Now that the Election has decided the Reform matter, it is time to take a closer look at the Gap between what people think about the legislation and what it actually says. The source of the disconnect is to a large extent due to the scale and complexity of the legislation but also due to bad reporting by the press and the predictable politicization of the facts.
Mandated health insurance will cover just about everything
–Wrong – it only covers Minimum Essential Benefits
PPACA forbids lifetime limits and annual limits in health insurance policies
–Wrong – it only forbids those limits with respect to Minimum Essential Benefits
–Wrong Again – policies can impose limits on the scope and duration of benefits, which can have a similar affect.
There is single standard for all health insurance
–Wrong – individual and small group policies are more regulated, more risky and will be more expensive and with fewer benefits as compared to large group and self-insured plans.
The PPACA requires states to cover all individuals thru Medicaid where income is under 133% of the Federal Poverty Level
–Wrong – it is 138%. Need to read the small print!
The PPACA contains provisions that will reduce premiums
–Depends – Unless you are an individual policy holder where the merger with the small group market will help, there are no specific insurance cost control provisions.
–More importantly, PPACA has sparked an almost unprecedented period of Provider Consolidation, that will cause premium increases.
Individuals are required to pre-qualify or enroll in Medicaid
–Wrong – PPACA contains a presumption of eligibility and allows healthcare providers to treat anyone presumptively eligible and be paid, even if they are subsequently found NOT to be eligible
Federal subsidies thru the Exchanges are only available to the economically disadvantaged not poor enough for Medicaid
–Wrong – a Family of 4 with $88,000 of annual income is eligible for subsidized health insurance
The PPACA provides comprehensive, affordable coverage
-According ot the Kaiser Family Foundation “The share of workers in a plan with a deductible of $1,000 or more grew from 18% in 2008 to 31% in 2011, and from 35% to 50% in smaller firms. The Affordable Care Act (ACA) will not arrest, and could accelerate, these trends. The individual deductible for a bronze plan in the new insurance exchanges could easily exceed $4,000, and the family deductible is about double that amount. In other words, to reference a different debate currently in the news, what is actually “mandated” for about 30 million people under the ACA is basically catastrophic coverage”
Romneycare was a Success
–Depends on how you define “Success.” 97% +/- of Massachusetts residents are covered BUT
-Highest individual premiums in Nation
-Benefits in small group and individual market less than and more expensive than those in large group and self-insured market
-So bad that two bills have passed the bicameral legislature to establish maximum annual healthcare spending and global budgets!