The Affordable Care Act is here and the sky has not fallen

The Affordable Care Act was enacted all the way back in 2010. But, even before then, critics were asserting that this new law would more or less destroy the American economy, insert Uncle Sam squarely between patients and providers, and initiate the end of freedom as it ushered in socialized medicine. That was nearly 4 years — and 40 repeal attempts — ago, and yet, the sky remains intact above us.

Sure, there have been some major bumps in the road along the way. No one, including perhaps most of all the president, was thrilled to receive cancellation notices in the mail from their insurers after being told they could keep their plans if they liked them. Others, particularly if they — or those they work with — are young and healthy, have seen some increases in their insurance premiums, and have attributed those increases to the new law, as if insurance premiums weren’t on a steady upward trajectory well before anyone ever heard the name Barack Obama.

And, of course, the infamous Healthcare.gov website was a tremendous embarrassment in the early days, threatening to derail enrollment efforts critical to the functioning of the new health insurance exchanges. Most of this has been, or is currently being, addressed by the Obama administration. And, it is helpful to keep in mind that this new law represents an enormous undertaking. Health care represents 18% of the American economy. Changing something that large takes time and is certainly prone to mistakes along the way. Similar efforts, like the implementation of Social Security and Medicare were also beset with more than their fare share of problems.

But now that we’re into the real heart of the ACA, with the most key provisions now implemented as of January 1, 2014, what has really changed? Has the government prevented you from seeing any doctor you wish? Have your taxes gone up exponentially? Are you now paying more for health care and getting less? Has a “death panel” convened to decide your fate? Or has life, somehow, gone on much as it did before? Some of you may say, “Yes, my taxes increased.” or “Yes, my health insurance premiums have increased.” For some, that is inevitably true, and I would not disagree.

But, for others, the world is a much brighter place as of January 1, 2014. The phrase “pre-existing condition” is no longer a part of insurance companies’ vocabulary. That means that the middle-aged woman with breast cancer who was unable to buy insurance because she was already sick, is now able to get covered and receive the care she desperately needs.

In many states, Medicaid has been expanded to everyone with incomes up to 138% of the federal poverty level. That means that the childless adult who works full-time for minimum wage is now able to have health insurance for the first time. And, across the country, the health insurance exchanges are open for business and subsidies are available for those with incomes between 100% and 400% of poverty. That means that a father or mother with a family of four, who works for a small business that doesn’t offer insurance benefits, can get federal assistance to buy insurance as long as they earn less than $94,200.

These changes are real and they are positive. And, I would contend, not only has the sky not fallen, but for many it also looks to be a brighter shade of blue. But, we are just getting started, and 2014 is full of new opportunities and challenges, as these experts predict.

Brad Wright is an assistant professor of health management and policy, University of Iowa who blogs at Wright on Health.

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  • Ron Smith

    Hi, Brad.

    More ACA shill. Didn’t you hear just yesterday about the families in Florida who once they are enrolled are discovering that either the parents are not eligible but the kids are enrolled, or the parents are enrolled and the kids are not eligible.

    And I suppose that you haven’t read about the women who tried to get off the ACA enrollment because she found something cheaper outside healthcare.gov? It took her only six weeks of daily effort to finally get off…after they had already deducted almost $1000 from her bank account following what she thought was a successful unenrollment?

    Now, in light of that women’s experience, I wonder just how big a mess these families in Florida are getting into where they find out that parents or kids are not covered like the web site told them? Probably a couple of months at least to straighten that out, I bet. And what happens in the meantime?

    You guys once again remind me of the ostrich with its head stuck in a pothole. Everyone sees you about to get your hiney run over all the while you are touting just how good the view is from your perspective.

    ACA is an utter failure and to the moment its collapse is final you guys are still going to be shilling the false claims. Enough already!

    Respectfully,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

  • th3o6a1d

    Have you tried buying “affordable care” on the state exchanges? It’s pretty bleak. Perhaps the worst thing about the ACA is not what it does but what it didn’t do — that is, control the rising costs of insurance.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    So the ACA was implemented and really not much has changed. Prices keep going up as they did before, access and quality are going down as they did before, and the only difference is that a new zero sum game has been put in place for the 99%, with less money on the table, because the 1% industry stakeholders had to extract another pound of flesh for their cooperation with the new rules, as evident from all health care related earning reports and subsequently rising stock prices.
    The sum total achievement is that a smaller amount of leftover crumbs are now more pleasantly distributed among the exploited. I would characterize the entire exercise as a spectacular waste of political capital.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Congressmen and their staffers are not exempt from the law. And are not exempt from its consequences. Fortunately for them, since politics is a very lucrative occupation these days, they have enough cash on hand to manage the “glitches”:
    http://www.politico.com/story/2014/01/obamacare-tom-coburn-cancer-doctor-102724.html

    • NormRx

      Maybe not Margalit, Congress is eligible for subsidies even though their salary is in excess of $174,000/year. Nobody outside of congress and their staffers are eligible for these subsidies at that income level Check out this WSJ article.

      http://online.wsj.com/news/articles/SB10001424127887324635904578644202946287548

      • southerndoc1

        There are tons of people making over $174K (which is way, way more than most Congressional staffers make) who have their health insurance entirely paid for, i.e. subsidized, by their employer. Same thing.

        • NormRx

          I don’t care what private employers do. I do care what our politicians do. They pass all sorts of laws and then exclude themselves from the effects of those laws. A few examples are sexual harassment, insider trading and the ADD. Nobody outside of government is going to get a subsidy if they are making over 175,000/year.

          • Bob

            However tens of millions will be getting free Medicaid!

      • Bob

        That didn’t help Senator Tom Coburn, who told us back in 2010 that $1 out of every $3 spent on healthcare is waste, fraud or abuse, now $1.2 trillion a year.
        As you might know he now has cancer and is stepping down and while having cancer finds his Senate ObmaCare policy doesn’t cover oncology so he has to pay out of pocket.

  • T H

    True: Finding a disinterested party is going to be a challenge.

  • NewMexicoRam

    It’s only been sprinkles compared to the deluge coming in Oct./Nov. The national wail will be very loud indeed.

    • safetygoal

      I wonder if POTUS will postpone the large employer mandate until 2015, after the 2014 mid-terms. :)

  • Bill Viner

    So you’re making your argument based on less than one month of data? The true effects of the ACA probably won’t be known until 2015 or later. Yes, 2 good things happened. Let’s see how it plays out and hope for the best, but expect the worst.

    • Bob

      Try April Fools day, and November 6, 2014, Bill

  • Anthony D

    How do you feel about the IRS controlling your healthcare? I’d be ticked off as well!

  • Anthony D

    When you have skyrocketing cost in education, and you have to jump
    through all these hoops to become a doctor (it is not an easy
    accomplishment) you are going to want to be well compensated. ACA is
    cutting into doctors paychecks making incentive to become a doctor less
    attractive, which equals less doctors. No, we won’t see this shortage in
    the next year or two. We probably won’t feel it for another decade. The
    average age of doctors in this country is about 50 (reports vary from
    49 – 51). 10 years from now, the average doctor is reaching retirement
    age and there are fewer med students filling their shoes. Also, there is
    an aging baby boomer generation who will need more health care than
    they require now.

    So you have a more limited supply of doctors and an increased demand for
    health care. Unless we kick our politicians out of our health care, we
    are never going to drive costs down.

    The pattern I see in this country is 1) Government identifies a
    hardship; 2) Government intervenes in private industry to try to fix the
    hardship; 3) The problem grows, as rules of economics react to the
    government intervention; 4) Government intervenes again, creating more
    problems (back to step 1).

    • Bob

      Anthony, you seem to forget the back end of medicine, which is all the “boomer” physicians and nurses, part of the overall “boomer” hordes which cause 4 million new Medicare recipients, as well as the rapidly expanding “over 90″ citizens.
      More patients and less caregivers will be with us forever, while the government keeps moving the deck chairs on the U.S. Ship of State!

  • buzzkillersmith

    The ACA is almost a month old. Please be sure to give us a February update. Maybe daily update would be of use.

    • Bob

      If the news was good you would have heard it Tuesday night in National T.V.

  • safetygoal

    Great post. I also read yesterday that employers’ taxes in NY will be going up 35% because of the ACA and its impact on the state.

  • christie

    All we have to do is note his credentials under the article to get a clear picture of where he gets his viewpoint. Someone else commented he needed to get out of his ivory tower and down into reality and I agree.