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Obamacare, Romneycare and Doyoucare*

Written by: Patricia I. James**

Okay, instead of relying on Dave, Shelly and Chainsaw for information regarding the healthcare debate, I decided to turn to the Los Angeles Times to broaden my education which, happily, ran two articles on the subject. They both ran under the banner, “Both sides face challenge.”

Obamacare:

With respect to President Obama, Noam N. Levey’s article states that the Patient Protection and Affordable Care Act (“PPACA”), passed in 2010, will ensure that all Americans receive health coverage, even if they have preexisting medical conditions: http//:www.latimes.com/news/nationworld/nation/la-na-obama-record-healthcare-20121006,0,5719995.story. It is designed to allow most Americans to keep the health coverage they receive through work.

Benefits are already being seen:
1. Adult children can stay on their parents’ health plans until the age of 26.
2. Seniors are getting discounts on prescription drugs.
3. Americans with insurance can get check-ups and other preventive care without a co-payment.

With regard to other aspects of the Act:
1. Beginning in 2014, insurers will not be able to deny coverage. “Americans who do not get health benefits through an employer will be able to shop on new Internet-based markets, or exchanges, for an insurance plan that meets government-mandated standards.”
2. “Low- and moderate-income Americans will get subsidies to help them buy insurance.”
3. The poorest Americans will gain access to Medicaid, except in states that reject the Medicaid expansion.
4. It includes initiatives to protect consumers against poor-quality medical care. For example, “the government will penalize hospitals where patients get infections and other dangerous conditions, and reward doctors who intensely manage their patients’ care.”
The Act is expected to cover about 30 million more Americans over the next ten years.

However, according to Mr. Levey, there are controversial provisions of the Act which are given as reasons for repeal if President Obama is defeated in November.
1. It mandates that all Americans get health insurance, commencing in 2014.
2. The program has a more than $1-trillion price tag. (Remember in Post #16, I said that the United States is struggling with a $2.6 trillion annual healthcare bill? Makes this seem like a bargain). In order to prevent deficit spending, the law is financed by tax increases for upper-income Americans and healthcare industries as well as cuts to future Medicare spending that may threaten seniors’ access to care.
3. It is unclear whether the Act will actually control costs.

Romneycare:

According to the article written by Mitchell Landsberg, http://www.latimes.com/news/nationworld/nation/la-na-romney-healthcare-20121007,0,1046327.story, Mitt Romney, as governor of Massachusetts, created the most far-reaching state health plan in the country which became the model for PPACA. Essentially, Romney’s plan relied on a device known as an “individual mandate, requiring virtually everyone to buy health insurance or face a fine.” This stems from the idea that “[o]nly when everyone jumps into the insurance pool, including the healthiest people, is it possible to afford coverage for the sickest people, including those with preexisting conditions.”

This “individual mandate” was prominently pushed by the conservative Heritage Foundation in the 1990s as a free-market alternative to socialized medicine. (Again, see Post #16: Socialized Medicine v. Insurance Coverage in the United States (If I was competing for the most boring title, I think this would win).) The individual mandate has since lost support and has instead been replaced with something much closer to what Romney now proposes. According to Nina Owcharenko, director of the Center for Health Policy Studies at the Heritage Foundation, what Romney is describing for the national plan is different from the plan he created in Massachusetts: “It’s an apples-and-oranges comparison.”

Romney has proposed alternatives, such as “a system in which consumers would have “portable” insurance plans, subsidized through tax deductions, that they could take from job to job. He also would partially privatize Medicare, the government health plan for seniors and disabled people (but only for future recipients), and would give states flexibility about how they spend Medicaid, the program for the poor.”

Similar to PPACA, Romney would require insurance companies to accept individuals with preexisting medical conditions. However, a difference would be that he would limit this to people who have been continuously covered by insurance. The article states that it is unclear “what would happen to uninsured patients with preexisting conditions.”

In light of my Post #15: “I Don’t Think a Doctor Should Be Doing This and Neither Does the California Department of Managed Health Care,” Romney’s alternate stance on emergency room care caught my eye. He has taken two opposing positions. On the one hand, in an interview with CBS’ “60 Minutes,” he stated that there is already a system in place for those Americans who lack health insurance to receive healthcare: an emergency room. He said, “We pick them up in an ambulance and take them to the hospital and give them care.” Of course, the article states that “answer flies in the face of universally accepted wisdom that ERs are the most expensive places to provide routine care.”

This is in contrast to a television interview two years before where he stated: “Look, it doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can to go the emergency room and get entirely free care, for which they have no responsibility.”

Doyoucare:

Now we get to Doyoucare? Of course, you do. Your access to medical care is important.

Although this is not meant to be an exhaustive treatise on the subject, it is meant as a vehicle to let you know what may be available to you. Is this complicated? Yes. Is this clear as mud? Yes.

So, here is my take on this. Drumroll, please. There is no easy answer and everyone is not going to be happy with whatever is decided. Is that a revelation or what?

You say I should become a politician? No, for many reasons. (Oh, and I heard that snicker, by the way). For one, my advisors would not allow me to say such things. They would say that was too clear a statement.

*Added Bonus:

The Los Angeles Times’ Scott J. Wilson, who writes “The Five” in the Sunday editions’ Business Section, addressed Governor Brown signing into law certain measures directed at preparing Californians for upcoming changes in how consumers get healthcare insurance. The link is http://www.latimes.com/business/la-fi-five-healthlaws-20121007,0,5955758.story.
1. Unauthorized individuals and businesses cannot claim to represent the California Health Benefit Exchange (“CHBE”) which is the new central marketplace for buying insurance that goes into effect in 2013. This is to prevent deceptive marketing attempts.
2. Commencing in 2014, Californians who have lost their health insurance due to job loss, divorce or legal separation will receive information about reduced-cost plans available through the CHBE and no-cost coverage through Medi-Cal.
3. Self-employed people will be covered. It is no longer required that there be at least two employees to qualify.
4. The CHBE will have minimum coverage standards which must be met by insurers hoping to sell policies through it.
5. California’s Managed Risk Medical Insurance Board, which oversees plans that help those who cannot get health insurance elsewhere, will get increased subsidies to lower rates consumers pay. The bill is estimated to cost California $16 million in 2013.

**No portion of this Post is intended to constitute legal advice.  The views expressed are solely those of the author.