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Saturday, August 24, 2013

ACA: Affordable Care Angst.

The  Patient Protection and Affordable Care Act  (aka "The Affordable Care Act" - ACA - and "Obamacare") was passed into law on March 23, 2010.

Ever since, the howling from the Right has not lessened one decibel.  The Republican majority in the House has attempted to repeal it no less than 40 times.

On June 28, 2012, the Supreme Court upheld the constitutionality of most of the ACA in the case National Federation of Independent Business v. Sebelius. However, the Court held that states cannot be forced to participate in the ACA's Medicaid expansion under penalty of losing their current Medicaid funding.

Since the ruling, the law and its implementation have continued to face challenges in Congress, in federal courts, and from some (guess which ones?) state governments.

Why? Beats the heck out of me.  Except, of course, it was passed under the leadership of the first Black President in our history. Wait! No! That couldn't have anything to do with it right? Right!
A full list of the provisions of the ACA are lengthy, but here are the central important points:  
It aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of health care for individuals and the government.

It provides a number of mechanisms—including mandates, subsidies, and insurance exchanges—to increase coverage and affordability.

The law also requires insurance companies to cover all applicants within new minimum standards and offer the same rate regardless of pre-existing conditions or sex.

Additional reforms aim to reduce costs and improve healthcare outcomes by shifting the system towards quality over quantity through increased competition, regulation, and incentives to streamline the delivery of health care.

The Congressional Budget Office projected that the ACA will lower both future deficits and Medicare spending.
All that being said, the ACA is one small but critically important step in leveling the playing field for access to affordable health care for every citizen in the United States. We need more revisions and changes and reform. Many more.
A personal example:

A few years ago, I developed an allergic rash. I didn't know it at the time but it was the fault of my pharmacist who dispensed the wrong form of a medication. I went to see a doctor locally. After the exam, she ordered a full battery of blood work. When I saw the order, I went right back into her office and questioned it. She was stunned - I mean, in addition to the fact that she had already spent the requisite 15 minutes with me - and said, "Why are you concerned? Your insurance will pay for it."

I was stunned by her response. "Yes," I said, "but do you really need to know my cholesterol level to determine the cause of my rash?" She admitted she didn't, along with several other blood panels. But, because this was the first time she had seen me, it was "allowed". Working together, we eliminated all but the ones she really needed, which turned out to be a few simple tests.

After that episode, I never went back to her.

Most consumers of health care still labor under the illusion that doctors are demigods. They are not. They are human. I'm reminded of what one of my physicians once said to me, "Remember, 50% of all doctors graduated in the lower half of their class."

Oh, and turns out that the lab the doctor used charged more than the "usual and customary" fees my insurance would allow and I ended up being charged to pay out of pocket to cover the balance. I contested it. After 3 months, the lab dropped the charges.
Oh, and turns out that my pharmacy had dispensed this other form of medication because -  guess what? - they made more money on it.

Medicare is a highly successful government program, saving hundreds of millions of dollars by containing the greed that has infected our health care system and the insurance industry. I can tell you from professional experience as a Hospice chaplain that Medicare is a model of effective compassionate care combined with business efficiency.

Unfortunately, doctors are often seduced by greed, supporting unnecessary lab, X-Ray and "Big Pharma" which feeds the system. Our political process is, more often than not, a reflection of that greed. Some politicians vote not to serve "we the people" but those who line their pockets with money that will get them re-elected.
Misrepresentations? Oh, yes. They abound. There are no "death panels". That has always been a heinous, fear-mongering lie.

It hurts business? People are losing their jobs? Corporations are laying off people or reducing the hours their employees work not because they can't afford health insurance, but because it cuts into their profit margin.

See also: greed.
Jesus said, "The poor will always be with you." I suspect he said that because he knew something about the human condition and the inclination we have toward greed.

The Affordable Care Act is complicated and complex because the health care and insurance industry have intentionally been made complicated and complex. The ACA is one small but critically important step in unraveling the tangled mess and changing a system that is in desperate need of revision.

I think we had best get used to it. Christians ought to support changes in laws and policies that insure best practices of medicine and businesses so that all of God's children have access to affordable health care.

I think that's the "conservative" Christian thing to do because it "conserves" as well as preserves the respect and dignity of every human being.
One last note: I'm curious to know if sermons about the Affordable Care Act in particular and health care in general are being preached in The Episcopal Church. Some of us preach on racism and sexism and domestic violence  and, God knows, homosexuality but I've yet to hear a sermon address this issue. Especially now that it is hitting closer to home.
Has the House of Bishops Theology Committee written a statement that outlines the scriptural and/or theological thinking about affordable health care? You know, something that might help stimulate some theological thinking in the pulpits and pews on this critically important issue? Anybody had an article written in HuffPo or done an OpEd piece or written a Letter to the Editor?

If you have heard a sermon about this or know where I can read it online, please let me know. I'm not holding my breath, but I'd love to hear from you.

I think church leaders ought to start making some noise about the Affordable Care Act.

Why? Because Jesus said, "The poor will always be with you."

He also said, "Whatever you do for the least of these, you do for me."

That's one theological cure for the Affordable Care Angst.


Heather said...

It isn't just greed that causes unneccessary testing. It is fear of lawsuits.

Marthe said...

Ah, dear EK ... the poor are with us because the rich think they need vast reserves of easily exploitable labor to remain rich. Oh, and I have always suspected that a couple of words were excised from that statement, specifically I think Jesus may have said the poor of spirit will always be with us because he knew that his message would not resonate with the selfish or greedy or insecure. Cropping the line to say just "the poor" gives the miserly an out, an excuse for their lack of generosity, a way to shrug off the misery of others as a hopeless, inevitable fact of the human condition, so not a problem worthy of sensible effort.
And on the ACA, a little evidence of the insanity of the current situation: five stitches in my thumb produced five bills totaling just over $2,100, one from the town ambulance service to drive me across the street to the local ER (policy at the store is to call EMTs for every incident, no matter how minor, so while I'm only a part time worker and thus not covered by the company health plan, they pick up the ambulance charge) one for ER service, one for the ER doctor, one for the clinic visit to remove the stitches, one for the clinic doctor who looked at it and had a trainee actually remove the sutures (badly, by the way - several days later a last bit of one of the sutures worked its way out of the one still really sore spot on the mostly healed wound - no rebate forthcoming, of course).
So, to the ACA - here in Ohio, no info available on what exactly will be available to us who are not technically so poor as to qualify for Medicaid and the Greed Over People party is in control and not promoting exchanges for care I probably can't afford anyway, so what are we to do? Spend the next 30 years paying off the credit card debt and try really hard never to have any sort of need again (yes, yes I'm aware that if I wasn't a wimp, I could have pulled the sutures myself and thus saved some cash, so part of the bill is my own fault ... this, my dear, is the thinking of one raised Republican, GDI division and not fully recovered from that condition). What I do fully expect is that those who profit from "care" will find a way to make ever greater profits from whatever system evolves next because the greedy are relentless and there is no such thing as "enough" to fill their gaping void where most people have a soul.

Elizabeth Kaeton said...

Heather - Yes, our litigious culture has more of an influence than necessary - especially for those docs who graduated in the lower 1/2 of their class - but ordering cholesterol and electrolyte levels for a rash? That's not fear of lawsuits. That's unnecessary testing, no matter how you look at it.

Elizabeth Kaeton said...

Marthe - Your post is precisely why I say that the ACA is a small but important step in the reform that we desperately need.

I'm so very sorry, my dear. It's just awful what the working poor have to go through in order to get help to stay - or be - healthy. It's simply unAmerican.

Linda Ryan said...


Elizabeth Kaeton said...

Linda - Indeed!

Sextant said...

50% of the doctors graduated in the bottom half of their class! It remind me of something Henry Kissinger said, 90% of the politicians give the rest of us a bad name.

Great quote and great post as always Elizabeth!

Elizabeth Kaeton said...

Sextant - Thank you.

Honestly? I wouldn't be surprised to learn that 90% of all politicians graduated in the lower 10% of their class. Especially this particular batch in the House. They are dumber than a bag of unmatched doorknobs.