A Very Controversial
Health Insurance Law

by Alan Shapiro

To the Teacher:

An introductory reading below provides students with an overview of the competing views about the new health insurance legislation. The first student reading below outlines: 1) provisions of the bill going into effect this year and 2) provisions phasing in over coming years. The second reading offers an array of views about various aspects of the new law. Discussion questions and a writing assignment follow.

Introduction:
A very controversial bill that became law

In the New York Times, the headline read, "Health Care Overhaul Becomes the Law of the Land." Financial columnist David Leonhardt called the bill "the federal government's biggest attack on economic inequality since inequality began rising more than three decades ago." (3/24/10)

The Tampa Bay (Florida) Online headline on March 28, 2010, read, "Poll finds most Floridians oppose health reform law." Kevin Wiatrowski reported that "the strongest opposition [was] coming from those 65 and older, according to a poll released on Saturday." (www.tbo.com, 3/28/10)

"Love it or hate it. Across the nation, reaction to the landmark health care legislation that made it through the House late Sunday seemed to echo the bitter division in Washington, drawing either praise or excoriation," said Scott Neuman of National Public Radio. (www.npr.org, 3/22/10)

Fox News' online headline was "Lawmakers Willing to Gamble on Public Anger Over Health Care." "You'll learn to like it," read the article. "That's the message from White House advisers and Democratic lawmakers to Americans opposed to the health insurance overhaul signed into law last week." (www.foxnews.com)

Most Republicans see the new law as a "government takeover" produced by "back room deals" and "rammed through" Congress. Most Democrats hailed it as "historic," and President Obama declared that the law "will set in motion reforms that generations of Americans have fought for and marched for and hungered to see." Meanwhile, progressives who had long called for a "Medicare for all" system were disappointed by the legislation, which builds on the the U.S.'s private, employer-based insurance system.

While people referred to the legislation as "health care," "health reform," "health care insurance reform," and "health insurance reform," the actual title of the bill is something else entirely: the Patient Protection and Affordable Care Act (PPACA).

For discussion

1. What do you know about the PPACA? What difference might it make in your life?

2. What would you call the new law and why?

3. What don't you know but would like to? How might you find out?

Student Reading 2:
Major provisions of the the new law

The PPACA is 2,309 pages long, and full of technicalities and complexities. A shorthand outline of what the law provides and prohibits:

Provisions going into effect this year

• allow uninsured adults younger than 26 to be added to their parents' health plans
  
  
• require new private health insurance plans to cover the full cost of preventive care, including annual physicals and children's immunizations
  
  
• ban insurance companies from excluding children under 19 from their parents' health insurance plan because of preexisting health conditions
  
  
• allow people who are considered "uninsurable" (they've been turned down by private insurers because of their health status) to qualify for insurance through a new federal program
  
  
• prohibit private health insurers from imposing lifetime limits on coverage
  
  
• offer tax incentives to small businesses if they pay at least half of employees'
  premiums
  
  
• phase out a gap, or "doughnut hole," in the Medicare prescription drug program
  
  
• increase funding for community health centers
  
  
• prohibit the government from providing or subsidizing insurance plans that cover abortion
  
  
• prohibit the government from providing insurance for illegal immigrants
  
  

Provisions to be phased in over several years

• require most Americans without insurance to buy it, or else pay a fine
  
  
• provide subsidies for those who can't afford the full cost of insurance
  
  
• through these and other other provisions, see that about 32 million Americans currently without health insurance become insured
  
  
• require insurers to accept all applicants regardless of "preexisting conditions"
  
  
• allow an individual not covered by an employer and earning too much to qualify for Medicaid (a state-administered program for low-income people) to buy insurance through a state insurance exchange and, depending upon their income, be eligible for a subsidy
  
  
• forbid insurers to discriminate on the basis of sex or to cancel a policy once a person becomes sick
  
  
• expand Medicaid to cover 10-12 million new people
  
  
• tax health benefits on the most expensive insurance plans
  
  
• cut sharply government subsidies for Medicare Advantage, a private plan option, to make it similar to Medicare

The first two items on this list are especially controversial. Those opposed to the new law argue that the government has no business forcing people to buy something they don't want, requiring private insurance companies to accept applicants they don't want, or supporting those with low incomes.

Those supporting these provisions argue that the mandate to buy insurance will bring health insurance costs down by giving insurance companies a larger risk pool. Spreading out risk is a key idea behind insurance. Because of the mandate, insurers will get millions of new customers--including both healthy, young people who will cost them little and subsidized lower-income people and those in poor health, who will cost them more. (Most of the sickest Americans, however, will continue to be covered by government programs, especially Medicare, the federal program for seniors and the disabled.)

For discussion

1. What questions do students have about any of the provisions? How might they be answered?

2. What is the answer to arguments that the government should not require people to buy insurance if they don't want it? Does it make sense to you? Why or why not?

3. What do you think are other objections to PPACA and why? What answers might there be to such objections?

4. What do you think are the most valuable elements in the PPACA and why?

5. Should the program have included government spending on abortion, a legal medical procedures? Why or why not?

6. Should it have included insurance for illegal immigrants? Why or why not?

7. Why would a large risk pool bring down the cost of insurance?

President Obama
"At a time when the pundits said it was no longer possible, we rose above the weight of our politics. We proved that this government…still works for the people." (3/21/10 at his signing the health insurance bill into law)

Question: Do you agree with the president that "this government…still works for the people"?

Senate Minority Leader Mitch McConnell (R, KY)
"Democratic leaders and White House officials may be celebrating their victory this week, but most of the rest of the country is not. Most people are not interested in celebrating a bill that makes their lives more complicated, takes more out of their paychecks and puts decisions they are used to making themselves into the hands of federal bureaucrats." (radio address, 3/27)

Question: Does the law make people's lives "more complicated"? take "more out of their paychecks"? "put decisions" they have made for themselves "into the hands of federal bureaucrats"? Why or why not?

Rose Ann DeMoro, Executive Director, National Nurses United and California Nurses Association
"The legislation fails to deliver on the promise of a single standard of excellence in care for all and instead makes piecemeal adjustments to the current privatized, for-profit healthcare behemoth. … Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need…."
(www.huffingtonpost.com, 3/23/10)

Question: Does the new law strengthen "the economic and political power of a private insurance-based system based on profit rather than patient need"? If so, how? If not, why not?

Speaker of the House Nancy Pelosi (D, CA)
This legislation may not have bipartisan support, but it has bipartisan imprint. There are over 200 amendments...that the Republicans advanced that are in this legislation. So, the fact that, before the president even went to see the Republicans in the House, when he became president, they said, whatever he asks for, the answer is no…. Bipartisanship is not more important than a little child who is sick, being deprived of coverage because he has a preexisting condition. It's not more important that women can stop being -- just being a woman is no longer a preexisting medical condition, that -- that, if you lose your job, you lose your insurance, that, if you want to start a business or be self-employed or change jobs, you're not job-locked, that the insurance companies don't have it over your head that they can… increase your rates, and you're at their mercy. (www.pbs.org, 3/24/10)

Question: Does the new law end the ability of insurance companies to keep you "at their mercy"? Why or why not?

Ed Hinkle, journalist
The increased federal involvement in health care will become a pretext for increased federal involvement in -- well, everything. The reasoning will be that individual health affects health care, which is now a federal enterprise. And everything can be said, with more or less sophistry, to affect individual health. So "managing" the "system" will become the all-purpose excuse for dictating the manner in which you live your life. (Richmond Times-Dispatch, www.timesdispatch.com, 3/31/10)

Question: Does the new law provide a government "excuse for dictating the manner in which you live your life"? Why or why not?

Virginia Attorney General Ken Cuccinelli
Charging that the new law amounts to "unconstitutional overreach," Attorney General Cuccinelli announced that he will file a lawsuit against the legislation on behalf of Virginia. He said, "Virginia is in a unique situation that allows it the standing to file such a suit since Virginia is the only state so far to pass a law protecting its citizens from a government-imposed mandate to buy health insurance. The health care reform bill, with its insurance mandate, creates a conflict of laws between the federal government and Virginia." (www.csmonitor.com, 3/22/10)

Question: Is it constitutional for the federal government to require citizens to buy health insurance? Why or why not and what is the constitutional authority for an answer?

Paul Krugman, economics professor and op-ed columnist
Can we afford this? Yes, says the Congressional Budget office, which…concluded that the proposed legislation would reduce the deficit by $138 billion in its first decade and…$1.2 trillion, in its second decade….An ideal plan isn't on the table. And what is on the table, ready to go, is legislation that is fiscally responsible, takes major steps toward dealing with rising health care costs, and would make us a better, fairer, more decent nation. ("Why We Reform," New York Times, 3/19/10)

Question: In what ways does or doesn't the new law make us "a better, fairer, more decent nation"?

Terry O'Neill, President, National Organization for Women
Forty percent of women have had or will have an abortion in their lifetime. It is a common medical procedure. It needs to be safe. It needs to be fully and equally accessible to all women. And what has been enshrined in this law is not so much the principle about whether federal dollars go to pay for abortion, what is really enshrined in this law is that ideology can trump health care needs of an entire class of people in this country. (www.pbs.org/moyers/journal 3/26/10)

Question: Does the new law enshrine the principle "that ideology can trump health care needs of an entire class of people in this country"?

Representative Steve King (R, IA)

Americans "must take their country back by methodically eliminating every vestige of creeping socialism, including socialized medicine." (quoted by Howard Fineman, Newsweek, 4/5/10)

A dictionary definition of "socialism"

1 : any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods
2 a : a system of society or group living in which there is no private property b : a system or condition of society in which the means of production are owned and controlled by the state
(www.merriam-webster.com/dictionary/socialism)

Question: Does the dictionary definition of socialism support Rep. King's view that the new law represents "socialized medicine"? Why or why not?

For writing

Below are three options:

1) Select one provision of the PPACA that you either approve or disapprove of. Then write a one-paragraph paper in which you provide a reasoned basis for your point of view.

2) Explain in a one-paragraph paper and with specific details how the PPACA will affect your life.

3) In an one-paragraph paper cite two or three specific items that would support one of the following:

a. David Leonhardt's statement that the health insurance law is "the federal government's biggest attack on economic inequality since inequality began rising more than three decades ago."

b. Sen. McConnell's view that the new legislation makes people's "lives more complicated, takes more out of their paychecks and puts decisions they are used to making themselves into the hands of federal bureaucrats."

c. Rose Ann DeMoro's view that the law "strengthens the economic and political power of a private insurance-based system based on profit rather than patient need."

This lesson was written for TeachableMoment.Org, a project of Morningside Center for Teaching Social Responsibility. We welcome your comments. Please email author Alan Shapiro at lnshapiro07@gmail.com.

Back to top