The Affordable Care Act was signed into law in March 2010 because for the previous 10 years, health insurance premiums had increased 100 percent, while those covered decreased 10 percent. There are more than 25 million Americans without any insurance at all. The expanding number and scope of repetitive tests has made health care expensive but not necessarily efficient.
Of the 34 nations in the Organization for Economic Co-operation and Development, the U.S. ranks 27th in most categories of health care. Americans pay 17.6 percent of every U.S. dollar spent on health care. Other countries average 9.3 percent. Our county medical centers have third-world waiting lines. Something, anything, needed to be done to correct this dangerous trend.
The ACA (also known as Obamacare) requires insurance companies to spend 80 percent of premium revenues on care or claims and 20 percent for administrative fees. As a result, millions of Americans received refunds from their insurance carrier this year. Coverage expanded for adult children, mental illness, wellness programs and maternity. Pre-existing conditions can no longer be a basis for denial of coverage. This is a good start to solving our problems.
The ACA requires an individual mandate, an employer mandate, an expansion of Medicaid and a reduction of health care costs. You do not have to do anything if you already have health insurance.
California will have 13 insurance companies offering three standard plans Oct. 1. You can go online at  to see what the individual can afford. If you are at poverty level income, you can qualify for Medi-Cal.
If you are over that limit, there is a sliding scale allowing you tax credits to help you buy insurance. For incentive, there is a penalty on your 2014 taxes if you do not get insurance.
The penalty minimum is $95 (larger for high income) in 2014 to $695 per adult in 2016. A family earning $500,000 will owe more than $12,000 in 2016.
As of March, 33 states did not want to implement expanded Medicaid. However, provisions for Medicare payments under the disproportionate share (of uninsured patients) will go away and health care facilities in those states will not survive.
Several states are opting for the federal government to establish the health care exchanges. Five states (Alaska, Florida, Louisiana, South Carolina and Texas) are refusing to establish any health care exchange. There are federal initiatives at the local level to provide for assisting staff in clinics and medical offices and centers to help the poor and uninsured to sign up for benefits.
The employer mandate has been postponed to 2015 for good reason. Small businesses were planning to lay off or reduce the hours of their employees to avoid the anticipated cost because the recovery is still slow. Forbes even advised employers to outsource!
Also, the requirement for all employers with 50 employees or more is presently difficult to monitor, so the delay will allow another year for that process to develop and for premiums to decrease.
The success or failure of Obamacare depends upon reducing costs. The act requires: electronic medical records (to quickly transmit information and reduce repetitive tests), changes in pay per procedure to pay for an outcome, denies payment for hospital readmissions within 30 days and has free annual physicals to prevent future costly catastrophic medical problems. The Congressional Budget Office projects an estimated budget reduction of more than $40 billion by 2020.
Theodore Roosevelt promoted universal health care, as did Harry Truman, Lyndon Johnson and William Jefferson Clinton. The model for the ACA was the product of the conservative Heritage Foundation in a response to Hillary Clinton’s 1994 proposals. Massachusetts has a similar law that was enacted in 2006 and signed by Mitt Romney. By 2011, 17 percent more companies offered insurance than in 2005 and health care costs are continuing to go down in that state.
Republican legislatures and governors refusing to enact portions of the ACA are acting on behalf of ultra-conservative constituents who should understand the logic that if everybody has to have homeowners insurance to spread the costs, the same theory is true for health care.
Republicans are angry that President Obama got to use the conservative model for health care reform. They just don’t like him. On the other hand, 17 percent of Americans don’t think Obama went far enough.
By 2020, this furor should subside as did the uproar over Social Security in 1935 and Medicare in 1965. I look forward to lower costs and efficient preventive care for all.