By skyforbes 
I still scratch my head about the CLASS Plan portion of the Affordable Care Act. The Community Living Assistance Services and Supports (CLASS) Plan was designed to solve long term services and supports. Don’t worry. Nothing happened. It was really just a congressional accounting tool used to collect premiums for years before any benefits had to be paid out. They cut that portion of the legislation from the law before it was implemented. Just like they did with most of the other ACA revenue side requirements. Yet somehow the ACA was scored and passed as revenue neutral even though it changed the way we do business around healthcare, built an exchange framework out of thin air, and advanced legal arguments that are in front of the Supreme Court — again.
Some good things are addressed in the ACA legislation. I worked somewhere where each Monday morning for a long time, I received detailed briefings on the 2,000-page legislation. Experts would summarize relevant parts of the legislation. It was my job to go out and educate clients about how these legislative dicta would change their business. There were just too many details to absorb without outside assistance. The whole industry was on its heels. Employers. Providers. Business. People who should have been making plans were sitting on their hands. What else could they do? Would you get in a car and start driving when the destination was yet to be known? I wouldn’t either. Things slow down until more clarity arrives. Welcome to a hockey stick shaped recovery. Considering the ACA primarily impacted insurance coverage, it is really an indirect piece of healthcare legislation. It did not magically create more doctors who accept Medicaid. Certainly not more dentists who do. Why should providers accept Medicaid when it pays approximately $0.80 of the dollar? The costs of Medicaid are subsidized by other insured individuals (namely employer based and Medicare).
During the ACA debates, there was a moment when Congress realized it might fall under the rules of the ACA and members would need to seek the coverage provided through exchange-based plans. A last-minute deal was brokered to save the staff of the congressional teams. Their concerns centered around retaining prized staff with meager benefits. Another example of the “do as I say, not as I do” ruling class. “Medicaid for all” has never been their rallying cry. Why should it be? Expand Medicaid. Sure. But for them over there. Those people. Not us. Not insiders who know how to shop for healthcare and leverage the system for our own gain. My counsel to everyone who thinks universal healthcare is the way forward and to all those who see the ACA as a glass half full, encourage your state legislators to sign up for Medicaid. Let them find a doctor who takes it. Let them have the ‘patient experience’ they themselves recommend. That’s the fastest way to truly improve healthcare in this country. Let them argue with the managed Medicaid pharmacy benefit manager about why they need a prescription filled before the next allotted timeframe. Let them carve out time and energy to covert ‘benefits’ into ‘services.’ Things will change only after they come to understand firsthand the level of service they are suggesting for others. Expand Medicaid. To the NC General Assembly.
In closing, let’s talk about one final signature piece of the ACA legislation. It allows children to stay on their parent’s coverage until they turn 26. It’s been a great feature for us. All four of our kids have benefited from this policy change because we enjoy employer-based coverage. Congress passed laws the private sector could absorb. Did you ever wonder how the children of Medicaid parents fared under this same provision? Is a Medicaid mother able to maintain health insurance coverage for her children after they turned 18? If not, why not? Talk about systemic racism. The private sector can be legislated but the public center benefits need not be adjusted even by landmark legislation. One aimed at expanding Medicaid coverage. Inequity exists and is enabled under the ACA. Medicaid should be expanded to include all of the state legislators who advocate for Medicaid expansion within their states. Show some leadership. After that, perhaps you will be able to help solve how pre-retirees can buy reasonable health insurance coverage until we qualify for Medicare.