My younger daughter was our family's first beneficiary of the Affordable Care Act (ACA), gaining several extra years eligibility on her Mom's employer group health insurance. But I wanted to make sure my other daughter met the pre-Christmas, December 23rd ACA enrollment deadline (also her birthday). In 2014, she will work part time as a teacher in a magnet school after-care program while completing a masters thesis based upon a study of that same magnet school and also student teaching there. Her 2014 income will be very small. Her graduate school required her to have health insurance at $500/semester if she didn't have other coverage, a cost of $1000 for part of the year for a student group health plan with high deductibles and co-pays, i.e. almost junk insurance. That extra cost would have inflated her student loan.
Although she lives in a huge state, thanks to Rick Perry and his ilk, she has no access to a state exchange. No biggie. Healthcare.gov worked great. Fortunately, she qualified for ACA subsidy credits. In the end, she opted for a BC/BS silver HMO at net cost to her of less than $50/month, something she can manage on her income. She even had access to decent insurance at pennies per month after subsidy. And she smokes, the idiot (like I once did).
The ACA is a groundbreaking change in American healthcare. No doubt, there are yet more groundbreaking things to be done in this arena. That takes nothing away from the importance of what the ACA does. The Affordable Care Act places federal regulatory control in place for health insurance. Before the ACA, the federal role in insurance regulation was mostly summed up by "hands off". From the beginning of the Republic through FDR, the insurance industry had always claimed and received immunity from federal regulation claiming that the "business of insurance" was not involved in interstate commerce. The insurance business was regulated state by state, and that was that. Then, in 1944, the Supreme Court jerked out the rug, finding that an insurance company operating on an interstate basis could be subject to federal antitrust law. Congress immediately folded to States Rights squeals and nationwide demands that only States should regulate the business of insurance, you know, like always. So, in 1945 the McCarren-Ferguson Act reaffirmed the independent role of the several States in oversight of insurance. Insofar as the business of insurance, insurance legislation, registration, observation, investigation and regulation fell almost completely off the federal government's radar. For generations, until the ACA, that's how it stayed.
Under the ACA all of that changes for health insurance, which becomes regularized, more available, simplified, easier to shop for, fairer, more affordable and widely subsidized. It's not what I wanted. It's not the best America can do, but I still say WOW. And, for the sake of my daughters, I say thank you for the good that a Democratic Congress and Democratic President can do.