12/17/2013
To skip this introductory analysis go below to
How the provision was distorted.
When President Obama made universal coverage a central part of his first campaign, rather than attempting a revolutionary restructure of single payer, or Canadian style socialized medicine, his congressional allies tried to incorporate this major change into our existing elaborate medical establishment, while still dramatically expanding coverage. To do this without increasing taxes, he (meaning congressional committees-and others) did something that could be viewed as creating a new government backed business venture, one that would incorporate all of the medical establishment- physicians, hospitals etc into a new delivery system. The promise and the hope was to make the proposed efficiencies of this law IE (capitation payment replacing itemized billing) compensate for the cost of subsidizing additional scores of millions of new patients.
To skip this introductory analysis go below to
How the provision was distorted.
When President Obama made universal coverage a central part of his first campaign, rather than attempting a revolutionary restructure of single payer, or Canadian style socialized medicine, his congressional allies tried to incorporate this major change into our existing elaborate medical establishment, while still dramatically expanding coverage. To do this without increasing taxes, he (meaning congressional committees-and others) did something that could be viewed as creating a new government backed business venture, one that would incorporate all of the medical establishment- physicians, hospitals etc into a new delivery system. The promise and the hope was to make the proposed efficiencies of this law IE (capitation payment replacing itemized billing) compensate for the cost of subsidizing additional scores of millions of new patients.
To
do this, insurance companies become the intermediary. They were
required to provide some additional services, but also were guaranteed a much
larger base of clients. Unlike most Government programs, this was not
to be achieved by raising taxes to cover its costs, but
rather by the voluntary purchase of health insurance by the demographic
group whose excess insurance premiums will pay for the additional people covered. While traditional
government programs such as Social Security or Military expenses are paid for by exacting taxes from the population under penalties of
law, meaning the political process will determine its proportion of GDP, ACA is different The contours of health care delivery will only be sustained by the voluntary choices of purchasers of health insurance (encouraged by tax penalties), which is a business rather than a government model. This is why the outlines of this plan were consistent with a conservative Heritage Foundation monograph.
ACA is similar to Medicare where people pay in when young and healthy to benefit when old and sick. Yet, rather than the payment being enforced by law, deducted from salaries, ACA business model component means that the prepayment, in the form of over priced health insurance, must be sold, marketed to a specific younger demographic. .
This law will only survive if they buy this product; and to make this happen it takes a mix of coercion and inducement, both the carrot and the stick. Unfortunately, once this is cast in the model of a private venture, it makes use of principles of product marketing that include obfuscation and exaggeration. This hybrid of business and government, with it's available of coercion, is inherently in conflict. A loss of trust in even the largest corporation can cause it to fail, while a similar loss of trust in a government, ours now at an historic low, brings more catastrophic possibilities.
ACA required a two part sales campaign; the first to gain political support to get the law passed, while the second was to convince the young group who will be financing the heavy users of health care to purchase this product. For the first campaign, the administration denied that many people would lose both their current insurance and physicians which only become known as false when the loss occurred. The universal availability of "guaranteed issue" insurance even to the sick, was a similar exaggeration during the first campaign to sell the law to the public. Those who will be harmed are the ones who relied on this not to purchase insurance during open enrollment, and find they need it at a later time.
This law will only survive if they buy this product; and to make this happen it takes a mix of coercion and inducement, both the carrot and the stick. Unfortunately, once this is cast in the model of a private venture, it makes use of principles of product marketing that include obfuscation and exaggeration. This hybrid of business and government, with it's available of coercion, is inherently in conflict. A loss of trust in even the largest corporation can cause it to fail, while a similar loss of trust in a government, ours now at an historic low, brings more catastrophic possibilities.
ACA required a two part sales campaign; the first to gain political support to get the law passed, while the second was to convince the young group who will be financing the heavy users of health care to purchase this product. For the first campaign, the administration denied that many people would lose both their current insurance and physicians which only become known as false when the loss occurred. The universal availability of "guaranteed issue" insurance even to the sick, was a similar exaggeration during the first campaign to sell the law to the public. Those who will be harmed are the ones who relied on this not to purchase insurance during open enrollment, and find they need it at a later time.
How the provision was distorted.
This page of Healthcare dot gov is for those with the question of the heading: What if I have a pre-existing health condition?
The page begins with three sentences saying the same thing, one in double size bold type:
Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a pre-existing health condition.
Being sick doesn't keep you from getting coverage.
Starting in 2014, being sick won't keep you from getting health coverage
While
this seems perfectly clear, comprehensive and definitive, a few lines
down it does describe one exception, which acts as a confirmation that other
than this unlikely "grandfather" clause, you can get insurance under ACA, whether sick or
not--period. Now we finally get to this admonition:
We have here the first introduction of the word "Marketplace" which is not used to modify the proclamation of the opening three lines, or what the President has been stating since the selling of this legislation continuing to this day. "Marketplace" usually implies a sales channel, and does not, and was not interpreted by many people (see dailykos survey below) as meaning that the non underwritten insurance polices themselves were only available during this period.
The first three clear statements all are misleading at best. In reality, the main modifier of the bold claim that pre-existing conditions will not prevent getting insurance, is that this only applies during "open enrollment, which will end on March 15th.. Next year, for ten months of the year you will not be able to get insurance if you have a pre-existing condition or find out that you are sick and face major costs. There is a provision to allow purchase a non ACA standard short term policy, that does not require insurer accepting someone with pre-existing conditions.
Here is a description of time of the open enrollment described on this secondary web site. (official sites with this information have not been located.)
We also do have this description from AARP, that mentions the guaranteed issue in this section on Open Enrollment
Yet it does not say that this is not available outside of this period
If clarity had been the top priority of Government for this highly complex confusing law, the section of Healthcare.gov could have included the words in italics.
Be sure not to miss open enrollment Open enrollment ends on March 31, 2014. Outside of open enrollment, you can't enroll in Marketplace coverage unless you have a qualifying life event. Open enrollment will begin again in October 2014.
We have here the first introduction of the word "Marketplace" which is not used to modify the proclamation of the opening three lines, or what the President has been stating since the selling of this legislation continuing to this day. "Marketplace" usually implies a sales channel, and does not, and was not interpreted by many people (see dailykos survey below) as meaning that the non underwritten insurance polices themselves were only available during this period.
The first three clear statements all are misleading at best. In reality, the main modifier of the bold claim that pre-existing conditions will not prevent getting insurance, is that this only applies during "open enrollment, which will end on March 15th.. Next year, for ten months of the year you will not be able to get insurance if you have a pre-existing condition or find out that you are sick and face major costs. There is a provision to allow purchase a non ACA standard short term policy, that does not require insurer accepting someone with pre-existing conditions.
Here is a description of time of the open enrollment described on this secondary web site. (official sites with this information have not been located.)
The annual enrollment period for 2015 and subsequent years will begin October 15 and extend through December 7 of the preceding calendar year. Starting in 2014, the Exchange must provide advance written notice to each enrollee about annual open enrollment no earlier than September 1, and no later than September 30.
We also do have this description from AARP, that mentions the guaranteed issue in this section on Open Enrollment
Yet it does not say that this is not available outside of this period
What happens during open enrollment?
You can choose health insurance that best meets your needs. This includes initiating or dropping coverage, or picking among such options as monthly premium costs, copayments, annual deductibles and prescription drug coverage. Participating insurance companies can't turn you away or charge you more because you have an illness or medical condition.
If clarity had been the top priority of Government for this highly complex confusing law, the section of Healthcare.gov could have included the words in italics.
Starting in 2014, health insurance plans can't refuse to cover you or charge you more just because you have a pre-existing health condition if you apply during the open enrollment periodOr this wording from the Covered California official website
To make sure you are covered in 2014, you must get health insurance before March 31, 2014, or you must wait until the next open-enrollment period begins, in October 2014, for coverage in 2015
This would have been responsible and probably not even lost support for the legislation, but sadly, this law was sold by exaggeration at every level, this being only one obvious example. We expect bait and switch from private enterprise where marketing often is synonymous with misleading, and business ethics is reduced to avoiding criminal prosecution, but we have a right to expect government communications to inform, especially in something as vital as health insurance. The Obama administration is still issuing "official information" as if it were selling the legislation, with spin trumping clear explanations of the reality of this law. With trust in government at an all time low, such intentional distortion, accelerates this potentially disastrous trend.
Some may want to refute the thrust of this article by claiming that the public understood that unqualified statement of guaranteed issue was limited. This article is from George Will's column in January of 2013 refutes this:
"Roberts noted that a person earning $35,000 a year would pay a $60 monthly tax and someone earning $100,000 would pay $200. But the cost of a qualifying insurance policy is projected to be $400 a month. Clearly, it would be sensible to pay $60 or $200 rather than $400, because if one becomes ill, “guaranteed issue” assures coverage and “community rating” means that one’s illness will not result in higher insurance rates".
This exact misunderstanding was shown by a majority of respondents in this survey of politically knowledgeable readers of the liberal Dailykos website done after the rollout of ACA.
This essay is not written to attack ACA; there is too much competition in that endeavor. It is written (as was a letter sent out on this issue) to inform those who do not understand the limitations on guaranteed issue, and to try to explain, if not excuse, why this distortion arose in this law. Perhaps President Obama is to be condemned for this, and while I feel that the willful exaggerations described here, and of "Under the new law you can keep your doctor and insurance" are unfortunate, history has the final word.
We are entering a new era of medical care delivery, with burgeoning knowledge of underlying disease processes unimaginable only decades ago, that, combined with computer technology can dramatically transform mass delivery of medical care. Such efficiencies could make medical care available to everyone as is the case now with computer-internet technology . ACA, like the internet interchange start up, is deeply flawed. Only generations from now will we know whether it was a courageous first step towards rationalization of this complex system, or something ill conceived and poorly executed, thus doomed to failure.
The defects of this law must be open to discussion, an imperative that far transcends political posturing by either party. There are those who say that the Democrats and Obama now "own" this law. I disagree. It was passed by our Congress and signed by our President, all duly elected. It is "our" law now, to fight to improve and demand such opportunity, no matter which party is in control.
While fearing the worst and trying to prevent it, I must hope for the best.
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