Simplifying Obamacare (Continued)

Unexpected wrinkles

The ACA was supposed to expand Medicaid eligibility nationwide to people at 133% of the poverty line, up from 100% where it is now. This is the single part of the law that was struck down by the Supreme Court, so the expansion of Medicaid will end up varying from state to state, with some states choosing to expand it and others choosing not to.

Will that cause healthcare migrations amongst the poor?


The ACA is massive and different, but not so different as you might expect. It's not European-style socialized medicine. It's uniquely American. It tries to balance our capitalist approach to health with consumer protections. It expands coverage to most Americans by requiring everyone to purchase insurance, but at the same time forces health plans to take everyone on at an equal cost, regardless of health status. This is the quid quo pro. It removes the worst abuses of the health plans but forces us to dance with them.

But it also looks forward to issues of access beyond just having insurance. It assures that we have enough doctors and nurses, and provides places for them to practice their craft.

It also realized that even before the first vote, our system of healthcare is the most expensive on the planet, getting more expensive by the year, and yet we trail 19th in the world in quality of health. We're not getting our money's worth, so the ACA tries to set up ways to see what really works and what doesn't. Some people cry foul and call that rationing.

I gotta say, if you think we don't have rationing today, you're crazy. I spend half my time fighting insurance companies to get the medicines and gear that my patients need. I'd much rather have decisions made by outside experts based on evidence, rather than by suits and ties based on quarterly profits.

So there it is. The Patient Protection and Affordable Care Act simplified. But hardly simple.


Read Wil's bio here.

Read more of Wil Dubois' columns.



Last Modified Date: April 23, 2013


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