by Larkin Callaghan
It’s almost impossible not to be confused by the Affordable Care Act, even though it’s one of the most significant laws to be passed in the last fifty years.
If the content slicing and dicing weren’t enough, there were the disingenuous characterizations of the law from its opponents, and the flagrant mistakes that some of our leading news organizations made in reporting the Supreme Court’s decision to uphold the law in June. A few misunderstandings that are particularly egregious keep arising in public discussions about the ACA.
Let’s clear them up, shall we?
Myth #1: The ACA is a Sign of Impending Socialism
It’s true that the ACA is the biggest social welfare legislation since Medicare. It’s also true that socialized medicine has existed here for decades, with little opposition and even much support.
The crux of the socialist argument seems to hover around the issue of government control over an industry that would supposedly better function under a free market framework and limited restrictions. But it should be obvious that this is the framework we’ve operated under for decades and that is has left millions without care. And true socialized medicine presumes that Americans are contributing to a government-administered healthcare delivery system. But that’s just not the case with the ACA.
Myth #2: The Government is Taxing You for Healthcare
Taxes have long been the poster child for government control. But the way this supposed “taxing” functions in the context of the ACA is tricky. Normally, taxes are levied against all citizens, gleaned from earnings or tacked onto spending — like the income and sales taxes you learned about in Econ 101.
While some justices used Congress’s taxing authority to render the law constitutional, the penalty fee — the “tax” in question — only applies to those who choose not to buy insurance, so outside of legal circles, calling it a tax seems a bit disingenuous to the true character of the penalty.
What’s more, whereas taxes are intended to pay for public goods that the government provides to everyone, the penalty under the individual mandate is intended to charge those individuals who don’t choose to buy insurance for the cost that society incurs as a result of their decisions — emergency room fees should they get hurt, for example.
Myth #3: It’s Going to Plunge Us Into More Debt and Cost Us Trillions
The claim that the entire bill will increase the deficit isn’t quite accurate. In fact, the Congressional Budget Office projects the ACA will save us money and cut the deficit by about a trillion dollars during its second decade of implementation.
In fact, as explained above, the ACA prevents average Americans from paying the healthcare costs of others: as is, those with insurance pay for the uninsured, who show up at emergency rooms requiring care. As a result, premiums go up, procedures grow more costly, and physicians charge more. The ACA helps end this cycle by requiring people to buy insurance — or else pay the penalty.
Myth #4: The Government is Eliminating My Choices
Opponents argue that under the ACA, the government will decide who lives and who dies and where Americans must buy insurance. In fact, choice is built into the ACA with health insurance exchanges. These allow people to choose the providers and plans they want, something that most people support and many states have begun to implement. By giving you the ability to select your physician, the ACA gives you the power, previously held by insurance companies, to decide which doctors you can see.
Additionally, with the expansion — and elimination, in some cases — of spending limits, you are no longer forced to choose which essential medical tests or procedures to pursue based on arbitrarily low spending limits imposed by insurers. Previously, these annual limits were in the tens of thousands. Now, the annual limit can be no less than $2 million, and lifetime limits are illegal for nearly all plans. This means you’re far less likely to run out of coverage if you develop a costly illness. It also means you don’t have to limit options if you and your physician choose additional forms of care or treatment that may improve your condition.
Myth #5: Obama is Raiding Medicare
In the last decade, payments from Medicare to private plans have increased dramatically — in fact, figures show that Medicare actually overpaid by 14-20 percent, and the costs of these over-payments fell on our seniors via increased premiums. Worse, there’s no evidence that these higher payouts to insurance companies improved care, probably because insurance companies — not seniors or providers — controlled allocation of that money.
The ACA has made Medicare more efficient by cutting some of that overpayment. This saves Medicare millions, but more importantly, it improves care for beneficiaries in ways that a raid would not: cuts will help close the prescription drug gap, reducing seniors’ costs. It also gives them preventive care free of any co-pays. Because of these changes, increases in payments to hospitals and providers are predicted to slow, hopefully slowing the growth of premiums and copayments along with them. Most importantly, saving Medicare money ensures its presence long into the future.
Article originally posted on the2x2project.org, an online publication sponsored by the Department of Epidemiology at Columbia University. 2×2 aims to inform the health conversation through timely and effective communication of emerging public health science.