Moral Obligation and Social Rationality of Government: The Affordable Care Act

By Okeke, Timothy C. | Forum on Public Policy: A Journal of the Oxford Round Table, Summer 2011 | Go to article overview

Moral Obligation and Social Rationality of Government: The Affordable Care Act


Okeke, Timothy C., Forum on Public Policy: A Journal of the Oxford Round Table


Introduction

"For me to voluntarily open my pocket to help the poor and needy is a worthy and honorable act of human compassion. But for you to reach inside my pockets and take my money to do so is stealing for which someone should go to jail" (1) (Walter E. Williams 2009).

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane" (Martin Luther, Jr).

Medicare/Medicaid programs were added to Social Security Act in 1965 under LBJ's "Great Society" program. In the 1970's the bill set up cost-of-living adjustment (COLA) making a yearly adjustment on basis of consumer price index (CPI) increase of 3% or more. In 1992, Social Security legislation expanded the minimum monthly benefits of persons employed in low-income positions for at least 30 years as well as for widows, widowers, and dependents which set up the Supplemental Security Income welfare program. The 1983 Amendment set up social security in excess of a household income threshold ($25,000 for singles and $32, 000 for couples) taxable to help generate revenue and prevent solvency. Social Security and Medicare funds, therefore, have been in crisis all along due to changing financial pictures. The question before opponents of the Guaranteed Affordable Care Act (ACA) then is "why the angst, the opposition to an Act seeking to fix a broken healthcare system as was allowed in 1983?"

This paper examines the implications of moral obligation and social rationality of the government re: the Affordable Care Act (ACA) of March 23, 2010. It provides valuable discursive insight into what is expected to be the outcome from the ongoing debate about the rationale behind the enactment of the ACA and predicts that the final decision on the constitutionality of the law resides within the U.S. Supreme Court (2) and, eventually, the 2012 general elections.

The ACA includes provisions designed to provide a high quality, high value, health care system for all Americans and to make health care insurance market more consumer-friendly and transparent. It will dramatically increase the number of people lacking coverage but it does not extend coverage to everyone; approximately 46 million are currently lacking healthcare insurance (3). The ACA will initially cover 32 million people currently uninsured but that only accounts for 94% of young Americans eligible to receive health care; about 83-85% Americans are currently covered. The ACA extends the number of people eligible for Medicaid and provides subsidies for the lower class to buy insurance, but lacks a government-sponsored public option that could have ensured universal coverage.

By 2014, states will open up health insurance marketplaces or "exchanges," which allow the unemployed, self-employed, part-time workers and small businesses to comparison-shop for private insurance plans at more affordable rates than the ones they have now. Until then, many reforms to the ACA are expected. Children are now allowed to remain on their parents' health plans until age 26 and can no longer be denied coverage for pre-existing conditions. Adults with similar conditions can take advantage of a high-risk insurance program provided by the government, and by 2014 assume full protection from denials of coverage. Insurance companies will no longer be allowed to set lifetime limits on health care coverage or cancel policy once someone gets sick. The ACA closes the Medicare "doughnut hole," a gap in prescription drug coverage that makes medication very expensive for older adults to help them purchase medicine below the catastrophic coverage thresholds. On the revenue side, the ACA delays its taxes until 2013, adding additional Medicare payroll/investment taxes in three years for richer families. In eight years, it will add an excise tax on high-cost insurance plans indexed to creep into more insurance plans in the second decade of the law. It bars insurers from rescinding coverage to shedding the sick based on pre-existing conditions and capping lifetime coverage.

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