Unit 07: Healthcare

Describe the conditions of the Affordable Care Act AS OUTLINED BY OBAMA IN 2009.

-individual mandate -people can remain on parents' plan up to age 26 (intended to help with young people having no insurance, especially during transitional periods) -no denying insurance because of preexisting conditions -no lifetime cap -free preventative care -insurance exchange (online marketplace for all insurance companies) created -expanded Medicare and Medicaid -public health insurance option -no added deficit

What distinguished the passage of the ACA in the House and Senate? What were the consequences?

Both passages were on strict party lines; Democrats lost widely in 2010 elections (kept majority in Senate but lost it in House)

lifetime cap

lifetime maximum amount of money that insurance companies will provide to a single person

cap

limit on the amount an insurance company will pay for healthcare

What were Republicans' fears about ACA?

-Socialism -death panels ("when to pull the plug on Grandma") -government-funded abortion -burdens on small businesses -high taxes/deficits

Why is healthcare so expensive?

-baby boom is starting to need end-of-life care -overly litigious society - doctors overdiagnose to protect themselves -Americans want the best (i.e. most expensive) care available -American lifestyle is unhealthy

What are some problems with strictly private health insurance? How did President Johnson fix these?

-based on the principles that there are more healthy people than ones needing care, and that individuals can pay a premium -the elderly and the poor run into problems respectively -Johnson created Medicare (for people 65+) and Medicaid (for poor)

How did the ACA intend to impact the economy?

-create jobs in insurance and medical fields -reduce amount spent by Americans on insurance by making a competitive market with lower premiums -save government money due to increase in preventative care

Why might some people not have insurance?

-denied by companies because of pre-existing illnesses -HMOs are very expensive and provide poor coverage -most people get insurance from their employers; employer might not provide this (especially self-employed people) or they might be doing transitional work -young adults consider themselves invincible and choose not to

What are the current provisions of the ACA?

-health insurance available from private companies, government (Medicare and Medicaid), or state or federal exchanges -minimum standards on a policy -no denial for preexisting conditions -people can remain on parents' policies until age 26 -individual mandate (starting 2014) -employers mandated to offer insurance (starting 2015) -subsidies for low-income insurance purchasers

What are some embarrassments that the ACA has run into?

-healthcare.gov: huge technical failure; expensive website that only a few thousand signed up for -Obama had promised not to take away anyone's preexisting plan, but did in the cases of a few plans that did not meet the requirements of the law

What are the current arguments raised by the ACA's opponents?

-message going out that healthcare for pre-existing insurance will increase in cost -insurance prices are fluctuating now -potential Supreme Court challenge about subsidies

Name some modifications to the ACA that the Republicans are seeking to do. How is Obama reacting to these?

-reduce government spending on healthcare -stop "harming" small businesses -replace ACA with "common sense legislation" -change definition of a full-time employee to 40+ hours/week rather than 30+ -Obama won't sign anything to repeal the act or take healthcare away from those who now have it, but is otherwise open to suggestions

What were the initial arguments raised by the ACA's opponents? How did Obama respond to each?

-rollout plagued by setbacks like healthcare.gov not working -projected cost (Obama: healthcare spending is down) -unconstitutional (Obama: Supreme Court has upheld it) -lagging enrollment, especially young/healthy people

What are some problems with Medicare and Medicaid?

-they compose 25% of US budget -baby boomers are starting to become eligible for Medicare -due to better care, people are living longer than Medicare can support

Affordable Care Act

2010 act pushed by President Obama, aimed to bring healthcare to all Americans. Also known as Obamacare.

What is the last part of the ACA still to go into effect?

2015: employers with 100+ full-time (30+ hours/week) employees must offer health insurance 2016: employers with 50+ full-time employees must offer health insurance, or pay a penalty of $2000/employee

What do Republicans and Democrats agree on, concerning healthcare? Where do their views diverge?

Agree: System is flawed Disagree: Democrats want the government to step in and fix things, Republicans want to let business purge itself

How did the ACA intend to impact small businesses?

All companies would have to pay their employees' insurance; government would provide tax credits to help to businesses under 50 employees

Specifically, how did the ACA intend to expand Medicare?

Close the 'donut hole' (massive amount spent by senior citizens on prescription drugs)

Mike Baucus

Conservative Democrat in charge of the Senate Finance Committee to design a healthcare reform bill; controlled by healthcare firms who funded his campaigns; liberals hated his bill

Why is healthcare such an important issue?

Consumes 4.2 trillion annually, composes 20% of US budget, 75% of this money goes to preventable diseases and many Americans still don't have health insurace

Cornhusker Kickback

Controversial deal Emanuel cut with Nebraskan Senator Ben Nelson; $100mil to expand Nebraska's Medicare in order to get him to vote for ACA

Ted Kennedy

Democratic MA senator who died right after ACA was passed in Senate; MA replaced him with a Republican, taking away the Democrats' supermajority in the Senate

individual mandate

Everyone has to have health insurance (or pay a penalty if not; 2.5% of income or $685/person with a maximum of $2085/family, whichever is higher)

What are the difficulties in determining if healthcare is a right or a privilege?

If it's a right, how should it be rationed out? If a privilege, who deserves it?

Explain the potential Supreme Court challenge.

If states don't set up a healthcare exchange, people there can use the federal one, but it's ambiguous whether those people qualify for subsidies.

What deals did Obama have to cut with insurance and pharmaceutical companies to get the ACA through?

Insurance: No public option (a non-profit public option would compete heavily with their 5% profit private ones), individual mandate Pharmaceutical: $80bil in savings (not as much as Obama had promised public)

Sebelius Case

June 2012; Supreme Court upheld individual mandate, but shot down penalties for the 21 states (mostly Republican) who chose to opt out of expanded Medicare

What was the Republicans' strategy in relation to the ACA?

Just say no to everything; hoping it would break Obama

When Obama came into office, what were his options concerning healthcare? Who supported each? What did he eventually decide?

Leave it alone (Biden supported this) or tackle it (Rahm Emanuel supported this, but said he'd have to do it quickly). In February 2009, he decided to tackle it.

Whose failure did Obama have to be particularly mindful of when tackling healthcare reform?

The Clintons in 1993; they had not been able to pass a bill because they ignored key players (Congress, special interest groups) in the design process

How does health insurance make a profit?

Total expenses are less than total premiums they take in

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deductible

amount an individual pays before the insurance company starts to pay

health insurance

coverage an individual purchases to help pay for health care

healthcare

diagnosis, treatment, and/or prevention of disease

major medical

expensive procedures (e.g. surgery)

medicare

government insurance plan for elderly Americans

medicaid

government insurance plan for lower-income Americans

baby boom

post-WWII population boom

premium

regular fee paid to an insurance company by each individual in a group covered by a plan

preventative care

routine care aimed at maintaining health (e.g. annual physicals). can make healthcare vastly cheaper.

co-payment

splitting the cost of a medical procedure between the patient and insurance company

What does current support for the ACA look like?

the majority (by a small margin) don't support it, but do support individual parts of it