The Affordable Care Act

February 25th, 2013

An Act With Many Acts

The Affordable Care Act (ACA) almost didn’t happen. Since its narrow passage in March 2010, it has been debated, derided, and even repealed by the US House of Representatives in a vote that was mostly symbolic. In 2012, the law survived a Supreme Court challenge and a presidential election during which its future was called into question. But this major overhaul of the nation’s health-care system is going forward and is now set to take full effect in less than a year.

Some changes have already happened, affecting everyone from children to seniors. Hospitals, doctors, insurance companies, and many others are preparing for the changes to come. Despite all the news stories covering the ACA (or perhaps because of all the stories), the new system is still something of a mystery for many people. What is the Affordable Care Act all about? What and whom will it impact? And how should Christians evaluate the impact of health-care reform in light of biblical themes such as health, justice, mercy, and responsibility?

What Is the Affordable Care Act?

Passing the Affordable Care Act was a major priority for President Barack Obama during his first term. As the title of the legislation suggests, a primary goal of the ACA is to make health care accessible and affordable for Americans, particularly those who currently have no insurance. The law extends insurance coverage to 30 million people and forbids insurers from denying coverage to individuals based on pre-existing conditions. New insurance exchanges will be created on the state level to help individuals and small business owners compare and purchase qualified health plans.

The expected cost of the new plan is around $1,168 billion over ten years, according to figures from the nonpartisan Congressional Budget Office cited by The New York Times. In order to keep costs under control in the government Medicare program, the ACA establishes a panel to review treatments and to limit government reimbursement only to those that are found to be effective. The new law also includes an individual mandate that will require individuals to have health insurance or face a tax penalty. To help individuals who cannot afford insurance, the act provides for subsidies in the form of an advanced tax credit.

What Has Happened Already?

Even though full implementation of the ACA is not planned until 2014, some changes have already occurred. One measure that impacted young adults who may not have a job that offers health-care benefits is a requirement that insurers allow young adults to remain as dependents on their parents’ health plan until the age of 26. According to Consumer Reports, this immediately offered coverage to 6.6 million people who would otherwise have been uninsured.

Another change already in place is a benefit for seniors and disabled persons who have unreimbursed prescription costs. Consumer Reports says that “seniors who reach the ‘donut hole’—the point when they have to start paying prescription drug expenses themselves—now get a 50 percent discount when buying brand-name drugs and a 14 percent discount on generic drugs covered by Medicare Part D.” The magazine estimates that more than five million people have been impacted by this provision.

Other ACA reforms that have already taken effect include a required premium rebate from insurers who did not spend enough of their previous year’s premium income on health care, required preventative care coverage, and a prohibition on lifetime limits of coverage. New in 2013 are two Medicare-related taxes that will affect high-earners and a $2,500 cap on the amount of money from their income that individuals can set aside tax-free as a flexible spending account.

What Will Happen in 2014?

Next year the reforms will be fully in place, and shopping for health-care plans will become a very different system. One change required by the law is that everyone must be given coverage regardless of his or her health history, and people cannot be charged more for coverage based on their health or gender. The government-run Medicaid program, which covers many low-income Americans, will also expand to include 16 million more people who would not otherwise be eligible.

The new insurance exchanges will begin running on the state level. Individuals and small businesses can explore and purchase plans through the exchanges, probably online. States have the option of setting up the exchanges themselves, but Consumer Reports says that the federal government will probably end up operating the exchanges in as many as half of the states.

The Supreme Court Challenge

One of the most controversial provisions in the law, which will go into effect next year, is the individual mandate and corresponding tax penalty for those who do not get health insurance. Last year the US Supreme Court reviewed the law and allowed those measures to stand with some modification. The Obama Administration had argued that the law, including its mandates, was legal by virtue of the Constitution’s “commerce clause,” which gives the federal government the power to regulate interstate commerce. Chief Justice John Roberts, in his opinion for the majority, rejected that argument but found that the mandate and fine amounted to a tax, which was within the government’s purview to impose.

In addition to this finding, the Supreme Court restricted the expansion of Medicaid, giving states more flexibility in determining how much to expand. In recent months, the Obama Administration has pushed states by declaring that the federal government would only cover the full costs of newly eligible Medicaid beneficiaries, as they are supposed to do between 2014 and 2016, if states adopt the law’s expansion targets. Governor Bobby Jindal of Louisiana was quoted in The New York Times as saying that the White House policy “will make a state’s decision on Med- icaid expansion more difficult.”

Health Care and Faith

Many religious leaders have welcomed efforts to expand coverage to the nation’s uninsured persons. Jim Winkler, general secretary of the United Methodist General Board of Church and Society, called the act “a huge step in the right direction.” Winkler celebrated “provisions in the law that continue to fill the gaps and expand existing health care, particularly to low-income Americans.”

That concern for providing care for those in need was echoed by the Reverend Michael Livingston, director of the National Council of Churches Poverty Initiative. “God is smiling down on [the Supreme Court’s] decision,” Livingston said. “I hope that people of all faiths hear this decision as a clarion call to continue fighting for protections for all God’s children, just as Christ intended.”

The ACA is a product of a political environment with many different interests, but it does reflect an attempt to wrestle with a problem that has been a perennial concern for people of faith. Sections of the Bible as varied as the Law, the Prophets, and the Gospels all speak to God’s compassionate care for those who are most vulnerable, including those who need healing. Part of the biblical evaluation of a people’s commitment to justice is their provision for the health of children, the poor, and those who cannot work. To the extent that the new health-care reforms reflect these values, it is consistent with God’s vision for beloved community.

Christians have long been engaged in health-related ministries, and many hospitals across the country bear the names of Christian denominations that established them during the nation’s growth. In this new era of health care when so many of the systems of health-care delivery have become so complex and expensive, Christians may also need to envision how they can continue to be advocates for and participants in providing health care. Responsibility for health care cannot be left solely to government institutions, but must be shared by individuals, communities, and faith communities where the notion of healing is bound up in a holistic definition of salvation.

Be sure to check out FaithLink, a weekly downloadable discussion guide for classes and small groups. FaithLink motivates Christians to consider their personal views on important contemporary issues, and it also encourages them to act on their beliefs.

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