The former president Barack Obama signed the Patient Protection and Affordable Care Act into law on March 20, 2010. The legislation aimed at making all Americans insurable by making insurers to accept all applicants regardless of their health status. Before the legislation, Americans with pre-existing conditions could not access health care coverage. The act also expanded Medicaid’s coverage. Affordable Care Act (ACA) attracted a lot of controversy from the beginning, and it still is controversial because it affected various players in healthcare financing. ACA came with many benefits, particularly for those who do not have health insurance. ACA is not as extensive as universal coverage plans, but it has significantly increased the number of Americans with health coverage.
The American healthcare system is subject to constant criticism. The system is the most expensive in the world, and yet it has poor outcomes. Healthcare is quite costly in the US, and a substantial percentage of Americans, about 79 million did not have access to healthcare before ACA. Approximately 20% of Americans live below the poverty line, and a substantial percentage of individuals below the poverty line did not have insurance. States were in charge of coming up with their plans. Massachusetts pioneered a universal health care plan 2006, and by 2012 it had the lowest population of underinsured and uninsured in the US (Choksi, 2014). Texas had the worst rate, with 38% of the population lacking adequate health coverage. The northeast states had the lowest levels of coverage in comparison to the South and West states. Inadequate coverage also affected the middle class too with 28-31 percent of the middle-income population uninsured or underinsured in states such as Texas, Alaska, and Wyoming (Choksi, 2014). Lastly, another motivation for ACA was the need to curb rising healthcare costs in the US. Healthcare rose at an alarming rate whereby the average annual premium of 15% rose to 22% by 2012. The government had to step in to create a national health framework (Choksi, 2014). ACA was officially implemented in 2014, and it had an immediate significant effect. In 2014, there were over 44 million uninsured nonelderly Americans, and the number reduced to 27 million in 2016 (Amadeo, 2019).
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ACA pitted politicians against each other with Democrats supporting the bill and Republicans opposing it. The Republicans did not support ACA terming it as an ambitious plan by the government to use subsidies to ensure individuals who are not insurable. According to Republicans, 20% of people have the most expensive medical needs. Republicans are opposed to taxes on high incomes or plans such as universal healthcare that will result in more taxation. The source of funding was a 3.8% surtax on investment income, 0.9% surcharge for wages above $250K, taxes on drug companies, and taxes on health insurance company profits. Republicans were also against regulation of health insurance companies or the health sector in general. The Democrats justified the sources of income as necessary to ensure poor Americans have access to healthcare.
I believe that ACA is good legislation aimed at improving the state of healthcare in the US. By now, the law has touched millions of lives and made a real impact on the millions of families who could not afford insurance or were not eligible for Medicaid. ACA made it possible for people with pre-existing conditions to access insurance. Insurance companies denied coverage to people with diseases such as Type 1 diabetes, cancer, and high blood pressure (Hall & Lord, 2014). The insurers do not want to assume the high cost of covering patients, and the individuals have to pay the high costs of care on their own.
ACA is the only comprehensive health reform since the 1960s. ACA does not only expand health coverage for low-income families, but it also expanded Medicaid. Before ACA, many states did not give coverage to adults without children no matter how poor they are. Most states also covered patients if they had meager incomes. ACA set up the limit for health coverage such that most poor people would access health coverage. Many hardworking people in low-wage jobs such as waiters, sales clerks, cooks, and home health aides rely on Medicaid and ACA. Repealing ACA would deny healthcare to many workers in low job groups.
I support ACA not only because it increases coverage, but it regulates the cost of care in the US. It is undeniable that healthcare in the US is quite expensive because it does not prioritize preventative care. ACA required health plans to include cancer screenings, birth control, vaccine and blood pressure tests at no additional costs. In 2016, the cost of healthcare increased by 1.2% in comparison to the 4% increase in 2004 (Amadeo, 2019). ACA also covers addiction, mental health, and chronic diseases that were not included in the past with the aim of providing comprehensive healthcare services to Americans.
Opponents of ACA gave many reasons for not supporting the legislation. Some reasons are valid while others were politicized reasons that made no sense. ACA increased the cost of care in the short term because of the many provisions that were not there in the past, including preventative care and testing. Approximately 3-5 million people lost their employment-based health insurance because they found ACA expensive. Small businesses looked for other better plans through state-run exchanges. Insurance companies canceled many insurance plans that did not include ACA’s ten essential benefits. The main reason for contention emanated from the increase in taxes to cover the costs of ACA. ACA led to the rise in income tax from for 1 million individuals with income over $200,000 and 4 million couples filing joint returns for over $250,000 (Choksi, 2014). Their taxes were increased from 1.45% to 2.35%. An additional 3.8% Medicare tax was imposed for lesser of income from dividends, capital gains, rent, and royalties.
Opponents and other policymakers suggested alternatives and modifications to ACA. One option was to modify Medicaid expansion to increase coverage. Medicaid is an existing plan that has been in use for many years; the government could expand Medicaid and Medicare instead of introducing a new and costly program. A controversial part of ACA is the individual mandate. The individual mandate has been termed as counterproductive as it limits the patient’s ability to choose healthcare needs that best fit personal needs.
The politicization of the ACA shows one of the main challenges that affect the legislative process in the US. Healthcare is a heavily politicized topic even after extensive consultations involving individuals in the healthcare sector. Politicians supporting ACA talked about the benefits of ACA, while the opponents focused on the cons. Obamacare was so politicized such that it became difficult to differentiate the facts from the false information. Some of the false information was that ACA was going to increase costs of care for everyone and it will result in a higher premium. Other opponents argued that ACA is socialized medicine like the one in Canada or the UK.
Healthcare has become a political issue in America like immigration, LGBTQ, and climate change. Democrats and Republicans have adopted a polarized approach to the issue such that it is hard for them to agree on the best healthcare system that works for all Americans. ACA was created with the best intention of ensuring the underinsured and uninsured Americans accessed healthcare. ACA was politicized such that it became a battle between Republicans and Democrats. Instead of suggesting better alternatives and modifications to ACA, Republicans resorted to scaring people with misinformation while some Democrats overemphasized the benefits rather than working on the shortcomings of ACA. ACA became a partisan issue rather than a human issue. It was a litmus test for party affiliation, and its passage relied on a technical provision rather than support from Democrats and Republicans.
In conclusion, the reality remains that the US healthcare system is broken. ACA was the first step in overhauling the system, and it came with many benefits. ACA made healthcare to many Americans who could not afford insurance. ACA also made it possible for Americans with preexisting conditions to access care. Even with the passage of ACA in 2010, many Americans lack insurance or are underinsured. ACA is a good policy, and it should be used as the foundation for health reform in the US.
References
Amadeo, K. (2019, March. 4). What Is Obamacare? The ACA and What You Need to Know. The Balance. Retrieved from: https://www.thebalance.com/what-is-obamacare-the-aca- and-what-you-need-to-know-3306065
Choksi, N. (2014, March. 26). Historians take note: What America looked like before Obamacare. Washington Post. Retrieved from: https://www.washingtonpost.com/blogs/govbeat/wp/2014/03/26/historians-take-note- what-america-looked-like-before-obamacare/?noredirect=on&utm_term=.f76eee98ccd7
Hall, M. A., & Lord, R. (2014). Obamacare: what the Affordable Care Act means for patients and physicians. Bmj , 349 , g5376.
