An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

For example, the ACA barred insurers from denying insurance or treatment to people with preexisting conditions. Before the ACA, insurers had lowered the bar for their definition of “preexisting condition” to include a distant abnormal pap smear, a history of occasional allergic asthma, or the use of an antidepressant. The ACA banned lifetime limits on insurance payouts, which had been potentially deadly for patients with chronic illness. Its policies capped annual out-of-pocket spending per person (at $6,850 in 2016) as long as the patient stayed in network, in an effort to avoid the extreme duress of bankruptcy. It defined a list of “essential health benefits” that every insurance policy had to cover, including maternity care—which many policies had previously excluded—and the provision of free screening for certain conditions. The ACA did little directly, however, to control runaway spending. President Obama had initially included several ideas in the bill that would have done so—like national negotiation for pharmaceutical prices. To get a healthcare bill passed and to win support from powerful groups like PhRMA, the AMA, the American Hospital Association, and America’s Health Insurance Plans, the administration had to cave on anything that would directly limit the industry’s ability to profit. Given those political constraints, the ACA promoted some programs that might render the practice of medicine more cost-effective. It used financial incentives to encourage the fo...