Affordable Care Act: it’s about social justice


By Frank Wessling

Disaster stories are the sticky ones in the news business. It’s always been so. The latest in our part of the world is the clogged-up computer line for signing up to “Obamacare,” or the Affordable Care Act. As long as the story is one of “disaster,” “fiasco” and “outrage” it will stay high in news reports. If it becomes more sober — more factual and contextual rather than emotional and anecdotal — it will fade.
Here’s hoping the fade comes quickly. Too many of us are forgetting that the ACA originated in a noble desire to help millions of Americans gain some peace of mind over health care and its cost. Moreover, there is nothing new about this desire. It began over a half-century ago, was resisted over fear of “socialized medicine,” continued through the advent of Medicare, which gave older Americans some freedom from fear of disease, and to Medicaid, which provides at least a floor of dignity for poorer people when they need medical care. The Catholic Church has backed this long march for social justice.
Finally, with the 2008 election of Barack Obama as president and a Democratic super-majority in the Senate, the political will existed for some kind of leap forward toward universal coverage. Unfortunately, the political calculations that brought success in 2010 with the ACA also required the compromises that produced a great complex lump of law.
Instead of a relatively straightforward move, such as expansion of Medicare for everyone, we got an administrative monstrosity so complicated that even now, more than three years after its adoption, regulations putting it into effect are still being written and argued about. And the situation is made worse as some Republican governors continue to resist and manipulate aspects of the law, adding complexity while looking for political advantage.
The news of recent weeks is about how the computer system for signing up to the ACA insurance exchanges broke down and whose fault that is. Most recently we’ve heard about people getting letters from their insurance company saying they can’t continue their old policy but must take a new one with higher cost — and more coverage.
Short answer to the first problem, the sign-up fiasco: our politics is the fault. The ACA’s startup life has been within a culture of political resistance rather than good governing practices. When we must be most attentive to protecting our back with every step, energy, time and skill are diverted from the main task. Who knew that it would take an army of computer geeks working overtime to get this thing done?
The second problem, surprise over policy change requirements for people buying their own insurance, also comes from the complex, drawn-out way the ACA is starting. And that isn’t helped by poor news coverage.
People accepted in the individual health insurance market tend to be healthy enough that they can buy cheap policies with minimal coverage. They could keep their old policies under the law if they grandfathered them in. Policy-holders had to apply for grandfather status early, during 2010, or lose that privilege. Probably a majority of these people didn’t understand the need to do that or ignored the deadline. Now they are told their old low-cost, low-coverage policies are no longer available and they must buy into the new level of basic coverage required by the ACA. But there is also money available through the ACA for helping pay those higher costs. Subsidies go to individuals with annual income up to $45,960 and up to $94,200 for a family of four.
Meanwhile, the 40 million or so Americans without health insurance can find affordable coverage because of the ACA. That should be a story, a story of social justice, that we remember along with the “disaster” stories of administrative mess.

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