Political Irony

[Tired about all the lies and mischaracterizations being made about ObamaCare?  Want to know what the bill actually says and does? Well, someone on Reddit posted a very concise and easy to understand description of the bill. I’m reprinting (most of) it here (he said I could). The same guy is also creating a post where he goes through the bill point-by-point. Enjoy!]

What people call “Obamacare” is actually the Patient Protection and Affordable Care Act. However, people were calling it “Obamacare” before everyone even hammered out what it would be. It’s a term mostly used by people who don’t like the PPACA, and it’s become popularized in part because PPACA is a really long and awkward name, even when you turn it into an acronym like that.

Anyway, the PPACA made a bunch of new rules regarding health care, with the purpose of making health care more affordable for everyone. Opponents of the PPACA, on the other hand, feel that the rules it makes take away too many freedoms and force people (both individuals and businesses) to do things they shouldn’t have to.

So what does it do? Well, here is everything, in the order of when it goes into effect (because some of it happens later than other parts of it):

(Note: Page numbers listed in citations are the page numbers within the actual document, not the page numbers of the PDF file)

Already in effect:

• It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices) ( [1] Citation: An entire section of the bill, called Title VII, is devoted to this, starting on page 747 )
• It increases the rebates on drugs people get through Medicare (so drugs cost less) ( [2] Citation: Page 216, sec. 2501 )
• It establishes a non-profit group, that the government doesn’t directly control, [3] PCORI, to study different kinds of treatments to see what works better and is the best use of money. ( [4] Citation: Page 665, sec. 1181 )
• It makes chain restaurants like McDonalds display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy. ( [5] Citation: Page 499, sec. 4205 )
• It makes a “high-risk pool” for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of “pre-existing conditions” altogether. For now, people who already have health issues that would be considered “pre-existing conditions” can still get insurance, but at different rates than people without them. ( [6] Citation: Page 30, sec. 1101, Page 45, sec. 2704, and Page 46, sec. 2702 )
• It forbids insurance companies from discriminating based on a disability, or because they were the victim of domestic abuse in the past (yes, insurers really did deny coverage for that) ( [7] Citation: Page 47, sec. 2705 )
• It renews some old policies, and calls for the appointment of various positions.
• It creates a new 10% tax on indoor tanning booths. ( [8] Citation: Page 923, sec. 5000B )
• It says that health insurance companies can no longer tell customers that they won’t get any more coverage because they have hit a “lifetime limit”. Basically, if someone has paid for health insurance, that company can’t tell that person that he’s used that insurance too much throughout his life so they won’t cover him any more. They can’t do this for lifetime spending, and they’re limited in how much they can do this for yearly spending. ( [9] Citation: Page 14, sec. 2711 )
• Kids can continue to be covered by their parents’ health insurance until they’re 26. ( [10] Citation: Page 15, sec. 2714 )
• No more “pre-existing conditions” for kids under the age of 19. ( [11] Citation: Page 45, sec. 2704 and Page 57, sec. 1255 )
• Insurers have less ability to change the amount customers have to pay for their plans. ( [12] Citation: Page 47, sec. 2794 )
• People in a “Medicare Gap” get a rebate to make up for the extra money they would otherwise have to spend. ( [13] Citation: Page 379, sec. 3301 )
• Insurers can’t just drop customers once they get sick. ( [14] Citation: Page 14, sec. 2712 )
• Insurers have to tell customers what they’re spending money on. (Instead of just “administrative fee”, they have to be more specific).
• Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they’re turned down. ( [15] Citation: Page 23, sec. 2719)
• Anti-fraud funding is increased and new ways to stop fraud are created. ( [16] Citation: Page 699, sec. 6402 )
• Medicare extends to smaller hospitals. ( [17] Citation: Starting on page 344, the entire section “Part II” seems to deal with this )
• Medicare patients with chronic illnesses must be monitored more thoroughly.
• Reduces the costs for some companies that handle benefits for the elderly. ( [18] Citation: Page 492, sec. 4202 )
• A new website is made to give people insurance and health information. (I think this is it: [19]http://www.healthcare.gov/ ). ( [20] Citation: Page 36, sec. 1103 )
• A credit program is made that will make it easier for business to invest in new ways to treat illness by paying half the cost of the investment. (Note – this program was temporary. It already ended) ( [21]Citation: Page 830, sec. 9023 )
• A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they’re not price-gouging customers. ( [22] Citation: Page 22, sec. 1101 )
• A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn’t paying for the Aspirin you bought for that hangover. ( [23] Citation: Page 800, sec. 9003 )
• Employers need to list the benefits they provided to employees on their tax forms. ( [24] Citation: Page 800, sec. 9002 )
• Any new health plans must provide preventive care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge. ( [25] Citation: Page 14, sec. 2713 )

1/1/2013

• If you make over $200,000 a year, your taxes go up a tiny bit (0.9%). Edit: To address those who take issue with the word “tiny”, a change of 0.9% is relatively tiny. Any look at how taxes have fluctuated over the years will reveal that a change of less than one percent is miniscule, especiallywhen we’re talking about people in the top 5% of earners. ( [26] Citation: Page 818, sec. 9015 )

1/1/2014

This is when a lot of the really big changes happen.

• No more “pre-existing conditions”. At all. People will be charged the same regardless of their medical history. ( [27] Citation: Page 45, sec. 2704, Page 46, sec. 2701, and Page 57, sec. 1255 )
• If you can afford insurance but do not get it, you will be charged a fee. This is the “mandate” that people are talking about. Basically, it’s a trade-off for the “pre-existing conditions” bit, saying that since insurers now have to cover you regardless of what you have, you can’t just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you’ll have to pay the fee instead, unless of course you’re not buying insurance because you just can’t afford it. (Note: On 6/28/12, the Supreme Court ruled that this isConstitutional, as long as it’s considered a tax on the uninsured and not a penalty for not buying insurance… nitpicking about wording, mostly, but the long and short of it is, it looks like this is accepted by the courts) ( [28] Citation: Page 145, sec. 5000A, and [29] here is the actual court ruling for those who wish to read it. )

© Ruben Bolling

The funny thing is that everyone pretty much knows what the Republicans are trying to do, but for some reason they keep voting for them. Is money really that powerful that it can convince people to vote not only against their own interests, but against the interests of their own country?

Think this is overstating the issue? Well, listen to Suze Orman explain how banks are completely screwing students:

If I didn’t know better, I’d swear that somebody doesn’t want anyone other than the rich to get a higher education.

UPDATE: Daily Kos published this same infographic, along with links to further information and raw data.

One of my favorite sites, electoral-vote.com has a good history of Health Care reform in the US, which they printed before the Supreme Court decision was announced. Here’s an extended quote:

President Harry Truman tried and failed in 1945. President Lyndon Johnson, the master of the Senate, twisted enough arms and other body parts to get Medicare through Congress in 1965. While it didn’t provide universal health care, it did provide care for seniors. Johnson, the consummate politician, apparently thought this was the best he could do.

The next major attempt was from President Richard Nixon, who issued a proposal in 1974. The core of the proposal was an employer mandate, requiring nearly all businesses to offer health insurance to their employees. He didn’t get it passed.

In 1989, the very conservative Heritage Foundation took up the problem and looked for a conservative solution. What they came up with was a plan to have everyone covered by making them buy insurance from a private insurance company. It was obvious to them that this was constitutional since big insurance companies all engage in interstate commerce. This plan had the huge advantage from their point of view that it left the entire health care system in the private sector, with no government involvement. It also meant big profits for the insurance companies. What else could you ask for? Sen. Don Nickles (R-OK), a very conservative senator, introduced a bill with the Heritage Foundation plan in 1993. It didn’t pass.

In 2006, then-governor Mitt Romney of Massachusetts advocated passing a modified version of the Heritage Foundation plan in Massachusetts. The state legislature tweaked it a bit, but it passed in 2006.

In 2009, President Obama thought the easiest way to get the Republicans to support a health-care plan was to use theirs, so he proposed Romney’s plan on a national scale. By doing this, he demonstrated that he was no Lyndon Johnson. The Republicans closed ranks to oppose their own plan, just to avoid giving Obama a big victory. None of the opposition at the time had anything to do with its constitutionality. Even the most conservative legal scholars agreed with the Heritage Foundation that regulating the massive insurance industry fell under the interstate commerce clause. Only after the bill passed and Republicans began looking for a way to get rid of it, did the constitutionality come up as a possible angle.

One of the reasons that conservative legal scholars didn’t think a case could be made on constitutional grounds is the 2005 Gonzales v. Raich case. In this case, the Court ruled that Angel Raich’s growing medicinal marijuana for his own personal use under his doctor’s instructions constituted interstate commerce and Congress had the power to overrule the California law allowing cultivation of marijuana for personal medical use. At the time of the decision, many legal scholars were surprised at the concept that growing your own (legal) marijuana with no intention of selling it at all, let alone interstate, somehow constituted interstate commerce. But that is how the court ruled. This led most Court observers to believe that the Court had a very expansive definition of interstate commerce and if growing your own marijuana was interstate commerce, then certainly something that affected 18% of GDP was going to be interstate commerce. We will find out if that is true later today. If the Court rules against the ACA, it will especially interesting to see how the majority reconciles the decision with Gonzales v. Raich..

In summary, the Republican opposition to ObamaCare (a.k.a. RomneyCare a.k.a HeritageCare) is purely political since it was their plan to start with. If a Republican senator had introduced it during either Bush administration it would have sailed through Congress with a huge bipartisan majorities. After all, 40% of the Republican senators voted for Medicare, which is essentially socialized insurance and goes much further than ObamaCare.

© Mike Luckovich