My interest in health care policy was spurred by researching women's health care issues and discovering more women than men die from heart disease. Heart research, however, was primarily conducted on men. I approached Cedars-Sinai Hospital and helped establish the Women's Heart Center there. Under the guidance of Dr. Noel Bairey Merz, the staff is conducting groundbreaking research. From this point, I naturally became interested in how the Affordable Care Act (ACA) will help women, and as a mother, how it will affect young people.
The law is particularly important to American women. Formerly, a healthy young woman could legally be charged premiums 150 percent higher than a young man of the same age and health. Pregnancy was considered a "pre-existing condition" commonly used to deny coverage for some women. Under early provisions of the ACA however, 45 million women started receiving preventative services from both private insurance and Medicare. These services included prenatal care and well-baby visits, as well as mammograms, cervical cancer screenings, flu shots and domestic violence screenings. The improvements in prescription drug coverage under Medicare saved 2 million women $1.2 billion in 2011 alone. And over 1 million uninsured, young adult women were able to receive coverage through their parents.
Young people benefited at the outset. Nearly a third of young adults have no health care coverage. Already the ACA prohibits insurance companies from denying coverage to individuals under 19-years-old based on pre-existing conditions. Young people are now free to stay on their parents' policies until they are 26-years-old. Because of this early ACA provision, over 3 million young, previously uninsured adults gained insurance. Compare this with the 41 percent of young adults who forewent needed medical/health care because of costs prior to the ACA. Under the ACA, young people making less than $43,000 will also have tax credits available to them to make coverage affordable.
The ACA is a system the conservatives first designed to maintain the private insurance market rather than a so-called "public option." Obviously the rollout of the program was a bureaucratic mess and the Republicans refused any adjustments to make the law more efficient. Instead, conservative groups are pouring millions into ad campaigns intentionally spreading misinformation and conservative state legislators are throwing up roadblocks. Conservatives in 24 states have proposed measures to outlaw ACA insurance coverage for legal, medical abortions. In several states they will try to outlaw the procedure where rape or incest have occurred, tantamount to a fine for being a victim of a crime.
If you wonder why Republicans really undermine the ACA daily, maybe they are worried about its eventual success. Remember the GOP also largely opposed Medicare. As Ronald Reagan said on the eve of Medicare's passage, "We will wake to find we have socialism... [and] we are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free." Medicare has not put chains on Americans; actually it has afforded seniors some peace of mind.
While Americans were rightly frustrated by the rollout of the law, the website has been repaired. Well over two million Americans are enrolled through the state and federal exchanges. In states that cooperated with the federal government and established state health care exchanges, like Kentucky or California, the state exchanges are working well. The working poor who live in states without the expansion of Medicaid will have difficulty. An economically similar person in Kentucky has far more affordable options than one living across the river in Indiana. So as a result of a Supreme Court decision, the nation will have unequal health care outcomes based on geography.
Massachusetts' health care law, "Romneycare" as you remember, is a functional and successful state-predecessor of the ACA. It was also not without its early problems, specifically low and slow enrollment rates among the young and healthy who eventually signed up. (We can expect a similar pattern under the national law.) When Medicare was introduced, it was not seamless. Nonetheless, it has since provided a crucial benefit for seniors with very low overhead.
The uproar over the cancellation of some current insurance plans ignored the comprehensiveness of these plans. A lower premium does not always equal affordability if the deductible is off the charts. Insurance companies have also been quick to shift blame from themselves to the president. They will do everything in their power to extract as much as possible from your health care dollar. So further state and federal regulations or an optional state single payer system to police insurers may become necessary. The ACA fortunately mandates insurers spend 80 cents of your premium dollar on health care -- not padding their bottom lines. Consumers now find insurers sending refunds if they do not comply.
So what's in store for our future with the ACA? Republicans would have you believe nothing but socialism and apocalypse. Other developed countries, like Canada and those in the European Union, have various programs to help with their citizens' health care. This is simply common sense and can benefit all of us.
Here's another perspective for 2014: Nearly 9 million women will gain coverage for maternity insurance; individual insurance companies will no longer be allowed to charge higher rates for women simply because of our gender; almost 19 million uninsured women will have access to affordable health care plans; young adults can stop foregoing treatment as health care coverage becomes affordable; and preventative health care will become a reality for Americans. Americans now have some access to preventive care and relief from the fear of bankruptcy because of serious illness. Our citizens will have the ability to switch employment without ever again being uninsured because of some "pre-existing condition." The ACA can improve the health of our entire nation while also encouraging economic opportunity and entrepreneurship.
This sounds like a happier New Year to me.