"What’s in the Affordable Care Act?"
Ben Smith has an insightful item on the Democrats’ decision to “embrace the freakshow” by trying to focus attention on the existence of a violent fringe of opposition to the Affordable Care Act that’s clearly inspired by the unhinged nature of the discourse around ACA that all-too-mainstream figures on the right have created.
Clearly, there’s some sense to focusing on this and the media and the public should come to appreciate how loony the right is becoming. That said, I think it’s a tactical error at this point. The reason is that the narrative progressives should really want people hear today is one about the content of the Affordable Care Act rather than a political story about which bunch of politicians is more terrible. Thus I’m going to reprint below-the-fold Nancy Ann DeParle’s memo spelling out what aspects of ACA will be going on line in 2010-2011 even while we wait until for the main exchange/subsidy system to come into place.
Above the fold, I’ll pull out the things I think are most important—stuff readers may not know about, or may want to tell friends or family who don’t follow politics as closely:
— Chief among these is the idea that kids will now be able to stay on their parents’ insurance plans until they’re 26. I’ve seen this mocked in some precincts, always by people fortunate enough to have full-time employment. But with unemployment at 10 percent, clearly many people are not fortunate enough to have full-time employment. And if your son or daughter is about to graduate this spring out of high school or college right into the face of the worst labor market since the Great Depression, your family is probably going to be happy about this provision.
— This year, children with pre-existing conditions can no longer be denied health insurance coverage. If I were a member of congress who voted yes on reform, I’d be finding a family in my district that this will help and asking repealers why they think sick kids shouldn’t get medical treatment.
— Big increase in funding for community health centers starts more-or-less right away, which is a crucial recession-fighting measure as well as something helpful for the long run.
— Last, in 2011 the ACA provides a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. That’s a start on full closure of the “doughnut hole” over time.
There’s much more below the fold. But the point is that this kind of stuff is a news story. People want to know “what’s going to change for me and my life?” And the answers to those questions are more interesting and more important than a political story about who called whom what names and why is Eric Cantor so horrible.
Let’s start with how health insurance reform will expand and strengthen coverage:
— This year, children with pre-existing conditions can no longer be denied health insurance coverage. Once the new health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone.
— This year, health care plans will allow young people to remain on their parents’ insurance policy up until their 26th birthday.
— This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need.
— This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool.
— In the next fiscal year, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years.
— This year, we’ll also establish an independent commission to advise on how best to build the health care workforce and increase the number of nurses, doctors and other professionals to meet our country’s needs. Going forward, we will provide $1.5 billion in funding to support the next generation of doctors, nurses and other primary care practitioners — on top of a $500 million investment from the American Recovery and Reinvestment Act.
Health insurance reform will also curb some of the worst insurance industry practices and strengthen consumer protections:
— This year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.
— This year, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees.
— Beginning this fiscal year, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance companies.
— Starting January 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers who don’t meet those thresholds will be required to provide rebates to their policyholders.
— Starting in 2011, this bill helps states require insurance companies to submit justification for requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges.
Reform immediately begins to lower health care costs for American families and small businesses:
— This year, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable.
— This year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning January 1, 2011, Medicare will do the same.
— This year, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64.
— This year, this bill starts to close the Medicare Part D ‘donut hole’ by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50% discount on prescription drugs in the ‘donut hole.’