Has the sky fallen yet?
I'm asking because after years of threats, warnings
and the gnashing of expensively capped teeth, Obamacare
has finally arrived.
And the sky, I see, is still up there.
Starting this week, anybody who needs health insurance
can shop for it through the markets — called "exchanges"
— that have been created for this purpose in every state.
In Indiana, the federal government is responsible for
running the health insurance market. That's because our state's governor, Mike
Pence, wants nothing to do with Obamacare or, as the
law is officially known, the Affordable Care Act (ACA).
You may recall that in June 2012, when the U.S.
Supreme Court ruled that the ACA was constitutional, then Rep. Mike Pence
stormed into a conclave of his Republican cohorts and exclaimed that said
ruling was comparable to the 9/11 terrorist attacks.
It's not clear what Pence was thinking at the time.
Perhaps it was that Chief Justice John Roberts and the other justices who voted
in favor of the ACA were terrorists. Or maybe the idea of going to the doctor
without the fear of going broke struck Pence as being a surprise attack on
In any event, when word got out about his outburst,
Pence did what American politicians do best after unguardedly expressing their
true selves. He apologized.
Pence, however, is hardly alone in his demonization of
a bill that has yet to fully take effect. His fellow House Republicans have
voted to repeal Obamacare no less than 41 times. It's been called
called"a power grab" by Rick Santorum; a "health dictatorship"
by Newt Gingrich; and "a crime against democracy" by Michele Bachmann.
And then there's people like me, who are unhappy
because the bill seems too complicated, dislike the way it keeps control of our
healthcare in the hands of insurance and pharmaceutical companies, and would
rather see a single-payer, Medicare for Everyone approach. What's more, because
of Gov. Pence's opposition to the ACA, thousands of uninsured, working-poor
Hoosiers will be left in the lurch due to Indiana's failure to fully embrace
the bill's expansion of Medicaid.
That said, I still think we can be glad Obamacare's time has come. For all its potential glitches
and hiccups, the ACA stands to make peoples'
lives better in a number of ways.
As has been pointed out by other observers, the bill
makes a difference insofar as it prevents denial of coverage to children with pre-existing conditions
denial of coverage to children with pre-existing conditions, enables adults
up to the age of 26 to stay on their parents' health plans, prohibits
rescinding coverage as well as lifetime and annual limits, and requires new
health plans to provide free preventive care without cost-sharing such as
co-pays and deductibles.
But I suspect the bill's biggest impact will likely be
felt in how it changes the ways people think about their jobs.
For generations, Americans have linked health
insurance and employment. Our jobs have not only been our source of income,
they have also provided vital health insurance benefits. This approach took
hold during World War II, when employers started adding insurance benefits to
employment packages as a way of attracting workers during a labor shortage.
In 1945, President Truman proposed an optional,
national health insurance program. The idea was popular, but shot down by,
among others, the national Chamber of Commerce and the American Medical
Association, who branded it socialism
The employer-based system worked pretty well for awhile. But over the last 30 years, as medical costs have
risen, the terms of insurance policies have grown stingier and stingier. This
has cost both employers and workers. Now, while most people continue to be
insured through their workplaces, their coverage is less expansive and more
Onerous as it is, this situation is still preferable
to having no coverage at all. A serious accident or chronic illness can turn a
life into a financial ruin. That's why anyone who has a job with health
insurance will do almost anything to stay where they are. And if you're a
worker with a chronic illness or condition, holding on to your job can be a
matter of life and death.
This situation is bad for everybody. It makes younger
workers feel stuck and keeps older workers hanging on for dear life. It doesn't
do employers any good in terms of productivity, or profits.
By cutting the knot binding work and healthcare, the
ACA stands to make younger workers more mobile, able to follow opportunities
without fear that an accident or troubling diagnosis will derail them. It
provides older workers the security of knowing that if they are unable to work,
they can still get coverage.
This is new. Whatever Obamacare's
limitations, the decoupling of work and healthcare represents a kind of
liberation. No, the sky's not falling. It's actually looking pretty good.