance they have very few options for emergent care when means they go to the ER for their primary care. This had been a major issue before the ACA and one of the ones that had been an encouragement for the law to be in place. The hospitals will now have to see scores of people who cannot pay for their treatment leaving them with their own crippling debt and increasing ER wait times. If you want to see an example of this try and go to a place where there are a lot of uninsured poor people and attempt to go to their ER (example in my state is VCU) and enjoy the day long wait times. These debts have lead to threats of hospital closures in the past and this may be the case in the future.
Crippling Medical Debt: Debt isn't just a problem for hospitals but for working people as well. I know there are many who claim that they just put money in an account and they can do just fine without insurance and this works fine when it comes down to basic primary care. Lets say you break an arm and have to pay $25,000 for that treatment then they discover something bigger such as cancer. Do you think that the lower middle class person has $200,000-500,000 ready for such a thing? Nope they will go into debt and their credit scores will fall leading to sad stagnation.
No Replacement Coming Soon: After repeal there is not going to be any pressure to replace. When you have a party that says if a person isn't employed then they don't deserve things like food or shelter as it would simply teach them to be lazy many of these above issues wouldn't faze them much. You also have many different factions in the party. Many don't believe a replacement is needed at all and that the system was perfect beforehand (Rush Limbaugh preached this a few years ago himself), and then you have those that believe in a replacement but every one of them has a different idea what that would entail. This will result in bickering and little to no action.
The Media has already been reporting that the Republicans have a repeal bill passed and ready to be put in practice and this is simply not the case. They have simply made it so that they can pass a repeal and a replace bill with a simple majority vote (as they would not make it past the filibuster otherwise). Currently there are at least 10 Senators that are weary of a repeal without a replace so this could be a long fight (don't panic yet).
Well in this case you need to evaluate your own personal situation regarding the ACA and see how you would be effected by a repeal. You can then combine this with the information you already know and send a message to your congressman and Senator. You can find out the name of your representative on House.gov and your Senator on Senate.gov . When you find out who you are represented by then you have the opportunity to voice your concerns via email or postcard (never by letter as it takes forever for that to get through the screening process. You let them know that you are a voter in their district and tell them how the repeal of the ACA without a replacement will effect you personally. Believe it or not this is something that can work to sway them. A repeal without a replacement is not a harm only Democratic voters type thing as it effects us all. Stand up and Stand Proud.
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