The Patient Protection and Affordable Care Act is the most significant expansion of America's safety net since Medicare was created in 1965. While the landmark law won't take full effect until 2014, parts of it already provide Americans with better health care security and peace of mind. These accomplishments won't be reflected in the legal arguments before the U.S. Supreme Court this week in the challenge launched by Florida and 25 other states. But the case will help determine whether this nation continues to create a health care system that provides more affordable and accessible care for all.
One key point is often forgotten in the political debate: The law does not change the way private health insurance is delivered to the vast majority of Americans who get coverage as a job-related benefit. What the law will do for people not covered at work is to finally make comprehensive, private health insurance more available even for those with pre-existing conditions. The law expands Medicaid to more low-income families, and it establishes state-based health insurance exchanges where families can buy pre-vetted coverage. Those with incomes up to 400 percent of poverty level, or $92,200 for a family of four this year, can qualify for federal subsidies. In this way, an estimated 30 million of the country's 50 million uninsured will be brought under an insurance plan. And since the law expands the pool of healthy people with insurance by requiring nearly everyone who can afford it to have health coverage or pay a tax penalty, there will be downward pressure on the cost of coverage.
This so-called individual mandate is the most controversial aspect of the new law, but the idea was originally hatched at a conservative think tank and embraced by conservatives until Obama used it as the linchpin of his health care reforms. Mitt Romney, as governor of Massachusetts, implemented an individual mandate as part of his health reforms.
The success of the Massachusetts model has become a political noose for Romney as he vows to repeal the similar federal law. In 2010, only 1.9 percent of Massachusetts residents were uninsured, compared with 16.3 percent nationally. And 77 percent of businesses in Massachusetts provided their employees with health coverage in 2010, compared with 69 percent of businesses nationally.
Beyond the Affordable Care Act's future positive impact, the law is improving access to health care right now. If the law is overturned, parents would lose the right to keep their adult children on their policy until the child turns 26 years old, a change that has led to more than 157,000 young adults gaining coverage in Florida and 2.5 million nationally. Health insurers would again be allowed to engage in "rescission," or the cancellation of an individual policy after the insured gets sick. They could charge consumers for preventive care, deny coverage to children with pre-existing conditions, and reimpose lifetime maximums so that people with chronic conditions, such as cancer, risk crushing medical bills even with insurance.
No longer would insurers have to provide consumers with good value by spending at least 80 percent of premium dollars on health care rather than overhead and executive salaries. Gov. Rick Scott tried to get Florida a waiver from this rule, but the Obama administration wisely rejected the request. Seniors would lose the law's relief from the prescription drug doughnut hole, which currently provides a 50 percent discount on brand-name drugs and will close the doughnut hole entirely by 2020.
Americans are often confused about the Affordable Care Act. Six in 10 don't know how it will impact their lives, according to the latest Kaiser Health Tracking Poll. But for many Americans the law already provides a new level of medical security. It would be a tremendous loss to lose those protections, regardless of who wins the presidential election or how the U.S. Supreme Court rules.