Pardon us while we ignore the raging debate of the day, whether by upholding the constitutionality of the Affordable Care Act, a.k.a. Obamacare, the U. S. Supreme Court helped the president or his opponent and Republican candidates for Congress or Democrats. That all depends on the propaganda skills of Republicans and Democrats, and Republicans are nearly always better at that stuff.
But what does it mean for all the rest of us, the consumers of health care in the United States, both the insured and uninsured? We have no reservation in saying that it is a great victory for people—everyone—for it protects the financial security that the law will soon provide for the millions of people who cannot be, or choose somehow not to be, insured and it ends the cost shifting that has long hit every single American who enjoys insurance, either through one of the government insurance programs or private policies.
Yes, we know that the polls have consistently shown that more people dislike the law than favor it, but that will end when people discover that the law does none of the things that the propagandists said it would do: kill Grandma, give the government control over medical decisions, force people to abandon their present coverage, end Medicare or reduce its benefits, or tell people which doctor or hospital must treat them and what procedures they can perform on a patient. The Affordable Care Act, though imperfect, never did any of those things. Poll testing in 2009 showed that all those things would alarm voters, so the commercials, flyers and political speeches claimed that it would somehow produce all those horrors even if the words were nowhere to be found in the act.
The key provisions of the act—the system of insurance exchanges where people now uninsured and large employers who now don’t cover their workers can buy affordable health policies, the mandatory coverage for people with pre-existing conditions, and the expansion of Medicaid to cover nearly all poor adults—will not take effect for another 18 months, Jan. 1, 2014, but tens of millions of people are already realizing the benefits of other provisions, whether or not they know that the help is a result of the Affordable Care Act that they were led to believe would hurt them.
Let’s look at the impact on Arkansas so far.
Last year, the law began phasing out the infamous “doughnut hole” that forced elderly and disabled Medicare enrollees to pay full price for all their drugs midway every year. In the first five months of 2012, a total of 5,410 Arkansans with Medicare got a 50 percent discount on their prescriptions as a result of the new law. Tens of thousands more will be helped as the year goes along. Their savings totaled $3,460,414 through May. The discounts will go up each year until the doughnut hole is closed entirely in 2020.
Last year, 380,000 Arkansans on Medicare received free preventive services, such as colonoscopies and mammograms, as a result of the act. Through May this year 169,384 people received the services, free of deductibles or copays. Of course, most of them do not know that the new benefit was from “Obamacare.” Formerly, Medicare didn’t cover preventive services and if the law had been struck down or if it is repealed, it won’t cover them again.
This summer, some 115,000 Arkansans—people who have private coverage through their employer or individual policies—will receive some $7.8 million in rebates from insurance companies. Obamacare requires all insurance companies to send rebates to their policyholders if they spend less than 85 percent of the premiums from customers on actual care (80 percent in the case of small group of policyholders). The law sets a ceiling on what insurance companies can keep in profits and overhead, a rule that has affected regulated utilities for much of a century.
Twenty-three thousand young adults in Arkansas who were uninsured were placed under their parents’ health policies last year as a result of the new law.
Those are for starters. Next year, insurance companies can no longer impose lifetime dollar limits on health benefits so that cancer patients and people suffering from other long-term chronic diseases will not have to worry about going without treatment because they have hit their lifetime limits.
The big changes will come in 2014, when the uninsured who are not employed in a business with more than 50 full-time employees will have to buy a plan they can afford from the insurance exchange in their state (Republicans forced Arkansans to buy plans from a national exchange instead of one set up for Arkansans). That is when states that do not now cover poor adults in Medicaid can do so with Washington paying 100 percent of the cost until 2017, when it will gradually go down to 90 percent. The Supreme Court said the federal government could not force states to cover poor adults, but it seems insane that any state would not.
Those are the provisions that ought to be popular with everyone who is now insured. Since everyone except the few who will choose to pay a federal tax rather than buy a policy will then start paying for their hospital and doctor care with subsidized help from the federal government, Arkansas hospitals every year will no longer have billions of dollars in uncompensated care, which is routinely passed along to insured customers through higher room rates and surgical fees and higher premiums. Arkansas hospitals, by the way, were cheerleaders for the new law when Congress passed it in 2010.
Arkansas, as we pointed out in 2010, reaps a special bonanza under the act, primarily because we are one of the poorest states. The vast majority of the 500,000 uninsured Arkansans will get health and financial security, either with highly subsidized premiums, Medicaid or the guarantee that their illnesses or disabilities will not cause them to lose their insurance.
A band of Arkansas Republicans—state officials and legislators—gathered at the Capitol on Thursday to denounce the court decision and declare their opposition to taking advantage of the expanded Medicaid coverage to poor adults in Arkansas, the one option remaining for killing some of Obamacare. But what rational person would do that? Stop hundreds of millions of dollars from flowing into the Arkansas economy each year and prevent better health care for 200,000 of the poorest adults in the state? True, the state government by 2020 will bear 10 percent of the coverage costs, but it will recoup an equal or larger amount through lower premium costs for government employees and an end to uncompensated care at facilities like the University of Arkansas Medical Center, Arkansas Children’s Hospital and regional mental health centers.
If Mitt Romney and the Republicans are going to repeal Obamacare, they had better do it somehow early next year because after that they will not find an ally anywhere.
—Ernie Dumas
