2010

Affordable Care Act (U.S.): Compromise Nature of: “This is the puzzle of the Affordable Care Act. It calls for major changes, but it is also notable for what it leaves unchanged. . . the law does not substantially alter how medical care is organized, and it may not change the long-term trajectory of health spending. . . The Affordable Care Act was not socialized medicine; it was an effort to fill in the holes of the existing insurance system with a minimum of disruption to established institutions and the protected public. But much of the protected public could never be won over to a program that they perceive as primarily benefiting the poor and minorities. . . .”(Starr, 239, 276). . . . As originally written, the law “extends eligibility for Medicaid to all citizens with incomes under or near the federal poverty line and subsidizes private insurance for both citizens and legal immigrants earning up to four times the poverty level. According to projects by the Congressional Budget Office at the time the law passed, it would extend coverage to about 32 million people, roughly half through Medicaid and half through added private insurance, raising the insured shared of the population to about 94 percent (240). “But the legislation he [Obama] signed as president does not actually establish a general right to health care or to health insurance. Instead, it creates a series of individual rights in relation to private insurance – for example, a right against arbitrary rescissions and unreasonable limits of coverage. It also creates a right to federally subsidized coverage for people who otherwise would not be able to afford it. And to make the system workable, it calls for what the law itself terms ‘shared responsibility,’ referring primarily to obligations of individuals and employers to pay for insurance” (248).