Selling Affordable Care

Now that the Supreme Court has upheld most of the Affordable Care Act, Congressional supporters and President Obama have one final opportunity to sell the health care reform to the American people. Although they worked hard and long to pass the bill against Republican opposition in Congress, they failed to communicate the Act’s many benefits to the American people.

Instead, they allowed purveyors of misinformation to have a heyday, misleading the public about sacry “death panels,” coverage of illegal immigrants and, of course, the un-Constitutionality of the mandate. How could insurance be imposed on Americans?


With this historic Supreme Court ruling, the reformers have one last chance to make their case, to get the message out about what Affordable Care (not Obamacare) does and does not contain. To fail again in clearly communicating could lead to a second round of misinformation and, worse, to unrelenting efforts to underfund the Act’s provisions and/or to repeal the bill entirely. On the other hand, if the public were to understand and begin to support the reform, or at least to embrace its general direction and goals, then many might see the urgency of voting for representatives and a president who has the “general welfare,” that is, the common good at heart.

Supporters should emphasize the most popular provisions:

• requires health coverage for those with pre-existing conditions

• prohibits annual or lifetime caps on coverage, or dropping coverage of the ill

• allows parents to extend family coverage to include children through age 26

• subsidizes indigent individuals and some small businesses, allowing them to negotiate volume discounts, the way large companies do.

Other points should also be quickly and forcefully made:

Is Affordable Care a tax increase? Look at it this way: taxpayers already pay thousands of dollars each year for all the uninsured people who seek routine medical care in an emergency room for want of insurance. The Affordable Care Act changes that scenario; see that these people have coverage and insurers would pay for routine care in a doctor’s office or clinic, not a hospital.

Why the mandate? So that the insurance pool is as large as possible, which helps to keep insurance premiums low. The mandate is necessary as long as the system is based on private insurance, which Affordable Care is (it is NOT socialized medicine or care provided by government doctors). Insurance companies rely on premiums from the healthy to offset costs of medical care for the ill; the bigger the pool the lower the costs.

Coverage for the Uninsured. Most Americans are and will continue to be insured through employer-provided plans. Those with pre-existing conditions can now apply for coverage through their employer plans. Others—individuals and small businesses--could choose to purchase insurance from a competitive exchange, selecting what best meets their needs and budget.

Illegal Immigrants. Illegal immigrants are excluded and so are some immigrants who cannot meet all the requirements.

Prevention. Many preventive services, like mammograms and other types of check-ups, would not require a co-pay under the reform. That is because preventing illness and disease is much less expensive than treating illness and disease. It makes long-term sense for the government to promote preventive medicine.

Lower Health Care Costs. The reform does cut waste in Medicare and elsewhere; it does look at reforming the way doctors are reimbursed, not per test prescribed, but for treatments; it does include some research and experimentation to test effective treatments; it does promote prevention and electronic record-keeping. But overall, the intent is to extend coverage. Lower health costs will have to come later, when the research results come in and the best treatment models are known.

There is much, much more included in the Affordable Care Act—all of it aimed to help the American public and to promote health. Maybe that is why the Catholic Health Association and the American Medical Association have supported it.

Surely, our communicator-in-chief and all Americans who support affordable care should explain Mr. Obama's signature achievement—before others explain it away.



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William Lindsey
6 years 6 months ago
Carlos, I get the distinct impression you're unhappy with, well, something.

My problem is figuring out precisely what the problem is-where your critique is headed.

Are you incensed at the "President-Emperor"?

Or is it that "the Constitution takes another hit"?

Or perhaps that "Obamacare" is "impos
Or maybe that we now have "exploding costs" on our hands?

I look for the distinct insights of the Catholic moral tradition in this critique or these critiques, and have to confess that I'm at a loss to find them.  

But perhaps I simply don't understand the critique, which seems to me to rely on some totally unsupported identification of the current president with the powers of darkness, and which seems to imply that "Catholics" all recognize this identification and will doughtily resist it as good "Catholics."

Please help me to understand what I'm supposed to be enraged about right now as a dutiful "Catholic." Thanks.
Bridget O'Brien
6 years 6 months ago
Ed, have you spoken with any of these young people you imagine to be gleefully skipping to Starbucks spending insurance premium money on lattes? All of my friends in our 20s are profoundly relieved by the upholding of ACA, and often rather terrified of our inability to pay medical bills in case of an emergency (and yes, I am lucky enough to have full insurance). Is support for the mandate universal among adult Millennials? No. It's also not universal among Gen Xers or Boomers, as news coverage makes abundantly clear. The economy is difficult for veryone right now, and making the choice between making student loan payments and acquiring health insurance isn't something anyone takes lightly. 
6 years 6 months ago
I don’t get emails asking me to vote one way or the other. But nearly every day I get sober, non political emails explaining the latest regulations, rules,  interim regulations, mandates, restrictions , penalties & fines , requirements to eliminate or modify existing health care options, and assorted legalese on the ACA / Obamacare .
Here at AMERCIA, to point out any of the numerous faults and problems with this law is to speak heresy and to be condemned as a money grubbing,  FOX-news-watching cretin and out of step with the Church and on top of that wishing to condemn sick uninsured children to untimely deaths. But facts are pernicious things so I will try to offer some other thoughts.
Today, - most American’s obtain health insurance via their employer or a spouse’s employer. In what I truly believe is a quote that will haunt Obama, he famously told these Americans that if they like their current health coverage plan, nothing would change.  This just will not happen for two simple reasons- one—four years is a lifetime in the course of a healthcare plan and few companies can afford to lock in every single aspect from 2010 with no change  and only  add costly Obama care mandates.  ( my personal favorite is the “ slacker rule:” which not only covers children up to age 26 without medical coverage at “ no additional cost “  - it even covers those same children who are employed and are provided medical coverage at the young adults place of work.   As every employer now knows , the up to 26 crowd , all opt out at their new job, often get paid a opt out fee of thousands of dollars, stay on dear ol’ dad’s plan at no extra cost and dump the entire extra cost on Dad’s employer. This occurred from day one and is now the common approach for under 26 employed workers because people react to basic economic incentives – not idealism that is against their interests. Insuring young people is a good idea, setting up a program to scam the system in the manner I describe and letting it continue for two years is wasteful and destroys confidence in the system) The so called grandfather plan option really not a viable option for most employers because you lose it once you make any change at all to the plan.
The second reason is the one “everyone’ says won’t happen and yet is the most logical to me. When it occurs Ms. Smith, it will make a mockery of those like you who claim that the ACA will lower heath care costs – ACA will become a cost prohibitive disaster. Because all of the estimates assume that companies that provide medical insurance today will continue to subsidize it in the future.  For those few mean companies that do not—they will have to pay a $2,000 to $3,000 “tax” .  That will level the field- right?
Today (and the number will be higher in two years) companies net medical insurance cost per employee is $7 to $9k per employee.  This is after asking employees to pick up on average 25% to 40% of the cost of the premiums ( so the real average total cost per employee is  ~$11k)  
So here is the option businesses that offer medical coverage today face on January 1, 2014—continue to go along with the existing medical insurance circus of regulations, rules, HR and legal staff to manage and comply with rules, cost increases, at say $9,000 per employee or decide—we are not in the medical insurance business-  the heck with it—lets pay the $3,000 per person tax to the government, fire the insurance broker and lawyers and tell everyone they are on their own. Here is the address of the cookie cutter, straight-jacket “exchange” offering a one size fits all Washington dictated health care package.  The nicer companies will give the employees a fixed parting gift of say a few thousand dollars to use when they go and buy insurance. 
In my example – a company with say 4,000 employees can pay a $3,000/ year tax for $12 million to let the government deal with health care or continue to offer HC insurance for $36 million. Once more and more companies drop out of the system, the ‘pressure’ to offer such insurance to retain employees will fade.  After Obama drone son about how we have subsidies to make the exchanges affordable to all- ask him what happens when millions of people who are covered with $12k a year plans drop into the system and their employers send a $3,000 check.  The White House, the CBA and even a survey in the Wall Street Journal yesterday say it “won’t happen” and this is not part of the “projections”.  But the business people I talk with are all looking at this and saying  - they are all nuts- companies will react with their best interest – exactly like the 24 year old job holder who takes the opt out fee from his employer and lets Dad’s company cover him for “ free” today.

The challange all along was to expand coverage without breaking the part of our health care system that works. If companies don't continue to subsidize millions of workers the program will gusher red ink becuase a $3,000 tax doesnt remotely pay for $12,000 overge.
Beth Cioffoletti
6 years 6 months ago
"I doubt that Obamacare will lower this cost and as the previous commenter made, it makes sense not to provide it."

JR, my husband and I pay for our own insurance, to the tune of $12,000 a year, with a $3000 deductible. 

I am so looking forward to 2014 when we can buy into the state insurance offerings.  We can't be refused, and with so many more people in the pool, our premiums will be drastically reduced.

By the way, I am very involved in my healthcare needs.  I exercise and eat right and am only about 10 pounds over optimum weight.  I am very frugal about when I go to the doctor because of the outrageous expense of everything.  Perhaps too frugal.  What did you mean when you said:

"If one let's the market sort this out then we will work our way to a much more desirable solution as the individual then gets involved in his or her health care needs.  Right now the user is not involved so this is disaster waiting to happen as parties with no personal interest make the decisions."

How does "the market", with its primary goal of monetary profit, trump everything else when it comes to healthcare?  I'll take socialized medicine any day.
Michael Appleton
6 years 6 months ago
Anything can be made the subject of idolatry, and the free market is an example.  Insurance companies are operated by very smart people.  If they could earn a profit insuring the sick and the elderly, it would have happened by now and the adoption of Medicare would have been unnecessary.  Therefore, the first issue is whether we believe, as I do, that healthcare should be accorded the status of a fundamental right. If you disagree, you need read no further. But if you agree, the next question becomes how health care should be provided.

The ACA is a compromise which attempts to extend coverage to a lot of people while maintaining a private health insurance market.  I'm not convinced that that makes sense, but that's what compromises are all about.  Over time, additional compromises will be reached and we will eventually adopt a single payer system.  Employer coverage will no longer be an issue (companies have been dropping coverage for years anyway).

My wife and I presently pay over $5,000.00 per quarter, with a $5,000.00 annual deductible, for good coverage through a very reputable company.  Our kids have long been grown and on their own, so our coverage is for two people.  The vast majority of people in this country could not afford our premiums. And the cost of medical care increasingly makes the traditional private market unsustainable.  That's the simple fact of it.  So it will be necessary to have government involvement to provide truly universal coverage, and everyone will have to share the cost burden, just as we share the cost burden of other programs we have determined to be beneficial to us as a society.

The wealthiest portions of the population will still be able to receive the most advanced, high-tech care imaginable.  For the life of me, I am unable to comprehend the outrage of people opposed to something so central to the notion of the social contract and Catholic social doctrine. 
Michael Barberi
6 years 6 months ago
I have spent 30 + years in the health insurance and benefits consulting industries. Below are my concerns, as well as the opinions of many experts.

1. The "doc fix" has not been resolved yet; it was simply postponed. This amounts to a staggering $276 Billion over 10 years. Where is this money going to come from? It was not part of the CBO's cost/savings estimates for ObamaCare.

2. The CBO report says ObamaCare will reduce the deficit. In other words by new reimbursement schemas and taxes and fees (e.g., cuts in Medicare provider fees and increased taxes on dividends). This was estimated to cover the higher costs for insuring the uninsured. However, the CBO report assumes that the reduced payment rates to Medicare providers will have no effect on Medicare beneficaries or Medicare provider services. This is simply absurd. The projected 2019 Medicare payment rates (to providers) are estimated to be LESS than the payment rates in 2013!!! Does anyone really believe this will have 'no effect' on provider services or participation, or that access to care for Medicare beneficaries will not be impacted? Does anyone with a brain believe that these Medicare cuts will really work?

3. There are 11 million uninsured that are eligble for Medicaid but are not enrolled. Starting in 2014, these individuals will automatically get covered but the cost for these individuals will not be covered by the special 100% subsidies that the government will offer for "expanding Medicaid". These 11 million will be subsidized at the current 50/50 cost sharing ratio. Given the dire financial condition of most states today, this will not be possible unless state revenues are increasing state taxes...something that state governors, legislators and citizens will consider unworkable.

4. A big part of ObamaCare savings will come from new unproven cost management programs. Some of these programs are "capping payments on a treatment basis". Capping fees has always resulted in provider manipulation especially if the fees are consider unreasonable (significantly less than a provider's cost). Other methods include what amounts to rationing of care based on cost/benefit analysis. Can you envision what this would be like with aggressive cancer treatments? 

I am all for reforming healthcare. However, I am not convinced that ObamaCare is the answer.
Michael Appleton
6 years 6 months ago
Michael J. Barberi:

Thanks for posting some very helpful information.  If all of the cost and savings estimates are that much out of kilter, it may well be that universal health care will have to have some unfortunate limits imposed while cost issues are addressed. But people would still have to rely on insurance companies for catastrophic coverage.  However, we need to start somewhere.
Jim McCrea
6 years 6 months ago
Without single payer health insurance that covers ALL events (not just minimal coverage), Obamacare (I think he deserves full credit for his magnificent effort) is a good start.
Michael Barberi
6 years 6 months ago
Mike Appleton:

Thanks for these good comments. Based on my experience, once you have to remedy these significant issues by imposing limits and other restrictions on the major elements of ObamaCare, this leads to other problems. This is commonly referred to as the 'baloon effect'. To say we must start somewhere is a good general prinicple, but not when your premise is seriously flawed. Also, there is no provision in ObamaCare where people must rely on insurance companies for castastrophic coverage.

Jim McCrea:

I do applaud Obama for his objective to reform the US Healthcare System, but not the way he went about doing it...leaving it up to Pelosi and Reed who shut off any dialogue with Republicans. No Democratic read the thousands of pages of proposed legislation, but simply relied on talking points of the Democratic leadship who themselves did not read the report.

As for a single payer system, it was never a realistic option either party seriously considered. During the healthcare debates under Clinton (e.g., HillaryCare), I participated in a study of 10 country's Healthcare systems compared to the US system. If the Federal Government would have adobted any version of these single-payer plans, the US public would have rejected the restrictions versus the so-called benefits. The US public wants reform but not serious restrictions, long waiting times for procedures or the rationing of care which is common among single-payer systems. 
J Cosgrove
6 years 6 months ago
''How does ''the market'', with its primary goal of monetary profit, trump everything else when it comes to healthcare?  I'll take socialized medicine any day.''

Because it is much more efficient at lowering prices and providing better services than any other method known to mankind.  So if you want better healthcare at a lower price we should push for the tried and true method.  It has rarely been tried in healthcare but where it is allowed to work it, it has produced better outcomes at lower or steady prices.  Healthcare is different than nearly all other products and services.   The older one gets the more one requires them so there is little interest in the young for them other than maybe have a catastrophic policy.

''Anything can be made the subject of idolatry, and the free market is an example.'' 

Who is worshiping the free market?  It just happens to be the most effective way to economically provide goods and services.  There are some obvious exceptions and it is certainly not perfect but nothing is better than it as organizing economic activity so why not look to it for healthcare when it has never been tried in the last 50 years except for odd occasions and has worked when tried.

The question is how to get the employer out of the equation and limit government intrusion and still have a system that meets Catholic Social Teaching.  That is why I suggested people look at the Acton publication.  We have an expert as one of our commenters.  It would be nice to have Mr. Barberi comment on the Acton document which is based on Catholic Social Teaching as to its feasibility or whether it is just too pie in the sky.

''Therefore, the first issue is whether we believe, as I do, that healthcare should be accorded the status of a fundamental right''

What does this mean?  A right to what?  Total care on any procedure available on the planet? Or some basic level of health care?  Do we want a McMansion or a simple one bedroom apartment?  Do we want a Harvard education or a degree from a local state school?  One of the problems with this statement is that the term ''right'' is not defined.  Tthe available pool of healthcare options increases each year.  What was state of the art in 1990 or 2000 is probably not even a basic plan today.  Everyone wants it all especially if it means survival for a long time or even just a short time.  And in this last case, for a short time, is granny or grandpa to be cut off if the life expectancy increase is only x years or y months.  What if granny or grandpa is willing to spend their own money for the procedure which the bureaucrats say can not be made available to them?  Done all the time in the UK as some have said the system euthanizes a lot of people.  Are death panels built into Obamacare but under some harmless sounding name?

Are people interested in answers especially answers that fit the CST model or just in promoting their particular political agenda?  Healthcare costs are a real problem so we should get some straight answers and not some 2700 page plan that had to be passed to see what was in it and still apparently has lots of rules to be written and unknown costs for businesses who will not hire because of the uncertainty and will offshore jobs because of it.  From what I gather no one knows just what this beast will do.  But I bet it will not be nice.  I hope I am wroing.
ed gleason
6 years 6 months ago
The USCCB has already taken their slap at the ACA being upheld. . They whine about ACA without mentioning that it's the married and married with children who want health insurance reform . It's the Single young and healthy who are the ones skipping health insurance to buy lattaes...
 And these are the ones the USCCB sides with??
It's nice that the USCCB speak for the undocumented but why not pick up the phone and ask the Catholic hospitals and their organization to do what they can... Waiting for the GOP to vote for the undocumented is their plan? Phew..
Beth Cioffoletti
6 years 6 months ago
I've already gotten 3 emails from people at the local Chancery office, forwarding to me a missive from the US Bishops asking me to keep praying for an end to the mandate and asking me to text the word FREEDOM (or LIBERTAD for Spanish) to 377377.

This is beginning to feel like some kind of childish contest.
6 years 6 months ago
I get my hysterical emails from the same source Beth has. Now that Chief Justice Roberts has risked Communion rail confrontations to uphold "Obamacare" the only chance the Catholic  bishops have to kill it is to support the Mormon bishop for president. That is getting pretty partisan, it seems to me. But I am sure they will say it isn't.

For some reason, the emails say the USCC still supports health care for everyone. That confuses me.
Carlos Orozco
6 years 6 months ago
It's no surprise that the same Supreme Court that has recently ruled that citizens can be strip searched because of a traffic violation, has decided to side with the current President-Emperor and avoid becoming target of his drone-warrior wrath.

This is just another step in a gradual -but acceleating- process of concentration of power by the government, that began with the Bush administration, immediately after the terrorist attacks of 2001. The Constitution takes another hit, and for what? The President has already showed how Obamacare can be used to begin to impose an eugenics agenda.

Wishful thinking is not serious. The article states that "Lower health costs will have to come later, when the research results come in and the best treatment models are known." Yeah, right. Leave it to the bureaucrats to solve the problem of exploding costs.
William Lindsey
6 years 6 months ago
For some reason, the comments program seems to have eaten a bit of my preceding comment: where the comennt reads, "Or perhaps that 'Obamacare' is "impos," it should have read, Or perhaps that "Obamacare" is "imposing an eugenics agenda."

I actually used square brackets for the -ing after "impos," but in case that's why the program dropped the rest of the sentence, I'm deleting them in this correction.

J Cosgrove
6 years 6 months ago
For an alternative to Obamacare, one should read ''A Prescription for Health Care Reform'' published by the Acton Institute.  The Acton Institute is the organization that Fr. Sirico founded and is heavily invested in ways that could help the poor around the world.  This book covers extensively Catholic Social Teaching and the provision of health care.

Here is a link.  It costs $2.95 and can be read on any tablet or your computer.  And one of the formats is set up to print like a book.

Also one of the main inhibitors of hiring here in the US is the cost of medical benefits for employees.  It is over $12,000 for someone with a family so one can see the reluctance of a business to hire someone when that is a cost that must be paid.  It means almost certainly they will not hire someone with low skills and these are the people who need the jobs the most right now in our society.  I doubt that Obamacare will lower this cost and as the previous commenter made, it makes sense not to provide it.

Like anything the libs do, there are unintended consequences for their dreams and schemes.  The intentions are often good but then they ''mandate'' a solution and they have no idea where it will lead. If one let's the market sort this out then we will work our way to a much more desirable solution as the individual then gets involved in his or her health care needs.  Right now the user is not involved so this is disaster waiting to happen as parties with no personal interest make the decisions.
Michael Barberi
6 years 6 months ago
JR Cosgrove,

I tried to google the Acton plan but was unsucessful to find one. However, I have read the USCCB's suggestions and they follow the Church's social ethical teachings. Nevertheless, they are broad-based principles that are abstact because they are not specific enough.

I found other articles by Acton Institute representatives. Some suggest decoupling healthcare from employer provided plans and allow people to purchase what they want in the open market, equalize the tax laws so healthcare expenses are deductible for individuals and corporations, repeal government mandates, enact tort reform, make costs transparent, reform Medicare etc.

Nice suggestions, but no specifics. The problem with the US healhcare system is tradition. To go to a single payer system is not practical, nor is it wise. The government can't adminsiter anything effectively and efficiently. ObamaCare attempts to maintain a role for the private sector insurance industry coupled with a more significantly broader role for government in terms of oversight and control.

My suggestion would have been to develop a bi-partisan approach where two pilot programs would be implemented: one would be similar to ObamaCare, the other would be similar to the things the Republicans wanted. This would have been a better starting point. The pilot programs could be comprised of several states willing to try each program, or it could be a voluntary program with a solid cross-section of citizens, by age and gender, location, health status, etc. Incentives could be provided to encourage participation. An outside independant panel of experts would report to the Congress each year on what is working, not working, and suggestions for improvement, expansion, adjustments etc. This idea is complicated, just like any healthcare refore intitiative, but at least, there would be data and experience to rely on in what would still be a political debate. 
J Cosgrove
6 years 6 months ago
Mr. Barberi,

I will send you the pdf of the report but what you say comprises much of what the doctor who wrote it recommends.  Essentially they say get both the employer out of the financing and the government out of the medical decisions. The government will have to be involved somehow in the financing for those who need it but not the oversight of the specific medical programs.
Michael Barberi
6 years 6 months ago
JR Cosgrove.

Thanks, I will read the pdf and let you know what my thoughts are. My earlier comments only reflected some other suggestions made on the internet that appeared to be related to the Acton Institute. 

If the Repulicans control the White House and Congress, then other ideas will find their way as considerations. However, any really major changes in the system will likely not embraced by Republicans. However, I am in favor of major changes, even if only as a pilot program, because the current system is not working. I am not convinced that Republicans have the answer, not at this point. However, ObamaCare appears to be far worse. I hope I am wrong.


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