Introduction
The Patient Protection and Affordable Care Act is a law which has changed health care in the United States. Yet over a year after the bill became law plenty of people still do not realize what has changed and how the law will affect their lives. Its name is long, but speaks to what the bill hopes provides; protection and affordability. After researching the health reform law over the semester, combined with course lectures and readings I have come to believe that the current health care law, but one including a strong public health insurance option, serves as the proper framework for health policy in America. I say this firmly believing in the ideals of federalism, and the fundamentals of public policy that I have learned. By that I mean the structure of reform being implemented in the current law is proper. It provides broad regulations and a minimum standard of care for States to follow, at the same allows for States to create their own rules governing the insurance exchanges created in the PPACA. Current health care law, but one including a strong public option, fits the logical, structural needs and the ideologically cautious political mood of the nation.
Why The Structure Of PPACA Works
Something was needed in order to gain bipartisan support of the health reform bill and the insurance exchanges are the basis for that support. As Robert Pear noted in his piece on health exchanges “the idea of an insurance exchange has bipartisan appeal” adding “liberals and conservatives alike see it as a way to concentrate the purchasing power of individuals and small businesses” (Pear, para 8, 9). The exchanges are “envisioned as a kind of ‘bazzar’ where insurers offer products side by side” (Pear, para 14). The bazzar Robert Pear refers to are in fact “structured web-based [insurance] markets” according to the Kansas Health Policy Authority (Allison). This website will be free and accessible to all and be required to be in operation in the States by 2014. Once functioning, all existing insurance regulations are to be required to be enforced (Allison).
The states have been granted the authority to decide how and who will run the insurance exchanges (Allison). This fact is far under reported and is important because the core purpose of the entity that runs the exchange will be to manage and rate plans according to quality and cost. Moreover the requirement of the exchange management entity to facilitate web-based determinations of eligibility for premium subsidies, as well as web-based selection and enrollment in health plans can work for or against public opinion of the health exchange depending on how they are managed.
The reasoning behind my position on this portion of my argument is two fold. First, this type of structure has worked at the state level before. There is a working model for a successful implementation of a health exchange for all 50 states. We also have two types of working models to choose to model from both offering distinct differences in approach; Utah and Mass (Pear). Second, the PPACA’s implementation is incremental in its approach according to Deborah Stone. If serious fluctuations were to happen quickly in the process of how health care became administered, the deductive argument against it is certainly the potential for a reduction in quality of care could occur (Stone). Frankly, The chance of that happening are just to great for any politician to take.
The Climate; Then And Now
A major factor in my decision to advocate for the current policy other all others was influenced by the highly partisan political environment the nation is currently experiencing. Ideology seems to have trumped practical reasoning in terms of crafting solutions to the problems the country faces. A Pew Research poll from April 2010 asked what issues US families talking about; second to the economy was health care reform. With health care consistently being one of the top issues Americans are interested in, something needed to be done to address the concerns of the public. Pew research again cites twenty seven percent, almost a quarter of the public polled, said they followed news of health reform closer than any other news story of 2009. This number accounts for all viewpoints, ideologies, and biases. I mention these figures to make the point that rancor from both Republicans and Democrats have seriously stunted the ability of our leaders to solve public policy problems Americans want solved.
The current implementation of the Patient Protection and Affordable Care has been undercut by a lack of enthusiasm from Democrats who were instrumental in its formulation. This current yet familiar reality is compounded by Republicans, who after the midterm elections, passed a health reform repeal bill which has gone nowhere in the Democratically controlled Senate. Moreover, the current partisan battle and concurrent House vote for Rep. Paul Ryan’s budget has pinned congressional Republicans against older constituents concerned about the future of the American Medicare system. The Ryan plan would fundamentally change the social contract from a premium for service structure to a voucher program. This is significant because the same anger and vitriol held toward Democrats before reform became law, is the same anger now held towards Republicans for their vote. A serious change to how health care is administered is a tough political, and practical policy to implement especially in the current climate.
A Strong Public Option
The position for a strong public option to be a insurance plan within the exchange framework was fought for by progressives and the President over the health care reform debate. I am one, however, who does feel that President Obama did not come out strong enough for the public option. As mentioned before, the debate over provisions in the final bill centered on falsehoods like “death panels” and the fake charge that the public option would amount to a government take-over of health care. The Pew Research found that over the debate fifty percent of people polled heard about the public option. The problem I feel is what they heard was not from the administration, but from surrogates or opponent. President Obama did make statements to the public specifically about health care fifty two times, most of which I saw. The public option was not the rallying cry for the President which I feel hurt the chances of it being established under the Patient Protection and Affordable Care Act.
My reasoning behind adding a public option to the current health care framework as the best course of action isn’t proven by an active model but my intimate involvement with the health care system. Due to medical conditions I am frequently having to make appointments, pay co-pays, and be seen by physician. Working or being a full time student with out a 9 - 5 job to help cover my health expenses have both proven difficult in dealing with insurance companies over the years. The loss of my employee-based health coverage and now being a part the Medicaid program in Maryland has been a decent experience, so my feeling about being on a federal instead of a state run plan is held in a favorable light.
Conclusion
Over the course of the semester I have been a student of the Patient Protection and Affordable Care Act while engaged in a intellectual conversation over how public policy is created in America. The redistributive nature of the policy tends to make it a progressive reform attempt. The PPACA has both positive and negative inducements to spur movement from the states and individuals to be proactive regarding compliance to the new law. The law is being implemented incrementally and holds true to the federalist system American public policy is known for. I am all for the current law and hope that progressive members are able to add a strong public option for Americans like me.
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