In January 1 2014: US health reform's Gettysburg moment, a veteran of decades-long battles over health care policy sees a parallel between the Union Army's victory at Gettysburg in 1863 and today, which he calls
the most transformational day in the history of United States health care policy, ever....the first day of fundamental reform of the business and regulation of health insurance in all 50 states.
In his article,
John E. McDonough, a professor at the Harvard School of Public Health and the author of
Inside National Health Reform, lists these accomplishments of The Patient Protection and Affordable Care Act (PPACA), which was signed into law by Barack Obama on March 23, 2010:
Banning the practice of "medical underwriting" by which insurance companies rate enrollees based on their health status and medical history,
Banning pre-existing condition exclusions from US health insurance everywhere,
Establishing "guaranteed issue" as the new operating paradigm for individual health insurance,
Completely eliminating lifetime limits on all health insurance, and
Establishing "minimum essential benefits" that must be included in nearly all licensed health insurance policies everywhere.
In addition, McDonough highlights Medicaid coverage beginning today for five million previously uninsured low-income people, "with many more millions to follow"; private health insurance coverage obtained through federal and state exchanges and starting today; and the principle of personal responsibility to obtain health insurance - the individual mandate. Although the July 1, 1966 beginning of Medicare was another historic date in health care policy, McDonough says "the scope and breadth of changes" beginning today are "far more consequential by comparison."
Regarding the Battle of Gettysburg analogy, McDonough compares the Republican 17-day shutdown of the federal government on October 1 to Picketts Charge on July 3, 1863, "the final and failed Confederate assault at Gettysburg." And just as the Civil War did not end for almost two years after Gettysburg, so the Republican war against the ACA will continue but "the ultimate outcome is no longer in doubt."
McDonough concludes:
The overriding importance of 1/1/2014 is the actualization of a new principle of health justice for all Americans, however flawed that principle is in form and in practice under the ACA. That principle now is here to stay.
I strongly recommend McDonough's book
Inside National Health Reform, with its fascinating details about the ten titles of the ACA and the many people who fought to include them in the law:
Title I. Quality, Affordable Health Care for All Americans
Title II. The Role of Public Programs
Title III. Improving the Quality and Efficiency of Health Care
Title IV. Prevention of Chronic Disease and Improving Public Health
Title V. Health Care Workforce
Title VI. Transparency and Program Integrity
Title VII. Improving Access to Innovative Medical Therapies
Title VIII. Community Living Assistance Services and Supports Act (CLASS Act)
Title IX. Revenue Provisions
Title X. Reauthorization of the Indian Health Care Improvement Act
You can also find a brief outline of each title here and then read the law section by section.