Opinion : An uncomplicated way to understand the Affordable Care Act

By Rosemary Schwartz · September 21, 2013, 11:18 pm

By Rosemary Schwartz

Disclosure: I am chair of the Benton County Democrats and a non-producing licensed health insurance agent. I currently receive health insurance through my employer.

I received an email from Rep. Dawn Pettengill’s District 39 list serve on Friday, Sept. 20. The rather long and convoluted document was no doubt written by Republican House Leadership and sent out for Republican legislators to send to their constituents. Please remember that Republicans have not been supportive of the Affordable Care Act, Obamacare, as the 40 votes in the US House to repeal and the futile attempt to defund the legislation proves. It is not surprising that Republicans would choose to try to explain ACA in the most complicated manner to further confuse the public in an attempt to sabotage public opinion.

I am not an ACA aficionado but I have made myself familiar with the key components of the plan and here is a simple explanation of who will need to seek out insurance plans.

1) If you are on Medicare and have a Medicare Supplement or on Tri Care, you do not need to do anything. There are no changes to your plans.

2) If you are an employee with employer health insurance provided-you do not have to do anything unless your employer changes plans (a practice that is currently in place yearly for open enrollment) and the employer will inform you if that should happen. (I received a letter from my employer a few weeks ago that informed me that the current insurance plan offered by my employer satisfies the ACA requirement.)

3) IF YOU CURRENTLY HAVE NO INSURANCE, OR ON MEDICAID, THE AFFORDABLE CARE ACT AFFECTS YOU AND YOU SHOULD SEEK HELP TO DETERMINE THE NEXT STEPS. GO TO WWW.HEALTHCARE.GOV OR CALL 800-318-2596. THERE IS HELP OUT THERE READY AND WILLING TO WALK YOU THROUGH THE PROCESS. For people meeting financial thresholds, there is financial subsidies to help pay for insurance.

4) Employers with 50 or more employees implementation of employee insurance part of ACA has been delayed until 2015.

Some of the provisions of ACA are already in place.. These are a few of the high-lights.

1) Beginning 2014, no longer can insurance be denied for pre-existing health conditions. This is huge for people with chronic illnesses, heart issues, cancer as well as other conditions.

2) Insurance caps have been removed and this is again huge especially for people with chronic illnesses or anyone who experiences a major health condition or accident. (I know of a family with a small child with two chronic and permanent diseases. Her mother estimates that if the caps were not removed that her daughter would hit that cap before she is 21 years old. Where would her daughter find health care then? Thankfully this family does not have to worry under ACA.)

3) A move towards preventative healthcare rather than funding expensive medical procedures to deal with a major disease is now the norm. DAH. This should have already been in place, but under ACA preventative measures such as mammograms, cancer and heart screenings are now free or a very low cost.

4) Young adults until age 26 can remain on their parents insurance plans while they are in college or getting themselves established in the workforce.

5) For seniors with Medicare Part D drug plans, the donut hole that currently is in place will be narrowing over time to provide seniors who hit that limit better coverage. This process has already started.

These benefits are already either in place or operating right now. If Republicans are successful in stopping the implementation of Obamacare, people who currently have insurance will lose these benefits. Gone will be coverage for young adults 26 and under who are on their parents health care plan, gone is the protection of that pre-existing health conditions. Insurance companies can once again deny coverage for people with chronic conditions, gone will be the implementation of no more caps for insurance coverage which for the family mentioned above will become a worry for their daughter, gone will be preventative measures at no cost to help diagnose expensive and deadly diseases, like cancer, resulting in more expensive treatment costs or death.

Gone will be the option for Iowans who do not have health insurance the opportunity to purchase insurance on the exchanges and to receive financial help for that purchase. Do you not see the value of these provisions you are currently or will be receiving under ACA?

Republicans do not want you to understand want ACA means for you and your family. To make a political point, Republicans prefer to take benefits away from you now and prevent other benefits from being implemented. They know that if the consumer sees the benefits of ACA, consumers will not want to give up those benefits. Republicans are playing politics with your health to politically oppose anything attached to the President. The Affordable Care Act is not perfect and no doubt will need to be improved and changed but the alternative is to go back where insurance companies decide who will get insurance and how much it will cost.

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SZ October 10, 2013, 2:29 pm I agree with Joe. Not to mention what this act does to the doctors. No longer will doctors have control over your care. If your condition doesn\'t fit a government designed table of averages, too bad for you. Medicare already set that standard with insurance companies, ask any doctor. If this plan is so great why aren\'t the folks in DC clamoring to sign up for it themselves. Time to drain the swamp in Washington. Time for them to live under the same rules they impose on everyone else.

CAM October 10, 2013, 1:52 pm Two point to make. 1) People w/ pre-existing conditions may not be able to be denied coverage, BUT, most won\'t be able to afford the premium, AND, the deductible will be so high that the insurance won\'t be of much, if any, value, anyway. 2) To the heart of the problem... NO ONE is entitled to insurance coverage OR health care -- even if you \"don\'t think that\'s fair\"! AND, it is NOT my responsibility to BUY insurance for YOU -- even if you \"don\'t think that\'s fair\"!

JR September 26, 2013, 7:50 pm Unfortunately before the ACA was passed I had good healthcare. Shortly after it was passed, I received a letter from my employer stating that due to the passage of the ACA and the uncertainties it was creating due somewhat bulky and unclear rules, my employer started scaling back our healthcare. When it was determined that we would have a \"Cadillac plan\" it was scaled back even further with larger premiums, larger deductibles and higher copays. I believe that the government has created equally poor health care for all in attempt to derail private insurance and make us all wards of the state. I for one am tired of the government fixing things for me because it only seems to cost me more out of my pocket every time they \"help me.\"

VoEVC September 26, 2013, 7:31 am *Sigh* and just when it was getting interesting, if you aren\'t careful, he will follow up on making you all hug each other! Hey, burn up our email with your own \"Letter to the Editor\" we\'ll be more than happy to print those as well! Simply address it to: VintonToday@hotmail.com -Val who enjoys all the political debate more than the other guy on this side of the website! ;)

VEDC September 25, 2013, 7:04 pm ENOUGH! The comments on this story have deteriorated into personal attacks on both sides. Therefore we are implementing a new policy: Only ONE comment per opinion piece will be allowed from now on, and the person writing the column does not get to reply -- he or she already had a chance to speak. This is what the Iowa State Community Journalism book advises and it\'s a good policy. I am willing to make an exception to this policy if every person who submitted a comment agrees to gather at the courthouse, and spend a day doing nothing but hugging each other with only a wordless smile on every face. Before you mention the First Amendment, let me remind you that you have the right to say whatever you want about this policy. Do I make myself clear?

dw September 25, 2013, 6:01 pm The biggest question to answer: Why, if AHC is so good, did congress elect to exclude themselves? There are other reasons I have for not supporting it, but this should arouse everyones suspicions!

DW September 25, 2013, 5:12 pm Rosemary, The more I read your articles the more it sounds like you have a personal problem with Dawn. Get over it and move on.

JW September 25, 2013, 1:50 pm Rosemary, According to the Small Business Administration, The following criteria is used to define a small business: Manufacturing: Maximum number of employees may range from 500 to 1500 Wholesaling: Maximum number of employees may range from 100 to 500 Services: Annual receipts may not exceed $2.5 to $21.5 million Retailing: Annual receipts may not exceed $5.0 to $21.0 million General and Heavy Construction: Annual receipts may not exceed $13.5 to $17 million Special Trade Construction: Annual receipts may not exceed $7 million Agriculture: Annual receipts may not exceed $0.5 to $9.0 million Of those I am thinking there are a lot of 50+ employee businesses. I happen to work for a Family owned small business that provides health insurance to their employees. How is the Obamacare effecting my employer? An increase of paperwork causing an increased cost that does not improve the coverage we are receiving. We as employees are asked to pay a little more for our coverage which leaves me a little less take home money to spend. Who benefits from that? Not all businesses are fortunate enough to have the overhead to provide health insurance at the increased cost to all their employees and rather than fire them, are choosing to reduce their hours. This is something the Obama administration is happy about. Although they may be underemployed it won\'t impact the unemployment number. I believe we\'re still teaching our children that we live in a free country. That means if we have a job we don;t like, we can find a different job. If people were really so concerned that they aren\'t getting heath insurance with their jobs, they should look for a different job that does.

RS September 25, 2013, 12:57 pm Jim, You set the criteria in your earlier post. You said businesses already paying for employees insurance are cutting back hours to avoid paying insurance. I am just pointing out that there is something wrong when an employer puts more profit ahead of their employees. Secondly, Mom and Pop businesses employing less than 50 employees are not affected and those with 50 or more have until 2015 to come up with a plan. Thirdly, tell me what is so wrong with employers providing health care to their employees? The employers who already do that have nothing to complain about--kudos to them for caring about their employees!!

JW September 25, 2013, 12:21 pm So Rosemary, your not worried about the 52% of the workforce that is employed by small mom and pop businesses. You want us to be mad at the 48% that work for the large corporations. Once again it shows the anger liberals have toward business in general when you will make the majority suffer to try take get back the the wealthy. You don\'t care that studies show that premiums in Tennessee will increase by 190% for a 27 year old male and 97% for a 27 year old female as reported in the Washington Examiner. You don\'t care about the extra regulations and paperwork that is required by medical providers is causing them to see less patients in a day. You don\'t car that in order to try and keep costs down they are regulating a lower quality of medications and limiting them to patients. All you care about is sticking it to the man.

RS September 25, 2013, 10:35 am Jim, The outrage over employers who are cutting full-time employees who currently have employer co-paid insurance is misplaced. Why isn\'t the outrage with the employer who thinks so little of their employees that they would cut their income and insurance to make more profits? I am not talking about Mom & Pop small business, I am talking about multi-million dollar businesses who see this as a way to give their investors a larger stock dividend. As you stated the businesses are already paying for employee healthcare what other motivation is there to stop that practice than to create more profit? The American public should be up and arms that these businesses are treating their employees this way. Instead they get a collective pass so others can criticize Obamacare. Let\'s put the blame where it belongs on the businesses who are hurting employees.

JW September 24, 2013, 11:03 pm Rosemary, in your list of people that will be affected by the Affordable Healthcare Act, you left one one group. The people who have insurance through their employers who are now having their hours reduced to be below level of \'full-time\' as written in the AHA. They will now, no longer have healthcare and with the reduced hours also have less income to pay out of pocket for healthcare. So they can either choose to pay themselves and sacrifice something else, or for go healthcare and pay a penalty to the IRS. Of course this can be fixed by raising the minimum wage. Another Idea being passed around. This of course would also cause inflation making the basic essentials to increase netting the minimum wage earner a net ZERO, or worse. It always concerns me when lawmakers, who are so excited to create a law to \'help\' the people make sure to exempt themselves, there families, their companies, the supporters, etc. It also peeks my interest when a group that was so completely in support of a law before it was being enforced are now running away from it like rats from a ship. Case in point the 40,000+ AFL-CIO Longshoreman union works who walked away from the union over Obamacare. With the federal government showing they can run a business so well with the USPS or even the federal budget, why should we be afraid of the government taking control of 1/3 of the US economy?

RS September 24, 2013, 11:21 am

MC September 24, 2013, 8:39 am I am not sure \"understanding\" the Affordable Care Act is the issue. Those of us who value liberty and freedom do not appreciate the government intrusion and control of our health care or anything else affecting our lives. I realize there are those in our society who worship the \"god\" of government but I do not and I\'m pretty sure there are a few people out there who might be inclined to agree.

RS September 23, 2013, 4:42 pm This link just came across with a clear document, (from the Governor\'s office) on where the information meetings for ACA will be held. http://www.iid.state.ia.us/sites/default/files/page/2013/04/10/iid_itinerary_statewide_meetings_pdf_20430.pdf

RS September 23, 2013, 4:24 pm

DP September 23, 2013, 2:00 pm Let me assure you, I do not need anyone to write my articles or feed me information or tell me talking points. It\'s insulting that you even suggest it and you know that. If you want to critique my work, that is fine. However attributing your motives or anyone else\'s to me, I do not accept. The history and motive behind me writing the article/newsletter is to prepare the public for changes that are 8 days away. In the last two weeks, the Consumer Advocate of the Insurance Division presented to the committee I chair, the adopted administrative rules on the ACA and what will be happening in Iowa. Also, the Insurance Commissioner is going on an educational tour around the state. I was passing the information along. Why? There are upcoming meetings that the public may want to attend. The public needs to know health insurance is now required for everyone who does not have it, in order to comply there are minimum essential benefits required with your coverage, who they can talk to for guidance and what the penalties would be if they don\'t comply. There was no dastardly plan or motive. If I said anything that is incorrect, I would like to know. As far as the presentation of information, I am happy to have as many different presentations as possible, so that people know what to do. The law is the law. We are charged with implementing it and we are trying to do that as responsibly and thoughtfully as we can. Do not tar me with the actions/inactions of Congress. We operate a little differently in the Iowa Legislature. We work together for solutions, have a balanced budget and don\'t spend more of your money than we take in. In fact, this legislative session, every budget bill and every major reform had unanimous or very large majorities of both sides voting for them. We do not have this partisan divide at the Iowa Capitol or question the motives of each other. It is against our code of ethics. Our collective motive is a good Iowa with successful Iowans. We might have different ideas of what that means, but we do not doubt the sincerity of each other. When you do, you lose the ability to work together. Civility is a big deal if you want to solve a problem. If you just want to poke someone in the eye or try to make them look bad, that\'s not leadership, but it is counterproductive.

EH September 23, 2013, 12:54 pm I would like to see these links but they are not showing up fully. Thank you Alex for promoting information vs. partisanship. Editors can you find a way to make these links live or at least copy and pasteable? Editor\'s Note: Elise: Nope. We tried.

AV September 22, 2013, 3:04 pm Before this post generates a huge amount of partisan debate, I would like to submit two links to better understand this act, the impact it will make, and criticisms of it. These links come from the website reddit.com, which has a subsection titled \"Explain Like I\'m 5\", wherein authors attempt to explain complex ideas, legislation, and so forth in an understandable, referenced, and bias-free manner. Link explaining the bill, its timetable, including references to the bill\'s text, and impact: http://www.reddit.com/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx Link explaining the primary criticisms of the bill: http://www.reddit.com/r/explainlikeimfive/comments/1mppxm/eli5_what_are_the_primary_arguments_against_the/ While true Liberal and Conservative supporters will not be able to approach this topic with anything remotely resembling an open mind, I present those links for the few true Independent minded people for scrutiny and consideration, relatively free from unproductive partisan rhetoric.