The Patient Protection and Affordable Care Act (PPACA), also called Obamacare, has been one of the most hotly contested pieces of legislation in recent memory. Fewer laws have created such intense, angry debate, and fewer still have cut so deeply into so many different aspects of American belief systems. With all of the controversy surrounding the 2010 bill, it can be extremely tough to separate out what is a true part of the PPACA and what is a talking point. Here are a few commonly held beliefs about the Obamacare bill, and how close they are to a reality.
One of the biggest problems with the PPACA is, without question, the individual mandate: the requirement of all Americans to purchase an insurance plan if they are able to afford it, or else pay a yearly penalty. A majority of states have challenged the constitutionality of the mandate, and the decision has gone all the way to the Supreme Court.
The mandate comes from a well-meaning place. The United States does not have a universal healthcare system, and over 15% of the population remains uninsured. The end goal of the healthcare reform is to make sure that as many Americans are insured as possible, so that they can receive the care they need. Without a universal option, the individual mandate is one of the only ways to ensure this. But many have decried it as a government cash grab and an infringement on individual rights. Furthermore, many people worry that they will be forced to buy certain plans that conform to a hidden agenda or are worse than the plan they currently pay for.
While the individual mandate does exist in the bill, absolutely nothing in the PPACA forces anyone to change the insurance they currently have. The goal is to open the market and allow all Americans to choose an insurance plan that works for them. It also aims to make insurance more accessible to those who need it, by forbidding insurers from refusing coverage based on pre-existing conditions or canceling a policy over arbitrary mistakes in paperwork. While the mandate may or may not be upheld, the intent is to make sure America's citizens are taken care of.
It's no secret that the United States spends an atrocious amount each year on healthcare. Part of this goes to treating seniors who become seriously ill; extending their lives is often costly, painful, and futile in the long term. The term 'death panel' entered the public lexicon in 2009, used by former Alaska Governor Sarah Palin in reference to debate over federal coverage of the uninsured. She charged that the proposed legislation would create a 'death panel' of bureaucrats, who would judge which Americans were worthy of receiving health care - implying that her elderly parents and Down's Syndrome child would be denied. The comment was completely unfounded - nothing in the proposed legislation would have allowed for this - and was widely debunked by a variety of sources.
Nonetheless, the frightening idea of a death panel has remained prevalent in the minds of some Americans. It speaks to a deep-seated fear of giving the government too much control over one's fate. A survey in 2011 showed that nearly 23% of Americans thought that the Affordable Care Act would give the government control over making end-of-life decisions for seniors. Despite this worry, there is nothing in the PPACA that would allow this. The original bill that caused so much fuss was one that would pay doctors who provide patients with advice on end-of-life planning, which may include alternatives to aggressive, expensive life-extending treatments. When the controversy resurfaced, this provision was dropped from the PPACA.
The worry over 'death panels' is a subset of a larger fear: that of healthcare rationing. Some people worry that the provisions of the PPACA give the government too much control over healthcare decisions, allowing for the restriction of care based on certain criteria. It's something that everyone can agree on: it's fundamentally unfair to ration out care, and every person fears that they will not pass the test.
Multiple sources - including economists, writers, and Obama himself - have pointed out a tough fact: healthcare in the U.S is already rationed. It is restricted based on income, employment, and pre-existing conditions, and is part of the reason why over 15% of the country remains uninsured. As a scarce resource, it is necessary to divide it in some way; far from arbitrarily granting care to certain citizens, the Affordable Care Act seeks to level the playing field in many ways. The current iteration of the PPACA takes the rationing decisions out of the hands of insurance companies, who are no longer allowed to deny coverage based on pre-existing conditions. This is only the start; true reform will require a massive overhaul of many aspects of how the healthcare system works.
These are just a handful of the many contentious points that mire Washington in debate over the PPACA. The bill has provisions which kick in at multiple points over the next decade; some points may end up making changes to those events, and others may occur as planned. While a majority of polled Americans have issues with the PPACA, they nearly universally agree that the healthcare system in the United States is in dire need of reform; just what that reform will look like, and how it will come to pass, remains to be seen.
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