If you’ve dealt with the ins and outs, the fine points, the agonies of state obstruction, the competing data, the cautious experiments, and of course the lies and smears, associated with the Affordable Care Act of 2010, it’s important occasionally to step back and recall why this law was enacted, how it was designed the way it was, what it actually aims to do on challenges ranging from health coverage for those with preexisting conditions to the health care delivery system. It’s equally important to remember how Obamacare compares with the status quo ante and Republican alternatives, such as they are.
You can find all this and more in Jonathan Cohn’s latest piece for TNR. Jon is one of a very small handful of political journalists who have covered every element of the health reform debate before, during and after the enactment of ACA, calmly explaining the technical details, fairly assessing the emerging data, and going out of his way to engage skeptics and opponents of the law without losing his own way. But this comprehensive refresher course on the Affordable Care Act is arguably his most important contribution, if only people will read it. Here’s a small sample:
America’s most cherished programs evolved over time: Social Security famously left out agricultural and domestic workers, and didn’t provide the support it does today. Obamacare, as enacted, has similar deficiencies. The minimum coverage that the law guarantees everybody is not that generous, which means even some people with insurance will face high out-of-pocket expenses.
But the relevant comparison is to what those people have now—frequently even less protection, or no protection at all. And that’s the standard by which to assess all of the law’s side-effects. Are employers squeezing retirement health benefits? Yes—but they’ve been doing that for years, long before Obamacare came along. Are some part-time workers losing hours? Yes—but part-time work was rarely stable and at least now all part-timers can get health insurance. Will people trying to buy insurance on the new online marketplaces sometimes find the process difficult and frustrating? Yes—but buying individual coverage is even more complicated and nightmarish now. As a recent Kaiser Foundation briefing notes, the standard applications for insurance in Wisconsin and Illinois include five pages of questions on medical history alone. Under Obamacare, insurers won’t be asking those questions at all.
You almost get the sense that if every American worried or concerned about Obamacare could spend a half-hour with Jonathan Cohn, we’d be arguing over how to improve this landmark law rather than fighting over its survival.
So I urge you to set aside the time needed to read this important article, which may just remind you how heroic if flawed and limited an accomplishment the Affordablle Care Act represents.