By Jacob Molyneux, AJN senior editor/blog editor
I am amazed at the amount of time being wasted on the relatively mundane matter of health care exchanges. It seems we are now facing a government shutdown; there are creepy and misleading advertisements funded by conservative billionaires like the Koch brothers in order to scare people from signing up for insurance; some red states have actually enacted laws forbidding the health care navigators from helping people understand the new system and sign up for it, and many of these states have refused to create their own exchanges to help their citizens comply with the new law.
The ACA is a law. You can’t just ignore it if it doesn’t meet your personal preferences or political ideas. Given the heated rhetoric the Republicans are trotting out about it, you’d think the government was trying to take away our puppies, instead of implementing ideas originally floated by Republicans themselves to make life a bit easier for millions of Americans whose life decisions are unduly ruled by crazy health care billing practices, byzantine insurance regulations, discrimination against those who have chronic conditions, insanely varying pricing for simple tests, and the like.
Short detour into personal history: when I was 26 (i.e., 20 years ago), I quit my job running a classroom for abused and neglected toddlers in Boston and headed to North Carolina for graduate school. When I enrolled in grad school, I opted out of the health insurance option, thinking quite naturally that I’d like to save myself money. I also opted out of COBRA, a pretty expensive way I could have continued the coverage I’d had from my former job for six months or a year. That fall, I lost a ton of weight and nearly ended up in a coma before finally getting diagnosed with type 1 diabetes, my body having attacked itself in an act of supreme autoimmune confusion and wiped out all my insulin-producing cells. My lack of insurance was a serious source of stress for a number of years, as the supplies I needed just to test my sugar regularly and take insulin cost a lot of money, and buying affordable insurance on the open market with a preexisting condition was basically impossible. In such an America, many of my career choices ended up being heavily influenced by the need for employer-sponsored insurance, which I now blessedly have through my job.
The Affordable Care Act (ACA)—I do not accept the politically charged name Obamacare, and fail to see why journalists have consented to use it, or why the Obama administration has even done so in many cases—is not out to get anyone. It’s simply an attempt to bring a little order and regulation to a system that has become untenable, inaccessible to many millions, inefficient, and deeply inequitable. As everyone knows, the ACA was enacted against stiff opposition from industry and multiple conservative groups. This means it’s not as good as it could be; it could be improved, and probably will be once we stop wasting time trying to fend off those who simply want it to fail.
The health care exchanges (about to go into effect) are not at root a complex idea: they are about offering a menu that meets certain standards of honesty and transparency, one that is intended to help people who don’t currently have health insurance purchase plans that fit their financial realities and their health care needs. It’s that simple. If some sites turn out to be better designed than others, this is something that can be worked on and improved.
There is a health care exchange in Massachusetts that works just fine. I spent a bunch of time investigating it a couple of years ago when I edited an article about it. There are gold, silver, and bronze plans on offer; each category has to meet certain minimum standards about things like deductibles, copays, out-of-pocket limits and costs, etc.
It’s complex, but a lot less so than the system it replaced. Even the conservative politicians in that state mostly want to keep the health care system often referred to as “Romneycare.” It’s not perfect, with funding being a real issue, and a lack of sufficient numbers of primary care providers a problem in some areas, but there’s a general sense one gets that the focus is on improving the system already in place rather than subverting it or removing it. No one really wants to go back to the entirely disorderly and market-driven system that afflicts most of this country. (Okay, maybe a few rich people do, as they can always buy the best health care in any system, whether or not they are insured or not.)
This isn’t at baseline about Obama; it’s about the American people. And it’s called the Affordable Care Act for a reason, even if we still have a long way to go toward true affordability for many of us.