The Duncan Banner

November 13, 2013

Work together instead of fighting over semantics

Kenneth Wells
The Duncan Banner

DUNCAN — He was so tired of the words “stop”, “defund” and “regurgitate” that ex-congressman Ron Paul created a replacement word, “nullification” - to continue his ineffectual attacks on the Affordable Care Act. We hear from talk show to talk show that “they” have a plan for controlling the cost of health care. The problem with that rhetoric is that “their” plan is what got us into trouble in the first place. Lack of regulations - Republicans proposing deregulation to allow insurance companies to sell policies over state lines — is one leg of the rise in premiums. Another is the lax control that some states maintain over the insurance companies. By comparison, why are we criticizing the Patient Protection and Affordable Care Act?

Starting with the known fact that Public Law 111-148 is not perfect, what law passed by national or state legislators is? We can only guess at the millions of dollars Oklahoma has spent defending some of its laws passed by its legislators in the past four years instead of working with national legislators to FIX the “glitches“ in the ACA. The “glitches” don’t come close to the destructiveness of a majority of the bills Oklahoma’s legislators passed pertaining to personhood, abortion, discriminatory voting requirements, taxing the middle class more and the wealthy less, etc.

What the executive and legislative bodies in Oklahoma and other states know — but hide — is the fact that states, operating with 3-pronged, conservatively controlled-run governments, refused to set up State Insurance Marketplaces, thus overloading the Federal Marketplace. Although, some state legislators were intelligent enough to accept the federal monies to implement an Expanded Medicaid Program to cover individuals, that still did not fully satisfy the requirements of the Marketplace guidelines.

The small percentage of people who have said their health insurance premiums have risen under the Affordable Care Act do not tell you what their present policy covers. If you are female, it does not cover pregnancy, free yearly mammograms, yearly gynecological exams and yearly general health checkups. For males, you have an insurance policy that does not cover prostate exams or yearly health checkups. In addition, if one of the above health conditions happens to be a pre-existing one, that condition is specified as “not covered” in your policy. Students, part-time workers and/or out-of-work people under the age of 26 may now stay on their parent’s health plan until age 26 or they can afford their own insurance.

The Society of Actuaries works for the insurance companies and is the one that justified the 30%-50% yearly increases in health insurance premiums during the past four years. That can no longer happen without a Congressional change to the current ACA law. At an ongoing rate of 30%-50% per annum, by 2017 premiums would be 200% higher - not 32% higher - as quoted on last week’s newspaper “Opinion” page. Instead, from now on, the ACA allows a maximum premium increase of 10% yearly, which negates our President’s “situational ethics” as quoted. The Society’s report to Congress also pointed out the need for the Marketplace to continue operations and for the Expansion of Medicaid.

Another benefit from the ACA — not widely publicized — are the checks you received from your insurance companies earlier this year. Because of the 80%-20% requirement, 80% of your policy fees must now be spent on health services with 20% used for administration and stock dividends. If your insurer did not spend 80% on health services, it had to refund the percentage difference to you instead of disbursing multi-million dollar bonuses to its company officers.

U.S. Senate Majority Leader Harry Reid recently publicized the following information: Consumer Reports has a new online-tool to assist when determining one’s options for insurance. Healthcare Law Helper is available at www.HealthCareLawHelper.org and in Spanish at www.AsequraTuSalud.org.

We need to work together, not fight over semantics.