Last week’s announcement of Tom Price as Secretary for Health and Human Services was eclipsed by several things, including tweets about flag burning, SNL, and canceling an order for a new Air Force One. This stream of tweets, unfortunately, serves as a distraction from much more important issues. (Both CNN and The New York Times featured the Air Force One tweet at the top of their respective websites.)

The Department of Health and Human Services is a big deal, and it affects everybody. Of the federal government’s budget of approximately $4 trillion, the Department of Health and Human Services’ budget is 1/4 of that. Written out, that’s $1,000,000,000,000, or the red slice of the pie below.

DHHS Budget.png
United States Federal Budget is the entire pie; the budget share of Health and Human Services ($1 trillion) shown in red. Four and a half of these pies would make the entire US GDP.

Tom Price has a very clear stance on the Affordable Care Act (ACA): repeal it. There is some talk currently of repealing it and replacing later, say, after the 2018 mid-term elections.

We, as citizens, have a responsibility to understand these issues, and so we need to understand the basic structure of the ACA. There are three core items:

  1. No exclusions: Coverage for people with pre-existing conditions
  2. Universal Participation: A mandate to require all people to have health insurance
  3. Subsidies: Assistance to help the poor buy insurance

This is pictured as a three-legged stool; removal of any one “leg” would lead to collapse of the stool.

The three “legs” of the Affordable Care Act. Each is necessary. Everyone likes “No exclusions”. The other two have been fought all the way to the Supreme Court.

Components of the Affordable Care Act remain popular, like the provision for people with pre-existing medical conditions to be able to buy insurance.

The other components have been fought in the Supreme Court, notably the “mandate” and the technical question of whether subsidies are allowed in states that declined to set up their own health insurance exchanges. (Easily readable summary here.)

The basic tension here is one between government and the private sector. The argument centers on whether the Affordable Care Act, through its three components, makes health care more accessible and affordable, or whether the government should depend on free market forces of the private sector to do the job through “choice and competition“.

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