Obamacare Debate Defines End of the Year
To understand the fiscal tension in Congress defining the end of 2025 it is helpful to grasp it as a debate between continuing health care subsidies on which average Americans have come to rely to be able to receive medications, treatment, hospitalization and other medical services and continuing and extending tax breaks to the most affluent Americans and corporations. In short, the issues are controversial.
That part of the current American health care insurance system under the Affordable Care Act known casually as Obamacare passed the U.S. House of Representatives on November 7, 2009 on a vote of 220 in favor and 215 opposed. It passed the U.S. Senate as the “Patient Protection and Affordable Care Act on December 24, 2009 with a vote of 60 in favor and 39 opposed – just in time for Christmas of that year.
What became known as the Health Insurance Marketplace and also Medicaid expansion went into full effect beginning January 1, 2014. Since then 41 states and the District of Columbia have become “Medicaid expansion” jurisdictions allowing Medicaid to expand to cover adults up to 138% of the federal poverty level. North Carolina was a recent adopter. Ten states have not yet expanded including Georgia, Florida, Kansas, Mississippi, Texas and Wisconsin.
However, many states still have had ongoing discussions regarding it in their state
legislators. This is one part of the Act.
The Health Insurance Marketplace on the other hand, the most discussed aspect considered at this time, has taken various names in states throughout the country. Participants often do not realize they are receiving coverage through a federal program. In Pennsylvania, for instance, the Marketplace is known as Pennie. These “marketplaces” allow individuals to “shop” for their health insurance and also provide valuable information and support. It is primarily here and now when we are discussing the threatened loss of federal subsidies that allow average people to receive reductions from what would otherwise be extraordinarily high health insurance premiums (not to suggest that health insurance premiums are not also currently considered high by many but noting many quotes making some of them unaffordable to the point that individuals could lose their insurance altogether). Also at risk are subsidies to hospitals, especially rural hospitals and those servicing lower income markets.
Note that Obamacare and the also the Marketplace are not perfect. Costs for insurance, for example, for individuals who are approaching but have not yet reached the age to participate in Medicare (i.e. age 65 for most) are, for instance often cited as high. However, on the other hand, this is the only generally used and accepted health insurance program conducted through the federal government and the states that has brought general relief for individuals not otherwise covered by health insurance from other sources, for instance, through their employers.
Obamacare laws and regulations have been beaten up, interpreted, reinterpreted and challenged more times than it would make sense to describe here. There were three major challenges before the U.S. Supreme Court. The then Supreme Court almost miraculously found in separate cases that the Act could continue as taxing legislation and in another that, although the early requirement that individuals carry health insurance was removed, it was not a tax maybe or, at least, since the requirement to buy health insurance was removed, then no one had standing to bring the action anyway. It would seem that then,at least, even the then existing Supreme Court believed the law was an important part of American culture and deserved to stand.
Many would also remember John McCain’s dramatic action in returning to Congress to cast the deciding vote (the famous “thumbs down”) on the Senate floor. This occured on July 28, 2017, more than eight years ago, rejecting what became known as an attempted “skinny repeal” of the Affordable Care Act. Democrats now have proposed extending the subsidies at least for a period of three years. Some Republicans have suggested Health Savings Accounts established by individuals, a complicated process and one requiring another government system, but this does not seem to have been aggressively pursued.
One significant point is that, like Social Security which was passed in 1935, provisions under the Affordable Care Act including health insurance subsidies, have become part of our culture. To turn back now is to rip away from large numbers of Americans something they have become accustomed to and do not want easily to to surrender.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.