Historical Overview
Healthcare is among the most expensive services in America, hindering its citizens from accessing appropriate medical care. The introduction of the Affordable Care Act 2010 was a relief for many Americans, especially uninsured citizens, allowing them to access medical care. President Barack Obama signed the Affordable Care Act (ACA) into law on March 23, 2010 (Serakos & Wolfe, 2016). For this, the law was also known as Obamacare. ACA's main purpose was to expand health care coverage to Americans. Millions of Americans could not access healthcare services since they lack insurance covers and high medical costs. Thus, the ACA acted as a green light, extending American's access to medical care. The legislation's other purposes were to control healthcare costs and bolster the quality of the healthcare system.
The Obamacare Act had a significant impact on society to reduce health disparities by expanding healthcare coverage to millions of Americans. Obamacare had significant values that strengthened its initiative. Firstly, it extended dependent coverage to 26 years for all American citizens (Serakos & Wolfe, 2016; Garrett & Gangopadhyaya, 2016). For this, young adults could be covered under their parent's healthcare plans. Secondly, Obamacare opened opportunities for individuals with preexisting conditions to acquire health insurance and access medical care (Garrett & Gangopadhyaya, 2016). Besides, Obamacare prohibited lifetime limits on health coverage, allowing Americans to spend their benefits on medical care without hindrance (Garrett & Gangopadhyaya, 2016).
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States expanded Medicaid coverage to citizens under the age of 65 as the Obamacare act stipulated it. Additionally, it required that states expand Medicaid insurance below 133% of the federal poverty level (Serakos & Wolfe, 2016; Garrett & Gangopadhyaya, 2016). The U.S. Supreme court made these provisions optional for states to implement in 2012. For this, 32 states and the District of Columbia extended Medicaid insurance to low-income citizens, expanding healthcare access (Garrett & Gangopadhyaya, 2016). Studies show that around 1.4 million to 2.1 million young adults benefited from ACA in 2011 (Serakos & Wolfe, 2016). Besides, the population of uninsured Americans decreased, allowing more people to access healthcare services. The population of uninsured adults between the ages 19 to 34 decreased by 8.7 million (42%) (Garrett & Gangopadhyaya, 2016). Obamacare also opened opportunities in maternity services, enabling pregnant women to obtain services before, during, and after pregnancy, including coverage for their infants. Thus, Obamacare played a substantial role in improving healthcare, allowing Americans of different ethnicities to obtain medical care without health insurance coverage.
Target Population and Eligibility
ACA subsidies were eligible to only U.S. citizens and legal residents. Citizens from other nationalities could not apply to the legislation; hence, they were required to acquire private insurance. ACA targeted individuals below the age of 65 and aimed to extend health coverage to uninsured adults. It also targeted low-income citizens below 133% of the federal poverty level (FPL) (Serakos & Wolfe, 2016). Individuals earning less than 400% income were eligible for ACA subsidies. Obamacare enabled young adults aged 26 and below to be covered under their parent's health plans (Serakos & Wolfe, 2016). For this, young adults could obtain medical care under their parent's health plans even if they did not stay with them or were financially dependent on them. Besides, married young adults were eligible for Obamacare since they were covered under their parent's plans (Serakos & Wolfe, 2016). Additionally, young adults who enrolled in schools or those eligible for their employer's plan were allowed to access healthcare services under their parent's health plans. Obamacare enabled individuals with preexisting conditions to acquire health coverage and access medical services.
Individuals are eligible for Obamacare subsidies based on their annual income. This means that American citizens are covered by their health plans but not on their income. Individuals earning more than 400% of the federal poverty level must pay back all subsidies to their monthly health insurance premiums (Garrett & Gangopadhyaya, 2016). However, individuals that earn less income annually are eligible for additional subsidy assistance. Such individuals can apply for assistance when filing annual taxes. Obamacare also provided maternity and newborn care. It stipulated that individual and small employer insurance plans must cover maternity and newborn care (Garrett & Gangopadhyaya, 2016). This was eligible before and after the baby was born. Obamacare advocated for preventive care services like preconception, prenatal care, newborn checkups, counseling, and screening tests (Garret & Gangopadhyaya, 2016).
Obamacare is not eligible for individuals who are currently incarcerated since the law requires correctional facilities to provide medical care to prisoners. Obamacare is also not eligible to individuals who are not citizens of America. Such individuals can acquire Medicaid coverage only if they meet state income and residency rules (Serakos & Wofle, 2016). American citizens earning more than 400% cannot qualify for Obamacare subsidies since they are above the federal poverty level. However, the federal poverty level also depends on the household size. Tax filers are allowed to include dependent children under their household to be eligible parental health plans (Garrett & Gangopadhyaya, 2016). If the household's total income is above the federal poverty level, then the individuals in the house are not eligible.
Similar Global Social Welfare: Canada Medicare (Public Health Insurance)
The Canadian Medicare, commonly known as the Public Health Insurance, is a decentralized, universal, and publicly funded health system that seeks to improve Canada's healthcare services (Tikkanen et al., 2020). Canadian citizens can obtain health services through the country's 13 provinces and territories (Tikkanen et al., 2020). The federal government funds the 13 provinces and territories on a per-capita basis (Tikkanen et al., 2020). Canadian Medicare allows citizens and permanent residents to obtain hospital and physician services free of charge. Canadian Medicare also facilitates care based on special needs to disabled individuals, the elderly, and children. The federal government allows every province to stipulate its residency requirements (Tikkanen et al., 2020). It also offers additional healthcare benefits to veterans, inmates in federal jails, Canadian forces, and the police (Tikkanen et al., 2020). Canadian Medicare does not cover undocumented immigrants and those illegally within Canada's territory. A majority of Canadians all have private health insurance that covers extra services that are not covered under universal health coverage. Services that are not covered under Canada's public health insurance include drug rehabilitation, vision, and dental care, acquisition of private hospital rooms, and outpatient drug prescriptions. However, Canada's Public Health Insurance covers every citizen in Canada, while private coverage accounts for 67% of the population (Tikkanen et al., 2020). Canada's Public Health Insurance does not allow cost-sharing or patients paying health costs from their pockets. Also, it protects citizens from being charged fees above the exact healthcare cost. Most private health insurance coverage is mostly for-profit. Canada's Public Health Insurance requires that Canadian provinces and territories provide healthcare coverage to their citizens based on their residency requirements (Tikkanen et al., 2020). However, Canada's healthcare laws suggest that undocumented immigrants, temporary legal visitors, illegal immigrants, and individuals within Canada past their duration, as stated in the legal permit, cannot obtain Public Health Insurance coverage (Tikkanen et al., 2020). Canada's Public Health Insurance also provides maternity services, allowing midwives to attend to pregnant women and their infants (Tikkanen et al., 2020).
Comparison between the Affordable Care Act 2010 and the Canadian Medicare
The similarity between ACA and Canadian Medicare is that both healthcare systems seek to improve medical care services, reduce healthcare expenses and reduce health disparities. Both ACA and Canadian Medicare are eligible to citizens or permanent residents. ACA and Canadian Medicare does not cover illegal immigrants and undocumented foreigners. ACA and Canadian Medicare receive funds from their federal governments, facilitating healthcare services. However, Canadian Medicare covers every citizen irrespective of age, unlike ACA, which focuses on individuals below age 65. Canadian Medicare covers prisoners in federal prisons, while ACA does not cover incarcerated individuals. Canadian Medicare covers every citizen regardless of their annual earnings. In contrast, Obamacare focused on providing healthcare services to low-income individuals. American citizens with annual income below 400% living under the federal poverty level are eligible the Obamacare. Canadian provinces have personal residency requirements stipulating the eligibility of Medicare. Similarly, the U.S. Supreme court rendered optional the Obamacare provisions of expanding Medicare below 133% (Garrett & Gangopadhyaya, 2016). From this, states could decide whether or not to implement the Obamacare provisions to boost health.
ACA and Canadian Medicare have similar policies to facilitate care for individuals requiring special needs. Notably, Canadian Medicare covers the elderly, veterans, and children, who mostly require special needs (Tikkanen et al., 2020). On the other hand, ACA covers pregnant women, infants, and special children. Pregnant women benefit from ACA coverages by enabling healthcare institutions to provide free preventive care and checkups to women. These services are provided to women before, during, and after pregnancy. Similarly, Canada's Public Health Insurance covers maternity services, although it does not stipulate how long services can last for pregnant women. Obamacare enables parent's health plans to cover children aged 26 years and below. In contrast, Canada's Public Health Insurance has no limitations on age since every citizen is eligible based on their respective residency requirements. Obamacare affects private insurers in terms of revenue generation since most of them are for-profit insurers. However, this is different in Canada since citizens also use private insurance to cover medical services not covered under Public Health Insurance; hence, it does not interfere with revenue generation in for-profit private insurers. Furthermore, only 67% of Canada's population use private insurance, while 100% of the population benefit from Public Health Insurance (Tikkanen et al., 2020). Thus, Canada's Public Health Insurance provides coverage to citizens, reducing health disparities and encouraging health promotion.
Triggers, Conflicts and Social Movements Supporting ACA
A larger percentage of the American population could not access medication since they lacked insurance covers. This led to social movements held by unions, organizations, and political leaders advocating for healthcare reforms. Health Care for America Now (HCAN) advocates for the need for health reforms to extend medical benefits to uninsured Americans (Kirsch, 2012). In 2010, the HCAN group supported the Affordable Care Act to increase healthcare coverage and prevent insurance companies from denying people with preexisting conditions from obtaining covers (Kirsch, 2012). HCAN supported national TV advertisements to advocate for an increase in medical coverage for all Americans. HCAN's message to the government was, "If the insurance companies win, you lose" (Kirsch, 2012). Currently, HCAN continues to advocate for quality and affordable health care for Americans. HCAN's vision is to ensure that elected leaders provide equitable healthcare coverage to every American citizen.
The American Association of Retired Persons (AARP) is a nonprofit organization that addresses the problems affecting middle-aged and older adults (Kirsch, 2012). AARP also supported the need for increased healthcare coverage for uninsured people. AARP acknowledged that most people in America could not obtain health services since they lack insurance covers. For this, the organization urged the U.S. Supreme court to maintain the Affordable Care Act 2010 since it benefited millions of older adults. In 2007, coalitions made up of organizations like AARP, HCAN, and labor unions held grassroots campaigns to promote healthcare reforms (Kirsch, 2012). America's healthcare system had been deplorable since the establishment of Medicare and Medicaid. Americans experienced high healthcare costs, and individuals could not access medical services due to the lack of insurance covers. Social movements had not been successful while pushing for healthcare reforms. However, the presidency of Barrack Obama unveiled the Affordable Care Act, allowing millions of uninsured Americans to access health services and acquire health coverage. ACA has been a significant policy in America, which has reduced ethnic health disparities and encouraged health promotion.
Conclusion
The Affordable Care Act (ACA) or Obamacare has expanded healthcare coverage to millions of Americans, reducing healthcare disparities. ACA has controlled costs and improved the quality of healthcare for Americans. Obamacare has provided coverage to young adults of 26 years and below under parental health plans. It has removed lifetime limits on health coverage, allowing citizens to acquire quality healthcare services without hindrance. The target population and eligibility of Obamacare include American citizens by birth, individuals under 133% of the federal poverty level, people earning less than 400% of the federal poverty level, and young adults below 26 years who are covered under their parent's health plans. Canada's Public Health Insurance is a healthcare policy act that seeks to provide Canadian citizens with quality healthcare at low cost. Canada's Public Health Insurance covers every citizen. It does not cover vision and dental care, rehabilitation services, and outpatient services. It covers maternity services and special needs for children and veterans. Canada's Public Health Insurance is different from Obamacare since it covers prisoners in federal jails. It is also eligible to every citizen by birth, unlike Obamacare, which allows only individuals below age 65. Canada's Public Health Insurance and Obamacare do not cover undocumented refugees, illegal dwellers, and legal foreigners. Social movements such as the American Association of Retired Persons (AARP) and Healthcare for America Now (HCAN) and labor unions advocate for an increase in healthcare coverage for Americans through Obamacare. Therefore, it is a significant healthcare policy that has increased healthcare coverage to Americans; thus, boosting healthcare quality and reducing health disparities.
References
Garrett, A. B., & Gangopadhyaya, A. (2016). Who gained health insurance coverage under the ACA, and where do they live? Urban Institute, ACA implementation—monitoring and tracking.
Kirsch, R. (2012). The politics of Obamacare: Health care, money, and ideology. Fordham L. Rev., 81, 1737.
Serakos, M., & Wolfe, B. (2016, December). The ACA: impacts on health, access, and employment. In Forum for health economics & policy (Vol. 19, No. 2, pp. 201-259). De Gruyter.
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, A., G. (2020, June 5). “International Health Care System Profiles; Canada.” Retrieved from https://www.commonwealthfund.org/international-health-policy-center/countries/canada
https://www.ncsl.org/research/health/the-affordable-care-act-brief-summary.aspx
