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ACA lives to fight another day

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For a non-partisan, comprehensive summary of the 2010 Patient Protection and Affordable Care Act, see the Kaiser Family Foundation’s excellent coverage here.

I can’t pretend I’m neutral – I cheered when the Supreme Court ruled that the individual mandate is constitutional. At some point, nearly everyone in America uses the health care system. By law, if patients need emergency medical care, hospitals are required to examine and stabilize them, regardless of their ability to pay. As a country, we are not willing to refuse emergency care to people in need; that is something to be proud of.

But it isn’t free, and that is why we need an individual mandate. The cost of treating uninsured patients is passed on others in two ways: 1) prices increase for patients who do have private insurance, and 2) the government (a.k.a. taxpayers) subsidizes charity care. So the Affordable Care Act requires all Americans to carry health insurance or pay a penalty. It asks all of us to prepare ourselves for the day we get sick, as we all eventually will. I’m young and healthy now, but I know that they premiums I pay are helping to off-set the astronomical costs of caring for people who are really, really sick.

But ACA isn’t just about insurance. It’s good for public health in other ways, too. Here are a few of the things it does:

  • Prevents insurance companies from denying coverage to people with pre-existing conditions and from setting lifetime limits on coverage
  • Sets basic guidelines for services that must be covered, so that everyone can be sure their insurance plan will pay for basic preventive care (often with NO copay)
  • Sets up health care exchanges, marketplaces where people can purchase private insurance plans, in every state
  • Expands Medicaid coverage for poor Americans and gives subsidies to middle class Americans (making up to 400% of the federal poverty level) to help them buy private health insurance
  • Sets up new systems to improve quality and efficiency, like affordable care organizations and patient-centered medical homes
  • Creates new programs to train the health care workforce
ACA won’t solve all of our problems. We haven’t yet figured out how to cover everyone, keep quality high, and reduce costs. Although CBO concluded that the ACA would reduce the deficit over 10 years, it’s possible that it might cost us more than the original estimates. But in my book, reducing the number of uninsured and raising the quality of care are worth paying for.   


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