An Unbearable Media Feeding Frenzy
Deep sea submarine cruise or interstellar voyage are probably the only two legitimate excuses for not knowing what happened in last Thursday’s Supreme Court ruling on the Affordable Care Act. It was all over the interwebs, to the point of becoming viral–used in the tech sense, but retaining the pathological implications of the biological definition. Therein lies the sticky issue of being informed–everyone, their mother, their four sons and all of their sons’ friends have an opinion on healthcare. The amount of tangential articles is absolutely maddening, but I’ve been trusting one question to guide my readings: is this the analysis of a fact or something that actually happened? Or is it tabloid coverage of what people think other people were thinking?
Almost every news outlet (read: including Twitter and Facebook, slightly guilty as charged) had self-proclaimed experts talking about what was going through the head of Chief John Roberts, how the conservatives would undoubtedly profit from this ruling, how the future of government is doomed, and, my personal favorite, what Mitt Romney would or would not do on the first day he is in the White House if he gets elected (which has interesting musings on the machinations of law-making and the Executive Office but becomes a little too “Ms. Cleo” for my tastes). Don’t get me wrong, these articles are useful, especially in policy, history and general news interest circles. So, they ask me, why are you then writing a post on this exact, already massively covered news story in which every possible point of view has been suffocated by the popular media? Because they’re missing the elephant(s?) in the room rather spectacularly by focusing on the minutiae.
This is the first installment in a series on Obamacare and the Supreme Court decision. Stay tuned for more. I’m going to post everything as one behemoth of a post when all’s said and done for ease of access.
A Million Opinions, But I Still Don’t Know What It Does
The Patient Protection and Affordable Care Act1 is the culmination of years of congressional scuffle about the state of the healthcare industry in the US. Passed in the 111th Congress, of which both houses were controlled by Democrats, the bill encompasses quite a few different aspects of policy in its 2,600-page length. The subsequent 112th Congress (for those of you who have been watching The Newsroom–which should be everyone–House = Republican/Tea Party; Senate = Democrat]) has now brought the idea of repeal up 33 formal times–all of which were blocked. Public approval ratings are opaque. You can break down the polling numbers in pretty much any way you want to support any claim. It’s a media analyst free-for-all.
Which is exactly why it’s so frustrating that the general public seem to have no idea what the healthcare bill actually does. Although the White House is doing a (choose a partisan adjectival phrase: dishearteningly ineffective, disturbingly bad, confoundingly inept) job marketing the PPACA as a win for the American people, it is also quite clear that there simply isn’t clear marketing at all.
Perhaps this is part of the point–perhaps there is no way to provide succinct, correct information for a voter in this post-post-modern day and age of three million blogs, more tweets than you can handle, and a brand of propaganda that is nigh indistinguishable from the facts. Perhaps experts simply think the normal person won’t get it. Perhaps the master narratives of this bill are simply partisan garbage. Perhaps I’ve lost one of the great summaries in the media shuffle.
Regardless, I’m going to try and distill the PPACA in less than five paragraphs for your reading pleasure.
Five Paragraphs or Less [Not Less]
First and foremost, the PPACA provides health insurance for every US citizen living in the States. The Act uses a multi-pronged approach to institute such sweeping reform. Firstly, uninsured adults with pre-existing conditions are eligible for temporary insurance with capped premiums until 2014; children and dependents are allowed to stay on their parent or guardian’s health insurance until age 26 (a provision so popular that three major insurance providers said they would keep it if the rest of Obamacare was repealed–keep this in mind, it will be important later); flexible spending accounts (aka self-contributed “use-it-this-year-or-lose-it” healthcare accounts, which are a tax-exempt slush fund for medical catastrophes) will be limited; and insurers cannot ditch patients when they become ill or chronically sick2.
When 2014 rolls around, the famed insurance exchanges will be fired up for the first time–providing nothing more than a government run, standardized marketplace where comparing insurance plans will be easy, understandable, and competitive. Every citizen of the US will be required to have health insurance–through an employer, from a previous transaction, or purchased through this exchange–with a monetary tax (or penalty, depending on who you are) on those still not insured that will come out of their federal tax return. Non-employer provided insurance will be purchased through these exchanges, with a cap on the cost to the consumer and a federal subsidy provided to families and individuals living in up to 400% of the federal poverty line. In 2017, any state that does not wish to continue to partake may submit a waiver directly to the Secretary of Health and Human Services (currently Kathleen Sebelius) to opt out of Obamacare–with the understanding that they must provide universal healthcare coverage to all inhabitants of their state. This is the federal government saying, “Please, do it better than us,” for if the state can, they will pocket the difference between the cost of Obamacare and the cost of their own system. Bipartisan legislature has been moving through Congress to change this provision to come into effect at 2014 so as to avoid a state setting up healthcare exchanges and then take them down in 3 years. Obama has also backed this modification.
Thirdly, insurers are held responsible for spending 80% of the money paid to them on medical care and programs–rather than administrative costs or any other misundry chasms into which insurance companies throw cash–and prohibited from utilizing “annual spending caps” on any policy or imposing dollar limits on core benefits like hospital stays. Insurers cannot bar anyone from obtaining health insurance due to a pre-existing condition, unless that condition is tobacco use. Women’s preventative care is completely covered, without co-pays, by all plans, as are a few other standard preventative screening procedures. By 2018, all co-pays will be eliminated. Most importantly (well, most visibly), the PPACA is responsible for the nutritional information you now see all over fry containers and Panera menus.
The Medicare ceiling of reimbursement for prescription drugs will increase steadily over implementation until 2020, when which all prescription drugs will be covered for all enrollees. In 2014, Medicare will be expanded to cover all individuals up to 133% of the federal poverty line–although this provision was ruled optional on a state to state basis by the Supreme Court. Small businesses will be eligible for a 50% tax break on all company insurance plans if they have less than 11 full-time employees who have an average salary of >$25,000.01. Larger firms–50+ employees–will incur a 2K per employee penalty if they do not provide health benefits.
A mega-fraud crackdown on Medicare and other policies will be instituted (and, in fact, has already begun). Tanning beds get a 10% tax increase. In 2018, expensive insurance plans–those with high premiums–are subjected to a 40% tax (look for a piece on how this tax works in the future). Medical devices get a 2.3% tax increase at purchase. Insurance and pharmaceutical companies will be taxed at a higher rate, directly corresponding to their market share aka how many patients they have under their umbrella. Most vaguely, Obamacare also provides for the payment of federally funded health insurance (i.e. Medicare/Medicaid) based on quality of care rather than quantity.
A bit dry, but very important.
Also, I know. I cheated on some of those paragraphs. A bit over the 5 sentences middle school standard.
Currently listening to: Less Than Jake – The Science of Selling Yourself Short.
1If you’re looking for an excellent, more in-depth summary of exactly what the bill provides for than I proffer here, check out Wikipedia’s page. Not to get into an academic fight about credibility, but for an overview of concepts, it’s a great place to start.
2I’m going to be honest–I did a double take when I first read this provision. Isn’t that the point of insurance? To provide for you when you’re sick?