Article+1


 * The Patient Protection and Affordable Care Act**

On March 23, 2010 President Barack Obama signed the Patient Protection and Affordable Care Act into law. This landmark act was a created significant reforms in the United States healthcare system and debate about it rages to this day and is likely to continue for years to come. It is essential that citizens educate themselves on the issues surrounding this act as it will likely shape not only politics but the way that they receive medical care. For years it has become increasingly clear that our health care system was in need of changing as it had several major flaws. First off, the cost is ballooning with advances in medical technology and prescription medicine. During most the sixties health care spending was a mere 6% of GDP but over forty years later in 2005, health care spending had reached 16% of GDP. In comparison with the rest of the developed world, Americans were being over charged for health care as countries spent half as much money per capita. In 2004 America spent approximately $6,100 per person while Canada, France and Germany spent approximately $3,100. The service that Americans were receiving was seemingly not worth the extra $3,000 as each of the aforementioned countries had a higher life expectancy level of at minimum 1.4 years. Surely, any politician would jump at the opportunity to give the median family making about $50,000 a year an extra $3,000. In addition, a politician worried about the budget deficit might be keen on lowering medical expenses as the government pays about 50% of the total cost of American health care. In addition to being cost inefficient the American health care system was rather ineffective as many went without health insurance. In 2008, approximately 46 million Americans were left with out health insurance; that is a staggering 15% of the country. This is unlike the vast majority other developed countries which consider health care a right and have systems which provide it to all of their citizens. Additionally, the American system is somewhat flawed as it is arguably too connected to our (purported) love of the market. Whereas insurance on most other insurance systems always cover damages when catastrophe occurs, health insurance companies often try to weasel their way out of paying up by denying claims, dropping coverage, or preventing covering people in the first place for their pre-existing conditions. This is clearly because they are profit oriented and the more money they pay out the smaller their bottom line. Many families find themselves on hard times when severe illness comes to a loved one. It would thus follow that our previously hypothesized politician would also want to give security to the American public against catastrophic illness. So we find ourselves with reason to reform the health care system and as it already is 2011 and the Patient Protection and Affordable Care Act is already passed we probably want to go about examining what the act does to alleviate the apparent problems with the American system of health care. The strategy which the act takes is a three pronged advance towards universal coverage and cost saving. Before diving into them it is worth noting that the power of insurance is that it spreads risk between large pools (of people) so as to limit the cost to each individual if something expensive occurs; one person's house fire would be a financial disaster but if many people are willing to pay monthly premiums for coverage the insurance company can easily pay the value of the homeowner's insurance contract. The act creates a mandate that everyone must have insurance to increase the pool of insured people, sets rules establishing equality of the premiums paid for insurance and the insurance provided, and provides subsidies to low income families to allow them to afford insurance. The mandate that everyone have health insurance is a very powerful tool. Without it many young and healthy people would opt out of the health insurance system and would only join it when they needed expensive care. The second part of that outcome is clearly something to be avoided as they would be gaming the system using other people's dollars freely. In addition, the first part of the outcome is also dangerous as it would effect the healthiness of the pool of insured negatively; if a pool is less healthy the cost of coverage will be higher and a feed back loop, known as a death spiral, may be created where healthy people leave the system causing rates to rocket which in turn causes others to leave creating a cycle. Ultimately, the mandate requires everyone to be part of the healthcare system allowing the most effective use of capital to occur. The mandate is enforced by a fine for not being insured rather than directly requiring insurance by law. Community rating, which is the rules requiring that insurance companies provide the same policies to everyone, is an equally essential aspect of the reform. Before this act insurance companies were notorious for dropping or denying coverage to people for "pre-existing conditions", however this practice will become illegal on January 1, 2014. Additionally, one might fear that health insurance companies will simply raise the premiums relative to the riskiness of the person's health circumstances but community rating also requires insurance companies to charge customers at equal rates. Essentially community rating makes all members of a health insurance pool equally responsible for the health of its members and fights inequality. The future of this bill is relatively unclear as much contention still exists. Conservatives often argue that the mandate is unconstitutional as it is beyond the federal government's jurisdiction to impose the fine required. as it is beyond the scope of the Commerce Clause and the Necessary and Proper clause of the Constitution. The case has been taken to Federal Court and while one judge found it unconstitutional, he did not use his power to void the act and two other judges in other parts of the country had found it to be constitutional. It is likely that the Supreme Court will be called upon to have the final say on the act's constitutionality. Additionally, the act faces the threat of an attack in the legislative (and executive) branch. Recently the Republican controlled House of Representatives passed the boldly titled "Repealing the Job-Killing Health Care Law Act." While the this Act is only a symbolic act, it foreshadows grave consequences for the reform should the Republican party win big in the coming presidential and congressional elections in 2012.