I am from a generation that lived without the need for health insurance. I remember when a doctor’s visit was affordable. I remember when hospitalization did not bankrupt a family. I remember when health care in the US was priced as it is in Panama now. Those memories are distant, because it is no longer that way in the US, and, even in Panama it is changing rapidly.
Years ago, in a land far away, I had a small business. I also had four children, and a wife with a health problem. As a small business owner, I wanted to provide health insurance for my employees; and, as the head of a family, I wanted to provide for my wife and children. Under the laws of the great State of Arizona, our company, at that time, was considered a small business; so small that no insurance company would insure anyone if they had a pre-existing condition. We needed to become part of a larger risk pool. We ended up paying a monthly fee (on top of insurance premiums) to an employee leasing company so that we could be part of their much larger pool. If not for this larger pool, we would have been uninsured in a country that provides healthcare for the poor, the elderly, government employees, and the military, but not for the small businesses and individuals that pay the taxes to cover all of those above.
That has now all changed. If you are an American citizen, or a resident of the United States, you will be affected by the PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010. Whether you agree with the law or not, the US Supreme Court has upheld the law against constructional challenge (surprising many, including myself. I believed, as did the Court, that the individual mandate was a stretch of the Commerce Clause. I never thought of the argument that won the day: it is within the taxing authority of the government. It seems, in retrospect, that if the government can tax for Medicare and Social Security, it can join the rest of the world for health care.
I have read the law, all 974 pages and admit that some of it is cryptic enough that I am sure portions will be back in court over and over. If you want to read the act as passed it is available for download as a PDF file at http://housedocs.house.gov/energycommerce/ppacacon.pdf .
Grab a bottle of rum and prepare to need it. The law is long, tedious, and in parts indecipherable, due to references to other laws on the books.
For those who object to the law, I would like to quote few items, and provoke some thought. This law may upset people because they are being forced to purchase insurance. It will however benefit many who cannot now obtain insurance. By forcing all to have insurance the pool of those insured will include more young healthy people, as well as people who really need insurance because of health issues.
According the the World Health Organization 2000 report the US had not the best healthcare in the world as propaganda might make you believe, but was number thirty-seventh in overall system performance and found to be the most expensive. WHO Report this is a PDF download.
According to a 2009 Article in Business Week, 62% of personal Bankruptcies in the US in 2007 were Health Care related, Business Week . The cost of healthcare and health insurance has grown to be a massive cost for the entire country. When an indigent person goes to a hospital and cannot pay for services the hospital needs to find the money someplace: higher bills for you, more taxes to subsidize the indigent. If you have health insurance in the US, you can read insurance statements and see the difference between what you would have paid and what the insurance company rate was — vastly different numbers.
This law will shift some of that burden. Under this law people pay for insurance based upon ability to pay, the government is subsidizing with some tax credits based on income. Under this law hospitals will get paid by insurance for bills that were un-collectable. Maybe in time this will slow the increasing costs of insurance and healthcare.
For this who think Mitt Romney will remove the law, he cannot unless Congress also votes to rescind it and I hope they do not. It was Mitt’s Medical Reform in Massachusetts that helped to create a model Federal law possible; he understands that affordable healthcare is essential.
“The Massachusetts health care insurance reform law, St. 2006, c.58,, enacted in 2006, mandates that nearly every resident of Massachusetts obtain a state-government-regulated minimum level of healthcare insurance coverage and provides free health care insurance for residents earning less than 150% of the federal poverty level (FPL). The law was amended significantly in 2008 and twice in 2010 and major revisions related to health care industry price controls were introduced in the Massachusetts legislature in May 2012 with expectation that some version of these controls will pass by July 2012.” http://en.wikipedia.org/wiki/Massachusetts_health_care_reform
Blue Cross of Oregon has posted a good summary of how the new law will impact some areas. LINK . This summary shows how this law will help people. The law itself may not be perfect but most people who are negative about the law, will benefit from the law. Stop believing the thirty second sound bites, read the law.
Under this Federal act many of the same elements are covered.
People who could not buy health insurance before can.
SEC. 1101 ø42 U.S.C. 18001. IMMEDIATE ACCESS TO INSURANCE FOR UNINSURED INDIVIDUALS WITH A PREEXISTING CONDITION.
(a) IN GENERAL.—Not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014.
Pre-exisitng conditions are no longer a bar for obtaining coverage.
‘‘SEC. 2704 ø42 U.S.C. 300gg–3¿. PROHIBITION OF PREEXISTING CONDI- TION EXCLUSIONS OR OTHER DISCRIMINATION BASED ON HEALTH STATUS.
‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.’’; and …
The law does not require you to leave your current insurer.
SEC. 1251 ø42 U.S.C. 18011¿. PRESERVATION OF RIGHT TO MAINTAIN EXISTING COVERAGE.
(a) NO CHANGES TO EXISTING COVERAGE.—
(1) IN GENERAL.—Nothing in this Act (or an amendment made by this Act) shall be construed to require that an indi- vidual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on the date of enactment of this Act.
An insurance company can no longer cancel a customer when they have a claim.
‘‘SEC. 2712 ø42 U.S.C. 300gg–12¿. PROHIBITION ON RESCISSIONS.
‘‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b).
So what does Obama care do? It makes health care affordable to those who could not afford it but were not so poor that they already received it free. In the past the poor had Medicaid or some State equivalent. The working might have had insurance from their job and those who were not part of a large group, or healthy had to pay the increasingly unaffordable costs of medical care in the US. The US has now joined the rest of the developed world in providing a path for it’s citizens to have affordable healthcare.
For Expats, this is how you will be affected.
‘‘(f) MINIMUM ESSENTIAL COVERAGE.—For purposes of this section—
‘‘(1) IN GENERAL.—The term ‘minimum essential coverage’ means any of the following:
‘‘(A) GOVERNMENT SPONSORED PROGRAMS.—Coverage under—
‘‘(i) the Medicare program under part A of title XVIII of the Social Security Act,
‘‘(ii) the Medicaid program under title XIX of the Social Security Act,
‘‘(iii) the CHIP program under title XXI of the Social Security Act,
‘‘(iv) the TRICARE for Life program,
‘‘(v) the veteran’s health care program under chap- ter 17 of title 38, United States Code, or
‘‘(vi) a health plan under section 2504(e) of title 22, United States Code (relating to Peace Corps volunteers).
‘‘(B) EMPLOYER-SPONSORED PLAN.—Coverage under an eligible employer-sponsored plan.
‘‘(C) PLANS IN THE INDIVIDUAL MARKET.—Coverage under a health plan offered in the individual market within a State.
‘‘(D) GRANDFATHERED HEALTH PLAN.—Coverage under a grandfathered health plan.
‘‘(E) OTHER COVERAGE.—Such other health benefits coverage, such as a State health benefits risk pool, as the Secretary of Health and Human Services, in coordination with the Secretary, recognizes for purposes of this sub- section.
and this section relevant to those who live out of the Uniied States.
‘‘(4) INDIVIDUALS RESIDING OUTSIDE UNITED STATES OR RESIDENTS OF TERRITORIES.—Any applicable individual shall be treated as having minimum essential coverage for any month—
‘‘(A) if such month occurs during any period described in subparagraph (A) or (B) of section 911(d)(1) which is applicable to the individual, or
‘‘(B) if such individual is a bona fide resident of any possession of the United States (as determined under sec- tion 937(a)) for such month.
“(d) Definitions and special rules