Navigating through the muck: Trying to interpret the Affordable Care Act AKA ObamaCare Part 1

Navigating through the muck: Trying to interpret the Affordable Care Act AKA ObamaCare Part 1

By Michol Mae

October 21, 2013

I have been considering writing an article on the Affordable Care Act, AKA Obamacare, for some time now but I have simply not had the time to wade through the befuddling resources available.  However, since it is such a major topic with impacts on the large majority, let us begin on the healthcare.gov site (https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/).  This particular page states “The law has 2 parts: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. We provide links to them in PDF and HTML formats below. We also provide a link to an unofficial, consolidated version that is more readable.”  Already I am confused, but I note the 4 items mentioned: Patient Protection, Affordable Care Act, Health Care, and Education Reconciliation Act.  Okay, the Affordable Care act has a certified full-text version at 2.41MB and the Reconciliation Act is a mere 257KB.  I’m tempted to start with the Reconciliation Act because it’s not only smaller, but I have not seen or heard nearly as much on it, but the lengthy nature of the Affordable Care Act means I will have to break it down, and write an article at a time, in sections.

Oh, here is a clarification! “This Act may be cited as the “Patient Protection and Affordable Care Act”. Terrific! Moving on, you can tell a lot about a book from the Table of Contents and it is no different in this case, 130 page table of contents! Ouch!  

There are parts of parts, subparts of parts, subtitles, I have to say I have my work cut out for me, and as a writer and a librarian I don’t mind a good read and analyze, but I am concerned that the majority of the citizens affected by this would not be so keen on reading it, not to mention at 906 pages an entire college course could be taught on it!

Let’s start at the beginning.  It appears that we start with amendments to the Public Health Service Act in regards to Individual and Group Market reforms for Improving coverage.  The topics that appear here are no lifetime or annual limits, prohibition on rescissions, coverage of preventive health services, extension of dependent coverage, development and utilization of uniform explanation of coverage documents and standardized definitions, prohibition of discrimination based on salary, ensuring the quality of care, bringing down the cost of health care coverage, appeals process  For the sake of keeping the articles short we will cover only a few items in each article, it is my hope this will make it easier to digest and research.

We will start with improving coverage, this says that those offering health insurance coverage cannot establish “Lifetime limits on the dollar value of benefits for any participant or beneficiary or unreasonable annual limits on the dollar value of benefits for any participant or beneficiary” However, if a group health plan or health insurance coverage does not provide essential health benefits they can place annual and lifetime limits per beneficiary on those specific covered benefits. (Page 131 of Public Law 111-148)  One question here, who decides what essential health care is?  Okay, two questions, how is essential health care defined?  Perhaps this is answered in the remaining 775 pages.

The prohibition on rescission tells us that those offering group or individual coverage cannot take back the plan or coverage once you are enrolled unless of course you are fraudulent or intentionally misrepresent yourself, “such plan or coverage may not be cancelled without prior notice to the enrollee.” Be sure to read the terms of the plan and coverage to be safe!

Coverage of preventive health services is a bit more meaty.  It looks like those providing group or individual health insurance coverage  will have to at least provide coverage for ‘‘(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force;”  What does that mean, what is A or B, evidence based items?  Wait, I found a resource (http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm).  So it looks like it’s mandatory to include coverage of the following;

• ·         Abdominal aortic aneurysm screening: men
• ·         Alcohol misuses: screening and counseling
• ·         Anemic screening: pregnant women
• ·         Aspirin to prevent cardiovascular disease: men & women
• ·         Bacteriuri screening: pregnant women
• ·         Blood pressure screening in adults
• ·         BRCA screening, counseling about
• ·         Breast cancer preventative medication and screening
• ·         Cervical cancer screening
• ·         Chlamydial infection screening” woman 24 years and younger
• ·         Cholesterol abnormalities  screening men and women ages vary
• ·         Colorectal cancer screening
• ·         Dental caries prevention: preschool children
• ·         Depression screening: all ages
• ·         Diabetes screening
• ·         Falls prevention in older adults: exercise or physical therapy
• ·         Falls prevention in older adults: vitamin D
• ·         Folic acid supplementation
• ·         Gonorrhea prophylactic medication: newborns
• ·         Gonorrhea screening: women
• ·         Healthy diet counseling
• ·         Earing loss screening: newborns
• ·         Hemoglobinopathies screening: newborns
• ·         Hepatitis B screening: pregnant women
• ·         Hepatitis C virus infection screening: adults
• ·         HIV screening: non-pregnant all
• ·         Hypothyroidism screening: newborns
• ·         Intimate partner violence screening: women of childbearing age
• ·         Iron supplementation in children
• ·         Obesity screening and counseling: all
• ·         Osteoporosis screening: women
• ·         Phenylketonuria screening: newborns
• ·         Rh incompatibility screening: first pregnancy visit: fist visit and 24-28 weeks gestation
• ·         Sexually transmitted infections counseling
• ·         Skin cancer behavioral counseling
• ·         Tobacco use Counseling and interventions: all
• ·         Syphilis screening: all
• ·         Visual acuity screening in children

It also looks like immunizations such as Anthrax, BCG, DTaP, Hepatitis A, Hepatitis B, hib, Hib and DTP, HPV, Influenza, Japanese encephalitis, measles, Mumps and Rubella, MMRV, Meningococcal, Pneumococcal, Polio, Rabies, Rotavirus, Smallpox, Tdap/Td, Typhoid, Varicella(Chickenpox), Yellow Fever, Zoster(Shingles) (http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/index.html) must be covered.  Women are covered for additional preventive care and screening mentioned in the list above.  Breast cancer screening, mammography, and prevention is mandatory based on the most current recommendations of the United States Preventative Service task Force.  Anything not mentioned above is not required and there are not limitations for insurance issuers on these additions services.  There is a mention that the Secretary can develop guidelines to permit those that offer health insurance a plan to utilize value based insurance designs, but in this I am not clear on what that means.

The extension of dependent coverage states that those providing health insurance to dependent children will continue to make coverage available for an adult child who is not married until the child turns 26 years of age.  Regulations to not appear to be set at this time, instead it states that the secretary will make known regulation to define the dependents that the coverage should be made available, and the definition of the dependent in the IRS will remain as it was for tax treatment purposes.

 Well folks we made it to page 132 of Public Law 111-148 and I think that is quite enough to digest at the moment.  Check back each week for more, or subscribe to my RSS feed.

Finding Integrity and Accountability in America

I am a writer, I try to write an article every week and aim to increase that to 2 or 3.  I look for like minded individuals or those who are more open minded and free thinking.  While discussing some of my views one day someone said to me that I probably never take sides one way or the other, there are two sides to this (no pun intended).  One I am a writer, a free writer, I try to look at all angles as unbiased as possible, I try to present from a neutral stand point; something modern media seems to have forgotten, and I aim to educate, or at the very least challenge people to think on things from different perspectives.  That said there are some topics that I have leaned to one side or the other.  In regards to all these topics I have come to realize that there is one underlying thing, one underlying issue, one underlying attribute, one underlying source to all of things that I write about. 

Let’s explore some of these things shall we.

You may have read my article about Guns and Gun Control where I leaned, I argued for upstanding citizens to retain their constitutional right to bear arms.  I argued that Amendments to this Constitutional law would unarm law abiding American citizens while leaving the criminals armed.  I challenged the naiveté of those that believe the criminal element will turn in their weapons.  I leaned, and I leaned toward retaining my right to bear arms, your right to bear arms, and chastised society for not standing up and with a little more integrity, with a little more grit.

I wrote an article about a video I saw regarding an officer who shot a injured girls father where I leaned toward the side of the officer, after reviewing several sources I used my own mind, crazy as it might seem, to conclude that as tragic as the incident was it was not the fault of the officer, it was not even the fault of the 4 year old who ran into the street, no, I concluded it was the parents and society to blame.  It was the lack of parenting and society’s acceptance off this decline, indeed society’s facilitation of this decline that was to blame.  It was the lack of integrity, and the lack of values, the decline of accountability, and the fall of values that once built greatness and now only serve to facility laziness.

In my article Finding America I state  I talked about the Boston Marathon shooting and other incidents and I leaned when I stated “It’s corporal punishment for America, where the general population will now suffer for the actions of a few.  Where the government cajoles and manipulates people into thinking that striping away more liberties is the only way to create more safety.  America, where we are sinking lower in our education and blindly following media and political agendas.  Where we no longer stop to think for ourselves, and have forgotten how to dig down and fight for what we once believed in! “ This wasn’t the only time I leaned against the media accusing them of having political agenda’s and no longer offering us the die hard search for the truth they once did.

One of my favorite and first articles The Decline of Personal and Societal Accountability I accuse the American people of sitting idly at best and facilitating the decline of accountability at worse.  

.  Then of course are the articles I have written about our school system, student loans, and the difficulties children and adults alike face when they decide to take their education seriously, the cost in all facets is staggering.

Have you noticed a theme yet?  Well for one thing every issue could use more integrity, for those who may have forgotten Merriem Webster’s Dictionary defines it as :firm adherenceto a code of especially moral or artistic values:incorruptibility  or:  an unimpaired condition:soundness  or 3.: the quality or state of being com.  The other is the decline of Accountability.  But overall, I feel frustrated because people miss the main point of it all.  Being a good person.  IT really all comes down to being a good person.  Most people have become numb, they have lived this lie too long, they don’t see the benefit in stopping the car for a squirrel, it’s not about the squirrel, it’s about your character.  They don’t stop to protect a person in danger, they walk on, not wanting to get involved even if it is so obviously wrong to them.  They want to pass the buck, blame others and let accountability and integrity die.

I hope that after reading this at lease of few of you will agree that something must be done about the decline of accountability and integrity, I hope even more will take a good look at their integrity and accountability and even more will act on it.  America we are in trouble, we have compromised one compromise after another and now I am afraid we do not know who we are or who we once were.  Let’s find ourselves, our integrity and our accountability. 

Education in America: The Cost

Whole day, half day, whole day, half day, half day, that is October’s schedule for grade school students in New York.  More and more parents and children are being challenged.  Children in grade school are now subject to math we were subjected to in High School, leading to an increase in pressure on children at a very young age.  To make it even harder the schools employ even more half days then most of us saw when we were in grade school, and the reason I’ve been given is that they still get funding if they have school for half a day.  Half of the half day’s that I see are for staff development and the other half are for parent teach conferences, so instead of having them after school hours when most parents can make it without taking time off work, they have it during school hours taking study time away from the children and money away from their household.

At the same time we wonder why more and more children are troubled, why more and more children have issues and why more and more are becoming increasingly violent.  Now holding with the decline of accountability I say it is that they are not held accountable no one is teaching them integrity no one is teaching them core values, they are floundering, left to their own to find their way without anyone looking out for them because their parents are too busy working trying to put food on the table, clothes on their backs, and shoes on their feet to say nothing of shelter and electricity, all of which cost more every year.  No it is not the guns, or the bombs, or the misguided children it is society that is to blame for the increase in violence.  It is society that accepts it and lets the fear run through it.  It is society that cowers in fear and no longer stands proud with courage, how far the mighty Americans have fallen.

I was talking with someone one day about these issues and he said that more households work and slave away because they want two cars, and while I am sure many think having a car a privilege  to many families they would not be able to go to work if they did not have a care and if they are lucky enough to have a two parent home where both parents work it is likely they need both cars.  This person did however make a valid point, more and more Americans are greedy, they want the newest electronics, the newest gadgets, even my 8 year old girl has been asking for a phone and an iPad.  We don’t need these things and we can certainly live without them and many families have to live without them.  Should they?  I know for certain my 8 year old does not need them, but some newer gadgets like e-readers could be beneficial and anything used for learning should be considered less and luxury and more a necessity.  All of that aside, the fact remains there are more and more single family house holds that don’t have the option of a second income, and many are living in the lower to lower middle class income bracket, congratulations on top of being a single parent, you must now deal with low income, and increased child care because once a week your child will be out of school.

I am under the impression the reason we have accelerated our math and English programs is to keep up with the rest of the world, America, it seems, has gotten dumber.  More and more countries are passing us by while we flounder around.  Those of us who do want to get an education do so at a great risk, and at great debt.  If the government is truly concerned perhaps they should make college more affordable, in fact shouldn’t they make if free, if nothing else then by way of a tax credit for all that you have paid.  Instead we earn tens sometimes hundreds of thousands to become educated, to show the world there are some of us left in America that care to learn indeed even love to learn.  In fact so willing are we to learn that we have accumulated this massive mound of debt that makes it hard to breathe when we consider the difficulty with which we are meet in the job market, when we consider how little we make in comparison to how much we owe, and how much these other companies and indeed even the government make off our plight.  Education should not cost use nearly as much monetarily but more importantly it should not cost us our health which surly pays the price from the stress if not from the long hours working to pay off a debt that seems insurmountable.

In the end it looks as though our system for educating America is broken, our society is broken, our integrity is hanging by a thread if not already lost or severed and our family values have declined so far that I am afraid they will vanish completely.