Who would have thought that once the Affordable Care Act (aka Obamacare) was deemed constitutional by the U.S. Supreme Court and ratified by the 2012 election, we would still have a vocal minority of Republicans demanding its repeal (and shutting down the government over it)? But that's exactly where we are. A surprising proportion of the American public still believes some astonishing lies about this law, and new lies are surfacing every day. The viral emails still exist and continue to circulate.
This is a post about what you should believe about the ACA, how implementation is going, and what the law is actually doing.
Let me evaluate some of these myths. I am not going to call this "Obamacare" anymore, because it is really called "The Affordable Care Act" or more precisely "The Patient Protection and Affordable Care Act." Let's settle on "ACA" or the "Affordable Care Act."
Myth #1: The ACA is destroying the American economy.
This statement is a bit hard to refute, since it is so over the top, but Senator Cruz and others keep saying it anyway. The one thing that might attract some attention is the assertion that the ACA is taking over 1/6th of the American economy. What does that even mean? Although there are aspects of the ACA that do apply to the health care system in general, the heart of the ACA is the state and federally run "exchanges" or "marketplaces" where individuals and small businesses who don't have insurance can go and select a health plan. The number of people who can use the exchanges is small compared to the millions of Americans who have insurance through their employment. Ironically, given the affection Republicans show for the "market," these exchanges have produced some real "market competition," driving prices for coverage, in most cases, lower than they have ever been, despite the fact that the plans cover more than they ever have (e.g. maternity care, prescription drugs, mental health and rehabilitation services).
This is an easy talking point for conservatives, but the actual outcome is not yet known. Some employers may change full time to part time to avoid having to comply with the law, but it's not at all clear how many will do that and what effect it will have on the overall labor market. The Congressional Budget Office and the Joint Committee on Taxation have issued a report attempting to quantify changes in the labor market due to the ACA. They conclude that it may cause a "small reduction in employment-based insurance." We do not yet know how many workers may be moved from full time to part time status, and what we do know is still anecdotal.
With any law, there are unintended consequences, and this law is no exception. Nevertheless, if an employer decides they want to drop coverage for part time workers or if they never offered it in the first place, employees have an option with the ACA. They will be able to buy insurance coverage through their state exchange, and their coverage may actually be more affordable and comprehensive than what their employer offered.
Myth #3: The ACA will come between you and your physician.
It is true that not every doctor will be in the network of every plan on the health care exchanges. But how many times have we had to select a plan with our employer-sponsored coverage where our physician was not in the network? This is not just an issue with plans sold through the exchange. Some doctors will not contract with plans that sell in the exchange. That is their right. But if you have ever bought insurance on your own, you faced the same problems.
Will the ACA dictate what your doctor can do for you? This is a particularly damaging claim, because it paints a picture of big government calling up your doctor and telling her not to allow you chemotherapy for your cancer. Other than defining what services a health plan must include, there is nothing in the ACA that mandates physicians to treat or not treat you for a given condition. Many of the viral emails claim crazy things about what services will be denied. In most cases, those claims are completely false. It is true that health plans even now deny coverage based on lack of "medical necessity," but under the ACA if you were to be denied coverage by a health plan for a service, the ACA gives you more appeal rights than ever before.
Myth #4: The ACA will cause your doctor to deny you treatment if you are over 65.
The short answer is that it will not. It will actually give you more benefits in terms of preventive care and coverage of prescription drugs. But the viral emails are scaring people about what will happen if you are over 65 or even over 75. If you receive one of these emails, check www.snopes.com or www.politifact.com.
What about the "real estate tax" on the sale of your home? There is a tax on the sale of real estate but it applies to very few people-- only those couples with more than $250,000 income and home sales that exceed $500,000 in profit.
So what is happening with the Affordable Care Act right now?
Jeffrey Young of The Huffington Post has written a comprehensive post about what happened as of October 1st. By now, we all know that there have been glitches in the online process for signing up for insurance via the exchanges. Lots of glitches. I am not an apologist about the difficulty, but I will point out that individuals and small business (NOT people with employment-based insurance) will have several months to select a plan and enroll so many of these problems should be worked out in time. The states that agreed to run their own exchanges have had the best experience in enrolling people--California, Washington, Kentucky for example.
What should you believe? Consider the source. Check out the source. One thing you can count on as true is that many aspects of the ACA are already in place, although the Republicans will continue to try to repeal them -- free preventive care, young adults staying on their parents' plan until age 26, discounts for senior citizens in the prescription drug "donut hole," no pre-existing condition denials for children (and for anyone after January 1 2014).