Sure, a buncha states' AGs are suing over it. Sure, some people think we've rounded the bend and are now hellbent toward permanent commieland. And, certainly, many others think it doesn't measure up to the ideal of single-payer health insurance.
But those cheering passage of the $940 billion Patient Protection and Affordable Care Act, signed into law this Tuesday by President Obama, say that while it's not perfect it goes a long way toward fixing some of the more troublesome problems with the country's current health care system.
"It's an important and very positive first step," said Dr. Luther Cobb, a local physician who is on the executive committee of the California Medical Association, on Tuesday afternoon.
The act will expand insurance coverage to more than 31 million Americans. It will put an end to insurance companies' dropping people when they get sick, and of denying coverage to people with "pre-existing conditions." And it will prevent insurance companies from putting a lifetime cap on insurance benefits. It also will make substance abuse disorder and mental health services required benefits, and will invest in prevention strategies. And it would allow kids to stay on their parents' health coverage plans until age 26.
The act is supposed to reduce the deficit by $100 billion over the next 10 years. Taxes on high-end insurance plans, fees levied on drug and medical device manufacturers and on health insurers will fund the reform, as well as Medicare cuts.
Under the act, most Americans will be required to have health insurance, starting in 2014. They can get it through their employers or a system of state-run health insurance exchanges where they can shop for policies.
Religious objectors, illegal immigrants, American Indians and prisoners will not be subject to the mandate. American Indians and Alaska Natives, however, will see expanded health care programs through the reauthorized Indian Health Care Improvement Act, part of the overall health reform package.
The Patient Protection and Affordable Care Act provides for subsidies, on a sliding scale, for which the Congressional Budget Office estimates about 19 million people will be eligible. People making, on the top end, an income no more than four times the federal poverty level (about $44,000 a year for an individual and $88,000 a year for a family of four) would only have to pay about 10 percent of what they make on health insurance, and the rest could be subsidized. Those making less would be responsible for an even smaller percentage of their insurance. And, people making less than 133 percent of the federal poverty level income would be eligible for Medicaid, which will be expanded under the act.
Businesses with more than 50 employees will have to offer health insurance to their employees, or possibly pay a substantial fine for not doing so. Businesses offering insurance also might be required to offer a voucher to their employees who make less than roughly $44,000 so they can shop for cheaper insurance on the exchange. Small businesses, meanwhile, could get tax credits to cover up to 50 percent of their premium costs.
Failure by individuals to get health insurance would lead to tax penalties, starting out minimal in 2014 and increasing by 2016 -- $695 per uninsured family member, up to $2,085 total or 2.5 percent of the household income.
As for local impacts of the act, right now 24.4 percent of the Humboldt population between 0 and 64 is uninsured, or 27,361 people, according to the Insure The Uninsured Project. ITUP, which has compiled a report on the effects of the reform on California counties, reports that in Humboldt in 2013, when the mandate to get insurance kicks in, there will be about 30,644 uninsured people between the ages of 0 and 64. By 2018, when reform is in full swing, there'll be about 6,873 uninsured people in Humboldt.
Connie Stewart, executive director of the California Center for Rural Policy at Humboldt State University, said more than 2,900 seniors in Humboldt will see an immediate benefit of a $250 rebate on prescription drugs as part of the legislation's closure of what's called the "Medicare Part D Donut Hole." Also, more than 22,000 Medicare beneficiaries will also receive free preventive and wellness care.
Humboldt County Department of Health and Human Services Director Phillip R. Crandall said on Tuesday that it's too soon to understand the full impacts of federal health care reform. But they'll be huge.
"This is health care reform on steroids," he said. "Its passage is an event that will profoundly impact Humboldt County residents, from children to seniors. While the costs of the reform package are significant, doing nothing would cost us much more, financially and morally."
Local doctor Alan Glaseroff, chief medical officer for the Independent Practice Association, said he's had a lot of post-job and pre-Medicare patients who've put off care, such as knee replacement surgery, because they couldn't get insurance coverage.
Cobb told the story of a local man who got a minor scratch on his hand and didn't seek care because he couldn't afford it and didn't have health insurance. It festered. He finally went to the emergency room of a local hospital, but it was too late and he died of infection, said Cobb.
"I've had a number of colon cancer patients who knew they had it but wouldn't get treatment," he added.
Glaseroff and Cobb both said there are serious issues with the new legislation. But they're happy to have it.
Within the Open Door Community Health Centers system, said CEO Hermann Spetzler, about 30 percent of the 50,000 individuals who sought care in the clinics last year had no means to pay for their health care.
"Right now, 32 million Americans have been receiving health care in the most expensive and inappropriate way -- through the emergency system," Spetzler said.
Meanwhile, Jerome Simone, CEO of United Indian Health Services, Inc., a private, nonprofit consortium of nine local tribes, was ecstatic that after 18 years of trying to get the 1976 Indian Health Care Improvement Act reauthorized -- it expired in 1992 -- it finally happened. Simone doesn't know yet what the appropriations from that act will be, but he anticipates they'll inject much needed cash into new facilities across the country and into behavioral health services -- things such as suicide prevention and substance abuse treatment. The act could benefit the 15,000 patients served by the UIHS's Potawot Village in Arcata, he said.
"We've had two recent suicides in our community, and that made us want even more to see this act reauthorized," he said.