On Fixing the Affordable Care Act

The Patient Protection and Affordable Care Act has to be one of the most important pieces of legislation in this decade. It’s also not perfect. The New York Times yesterday published an article pointing to fixes wanted by everyone from Families USA, a nonprofit advocacy group for healthcare access, to Richard Burr, a conservative Senator from North Carolina.

The New York Times identifies the partisan politics of the way the law was passed as the primary issue. A professor at GWU says that because of these politics, “we cannot use any of the normal tools.”

And yes, this is partially true. Shit has gotten partisan since…1988, 25 years ago, the last time a law cited in this NYT article was passed. If it feels reductive to dismantle the debate about a 1,000 page law to politics alone, that’s because it is. It is rare that legislation like this – so economically far-reaching – has actually made it through Congress and survived (er, sort of) multiple Supreme Court challenges.

The NYT knows this – or, at the very least, the authors of this article must. A good chunk of the article lists out different “key definitions” in the law that “must be changed,” to quote one accidental lobbyist. The changes to these “key definitions,” though, are not exactly obvious; otherwise, they would have been different the first time around.

Instead, so many people are affected by the passage of the Affordable Care Act that for every group who wants to change a definition or rule, another groups wants to keep it the same, and another two want to change it slightly differently. Families USA wants to make sure that “navigators,” the people who will help the uninsured access the state health insurance exchanges, are paid more. Another fifteen groups want the exchanges eliminated all together, leaving the collective salary for navigators at “zero.” For every business-owner who has 51 employees and doesn’t want to be required to assist in the purchase of insurance, there is another business owner who has 200 employees and still considers herself “small.”

The truth is, some of these rules are pretty arbitrary. Who knows what a “small business” actually means? What we do know is that a huge number of us are caught up in this law, and we all want the law to work better for us as individuals. Do I wish I could stay on my parents’ health insurance plan forever? Yes please. Do I think I should get a subsidy to purchase health insurance through the exchange? Obviously.

But this isn’t the way law works – you can’t make everyone happy, even in such a massive bill, even in 1,000 pages. So yes, 51-employee business owners may be pissed. But if you raise the requirements to purchase health insurance to only employers with 200+ employees, where are we leaving the employees who have 50 coworkers?

The politics behind this are driving the stability of the law, but it is so much more, and so much deeper, than the politics of partisanship.

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