What Does the Affordable Care Act Do?

This blog is usually a venue for my academic writing, but I feel the need to break from that vein a little bit. Today's political climate is rather heated, and with the election nearing in November, political rhetoric begins to be thrown around with increased passion and decreased logic or original thought. Therefore, I feel it necessary to point out that there is more to the Affordable Care Act (deemed by some as Obamacare) than just the individual mandate that has bred a political firestorm for the past three years. Many of the facets of the act have already gone into practice, while others will not do so until 2014.

I do not intend this to be a partisan-fused piece, and most of the information is from healthcare.gov. Take it for what you wish, and please do not use the comments below simply to bash others and their beliefs or actions. Debate is welcome, as long as you keep it civil.

Implemented as of 2010

• No lifetime coverage benefit limits can be placed on an individual.
• Children can not be denied coverage due to a preexisting condition.
• Preventative care coverage is expanded for many, eliminating co-pays for check-ups, mammograms, and colonoscopies (continued into 2011).
• Young adults can remain on their parents' insurance until they are 26 years of age, regardless of marital status.
• Seniors may receive expanded coverage for name-brand prescriptions, previously found in the "doughnut hole" of coverage.
• Tax credits are available to small business owners for making health care coverage available (credits % set to increase in 2014). 
• States are allowed to create their own Preexisting Condition Insurance Plan to provide an affordable plan for those who fall under this category. If they choose not to do so, the US Dept. of Health and Human Services will do so.
• Insurance companies cannot rescind coverage to a sick individual based on a mistake made in the application process.
• Blockers placed to begin eliminating annual limits to coverage benefits (completed in 2014).
• Insurance companies are barred from hiking premium rates by more than 10% (new appeals procedures have also been put into place, both in the private and public spheres).
• New incentives established to draw new doctors into primary care spheres, as well as incentives for those practicing.

Implemented as of 2011

• Prices for preventative care coverage are dropped, to zero for many.
• Funding to build/expand community health care facilities.
• A greater portion of insurance premiums are required to be spent on health care coverage (80% for small group plans, 85% for large group plans).
• Medicare recipients who are considered high-risk receive opportunities for greater coordinated care to avoid unnecessary readmission.
• An advisory board was created to ascertain how to extend the life of, lower the cost of, and increase the health care for Medicare.
• Cheaper options for at-home visiting care as an option to resident nursing homes.

Implemented as of 2012

• Data will be collected of overall quality of health among different groups to assess racial/ethnic disparities.
• Efforts being made to transition toward electronic record keeping and management to cut down on costs.

Implemented as of 2014

• Tax credits for small business owners offering health benefits increase.
• Affordable Insurance Exchanges will be established at the state level, providing a venue for individuals to compare private and public options together.
• Annual limits of coverage benefits abolished.
• Individuals will be able to apply their employer's premium match rate to whichever insurance coverage they choose to use.
• Tax credits applied to individuals for those who qualify, can be applied monthly rather than yearly.
• Coverage cannot be refused based on a preexisting condition.
• Coverage cannot be refused, and rates cannot be hiked on account of gender.

and...

• The dreaded individual mandate, referred to as the requirement for individual responsibility of coverage for all those who can afford it. If they do not, they will be required to pay a fee. "If affordable coverage is not available to an individual, he or she will be eligible for an exemption."

As I mentioned before, this is meant as a brief overview of what has been, and what will be implemented as a result of the Affordable Care Act, not as a partisan plea for one side or the other. In order to make an informed decision, one must seek out the information (of which I can only impart some). Please, any thoughts, comparisons, additions or omissions are welcome.

The Marketplace of Revolution: How Consumer Politics Shaped American Independence

Reviewed by Stephen Horrocks

The American Revolution burned with ideological fervor.  Political rhetoric was filled with cries for freedom, liberty and equality.  Why did these ideas stick?  What turned these ideas into action?  In The Marketplace of Revolution: How Consumer Politics Shaped American Independence, T.H. Breen attempts to assess popular mobilization, and what was so radical about the politics of the American Revolution, from a new perspective.  This perspective, he admits, may not fit very well with some of the analyses previously presented of the period. 

Marketplace attempts to answer two main questions.  First, how did such a diverse group of colonists build the trust necessary for a sustained rebellion?  Second, how did such a massive number of ordinary Americans decide it was better to risk their lives and well-being against British forces than continue to be politically oppressed?[1]  Breen concludes that the colonists’ “shared experience as consumers provided them with the cultural resources needed to develop a bold new form of political protest.”[2]  Their common role as consumers in a commercial empire would provide the link for an otherwise heterogeneous group of colonies. 

            Breen begins by presenting the context in which the consumer revolution will take place.  In what he refers to as the “Tale of the Hospitable Consumer,” Breen paints a picture of unprecedented colonial consumption.[3]  When the British military officers were stationed in the colonies during the Seven Years War, they saw evidence of high consumption and “that the colonies [were] wallowing in wealth and luxury,” which they equated to a thriving economy.[4] In fact, the colonial economy was artificially inflated by the heavy British military presence.  As a result of these erroneous observations, Parliament decided to raise taxes in the American colonies in an effort to pay off war debt.  Colonists were outraged and began to respond ideologically and politically.[5]

To establish the foundation of his argument, Breen lays out the various forms of primary sources important to understanding patterns of consumer behavior.  First, Breen looks at written descriptions by travelers and government officials.  These are very helpful, because they are very widespread.  The downside is that they are very impressionistic.[6]  Second, he turns to artifacts, primarily those found in museums.  These show the importance of British manufactures, though museums tend to have items owned by the upper-classmen of society.[7]  Third, Breen archaeologically studied the family trash pits of the common people.  These pits, while showing the consumption of hard goods by those in the lower end of society, tend to show an imbalance.  Items such as cloth and pewter would be long gone by now.[8]  Fourth, probate records of deceased individuals show an increase in ownership.  They do, however, tend to skew toward the upper-classmen.[9]  Fifth, and most important, are the customs records.  These official documents measure the quantity and monetary value of articles imported from Britain.[10]  Last, Breen studied the increased number of newspapers during the decades preceding the revolution.  An increase in ad space and a diversity of goods are widely displayed therein.[11]

These sources collaborate in Breen’s attempt to recreate the world in which the colonists lived.  In an address to Parliament in March 1775, Edmund Burke described British policies in the American colonies as “salutary neglect.”  He felt that commerce brought Americans closer to the mother country.  It placed the colonies in a state of political and economic laissez-faire.[12]  Commerce is definitely what connected the empire, but the “mutual benefit [and] mutual dependence” that Americans had relied on became nothing more than myth.[13]  An articulate and powerful middle class emerged, which saw consumption as a seal of imperial patriotism.  Colonists thought they were indispensible to the empire, and that disruption of consumption would discomfort the mother country.[14] 

Consumption of British goods could only be used as a tool for political mobilization if consumer products were widely available at all levels of society.  Breen answers this concern by thoroughly outlining the means by which consumer products reached the colonies.  He discussed the large merchant ships that sold to shop owners in port cities.  Local shop owners sold to small rural country stores, which were of particular importance because of the agrarian nature of the colonies.[15]  This shows that ordinary people were involved in the marketplace.  Consumer choice became synonymous with human rights; individuals felt entitled.  Fashion played a large role in driving consumption and blurred the lines between classes.  Tea was an especially fashionable and powerful example of the link between identity and market experience.  Breen quotes one New Yorker as saying that tea costs the province 10,000 pounds sterling, and that he knows some people who would forgo their bread to partake of this superfluity.[16]  Such imported goods became a source of political tension.

Next, Breen describes how economic dependence could become a source of political strength.  Ideology is not enough to build the widespread trust necessary for a sustained political resistance or produce the feelings of a common purpose.  According to Breen, “colonists could not have imagined national independence until they had first experienced the psychological burden of dependence.”[17]  In the minds of colonist, consumer excess led not only to dependence, but also to slavery.  Colonists did not want to be Britain’s “negroes,” as a young John Adams stated.[18]  Individual luxury must be sacrificed for the good of the whole.  New regulatory acts by Parliament incited anger, confusion, and disappointment.  Up to this point colonists had not built many bonds of mutual trust, so regulatory acts by Parliament led to many individual acts of non-importation throughout the colonies.  Newspapers connected the colonies and attempted to build trust while putting political pressure on Parliament.  Though these non-importation acts did not force any policy changes, they did help the colonists find means of popular mobilization that were more broad and inclusive.[19]

Colonists, as consumers, became more and more tense as the Townshend Act was passed in Parliament, tightening up commercial regulation in the colonies.  Non-importation became non-consumption, and communities began to make lists of items that were prohibited.  Anyone who betrayed these agreements were publicly shamed and added to lists of offenders published in the newspapers.  This revealed a lot about political solidarity on the eve of the Revolution.  Colonists communicated with each other through newspapers to see how others were responding to the common threat.  They assumed that these distant strangers depended on British goods as much as they did.  They could also see the link between consumption and liberty.[20]  The Townshend Act reminded Colonists of the yoke of dependence.  They were faced with the major difficulties of coordinating local protests and persuading all sorts of people to participate in the boycott.  Colonists were required to look at themselves in much broader terms than they had before: as Americans.[21] 

Ordinary people signed petition rolls and subscription lists, both highly innovative political instruments, in support of the boycott, which gave them the feeling that they had the power to make a difference in society.  When the Townshend Act was repealed, excepting the regulation on tea, much of the political trust between colonies dissolved.  It is, however, very important to note the way in which Americans used a language of unity to refer to a country that was not yet a country.[22]

According to Breen, Americans drew upon their experience as consumers to use their dependence upon British products as a political weapon to fight the Tea Act of 1773.[23]  Following the protests against tea (which included the Boston Tea Party and burning of the tea colonists possessed) Parliament passed the Intolerable Acts, which effectively shut down the Massachusetts Bay colony.  Other colonies stood behind Boston and implemented bans on all British imports.  This took place because the colonies began to think continentally.  They had experienced effective consumer protests and began to define themselves not as British, but as American. [24]

Breen analyzes the evidence very thoroughly.  He uses a broad view of colonial consumerism to conceptualize the major workings of the system, while acknowledging the smaller, individual pieces that fill in the blanks.  His analysis of how colonists built trust one with another is very logical and historically sound.  Breen uses a variety of sources, so that they fill the voids that are left by each other.  He utilizes the evidence well to support his claim that colonists were all separately, as well as collectively, invested in consumerism.

The Marketplace of Revolution takes an original perspective at the events leading up to the American Revolution.  It does not downplay the importance of ideology to the revolution, but it puts ideology into a socio-economic context.  Bernard Bailyn, a two-time Pulitzer winning historian, touches upon this context to a smaller degree.  He claims that ideology was reinforced once the invisible authority across the Atlantic began tightening the reins on the Colonial economy.[25]  Bailyn claims that ideas were the central force for revolution, and the economy was but a secondary influence.  Gary Nash, distinguished professor at UCLA, agrees with Breen’s economic-centered argument.  Nash noted that Per capita spending among the poor more than doubled in the 1740s and 1750s.[26]  He saw that economic frustrations of lower- and middle-classmen developed a political consciousness and political sophistication that led to public protests, and eventually played an important role in the beginnings of the American Revolution.[27]  Nash focused on consumption only as much as it led to economic distress, not as a driving force of revolution.  Breen pulls in parts of both Nash’s and Bailyn’s arguments to strengthen the notion that consumerism played a major role in American Independence.

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[1] T. H. Breen, The Marketplace of Revolution: How Consumer Politics Shaped American Independence (New York: Oxford, 2004) xiii.

[2] T. H. Breen, Marketplace, xv.

[3] T. H. Breen, Marketplace, 10-11.

[4] T. H. Breen, Marketplace, 11.

[5] T. H. Breen, Marketplace, 1-29.

[6] T. H. Breen, Marketplace, 36-44.

[7] T. H. Breen, Marketplace, 44-48.

[8] T. H. Breen, Marketplace, 48-51.

[9] T. H. Breen, Marketplace, 51-53.

[10]T. H. Breen, Marketplace, 59-64.

[11] T. H. Breen, Marketplace, 53-59.

[12] T. H. Breen, Marketplace, 75.

[13] T. H Breen, Marketplace, 89.

[14] T. H. Breen, Marketplace, 72-101.

[15] T. H. Breen, Marketplace, 102-147.

[16] T. H. Breen, Marketplace, 171.

[17] T. H. Breen, Marketplace, 201.

[18] T. H. Breen, Marketplace, 202.

[19] T. H. Breen, Marketplace, 203-234.

[20] T. H. Breen, Marketplace, 237-38.

[21] T. H. Breen, Marketplace, 243.

[22] T. H. Breen, Marketplace, 290-91.

[23] T. H. Breen, Marketplace, 298.

[24] T.H. Breen, Marketplace, 303.

[25] Bernard Bailyn, “The Central Themes of the American Revolution,” in Faces of Revolution (New York: Knopf, 1990) 204-05.

[26] Gary Nash, “Social Change and the Growth of Prerevolutionary Urban Radicalism,” in The American Revolution, ed. Alfred Young (Northern Illinois University, 1976) 8-10.

[27] Nash, “Social Change,” 10-11, 18.