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What’s at stake in the “Obamacare” debate of 2012


With recent polls showing the public remains almost evenly divided on the Affordable Care Act (ACA), the fate of the law won’t be decided by its effect on healthcare access but rather by the actions of politicians. So we’d better stop and assess what’s going on in healthcare debate in this election season. Although Mitt Romney said in September that if he becomes president, he will not rescind every aspect of the law, his website indicates he will. So your guess is as good as mine. President Obama, if reelected, undoubtedly will continue to implement almost all provisions of the law.  

To date, more than 3.5 million seniors are now paying less for prescription drugs because the ACA has shrunk the “donut hole” that denies coverage at certain spending levels. And at least 32.5 million people have received free preventive services. In addition, 2.5 million young adults are now covered under their parents’ health insurance plans, and about 100 million Americans no longer have lifetime limits on their coverage. However, because most of them will never reach the former cap, they don’t realize their insurance has improved.

This chart synthesizes major provisions of the ACA as it stands now.

Provisions in effect now (2012)

Provisions in process

Provisions to go into effect in 2014

Provisions on hold

adults can stay on parents’ plan until age 25.

of Medicare prescription drug “donut hole” will be completed by 2020.

mandate: U.S. citizens must buy health insurance or pay a fine.

retiree reinsurance program

coverage of children with preexisting conditions

Payment Advisory Board (no one has been appointed yet)

tax credits to help people buy health insurance coverage. Individuals with
income between 133% and 400% of federal poverty level can receive federal
subsidies in form of tax credits to purchase health insurance.

long-term care insurance program (CLASS)

on insurance companies cancelling coverage because persons become ill

Centered Outcomes Research Institute is now organizing itself.

on charging higher premiums because of health status or gender


on lifetime coverage limits


expansion in states (no longer required after Supreme Court decision of 2012)*


ban on annual coverage limits


ban on annual coverage limits in health benefits exchanges.


loss ratio (limits on insurance company profits and overhead spending) mean insurance
companies must return excess premium charges.


coverage for adults in the health benefits exchanges with preexisting


of preventive services


benefits packages required of all insurers


control coverage requirement


businesses with more than 50 employees must provide health insurance (employer


and public health fund

condition insurance plan; temporary high-risk pools are in effect until 2014,
when health insurance exchanges kick in.

insurance exchanges established (known as American Health Benefits Exchanges).**
Premiums in individual private insurance exchanges may not exceed 4.5 times
the cost of lowest cost independent premium plan.


provider payment cuts




advantage payment cuts to insurers




care organizations




for Medicare & Medicaid Innovation (testing ways to make medical care
more efficient, as with bundled payments or value-based purchasing)




* Depending on political climate in individual states, Supreme Court decision may result in exclusion of millions.

** Major requirements for insurers in exchanges are: (1) insurers won’t be permitted to refuse to insure anyone; (2) prices may vary based on four factors and not beyond a total factor of approximately 10; (3) plans will be offered in four comparable tiers ranging from 60% to 90% of bills in increments of 10% for each plan. Exchanges will work directly with insurance companies, effectively acting as their extensions.

So for all those interested in the future of healthcare delivery, this is where we stand now. After November 2012, depending on the politicians we elect, everything that has been implemented (or at least some portions) could be made null and void, everything that’s in process could be stopped, and everything that’s planned could be changed.

And who knows? Something else entirely could be dreamed up and written into law. Is it any wonder so many hospitals and healthcare systems have put hiring, planning, and developing new services on “hold” this year?

8 Comments. Leave new

  • If the Republicans take the presidency and gain majority in the Senate, the ACA act will be repealed in its entirety…so VBP would also be repealed.

  • What is going to happen to Value Based Purchasing if the ACA is repealed?

  • We also have already started changes to gear up for the upcoming medicare cuts from Obama care. I agree that quality needs to be a priority, but Obama care is going to hurt facilities and patients and I don’t see any affects to insurance companies.

    As for the children that can remain on their parents insurance – beware – you will have to report that cost on your income tax and will be taxed on it.

    Reform needed more work than was put into this and more people to actually read the bill.

  • Medicare cuts are already affecting our practice. See how many Medicaid patients you have to see to keep your head above water. It is a Obama’s dream and healthcare’s nightmare. If we put the responsibility of health and wellness whether primary/secondary/tertiary care in the laps of the noninsured person maybe this country could sustain cost control. People are rewarded to let someone else take care of them instead of them taking care of themselves. Why study for the test if we-all scorethesame

  • We need bipartisan agreement on health care reform in order to keep what is good about the ACA, repair what is faulty, and replace what is missing. The current President and Congress cannot (or will not) do this, so be careful and aware of what candidates on YOUR ballot actually say they will do. We should talk to them, personally. Don’t just believe the media hype! Get informed befory you vote!

  • RN needs to get a grip! This blog doesn’t support anything! All it does is tell anyone who bothers to actually read it where we are, as a nation, in the implementation of the law … The chaos that would be caused by repeal is mind numbing.

  • I am concerned as to how so many who are out of work, will be able to pay for their own insurance. I feel the basic healthcare reform, as it stands, appears to serve the American population across the economical range fairly.
    May I quote from a Book,Powerful Partnering by E.L. Hollenberg, M.D.? Albert Schweitzer, a Compassionate Physician’s Famous quote: “Reverence for Life” “All Life on earth should be respected. Seeking to preserve the physical & ethical ecology.” Applies to All.

  • Your support of socialized medicine is more anti~American sentiment this country doesn’t need. Gov’t controlled medicine has proved to be a failure in every country using it, and you’re a cheerleader for it. You fail to address the $700+ billion nobama yanked from Medicare to support his fiasco, and how difficult getting medical care is going to be if his so-called healthcare plan is implemented. For all patients sakes, we’d better pray it’s repealed.


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