I left this comment on someone elses thread in response to criticism of the Affordable Care Act, and I think its probably worth sharing: Im actually specializing in health care law, so I could probably write more about this than youd ever care to read. First, with respect to Mary Landrieus amendment- the so-called Louisiana Purchase controversy: The federal governments reimbursement rate for Medicaid expenditures had been based on a formula established before Katrina. Because of the population loss caused by the Katrina diaspora, the federal government changed its formula, and suddenly and unexpectedly, the state was on the hook for more than $300 million that it did not have, largely because of Bobby Jindals economic policies. Either way, regardless of Jindals leadership, it seemed fundamentally unfair for the federal government to put Louisiana on the brink of financial disaster because of the lingering effects of an unprecedented natural disaster and the flooding that was directly caused by the federal governments negligent construction of the levee system. Landrieus amendment was germane to the legislation proposed; it had bipartisan support in Louisiana, and it was a powerful bargaining chip. Im not sure why youd fault her for demanding this amendment as a part of the package. Maybe she was going to vote for the bill regardless; Im not sure. Maybe it was brinksmanship. Regardless, it worked, and it spared Bobby Jindal and the Republican leaders in the State House from disaster. I am not trying to assume anything here, but regarding your own experience- having claims denied for your childs birth: One of the problems that the Affordable Care Act addressed was bogus plans. Just curious: Was the company that denied those claims the same company that subsequently increased your rates and deductibles? If so, is it the same exact plan? Or are we comparing apples to oranges? It makes a difference, actually. Its worth noting: In the years before the passage of Obamacare, premiums rose, on average, around 10% every year. Today, nationally, theyre increasing at a rate of 5.6%. In fact, in some states, premiums have decreased by more than 20%. But heres the thing: In states that have refused to set up state exchanges and also refused to accept Medicaid expansion, premiums are increasing by double digits. Premiums have increased the most in Kansas and Louisiana, two states led by conservative Governors who have both championed market-led initiatives and privatization policies while their states continually teeter on the precipice of financial calamity. There are two interrelated reasons for this: Despite what conservatives have insisted, Obamacare is not government-run health care; Obamacare is almost entirely about insurance reform-- requiring, for example and among other things, that no one can sell you a plan and then deny claims related to the birth of your child. (Because thats not what you bargained for and thats not what insurance means). But in order to make it work, we must expand coverage, particularly for those who live at or around the poverty line. Put another way, yes, your insurance is going up because companies must now offer real plans. But primarily, as you point out, its because youre having to pay for the uninsured; however, that really has nothing to do with Obamacare. In fact, its exactly the same dynamic that occurred before Obamacare, and in fact, Obamacare was designed - just like Romneycare- to mitigate and reduce the built-in costs of the uninsured by expanding Medicaid. There are 751,000 uninsured people in Louisiana, and nearly half of them would be covered if Bobby Jindal accepted Medicaid expansion funds. That- more than anything else- would ensure a reduction in your premiums- or, at the very least, an annual increase of significantly less than what we experienced before Obamacare, as has been proven all across the country. Because of laws like EMTALA, we will always shoulder the burden of treating and caring for the uninsured, but if we can get those folks on the rolls, we significantly reduce those costs. Right now, youre paying more for insurance to offset provider expenses for the uninsured, and heres the kicker: Your tax dollars are actually going to pay for expanded coverage for the working poor (and therefore cheaper private-sector insurance for everyone else) in states like California and New York. If Louisiana didnt have an obstructionist partisan hack who has been running away from the state instead of actually running the state, your tax dollars would be supporting expanding coverage in your own backyard; your premiums would have never increased as exponentially as they have; and, as a result, youd have more money in your pocket- which you could then contribute into the stream of commerce. On a final note, theres a reason Ive written about the pervasiveness of white privilege in our media culture and the almost obsessive and bizarre antipathy toward the President: Its very difficult to have a serious and detailed discussion about the nuances of a complicated piece of legislation with folks who operate under the belief that Obama is a dictator who has to get advice from Al Sharpton (Ive lived long enough in the South to know when folks criticize Al Sharpton and Jesse Jackson, more often than not, theyre using those names as code language, metaphors for a larger argument against the need to confront the realities of racial discrimination). Im not trying to insult you here, so please dont get me wrong: Im just trying to have a conversation.
Posted on: Thu, 20 Nov 2014 08:30:44 +0000
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