Members of Indivisible Traverse City and concerned citizens met Sunday, August 20th, at the Workshop Brewery to hear Democratic Representative Christine Greig from Farmington, Michigan, and Charles Gaba, a national health care specialist, speak on the aspects and provisions of the Affordable Care Act. This portion of our report covers the information received from Charles Gaba on the specifics of the ACA compiled by Linda Pepper.
SPEAKER: CHARLES GABA
His complete slide show presentation can be found at www.ACASignups.net. There are both tutorials and YouTube videos to explain all the provisions of the ACA and what parts need to be fixed.
Before 2009, about ½ of all Americans were covered by employer paid or offered health insurance, about 1/6 were covered by Medicare and 1/6 more covered by Medicaid or Chip.
The Individual Market was about 11 million people who bought health care insurance from large companies.
About 48 million had no health insurance at all.
The Individual Market was very unregulated and discriminated against anyone with pre-existing conditions or who were likely to cost a lot of money. They would deny coverage or offer policies that were cheap but covered almost nothing (Example McDonald’s had a $56 per month policy that paid a maximum of $2,000) They never covered people with Cystic Fibrosis, Multiple Sclerosis, sleep apnea and pregnancy and many other conditions.
ACA sought to (1) decrease number of people with no insurance, (2) protect patients who had pre-existing conditions and (3) make health insurance as affordable as possible.
The ACA did this by (1) Medicaid expansion which had to be done state by state. People who make less than 138% of the federal poverty level were made eligible to enroll in Medicaid. Currently, 31 states and DC are taking advantage of this. Republicans have stopped it in 19 states. This covered about 14 million. Also, young adults could be covered under their parents’ policy until age 26. This covered about 7 million more.
(2) Patient protection which meant everyone paid the community rating price for insurance.
There are 3 legs to the program (stool) that the ACA developed:
(1) All policies had to cover basic services including hospitalization, maternity care and mental health treatment. All policies were based on a community rating.
(2) There were incentives for healthy people to get insurance with subsidies and tax credits
(3) There were financial penalties on your taxes if you did not have health insurance.
22 million have gained insurance but about 28 million are still not covered.
The uncovered 28 million are in the 19 states without Medicaid expansion, undocumented immigrants, and those who are in the Medicaid gap or it is too expensive to pay for insurance still.
Our penalty for no insurance was about $700. Countries like Germany and Switzerland have a $10,000 penalty and their insurance is cheaper.
When asked why Republicans always say that health care insurance costs have gone up under the ACA, Charles replied that generally, overall, health care costs are moving up. That pharmaceutical companies keep raising prices on medications. Doctors are not allowed to negotiate with pharmaceutical companies for lower drug prices under our current system.
He explained that the main problem with rising costs of coverage under the ACA lies with those who are unsubsidized in the individual market who earn too much to qualify for subsidies, but do not make enough money to afford the higher premiums. Those generally fall in the earning range of $35,000 to $60,000. Also, with the introduction of the ACA, a lot of people with severe health problems signed up which has driven prices up even as many younger, healthier people have opted to pay fines rather than sign up for coverage.