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Some myths about the Affordable Care Act -- Explained, and a link to some helpful information

By Andrew Pollack on 07/01/2012 at 08:58 AM EDT

You can start here:

Consumer Guide to Affordable Care Act, Everyday Health, Kaiser News Network
How Will the New Health Care Law Affect Me?, Lifehacker.com
How People Get Coverage Under the Affordable Care Act, The Henry J. Kaiser Foundation
What Does The Affordable Care Act Mean For People With Cancer?, The American Cancer Society
Health Reform Fact Sheets, AARP
Health Reform Law and Small Business Owners, AARP Fact Sheet
Health Reform Law for Small Business Employees, AARP Fact Sheet
Kaiser's Health Reform Quiz, Great 10 question quiz with the answers at the end.

* This last one is resources put together by Berkeley.
Health Care Resources - Berkeley Labor Center -- OK, this one is not exactly non-partisan but it does have some links to more solid statistical information including premium rate data and census data so it is very useful if you want to do your own research.


Stop repeating and think! WHICH PROVISIONS of the ACA do you NOT like?

a) Do you not like the provision that says you can't be denied coverage for a pre-existing condition?

b) Do you not like the provision that says you can't be dropped from coverage because you got sick and cost the insurance company too much?

c) Do you not like the idea that millions of people aren't trapped in corporate jobs they can't leave to start their own businesses or take a new job, because if they do their kid with asthma will be denied coverage on their next plan since it's a pre-existing condition?

d) Do you not like that you can keep covering your kids until they're 26?

e) Are you woried about "Government Run" healthcare? Good news! There is NO SUCH THING. The only Government Run Healthcare currently in the United States is in the military. Unless you are in the military, you don't and can't have it. There is nothing in the ACA that sets up any government run health providers.

f) Are you afraid there'll be "Death Panels" or that the Government will decide who gets what care? You've been lied to. There is no such thing. There are no panels of any kind that determine who can have what health care. The only thing remotely close, is that there are now minimum standards that health insurance companies MUST meet. Minimums that include preventative care items which you currently have to pay for out of pocket.

g) You're on Medicare and worried about it going away? It doesn't go away. In fact, the 4,000 dollar out of pocket hole (The "Donut" hole) is now gone, saving you $4000 a year.

h) Are you afraid your taxes will go up? Not if you don't make over $200,000 a year. If you CAN AFFORD insurance and CHOOSE not to buy it, your taxes go up because you're charged a penalty (that's the supreme court decision) HOWEVER, for everyone else, Congressional budget office (a non partisan panel) calls the ACA "budget neutral". The only change in taxes is as follows: Starting in 2013, an extra 0.9% Medicare tax will be charged on: (1) salary and/or SE income above $200,000 for an unmarried individual, (2) combined salary and/or SE income above $250,000 for a married joint-filing couple, and (3) salary and/or SE income above $125,000 for those who use married filing separate status. For self-employed individuals, the additional 0.9% Medicare tax hit will come in the form of a higher SE bill.

i) Are you afraid you'll be forced to spend money you don't have on insurance? Premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,404 to $43,320 for individuals and $29,326 to $88,200 for a family of four. The subsidies will be on a sliding scale. For example, a family of four earning 150 percent of the poverty level, or $33,075 a year, will have to pay 4 percent of its income, or $1,323, on premiums. A family with income of 400 percent of the poverty level will have to pay 9.5 percent, or $8,379. In addition, if your income is below 400 percent of the poverty level, your out-of-pocket health expenses will be limited.

j) Do you just not like it because it has Obama's name attached to it, and you've heard someone tell you lies about the things above?

Consumer Guide to Affordable Care Act, Everyday Health, Kaiser News Network

How Will the New Health Care Law Affect Me?, Lifehacker.com

How People Get Coverage Under the Affordable Care Act, The Henry J. Kaiser Foundation

What Does The Affordable Care Act Mean For People With Cancer?, The American Cancer Society

Health Reform Fact Sheets, AARP

Health Reform Law and Small Business Owners, AARP Fact Sheet

Health Reform Law for Small Business Employees, AARP Fact Sheet

Kaiser's Health Reform Quiz, Great 10 question quiz with the answers at the end.

* This last one is resources put together by Berkeley.
Health Care Resources - Berkeley Labor Center -- OK, this one is not exactly non-partisan but it does have some links to more solid statistical information including premium rate data and census data so it is very useful if you want to do your own research.
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re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Anonymous on 07/01/2012 at 10:23 AM EDT
I keep hearing "revenue neutral" applied to this discussion.

The original CBO estimate of the program when it was signed into law in
September of 2009 was $980 billion or so. Yes, revenue neutral at the time.

But that was before a lot of things changed, most notable being the massive
devaluation of the dollar due to stimulus, QE1, QE2, Operation Twist, etc.

The March 2012 CBO estimate is $1.74 trillion. Nearly double the original cost.

So if my response is:

(L) We can't afford it.

What is yours?

I agree the corporate lock on insurance is bad. I would have vastly preferred
either deregulation allowing insurance companies to compete across state lines
or the full-commitment of a single-payer program. Not this in-between stuff.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Andrew Pollack on 07/01/2012 at 10:48 AM EDT
First, understand that we ARE ALREADY PAYING to provide care to people who have
no insurance.

We do it badly, at the hospital emergency. It costs more, it's less effective,
and some states are either very slow are just totally remiss in paying for
those bills. It's putting some hospitals out of business, and it's costing us
as taxpayers a fortune.

Meanwhile, the insurance companies are reaping huge profits by insuring all the
healthy people, and shifting the full burden of care for those who cost the
most onto the American taxpayer. It's a hell of a deal.

Now, in answer to your question --

There are scenarios projected that range from public debt declining by 40% to
public debt rising by 200% depending on what projections you use. The CBO's
job is to sift all those and come up with the "most likely conservative
estimate" -- in other words, without assuming a change in the current economy
for better or for worse, what would it be. THAT projection comes back
revenue neutral. If you project the economy as going into recession, you see
debt go way up. If you project a recovery, you see debt going down. There is
a lot more detail here:

http://www.cbo.gov/publication/43113

It is very difficult to accurately quote that report without fully reading both
scenarios as referenced, however. It's very easy to draw almost any conclusion
you want from the report. That is, unfortunately, the nature of documents
created by committees that must satisfy both parties.


re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Anonymous on 07/01/2012 at 12:48 PM EDT
I do agree that projections can be tailored to the desired outcome. However the
projection I'm referencing appears to be the one that will actually happen
based on history and current trends.

The value of the dollar has plummeted since 2009. That devaluation of the
dollar is driven by governmental fiscal policy. Unless fiscal policy changes,
the number of dollars required to maintain the program will be significantly
higher than that projected in 2009 simply due to a dollar being worth less.

We also have Medicare, Medicaid, Social Security, etc. to consider for a track
record. If I recall, Medicaid was projected at $9 billion when it was proposed.
Medicare is now insolvent, as is Social Security. Even without this new program
we are continuing our fast-track towards further fiscal insolvency.

My opinion is that we can't afford to risk the adoption of any large-scale
government program now while we're pushing record deficits and pushing record
numbers into poverty and dependence.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Tim Tripcony on 07/01/2012 at 01:27 PM EDT
Yet despite this insolvency, I have yet to see any serious proposals from
(either party in) Washington for reducing our military spending.

http://en.wikipedia.org/wiki/Military_budget_of_the_United_States

Check out the budget for the current year: estimated on the high end to cost
$1.4 trillion. In a single year.

A high school teacher once told me that I would always be able to afford
whatever I really want... because if I think I want a new car, but don't have
the money, then apparently what I really want more than that new car is going
out to eat and to movies, and a new iPad, and a myriad of other avoidable
expenses. In the 16 years since he gave this advice, I have never found it to
be untrue. Our decisions and actions reveal our true motivations, and few of
these are more easily quantifiable than how we choose to spend our money.

You're absolutely right: we cannot afford to subsidize medical treatment for
our citizens as defined in the provisions of the ACA... because what we "want"
more is to spend nearly the same amount every year on national defense. And
that's perfectly fine: there are many strategies for saving human life, so we
must prioritize which we are willing to fund with tax dollars. I would just
prefer that we be more candid about where our money is actually spent, and what
we're opting not to be able to afford as a result.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Anonymous on 07/02/2012 at 08:53 AM EDT
You're absolutely right Tim.

There's only one person running for president who has proposed the cuts needed
(including military spending) to keep the country solvent.

Unfortunately most people think that he has dropped out of the nomination
process, and the media has been working hard to reinforce that perception. He
hasn't, and apparently has $3.3m in his campaign warchest. The Republican
National Convention in August may be very interesting.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Andrew Pollack on 07/02/2012 at 11:52 AM EDT
Oh wow. A libertarian among us! I hadn't realized! Welcome -- though be
warned, I have little empathy for the position. :-) Here's my take on
Libertarian-ism:
--------------------------------------------------------------------------------
----------------------
The Tragedy of the Commons -- My favorite irony of Libertarian-ism.

Libertarians always talk about "feeding from the public trough" and "the
Tragedy of the Commons" -- but there's a big flaw in the argument when it comes
to some things.

The point fails if you, as a society, are going to pay for CERTAIN things
anyway. You've already decided to have the commons and that everyone gets to go
there. THAT is why a tax is justified for it.

We're not talking about optional things like candy bars or chewing gum. We're
talking about things that we, as a society, have voted on and decided are too
important to stop people from using. Note that I said "voted on" -- do NOT EVER
confuse losing a vote, with having no representation.

Fire Service is a great example, because this DOES happen in some few places.

There are some counties in some (mostly southern) states, where you still have
to pay a separate fee -- monthly, yearly, whatever -- to the Fire Department.
If you don't pay it and have a fire, they fire department will not put out your
fire. In most places, they will still try to save your life by dragging you out
as far as I know, but they will not spend any other time or resources saving
your house.

This happened a year or so ago, and the outcry from the rest of the country was
huge. "How could we let this happen?" "Those bad firefighters were just
standing around watching the house burn!"

Yes, that was the rule in that jurisdiction. Yes, the homeowner made the
choice. We, as a society, don't find it acceptable. We're going to put the fire
out regardless. It's safer for you and it's safer for the community.

Since in my example we're going to put the fire out regardless of you paying
for it separately, when you don't pay for it you are stealing from everyone
else. You're getting the benefit from the public and making everyone else pay
for it.

The irony is, we commit to the path of the "Tragedy of the Commons" when we do
NOT collect payment from everyone equally for services that are distributed to
everyone.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Anonymous on 07/03/2012 at 09:15 AM EDT
Interesting how I'm now classified as a libertarian for bringing up a sound
fiscal policy and mentioning a particular candidate. :-)

"The irony is, we commit to the path of the "Tragedy of the Commons" when we do
NOT collect payment from everyone equally for services that are distributed to
everyone."

Last I checked, this plan doesn't collect payment from everyone equally. Isn't
that committing the "Tragedy of Commons"?

I'm not against the idea of government-approved healthcare, but the track
record in government cost containment is abysmal. Yes, we do a lot more for
cancer patients than we used to. But if you look at the more common things that
haven't changed much over the years, like appendix surgery, you'll see how
ridiculous things have gotten. E.g. when you're in a hospital with your own
medication you have to take the *hospital's* medications, not yours. A $2 pill
immediately costs $40 as soon as the hospital is providing it.

Why can I still not buy healthcare across state lines, but now must buy it or
pay a penalty?
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Andrew Pollack on 07/03/2012 at 09:33 AM EDT
It was the candidate mention that tagged you. We both know Ron Paul isn't
going to be the candidate. I think he's got some great additions to the
conversation and has been good for the process -- but also that he would make a
terrible president.

The crazy prices hospitals charge you is the way they make you pay for the
coverage they are forced to provide now for people without any coverage.
That's basically the insurance companies pushing all the expensive to insure
back on the taxpayer and off their balance sheets.

As far as cross-state competition -- I am 100% in agreement. There are MANY
things this bill does not fix. I hope it eventually does. One of the biggest
of them is that each state makes its own laws regarding insurance coverage in
that state and as a result even nation wide insurance companies have to have
entirely distinct offerings from state to state. In some cases, this even
means not mixing the risk pools within the same insurance company. The result
is you get FAR less competition. In my state, there are basically only two
major companies offering insurance.
That needs to change, but it was far more than could be put in a single bill.

When we eventually try to fix the state by state coverage problem, it's going
to be very hard to do without being a states rights constitutional matter. I
do't think the ACA needed another one of those right off the bat.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Bob Balaban on 07/01/2012 at 01:18 PM EDT
Awesome summary, thanks!
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Jason Hook on 07/02/2012 at 05:48 AM EDT
My perception of US healthcare is that it it's disproportionately expensive at
the point of use. Surgery is capable of burdening you with a lifetime of debt,
giving birth $10k , medicines can cost tens of thousands of dollars per month
for serious conditions.

Why should that be the case?

I enjoy healthcare pretty much free at the point of use. It costs me a fair
whack each month but you will never, ever hear me complain. Furthermore I would
fight tooth and nail to stop the Government breaking up or privatising the
system, which despite it's many failings, is wonderful.

I like America and I think you'd be happier and healthier overall if you
implemented a similar system. Of course it would have to be bigger and better
than ours....

To take Tim's point it costs a vast sum to project America's politics in Iraq
and Afghanistan both in terms of the actual monetary cost and the cost in
lives. I know politicians have to make difficult decisions but making people
healthy at home, creating jobs, reducing borrowing versus bombing little
overseas countries......tricky.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Timothy Briley on 07/02/2012 at 03:26 PM EDT
Being against these things is like being against free beer, but what scares the
hell out of many of us is experience with past health care program estimates:

At its start, in 1966, Medicare cost $3 billion. The House Ways and Means
Committee estimated that Medicare would cost only about $ 12 billion by 1990 (a
figure that included an allowance for inflation). This was a supposedly
"conservative" estimate. But in 1990 Medicare actually cost $107 billion.

So forgive me if I'm skeptical of the CBO score.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Andrew Pollack on 07/02/2012 at 04:29 PM EDT
Tim, that's a fair point, but health care costs in general have also
skyrocketed in that period -- even for private care and insurance. In 1966,
there were very few commonly prescribed drugs, no MRI's, surgery was unusual
and still fairly drastic, cancer treatment didn't exist for all the good it
did. If you got really sick, you died. Dead people don't cost much.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Anonymous on 07/03/2012 at 09:23 AM EDT
Every industry that receives government subsidies always exhibits skyrocketing
costs.

I know a comptroller at a major university. They set their tuition each year
based largely on the amount of federal subsidies they believe will be
available. If there were $20m of student loans last year and $25m this year,
tuition goes up 25%.

Housing, retirement, education, medical, military... I hope I'm wrong, but I
think this will likely be no different.

But it will feel good for awhile until we're bankrupt. :-) When we decide what
we REALLY want, as Tim says, hopefully healthcare will be ranked higher than
war.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Andrew Pollack on 07/03/2012 at 09:27 AM EDT
There are two things here to combat the problem of bloat resulting from
mandated purchase:

First is the 80% provision. 80% of all premium payments are require to be
spent directly on healthcare.

Second is that both the healthcare providers and the insurance companies remain
competitive private organizations. In each case, there are alternatives. In
the case of insurance providers the plan aims to increase the number of
alternatives.

We have far less competition among most utilities providers now. it isn't
perfect, but it beats having multiple power infrastructures on the same street
(as was the case in the first few yeas of electrical service).

Remember, under this plan there IS NO GOVERNMENT PROVIDER here.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Anonymous on 07/07/2012 at 12:07 PM EDT
There's no government provider of toilet seats either, but they cost us
taxpayers $100 when the military needs them. The same thing occurs in
education, housing, and the other programs mentioned: the government provides
the money, but somebody else provides the service. This doesn't change the fact
that it's wildly inefficient as a result of being devoid of market pressures.

The 80% clause doesn't combat bloat. It simply forces a proportion of the
obtained funds to be spent a certain way. When the bloat causes it to be not
enough money (which will be blamed on inflation or any other number of factors)
they'll just adjust that 80% to 70% or 90% or whatever they want. There are a
million ways to amend this bill down the road that will go unnoticed by the
public until it's far too late.

The problem with tying things to a tax is that it doesn't put everything in the
proper perspective to the public because Congress has a limitless supply of
dollars. If taxes were where they should be so that we didn't have a deficit
(i.e. much higher than what they are now) then this bill, which barely passed
despite a democrat-controlled congress, would likely have been shot down -
unless we were to simultaneously cut spending in other ways (e.g. our military
overseas.)

I noticed you didn't mention anything above about my "Tragedy of Commons"
comment. Any thoughts there?

Regardless, I'm glad in some ways that we have insurance reform (not to be
confused with healthcare reform, which this bill is not.) The corporate lock on
insurance, and the lack of competition in that industry, is the biggest thing
hurting patients. The insurance companies still benefit greatly from this bill
(300 million mandatory customers is a good thing for them, and they have
already started pricing their current plans prohibitively high for corporations
in preparation to coax them to move onto the "bulk" offerings they will launch
because of this bill.) I still believe the patient-doctor relationship will
suffer more with this bill, but we'll see.

However it all pales in comparison to the fact that we simply can't afford
anything with a 13-digit price tag. But hey, we've got the money apparently, so
why not spend it?
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Andrew Pollack on 07/07/2012 at 08:30 PM EDT
Oh, so close! We're so close to agreement here. lol.

Your toilet seat analogy is broken though.

First, and most important, is that the government was the one doing in the
buying in that case. That's not happening with the ACA. It's all still
private.

Of course, that assumes we take the toilet seat thing as a stand-in for
inefficient government purchase. The actual facts of that incident are
somewhat murky. Several people have researched this and come to the conclusion
that those "toilet seats" were very likely just a line item stand in for
something classified -- firearms for a special forces team, for example. I'm
told that's how accounting is done for such things.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Anonymous on 07/10/2012 at 08:04 AM EDT
I'm not using that as a stand-in for inefficient government purchase. I'm using
it as an example of market distortion caused by government involvement in an
industry.

Of course, if you don't like that specific example then you're free to use any
of the other examples I cited: housing, education, etc. :-)

I'm still curious to hear your response to the "Tragedy of Commons" concern.
re: Some myths about the Affordable Care Act -- Explained, and a link to some helpful informationBy Steve Kobb on 07/02/2012 at 05:25 PM EDT
Thank you, Andrew.

Beautifully stated.
Thank You, Andrew, For such a thorough list of resourcesBy John D on 07/03/2012 at 05:13 PM EDT
There's too much vitriol and anger in today's politics, and too little
compromise.

Thank you for posting!


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