what was the thorn in the ppaca
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8/4/2019 What was the Thorn in the PPACA
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P r i n t e d w i t h
j o l i p r i n t
CHCCFINC. A Christian
Community
The thorn that fell the lion: the PPACA’sdownfall
Our Political Spectrum
How did the PPACA (healthcare reform) (Pa-tient Protection and Affordable Care Act)with all its good intentions fall apart? How
did the PPACA undermine the Democratic Majorityin the House? What was the small but sharp thornin the side of healthcare reform that took the PPACAdown? Well, you know the saying, “the road to hellis paved with good intention.” In the end, good in-tention is exactly what fell the lion. The PPACA actalong with the Affordable Healthcare Act sought,nobly so, to expand healthcare coverage to more of the public while slowing the growth of healthcarecosts. These bills proposed various cuts in fee-for-service rates as well as the reformulation of whatis billable to Medicare including how often. Thesenew acts attempt to combine many doctors’ pro-cedures once billed to Medicare as separate servicesas single billable procedures. Another target of thePPACA’s (healthcare reform) was to expand coveragefor those people whose income is above the Medi-
caid coverage threshold, but is still too low for thatperson to afford to buy private health insurance.The PPACA also sought to insure a greater numberof people while preventing them from losing their
coverage once they qualied for it.
However, why did our government even seek tochange Medicare, to expand healthcare coverageand slow the growth of healthcare costs? As the costsof insuring oneself has risen and the number of Americans insured has dropped, the public’s desirefor government intervention has grown. In plainwords, these circumstances got to the point wherewe could not stand how much of our paychecks wewere spending on healthcare and how little coverage
we were getting for it. Our increasing concern overwho gets to have healthcare coverage and how muchit will cost us pushed healthcare reform onto thepublic policy agenda. Over the past two elections, wehave expressed a very strong desire for the govern-ment to propose new rules, which would expandhealthcare coverage, make it more affordable andlower overall expenditures on Medicare and Me-dicaid. This concern about affordable healthcareis very much warranted, maybe we disagree abouthow our government should attempt to solve theissues at hand, but we still all want to x-up ourhealthcare system.
Again, our concern about the cost of healthcare co-verage and access is justied because without policyintervention by 2015 the total number of uninsuredcould reach upwards of 56 million (Burton, Frie-denzohn, & Martinez-Vidal, 2007). Compoundingthe levels of uninsured, employers are droppingcoverage for employees all together, at an alarmingrate. In addition, employers are making it dicultfor employees to get coverage by tightening eligibi-
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P r i n t e d w i t h
j o l i p r i n t
CHCCFINC. A Christian
Community
The thorn that fell the lion: the PPACA’s downfall
lity requirements. This is somewhat understandablebecause if we cannot afford health insurance howwill they be able to pay for it, they are under the sameconstraints. Therefore, what this amounts to is this:if you have to leave your job, when you get another,you may not get health insurance or your most likelypay more for it than you would have before. In 2000,the average out-of-pocket costs that the employeehad to pay for family health insurance coverage was
3,354 dollars; the 2008 gure for that same amountof coverage for that same family was four times thatamount. The high cost of healthcare, in essence isforcing employers and employees to drop their heal-thcare coverage. Twenty million US workers do nothave been employer-based, employer-sponsored orpublic-sponsored health insurance at all. They arenow what we call the working uninsured (I mightadd that our jobless recovery has not helped any).
So how did the PPACA end up with such a thorn
in its side? Why does it seem that the creation of this bill and the healthcare reform that when alongwith it backred on us? The desire to have morethan others played a big part in it, that is becausewe live in a democracy, our social and economicinequalities are copied right into the political are-na, what we want is copied right into our policies.Our fractured views created a fractured bill. If thegriddle is bent, the waes will all come out with adent in them. To make matters worse, healthcarereform was disarranged further by the private sec-tor, which lobbied ercely in shaping the debateand the bill. We of course delegate many publictasks to the private sector. This is done in part dueto our government’s limited ability to provide forall of our citizens needs and is done in part for theeciency it brings to our society. This is one reasonwhy we are a market-based society, and it workswell, except for when major companies push toohard in slanting new policy in favor of them. Theyhave a powerful interest in how we distribute ourresources because they prot from their use by thegovernment. Private enterprises would naturally
prefer then to bring to bear as much inuence aspossible toward shaping the outcome of any policythat would dictate the distribution of such resources.Insurance companies had a staked interest in howthe PPACA was formulated because the bill couldbenet or hurt them in the end. Insurance com-panies wanted to limit the negative effects of thedeveloping bill on them. On the other end, becauseof the inuence of private enterprises on policy,
our government wanted to write regulations thatcould not be worked around by those same insu-rance companies. The result was a very large andunwieldy bill.
The debate seemed to be about the costs involvedin expanding healthcare to those who have lost it orwere not able to afford it and the costs involved innot expanding healthcare to them. The deliberationincluded who would be paying for this potentialpublic insurance expansion and the amount of re-
sources that should be transferred from one groupto another to offer such services. As always, in lifeand in our government, it then was a debate betweenself-interest and social altruism. How much of eachwas rational in today’s economic environment? Theresult again was a reection of our society today. Thebill could have been short and direct. For example,it could have just been about the enacting of uni-versal healthcare, but it was not. It tried to pleaseeveryone and in so doing, it became a bloated mess.The bill size (over 900 pages) created such a largesurface area, which opponents could later pick todeath. How we view the end law, whether we viewthe PPACA as good or bad for America the creationof such a large bill produced by any governmentagency is going to have much to look at and deridelater. For example, take relationships; if right awayon the rst date you told your partner everythingabout yourself, later on when you have an argumentwith her, she would have plenty to hit you with(this goes for men as well). That is not smart at thebeginning of a relationship and also for any partywho just took oce. How best to design a policy
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The thorn that fell the lion: the PPACA’s downfall
that would cut healthcare expenses and increasecoverage came down to one’s ideology; the two mostdominantly held in the United States conservatismand liberalism, the middle being the dividing lineand source or contention. No one wanted to givein, and no one wanted to lose anything, so we goteverything and nothing. This is the essence of thethorn that took the lion down and the PPACA with it.
During the 2009 healthcare reform debate, Congress’sviews on just how to change the way our private/public healthcare system functions was a reectionof our nation’s dominant ideologies; conservativeand liberal proposals, limited government versussocial equality. Conservative ideology views that therole of government in public life should be kept at aminimum while Liberal ideology favors governmentintervention in society to mitigate the tendency of the free market to produce large income inequali-ties. Conservatives also view the rights of the per-
son as paramount to the role and authority of thegovernment. They place great value in a person’sright to property and limited interference of thegovernment in the free market. Conservatives stressthat a governmental redistribution of wealth fromone group of people to another will cut the public’sincentive to work. Likewise, conservatives reasonthat too much involvement in the free market bythe government will lead to ineciencies and lowerproductivity.
As mentioned, the liberal ideological view, however,favors government intervention in the public to mi-tigate the tendency, or the free-market to producevery large income inequalities resulting from lack of regulation. Liberals stress the right to social equalityof all citizens. Liberals view the goal of any new pu-blic policy is to extend social and economic benetsnot just to those who have, but to those who may nothave as much. Liberals seek to carry out redistributepolicies through the transfer of wealth, or benetsfrom those who have extensive amounts of wealthto those who have much less wealth. The most used
public method’s Liberals use to transfer wealth isthrough the issuance of taxes, the regulating of the market, the regulating of the workplace andthrough the mandating of insurances such as health,disability, old age benets and disability benets.However, the transfer of wealth from one personto another, or the regulating of markets, requiresthe government to limit personal liberty, which isat odds with those who are conservative.
The Crisis of Policy
This ideologies are compatible but only towards thecenter and when moderated. If you polarize eachideology you get a congress that is uncompromisingand gridlock ensues. That is exactly what happened.The debate between the parties and their ideologiesbecame so heated and inexible that in order forhealthcare reform to be passed, it had to be for-ced through by only one party. If no one wishes tocompromise sheer strength in numbers is the onlyway to get anything done. Even then to get the votesnecessary, so much bartering had to be done the endresult was the production of a bill over 900 pages.Even then this bill was only able to be passed by theparty in power which then controlled the House, theSenate and the Presidency, the Democratic Party.Unfortunately, because the bill passed with onlyone party the bill reected a majority of that par-ty’s ideology. This in itself may not be bad, but weall have to be aware of the potential ramications.The fact that the resulting healthcare reform bill
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CHCCFINC. A Christian
Community
The thorn that fell the lion: the PPACA’s downfall
contained many liberal ideological regulations thenbecame a target in the next election by those whoare ideologically conservative because they saw itas too much governmental intervention into theprivate sector. With so much to choose from in abill that large, it became fodder for the upcomingmid-term elections.
The PPACA had several aws, which in the end
undermined the bill and the Democratic majorityin the House of Representatives. The debate overwhat was considered healthcare reform was so in-ammatory that the only way to pass the bill was tooffer a large quantity of regulatory “gifts” to thosestate senators who would not vote yes until theygot what they wanted. In addition, because thosewho stood to lose the most, insurance companiescould write around any new regulations in the bill,those who wrote the bill attempted to plug any po-tential future holes that would be used as a way to
work around the new rules. Again, these actionsby the Democratic majority lead to a rather largeunwieldy bill. Therefore, once the bill was passedthere were plenty of details to ght about in courtand to lobby against afterward. In the end, it alsocontributed to the loss of House to the RepublicanParty. Finally, in the end I think what brought thelion down was the fact that you have to ght for aclear identiable goal that stands on its merits ASIS. The PPACA act and the Democratic Party wereundone by the sheer amount of horse-trading ittook to get the bill passed. Whether a single payer,nationalized healthcare system is right or wrong,that is what the Democrats ran on, that is what theoriginal bill was supposed to be about and that iswhat they should have stuck with. The bill shouldhave been voted on AS IS. They should have stuckto what they believed in and have that in of itself voted on. They should have had a short, targeted,blunt, universal single payer nationalized health-care bill that would pass or fail based on face value.If it failed, then it would have failed. If it failed toachieve the amount of vote’s necessary, then the
debating could have begun on another bill, the nextone different but short and to the point as well. The
thorn was fear and no good is accomplished whenfear is the motivator.
State Strategies to Expand Health Insurance Cove-rage: Trends and Lessons for Policymakers -Burton, Friedenzohn, and Martinez-Vidal
The PPACA Act (PDF)
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