Happy ½ Birthday

With the exception of newlyweds and doting grandparents, there are few celebrations of a six-month anniversary or birthday.  Yet, this month – September 23^rd specifically – there is an important half-year milestone for the United States.

That day will mark six months since the President signed the historic Affordable Care Act into law.  And while the implementation of the provisions of the act will be phased in over the next several years, some of its benefits will start on September 23^rd. 

The bill that was signed last March is severely flawed.  It is complex and will result in 50 somewhat disparate systems because much of the implementation is left up to the states.  A Single Payer approach (“Medicare for All”) would have been a better, more fiscally sound system, and the current bill is a boon to for-profit insurance companies.  Nevertheless, it is a good start with some tangible benefits to be realized this month.

Here’s what happens on September 23^rd (courtesy NJ Citizen Action):

• Coverage Expansion for Young Adults – Young adults up to age 26 can participate in their parents’ health care plan.
• No Rescissions – Bans all health plans from dropping people from coverage when they get sick.
• No Lifetime Limits on Coverage – Prohibits all health plans for placing lifetime caps on coverage.
• Tightly Regulates Annual Limits on Coverage – Tightly restricts the use of annual limits by all employer plans and new plans in the individual market, to ensure access to needed care.
• Free Preventive Care Under New Plans – Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles.
• New, Independent Appeals Process for New Plans – Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions.
• No Discrimination Against Children with Pre-Existing Conditions – Prohibits all employer plans and new plans in the individual market from denying coverage to children with pre-existing conditions.  Already exists in New Jersey, but will now be extended throughout the country. 

Other provisions of the new law such as insurance exchanges and elimination of annual caps are to be phased in more gradually as the Department of Health and Human Services and the individual states work on appropriate regulations and implementation strategy.

Despite these incremental improvements, there are a number of pitfalls ahead that have the potential of reversing the positive trend and keeping America in the bottom rung of affordable health care among developed nations.

First, there are the politically-motivated lawsuits being pursued by several states and corporate-funded conservative advocacy groups to have the Affordable Care Act declared unconstitutional.  They are against the provision that requires all Americans who can afford it to have health insurance.  Apparently, the anti-health lobby would prefer the more expensive option of having people use emergency rooms for health care and eliminating preventative medicine for the poor.  Given the number of conservative activists on the Supreme Court, there is a good chance that the Affordable Care Act could be nullified or severely neutered.

The other danger is a Republican take-over of one or both houses of Congress.  The Republicans are campaigning on a three-fold platform – repeal of anything that President Obama has promoted (including the Affordable Care Act, which is very similar to what was proposed by President Nixon), endless and costly investigations once they get subpoena power, and more deficit-inducing tax cuts for the wealthiest Americans.  Repeal of the Affordable Care Act is a real possibility, and given the Republicans’ adeptness for legislative chicanery, even the threat of a presidential veto is not guaranteed to maintain the positive momentum in this area.

The anti-health lobby has a tremendous advantage – lots of stealth corporate money, Fox “News”, and right-wing hate radio – all working to limit care in the name of greed fiscal responsibility.

So we won the first battle – passage of the bill.  Celebrate the ½ birthday with joy, but not with relief.  Learn what’s in the bill, and where improvements need to be made.  We have a long war ahead of us.  The anti-health forces are powerful, organized, and well-funded.  We need to keep the pressure on our elected officials, demonstrate, and advocate for 21^st century health care for all the people in the United States.