10 Things About ObamaCare You May Not Know But Should

Harvard professor and author John E. McDonough
Harvard professor and author John E. McDonough

Let us be clear. John McDonough is a Democrat down to his DNA. Though he's a professor at the Harvard School of Public Health, he makes no pretense of being dispassionate about the Affordable Care Act of 2010, better known as ObamaCare. He calls it a landmark of the magnitude of the creation of Social Security or Medicare.

John also knows the law inside and out, and shares his knowledge — both of what's in the 18-month-old law and how it politically came to be — in a new book, "Inside National Health Reform." Thankfully, he's a great sport about turning esoteric knowledge into soundbites. On Friday, he took our "3-minute challenge" here, and below, he offers the top 10 things people probably don't know about ObamaCare but should:

1. 32 million newly covered
Beginning in 2014, an estimated 32 million people who today are uninsured will begin to be enrolled in affordable coverage. About 16 million will be enrolled through expansions of Medicaid, and 16 million through insurance "exchanges." That will leave about 23 million uninsured.

Who are those 23 million? The Urban Institute estimates about 40% of them will be eligible for Medicaid and just not sign up. We’d like those people to get signed up but the truth is, if they get sick and get health care, the clinic or hospital will be able to — or in fact, be required — to sign them up on the spot.

[module align="right" width="half" type="pull-quote"]'If it gets repealed, which could happen depending on what happens on Nov. 6, 2012, it will be a couple of generations before our federal government may find the political will to go at this again in such a significant way.'[/module]

So then about a quarter of them are undocumented, and the rest include some — like about 30,000 in Massachusetts — who say, 'I'm going to pay the penalty and not get covered.'

2. It's not really a 'mandate'

The individual mandate is not really a mandate; it is a financial penalty if you can afford to buy health insurance and don’t do so. Switzerland actually has a real mandate — the law requires you to buy health insurance and the government will make you buy it — versus what we have in Massachusetts and the Affordable Care Act, which is just a financial penalty for not purchasing coverage if you can afford to do so.

3. It's projected to lower the deficit

According to the Congressional Budget Office, the law, over 10 years, is fully paid for and is estimated to lower the federal budget deficit by over $70 billion.

The costs are more than compensated for by new taxes, savings in the system and other revenue enhancements.

4. It lowers Medicare spending by $450b
Title 3 of the law makes a lot of changes to Medicare, some to help enrollees and a lot to lower Medicare spending over 10 years by about $450 billion. That will pay for about half the cost of the law.

In the 2010 elections, the Republicans beat the Democrats over the head mercilessly for cutting Medicare, but Congressman Paul Ryan's budget plan, which was supported by almost every Republican in Congress, makes all these big changes to Medicare that people heard about and also repeals the entire Affordable Care Act except the $450 billion in Medicare cuts.

5. It greatly expands Medicaid

Beginning in 2014, the law engineers a major expansion in Medicaid, so that between now and 2019 it will bring in an estimated 16 million new enrolles who were uninsured.

Some states are saying, 'No no no.' But the truth is that for the first three years of the law, the federal government will pay 100% of the costs of the new enrollees, and in the succeeding years, the federal reimbursement will trail down to no less than 90%.

6. Half a million more young adults insured
One of the early reforms that took effect in September of 2010 was to allow young adults up to age 26 to stay on their parent's insurance policies as a matter of right. The census report that just came out shows that among all age groups, the only age group that did not see their rate of uninsurance increase are young adult 18-26. In fact, uninsurance in that age group declined by about 500,000 people, or 2%. So people are using it, It's already benefiting people.

7. It whacks fraud and abuse

Everybody agrees there's a big problem in Medicare and Medicaid with fraud and abuse, way too many people stealing the programs blind. the Affordable Care Act includes the most aggressive and creative set of provisions to prevent fraud and to catch fraudsters since the program was created in 1965, and the results show that this vigorous effort is working.

8. Related? Medicare spending mysteriously drops

Over the past 18 months, we are noticing a significant and surprising decrease in the rate of growth in Medicare spending. Economists and policy analysts are not entirely sure why at this point, only posing hypotheses, but perhaps there's some impact of the efforts against fraud and abuse, because it's not even so much the people you catch, it's the fraudsters who see what’s going on and get scared.

9. Help counting your calories

Calorie labeling on chain restaurant menus is coming to a corner near you very soon. I spent last year in New York at Hunter College after I left the Senate, and when you walk into a Starbuck's and see the calorie count on a maple scone, it has an effect.

I've talked to about 15 audiences where I asked, 'Tell me if you ever changed a food purchase because of the calorie count,' and about 80 or 90% of the audience raises their hands. My big disappointment with the Obama administration on the implementation of the Affordable Care Act is that in writing the regulations, they exempted movie theaters from calorie counts.

10. Reducing Racial Disparities

If implemented, the Affordable Care Act will do more to reduce racial and ethnic health disparities than any other act in American history.

And his big bottom line:

"The Affordable Care Act is one of the most important landmarks in U.S. social policy ever, comparable with the 1935 Social Security Act and the 1965 Medicaid and Medicare Act. And if it gets repealed, which could happen depending on what happens on Nov. 6, 2012, it will be a couple of generations before our federal government may find the political will to go at this again in such a significant way."

Readers, responses?

This program aired on September 19, 2011. The audio for this program is not available.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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