Later this month marks the 7th anniversary of the passage of the Patient Protection and Affordable Health Care Act, more commonly known as Obamacare, and from years prior to it's passage even on to today it is mired in massive controversy and legal battles. The fate and future of the Affordable Care Act was one of the leading talking points of the 2016 Presidential Election Cycle, and has even been featured in a senatorial debate after the election was over. The biggest topic on the legislative table right now is repealing the law, and the possibility of a replacement plan, but almost everything that has been spoken from either side of the argument has been peppered with such a level of extremism that no compromises can really be made. Let's take a few paragraphs and look at the act, some of the problems that it presented, and what I consider to be a feasible, reasonable replacement plan.
Healthcare has been a major talking point in this country since long before 2008 and the election cycle that preceded it. I remember being in high school, and even middle school, and hearing the comments from my union member father about the health insurance negotiations every time the contract came to it's end. Back then, it was still considered "insurance". What we have now can't really be considered insurance anymore. It's more of a subsidy for medical visits. The change in definitions is something that I'm actually OK with, but I'll go over that later. I also remember first going into the adult job market at 18. Every time I would apply for a job, and would tell my parents, one of the first things I would get asked would be how the health insurance was. Boy, do I wish I could go back to those rates. Up until 2007, healthcare was almost tied with wages as the biggest bait to draw employees from rival companies and recruit fresh faced new employees from their part time high school or college jobs, and sometimes insurance even trumped wages as the biggest draw. The Affordable Care Act (you may notice that I deliberately refrain from using the common "Obamacare") changed all that. I remember the first time I heard it explained bluntly by a co-worker named Bryan after the implementation of the ACA. During a discussion on why he hated his job, and my urging him to stick with it until he got something else in order to make sure he and his soon-to-be wife stay insured, he looked up and said "The pay here sucks donkey ----, and I don't care about the insurance. I mean, because of Obamacare, you can go to Taco Bell and get insurance now." That last sentence has stuck with me since the first time I heard it uttered. Insurance was no longer a driving factor in the job market, and that fundamentally changed the way that we worked in this country. It used to be that if you couldn't get a job, there was unemployment or welfare to protect you in the short term, or pull a McJob to get you by, but you had to deal with the implications of not having health insurance or paying the hugely bloated prices of buying it outright, since you're not longer on a big group rate. Once the ACA was implemented, there really wasn't any sort of urgency to go out and get that job, or stay at the one you were at prior.
Since we've established how the ACA fundamentally changed the dynamic of finding a good job in our country, let's have a look at what it actually is. I first encountered some of the basic outlines of the Affordable Care Act in 2007 when I lived in Massachusetts. At it's core, it's a healthcare outline that was originally theorized by former Governor Mitt Romney. One of the key proponents of the act was that all citizens of the Commonwealth were required to carry some sort of health insurance. I was never a legal resident of the state, so I never dealt with it directly, but I believe that catastrophic plans were acceptable at the time. It was a concept that actually seemed to work quite well in the Commonwealth. I often noticed that there weren't really a lot of people not working anywhere I went, and in two years, I was only out of a job for two weeks. While they were severely low paying jobs, the majority of my two years as an out of state student were spent juggling school and two jobs, so there was no shortage of employment there. The idea of the healthcare and the exchange as it was, in spite of the fact that I really didn't understand it at the time, was that a small amount of your private insurance went into a state exchange, along with a state tax penalty if you didn't have any coverage, and it helped to subsidize plans for people who's jobs didn't provide coverage to purchase and come into compliance with the law. This was the basic outline of the ACA that went across our country in 2010, but with a lot of other changes and implications.
The ACA was written initially in 2007 by a series of big insurance companies and modeled after this Massachusetts law. After some revisions, and some debate, the product that most closely resembled what we have now was introduced for vote in 2009, with the stipulation that we would have to pass the bill if we want to read what's in it. I'll briefly go over the biggest parts of the act that affected the biggest number of people, and explain that what we got was a one size fits all subsidization plan that required all citizens, regardless of sex, race, creed, or health situation, to carry plans that included a far reaching number of covered procedures and items that most of them wouldn't need. All people need to have coverage for birth control, abortion, sex change, catastrophic accident or healthcare, and a host of other things. The Affordable Care Act also carried a stipulation, as mentioned, that all citizens carry it, or some other type of healthcare. The premiums from the subscribers on the government healthcare website, along with a percentage of the premiums from people who carried private insurance, went into a fund together, available to cover premiums and deductibles for people who were on a financial hardship. Should a younger, healthier person decide to decline a coverage based on saving money and paying off other bills, he would face a penalty against his federal income tax intended to help subsidize a plan so he wouldn't have to go the next year without coverage. As I mentioned before, there were also stipulations that made it illegal to deny a person coverage based on that person having cancer or something big like that, and there was a premium cap on that kind of coverage, so it would also be illegal to gouge that person for already having a big major health incident prior to purchase.
Now, I'm mostly against a one size fits all health care plan for everyone in the US, no matter where the people live or the financial situation, the very last part of the act is something that I really want to address before going into a repeal/replace proposition. Pre-existing condition coverage essentially changed what health insurance was in the US, moving it from insurance to a subsidy. As insurance, Humana could deny you a new policy if you, or someone in your family got cancer and you had to switch jobs. After all, it's insurance against the worst happening. You don't go out and buy full coverage car insurance after you wrap your brand new truck around a tree. Jake from State Farm would laugh you out of his office if you tried to do that. Under the ACA, healthcare moves from being insurance to being a subsidy, and it's something that I'm actually completely OK with. Under the old plan, if your wife got breast cancer, you were stuck. You wouldn't be moving jobs ever again, lest you find a way to crowd fund the treatment. While all of your co-workers were usually very supportive of you, and your boss usually was as well, many of the higher ups in companies big and small knew instinctively, at that point, they owned you. Under the old plan, there was usually government run help for your medical bills at the state level, but everyone knew that you'd never get insurance again if you got fed up enough with the situation that you had to leave your job. The pre-existing condition mandate that came with the Affordable Care Act did fix a lot of that, and opened the free market back up to people. It gave negotiation chips back to workers who would have otherwise been victimized by the situations, and it also made sure that if a cancer family wanted to move to be closer to a more specialized cancer hospital, or be closer to a member's extended family, that they would be able to seek out jobs that had good healthcare and be eligible for that healthcare. I like the free market, and I like people being able to move on with their lives if they find impasses with their current situations that can't be overcome, so I am in big support of this mandate, and anything we do going forward needs to have this in mind.
Our congress has made it no secret that they already seem to have a repeal and a replacement for the Affordable Care Act in mind. While that was the big promise that a majority of Republicans and centrists ran on in our current sitting congress, I don't see it as a feasible option. Our Federal Government has been quite disastrous in anything involving healthcare, especially in the VA. The best thing that can be done at this point will a clean repeal of the law followed by a minimal stipulation. If Congress were to pass a law that would make complete denial of coverage based on a pre-existing condition discrimination. After that, invoke the 10th amendment. Release all healthcare responsibilities to the states. The states are in a much better position to listen to the citizens and find out what will work best for them, especially given the size of our country. It's not feasible at all for a person from Spokane WA to go to DC and talk to his congressman, or address the remainder of congress based on what is going on with his health and the laws, but that same guy could make a day trip to Olympia with many fewer obstacles. It's the same all the way across the board as well. Under this new system, states will have many different social structures for their healthcare systems, and that's OK. Many states, like Wisconsin, Texas, Montana, and Arizona, after seeing massive premium increases under the ACA, will revert back to a free market capitalist healthcare system, with some government regulation to make sure that people who have a pre-existing condition can still get healthcare. Other states, like Illinois and many of the New England states will continue on the path of the Affordable Care Act. This will mostly take place in states with very low unemployment and underemployment rates, and high workforce participation. I even predict that states like California, Colorado, and Vermont will implement a single payer system. This will take some working, increase some taxes, and these states will have to exempt themselves from our President's idea of being able to purchase insurance across state lines. After all the states settle on what will work best for the majority of their citizens, the people of the country will vote with their feet and go to live and pay taxes in the places that offer the insurance plan that best meets the needs of their families and themselves. As I mentioned before, plummeting airfares and high speed internet has made it so that long distances are a lower bar for families and friendships to stay in contact, even with a whole country between them. And just like before, some people are going to stay in their states no matter what is decided, and continue to grumble about the way that healthcare is run there.
