Attacks on the Affordable Care Act are remarkably ill-informed

A recent letter from a reader ("Obamacare won't be missed," Jan. 7) exemplifies the disinformation that is so prevalent among opponents of the Affordable Care Act.

The writer asserts that the ACA was passed with little knowledge of its contents based on an out-of-context 2010 statement from Nancy Pelosi that the bill had to be passed to find out what was in it. Perhaps we need to get rid of it, he suggests, to see if there is anything within it worth salvaging.

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When House Speaker Pelosi made that statement in March 2010, she was lamenting the fact that the public was notably unaware of the actual contents of the bill and what it would do for the American people amid all the coverage of contention and process rather than substance. Her statement reflected the hope that this information would become more widely known upon passage of the bill.

As others have reported recently, the ACA was the subject of many hearings and votes before final passage, having worked through Congress for a year. Multiple committees reviewed and passed it. It passed in two full votes in the House of Representatives and one vote in the Senate, and it was evaluated by the Congressional Budget Office.

And yet, incredibly, this writer appears to be totally ignorant of the ACA's workings and its impact upon the public even three years into its full implementation. Certainly, he must be aware that the ACA made it possible for those with a pre-existing condition (which includes me) to be able to obtain health insurance in the individual market. And he must know that the ACA made it possible for those 26 and under (including my daughter) to remain covered under their parents' health insurance until they are able to obtain their own.

But there are other elements of the law that have positively impacted health care delivery for everyone, not just the 20 million people who gained coverage under the ACA. These include spurring innovation in health care delivery and payment models to improve health outcomes and keep costs under control. Indeed, the CBO projected last August that 2016 federal health care spending would be $120 billion less than they had projected for the same period in August 2010. The CBO projects $34 billion in federal spending savings over the next 10 years from the activities of the Center for Medicare and Medicaid Innovation alone.

Some of this projected spending reduction may be due to Congress' failure to appropriate funds under the act intended to mitigate the risks insurers took upon entering the new exchange markets. This is one of the factors behind the recent exit of some insurers from the exchanges and the large increase in 2017 premiums. Enrollment in 2017 exchange plans increased, however, despite these premium increases, underscoring how important this insurance coverage is to those who have it.

The positive impact of the ACA on millions of Americans is no mystery; nor is there any mystery as to what can be improved in it. For instance, premiums have risen recently because many healthy people have chosen to pay a tax penalty rather than obtain health insurance. They still benefit from the pre-existing conditions provisions if they later become ill and need insurance. The penalty should be increased so that it is cheaper to sign up for insurance than pay the penalty, which should reduce premiums.

Some object to being forced to buy insurance. But they don't complain when the federal government steps in to help them when a tornado or hurricane or flood or earthquake strikes. All Americans pay for that "insurance" through taxes because we all know that it could be us in need one day. The same principle applies to health care.

Sanford M. Goodman, Baltimore

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