Dr. Clancy, president of TU:
My experiences with the Affordable Care Act date back to 2009, the year prior to its passage in 2010. At that time I was invited to the White House to meet with leaders who would be writing the first drafts. In early 2009, those writers were almost exclusively focused on simply extending health care to the uninsured. I thought that was a very good thing and I was looking forward to final edition of the law. Much to my surprise, the passed legislation in the Affordable Care Act of 2010 was something much more complicated than simply providing health care coverage for the 39,000,000 uninsured across the US.
In reading the entire legislation from cover to cover, I saw trouble from the start.
The law was very complex and I understood it only because I was trained as a physician. How in the world would most people understand this law? It is hard to support something you don’t understand.
The law was much more than extending health care coverage to the uninsured. Roughly 30% of the law was dedicated to extension of health care coverage. The other 70% were to be major changes in our health care reimbursement system. There were mandates, penalties and expensive electronic reporting requirements. There were Sunshine Laws that required physicians to report their relationships with drug companies. There were changes in how doctors and hospitals would get paid. Many things for many people to not support.
The law was 1,992 pages that rolled out over 8 years. Every year, the health industry would need to make changes to comply with the next aspect of the law as provisions were enacted.
So we had a complex law of 1,992 pages that rolled out over 8 years that was full of mandates and changes to how health care would be paid that would affect all Americans in a very personal way. What could go wrong?
Yet, despite these complexities, I was excited about the law. For more than 30 years, I have taken care of patients with severe mental illnesses. Over the past 5 years, my patients were almost exclusively from north Tulsa. Because of the impact of those mental illnesses on their ability to work, many of my patients lived in poverty and many did not have health care coverage. Because they did not have coverage, they could not afford the medications they needed to be well and go back to work. They avoided seeking medical care for diabetes and hypertension for fear of overwhelming medical bills. In fact, across the nation, those with severe mental illness have a 20-year shorter life expectancy than those without severe mental illness, due primarily to untreated medical conditions. So I had great hope.
As coverage expanded under the Affordable Care Act, I saw good things happening for my patients. They could afford their psychiatric and medical medications. They started to get better, much better. In fact, all of north Tulsa started to get better. In 2005, there was a 14-year difference in life expectancy between north and south Tulsa. By 2015, life expectancy in north Tulsa had improved by 3-years; from 67 years average life expectancy in 2005 to 70 years average life expectancy in 2015. The 14-year difference in life expectancy between north and south Tulsa was improved to a 11-year difference for roughly 20,000 people, adding almost 60,000 years of life for north Tulsa residents.
So now we are faced with an almost certain dismantling of a law that, despite its complexities, mandates, penalties and costs, has saved lives because health care coverage was expanded. In retrospect, this law would have had much more appeal across the nation if it was kept simple and about expanded coverage. As the “Repeal and Replace” discussions begin, I hope our legislators remember that this law is far more than policy and principles. This law has saved lives. Legislators, it’s on you to get it right. Keep it simple, but get it right.
Greyson Chance, president of Young Dems:
There is a general consensus amongst Democrats that the Affordable Care Act was certainly far from perfect; however, it was a step towards a larger goal that every American, no matter their socio-economic status, should have access to affordable and effective care. It is already disheartening that Republicans in Congress would repeal the ACA. But to repeal it with no laid-out replacement plan? That is the true disappointment. As a result, 18 million Americans will go uninsured and our country will take a massive step backwards in regards to a service that should not be a viewed as a privilege, but rather as a right to all citizens.
Sheridan Nolen, president of College Republicans:
First off, let’s remember that is actually called the “Patient Protection and Affordable Care Act.” Republicans and Democrats can agree that the Patient Protection aspects of the legislation are sound.
-Individuals may remain covered under parents until age 26. Between 1 and 2 million Americans benefit from this aspect of the ACA. Although individuals are considered legal adults at age 18, it is reasonable to assume that citizens 18-26 do not have jobs that provide enough pay to cover insurance costs.
-Insurance companies can no longer drop sickly people as soon as they need to receive more care. Insurance ensures that an individual has care in the event that he/she becomes ill. What is the point of having insurance if you are cut off as soon as the very reason why you purchased it occurs in your life?
-Insurance can no longer deny policies for pre-existing health conditions. This makes sure that all citizens are on equal ground and have access to all health insurance regardless of individual circumstances. No person is less than another simply due to pre-existing health condition. Equality is further represented in that women can not longer be charged more than men. Age discrimination is also taken away due to companies no longer being allowed to place lifetime limits on health insurance policies.
-I see a need for Medicaid in the United States. However, why did we create a new program that expanded a flawed program? Medicaid expanded 113% after the Affordable Care Act passed.
-Individuals are forced to pay Insurance premiums have increased exponentially in many states to compensate for individuals that cannot afford basic health insurance.
-In 2009, Americans were told that they would get to keep their current insurance plans after ACA went into place. However, more than 4.2 million Americans received notices that their plans have been canceled or that they would need to pay substantially higher premiums due to government requirements that insurance companies had to fulfill.
-Some of the coverage that is a part of the ACA could be considered asinine. For example, a 58-year-old woman said, under Obamacare, she was required to pay $5000 for maternity coverage. Why does she need to pay for a service that she is not going to use? Americans have the right to choose what they pay for. Additionally, this policy is a financial disservice because health insurance is not “one-size fits all.” Basic health care plans will cost $2000 and provide services that healthy individuals rarely plan on using.
-In essence, under the ACA, being a United States citizens means you must buy health care. If you don’t buy it, you’re paying tax penalties that increases over time. After a long period of time, it would have made more sense for an individual to just buy their own insurance plan.
-Companies of 50+ are fined if they do not provide insurance for their employees. Negatively affects the employees because they will either 1) Get Laid Off 2) See a decrease in pay due to needing insurance.
-Adding more patients to the already broken Medicaid system discourages doctors from accepting Medicaid beneficiaries and leads to hospital overcrowding. Doctors are not making as much money, so they will not continue to see certain patients. A shortage in doctors is also plausible because many of them are not receiving the same pay that they used to make. If I went to medical school, I would be irritated too. Doctors deserve to be paid well.
-On a personal note, one of my family member’s is a nurse at a local hospital. They see people who come into the emergency for minor issues, such as a cold, all of the time. By law, they are required to be served, but this overcrowds waiting rooms and gets in the way of people who legitimately need emergency medical attention. With ACA, this would only occur more often because doctors will no longer see Medicaid patients.
Brennen VanderVeen, student:
So, in discussing repeal, there are several issues to consider. As to whether repeal should happen at all, I think it should, for a few different reasons. For one, I reject the Supreme Court’s justification of the individual mandate being constitutional as a tax. Secondly, I think the ACA is bad policy. While many people have certainly gained access to coverage, others had to switch health insurance plans and premiums have risen for many people. I also don’t like the degree to which the government is able to define what constitutes good health care. For instance, the law’s requirement that insurance companies provide preventive care was interpreted by HHS to mean basically all contraceptives, which resulted in that coverage being mandatory for people who really did not need it or who morally opposed it, although subsequent litigation has reduced the number of people with moral opposition who have to have that coverage. Finally, opposition to the ACA is a major reason Republicans were able to regain control of Congress in 2010 and 2014. To not offer an alternative would be political malpractice.
This of course leaves the question of what should replace the ACA, if anything. I definitely think that a repeal effort should be done in conjunction with a replacement effort. Doing otherwise would create uncertainty in the health care market and potentially leave vulnerable people without health care coverage. Luckily, it is my understanding that both Republicans in Congress and President Trump want to do repeal and replace simultaneously. I’m not sure exactly how to make sure that people who currently have plans through ACA exchanges and subsidies are able to keep them, but I’m not opposed to keeping the subsidies in place for some time in order to make the transition go more smoothly.
In regard to what changes I’d like to see, I don’t really have a comprehensive plan. However, one major problem in the US health care market, I believe, is the reliance on third party payments in which patients are largely not responsible for paying for their own care, and I therefore think that health care reform should focus on reducing reliance on third parties. One thing I’d specifically, I’d like to see health insurance decoupled from employment. The reason health insurance is so often provided by employers is because of wage controls during WWII and has been continued in part because of subsequent government policy. The markets between health insurance and car insurance are obviously different in a number of ways, but if health insurance were more like car insurance, people would be more able to find the coverage that works best for them, and people would be more easily able to keep their coverage after switching or losing jobs.
A second proposal I like is the expansion of Health Savings Accounts. These allow people to save for health coverage and then pay for coverage from that. Since people pay from their own account, they would consider costs much more than they currently do. I know countries like Singapore have successfully used HSAs as one of several means of controlling costs.
Finally, there is the issue of what has actually been proposed. I’m not all that well-versed in current proposals, but I have read a little bit. I like Rand Paul’s proposals, at least in theory, but I haven’t seen a lot of analysis on them and I don’t think they’re politically viable. The main proposal, though, seems to be the one from Susan Collins and Bill Cassidy. That would allow states that like the ACA to keep it. I have no idea how that mechanism actually, works, though. Still, I support federalism, so I’m okay with states continuing ACA type policies of they so choose, though federal involvement makes me skeptical. That plan also keeps tax credits and subsidies, which I’m not necessarily opposed to doing, but having that sort of involvement makes it more likely that the government will have to define what constitutes good health care. The plan apparently does include HSAs of some type, though.
Overall, I guess I would say that I entirely support repeal, and I think the Republican plan will ultimately be preferable to the status quo, but I’m skeptical that their reforms will be as good as they could be. I’m expecting mediocrity, but hopefully I will be pleasantly surprised.