If you ask residents of Queens about the Affordable Care Act (ACA), they would scarcely be able to tell what it is. Although most people have an idea of Obamacare, not many understand this epic piece of U.S. legislation. Obamacare is the common name for the ACA. There are myriad points of view about Obamacare and whether or not it qualifies as good health insurance in Americans’ minds, one fact remains – it has changed the landscape of the healthcare delivery system in the U.S. To answer the question about whether Obamacare is a good piece of legislation in theory and practice, it may be helpful to compare the U.S. health care system before and after 2010, and also make comparisons with health care systems in other countries.
The U.S. health care system can be confusing to anyone who is familiar with health care anywhere outside of the country. As a matter of fact, the structure of health care systems of most other developed countries, share features similar to some Caribbean, South American and other developing countries. In Cuba or England, you can receive free health care for the same condition that will cost thousands of dollars in the U.S. Health care in the U.S. is three times more expensive than that of Japan and more than double the cost in France, U.K., Germany, Sweden, Canada and Australia (Sultz & Young, 2014). If you are wondering why, you’re like most, if not all Americans who ask the same question when they hear this truth for the first time. Well, the fact is, countries that can afford to provide free health care to their citizens and even visitors, do so because of a centrally controlled universal health care system that authorizes financing, payment and delivery of care by all who need it. The U.S. health care system is financed both publicly and privately, and therefore, costs more than health care provided in other developed countries. Private financing accounts for approximately 55% of total health care expenditures, mainly through employers and private businesses including hospitals and physicians’ clinics. The remaining 45% comprises public or government financing, provided primarily through expenditures and reimbursement for Medicaid and Medicare (Sultz & Young, 2014).
There are certain major indicators that determine the health status of individuals. To measure the health status of a nation, three of the most important indicators that provide a basis for comparison among countries are life expectancy of babies at birth, the infant mortality rate and the probability that citizens would die between ages 15 and 60 years old. When ranked among the developed countries: Japan, U.K., Germany, Sweden, Canada, France, and Australia, the U.S. falls at the very bottom of the list (Sultz & Young, 2014). This means that more babies are expected to die and in fact, actually die at birth in the U.S. than any of the other countries mentioned.
The ACA brought about four major changes in the way health care is delivered in the U.S. First, by requiring that individuals maintain at least minimum health insurance coverage, the ACA created new revenue from a pool of individuals who are required to pay premiums to the various insurance companies. It is important to note, however, that if an individual’s socio-economic status precludes his or her ability to purchase the minimum coverage required by the ACA, there are reasonable provisions for coverage. Whether individuals fail to qualify personally, through their employer, or for Medicaid, such individuals would be provided with federal subsidies for health insurance coverage (Wilensky & Teitelbaum, 2017).
Second, the ACA provides access to insurance for individuals with pre-existing conditions. In other words, insurers can no longer consider an applicant’s pre-existing conditions to determine whether he or she qualifies for health insurance coverage. In addition, this provision guarantees that the existing health insurance coverage is renewable, and that young adults up to age 26 are covered under their parents’ health insurance plans for certain preventive and immunization services. Furthermore, young people whose living expenses are high and cannot remain on their parents’ health insurance plans after their 27th birthday, can still qualify for a certain health insurance plan on the health exchange (Wilensky & Teitelbaum, 2017).
Third, in each state, the ACA has created what are referred to as health insurance “exchanges” or “marketplaces” or online shopping sites where individuals and small employers can easily access various health insurance options. This kind of access allows them to compare and ultimately purchase the type of coverage they choose. It has helped to alleviate the difficulties faced in navigating the previous insurance marketplace (Wilensky & Teitelbaum, 2017).
Fourth, in addition to the ease of access, by expanding the Medicaid program, the ACA has dramatically increased the number of people with access to better and more suitable health insurance coverage. The ACA now covers 32 million individuals who were previously uninsured (Wilensky & Teitelbaum, 2017). “In New York State, access to low-cost health plans have driven down the state’s uninsured rate from 10% in 2013 to 55% in 2015, the lowest in decades, according to Donna Frescatore, Executive Director of New York’s Obamacare exchange” (Daily News 1/6/17).
There is apprehension about the role the new administration may play in the lives of New Yorkers, regarding their access to affordable health care. According to Governor Cuomo, “since its implementation, the ACA has become a powerful tool to lower the cost of health insurance for local governments and New Yorkers, and it is essential that the federal government does not jeopardize the health and livelihoods of millions of working families.” For some people, the ACA has seemingly imposed an unfair demand. They feel that the ACA compelled them to purchase health insurance by virtually cancelling previous plans that failed to meet its requirements. Although the ACA provided them with several new options from which to choose, they were upset when none of those options provided the type of benefits, providers and the right price, compared to their prior plans. What such individuals do not realize, however, is that by paying a little more and having a few changes made to their previous health insurance coverage, they are making a sacrifice to help millions of people who are less fortunate, and who for the first time, can afford health insurance. In other words, the ACA might be somewhat an inconvenience for far fewer people than those for whom it is providing a basic necessity and right – health care. While some are skeptical about Obamacare, those whose lives have been changed because of this remarkable legislation, know that it has, in fact, provided health care essential to human life.
