The Affordable Care Act, otherwise known as Obamacare, marks its tenth anniversary amid a major global health crisis that has reignited the issue of affordable access to healthcare by many mid to low income Americans.
In the face of a fast-spreading Coronavirus (COVID-19), a pandemic that is threatening to devastate economies and worsen dwindling hopes for economic recovery, questions have arisen about what is the right gift for an Act that has withstood resistance all along to offer some modest protection to millions previously uncovered.
The point driven home more than any other by a public health crisis with a highly contagious virus is that ultimately, we can be only as healthy as the least healthy people among us. If large swaths of the population can’t afford to take care of themselves, guess what — it matters to you, too.
It’s a turn of events that will undoubtedly highlight both how the law has improved access to health insurance for many, and how it’s fallen short.
The law’s supporters note that without the Affordable Care Act, more people would be uninsured. For instance, more than 1.7 million Illinois residents — nearly 14% of the state’s population — were uninsured, on average, between 2008 and 2010, according to the U.S. Census Bureau. By 2018, that percentage had been cut in half, to about 7%, or about 875,000 people.
People with preexisting conditions should not be denied coverage, and insurance companies cannot cap how much they can spend on a person’s care. Preventative care, such as physicals, are now free. And most individual insurance plans must cover at least 10 major areas of care, including mental health, prescription drugs, and pregnancy.
More than 570,000 low-income people in Illinois have gained insurance through the law’s expansion of Medicaid, a state and federally funded health insurance program that was closed to most able-bodied adults before Obamacare.
And many people who make too much for Medicaid can get tax credits to offset the cost of insurance purchased through the exchange.
In the annals of American history, the ACA joins Medicare and Medicaid, the Children’s Health Insurance Program, and the Medicare Prescription Drug Program as one of the few concrete steps forward in securing America’s health and financial security.
The decade has been rocky for Obamacare. It once held the promise of affording the American population proper health coverage even when they were not working. This arose from the fact that in the US today, the number of employers proving healthcare benefits has been on a steady decline. As a matter of fact, the intent to cover Americans through the Affordable Care Act was inspired by two liberal ideas and one conservative idea.
Having Medicaid largely expanded is the first liberal idea for ACA. In the states that took it up, it has recorded tremendous success. In drawing comparisons with the states that did not adopt it, there is a huge difference in terms of improvements in health outcomes specifically for maternal healthcare, infant mortality, and cancer treatment.
This has had a major economic impact in a household since the payday borrowing, evictions from apartments, and filed bankruptcies have registered a drop. Rural hospitals have also experienced the good side of the law in terms of state budgets to their operations. A look into the states that did not adopt, especially the South, have different experiences, and as far as that goes, they have their leaders as well as the Supreme Court to blame for the unfortunate health and financial outcomes.
Secondly, there was the collection of consumer protections that every American so badly needed. This has become very popular and is very essential in any medical cover arrangement that has the interest of the majority in mind. The insurance companies no longer have the prerogative to choose how to cover you, and the criteria that you have to satisfy to qualify for the cover. Everyone, whether with a preexisting condition or not, is entitled to the cover and cannot be charged a penny more. Further, the cover is not limited to the maximum amount, and children can enjoy their parents cover up to the age of 26.
The conservative idea is that the insurance exchanges, or markets, that cover more than 10 million people. They work well for those with modest incomes who now for the first time receive subsidies to buy insurance. And they’ve been a huge boost to insurance companies after they weathered some initial rocky years.
Right now, saving lives during the coronavirus outbreak remains an existential challenge. Upon getting through it — and hopefully, the world will — the death toll bears the potential to be dizzying. When all is said and done, it should give politicians opposed to expanded access to care on ideological grounds a reason to reset their views closer to American public opinion.
No law is perfect, and the ACA has its flaws. People without subsidies are not protected from the high costs of health care. The insurance exchanges are too dependent on the private sector and a few powerful players. The inflow and outflow of people between the exchanges and Medicaid are clunky. But Congress has had the power to fix all of these flaws. Democrats have proposed many amendments, but Republicans have opted to try to repeal the law instead. The late Sen. John McCain’s thumbs down was one of several narrow escapes for the ACA.
The popularity of the ACA has steadily increased to its highest level as Americans have been faced with losing it. (If anything, many voters want a law that goes further.) The latest threat is a lawsuit from Republican states, supported by President Donald Trump, that the Supreme Court is scheduled to hear this fall.
But there’s nothing like a global pandemic to shake us from our politics. The same Republicans who for years have voted to block or repeal the ACA and to underspend on health care, all the while waging a rhetorical war against the government’s role in health care, are want to spend vast sums now that we’re in a crisis.
The Republican plan to repeal the ACA without a replacement has been exposed for its absurdity. Imagine 21 million people losing coverage now. Health coverage wouldn’t have prevented the spread of the virus, but with 20-60% of Americans who could potentially get COVID-19, guaranteeing affordable coverage for people with preexisting conditions and other ACA protections are looking like just the basics that need to be dug out of this.
But the law hasn’t been good news for everyone. Individuals who make more than $51,040 a year and families of four who make more than $104,800 don’t qualify for tax credits, leaving some to pay sky-high premiums for coverage. Also, choices on the exchange are limited, after some insurance companies pulled out of the state’s marketplace and others changed their offerings.
Pros and Cons of Obamacare
There are positives and negatives to the Affordable Care Act. Everyone who wants insurance can get it, regardless of health, and they don’t pay more if they have a health condition. That’s huge. But for people who make too much to qualify for the subsidies is some unpalatable aspect altogether.
The Affordable Care Act touched every part of the health care system, but its most basic goal was to expand access to quality, affordable health insurance. Many people obtained coverage through their states’ decision to expand Medicaid under the law. Not all states did following the 2012 U.S. Supreme Court ruling that made expansion optional.
Previously, only low-income people with disabilities, children or certain other circumstances qualified for Medicaid coverage. Now, it’s available to people without children or disabilities, with incomes up to 138% of the federal poverty level.
As of last year, 570,000 Illinois adults had coverage because of the Medicaid expansion. That expanded coverage also has meant more payments for hospitals, which otherwise often have to absorb the costs of treating uninsured patients.
In the Medicaid cover arrangement, the federal government pays 90% of the costs for Illinois residents covered under the expansion, and the respective state pays the rest. These payments may be especially important to hospitals as they gear up to treat potentially large numbers of people with COVID-19. This helps stabilize the finances of many hospitals.
The law has, however, been very tough on the finances of some people it was supposed to help, as prices for exchange plans escalated in recent years. In 2014, the first year people had insurance through the exchange, prices were often relatively low. A 28-year-old Chicagoan could have paid $120 a month for a bronze plan, a type of plan with low premiums but a higher deductible.
In 2020, Chicagoans of a similar age have to pay about twice as much for the same type of plan. Other states like Illinois pay far more. Over time, prices have increased for plans normally offered by employers, the system through which Illinois people get their insurance. For instance, employer-sponsored health insurance for a family of four cost an average of $20,576 a year in annual premiums in 2019 — a record high. Workers pay about $6,015 of that, and employers cover the rest.
Experts aver that most of that increase likely wasn’t caused by Obamacare, but rather rising medical and drug costs that also contributed to higher rates on the exchanges. When the exchanges first opened, many insurance companies were not sure what to charge. Insurers lost money as more sick people, and fewer healthy ones signed up for coverage than they had anticipated. Further, a federal program called reinsurance that helped fund insurers expired after 2016, adding to their financial woes.
Some blame the basic structure of the ACA law. Overcharging healthy people for insurance to give sick people a better deal never was going to be sustainable. Healthy people opt not to buy insurance, leading to increasingly expensive plans for those on the exchanges, he said. The law originally required everyone to buy insurance or pay a penalty. Unfortunately, the penalty was never enough to compel everyone to buy coverage.
Others blame efforts by congressional Republicans, and then President Donald Trump, to weaken the law and decrease funding. Regardless of the reason, insurance companies reacted to the losses. UnitedHealthcare and Aetna exited the exchange in Illinois, limiting options for consumers. Blue Cross and Blue Shield of Illinois stayed on the exchange but eliminated a popular PPO plan that included many of the state’s top hospitals.
Insurers like Land of Lincoln, folded. Land of Lincoln sent nearly 50,000 Illinois residents scrambling for coverage when it collapsed in mid-2016. It was a co-operative, a nonprofit created under the Affordable Care Act to help drive competition on the exchange.
Co-operatives across the country failed, in part, many say, because Congress limited their federal funding. Land of Lincoln and other co-ops sued the federal government over the loss of those payments — an issue that’s now before the U.S. Supreme Court.
Insurance companies that remained on the exchange increased their prices significantly. In 2016, average rates for many of the lowest-cost plans increased by 5% to 11%. Some consumers saw increases of nearly 40%.
For people receiving tax credits, those increases were not devastating, because the credits, in many cases, offset the increases. About 87% of the 288,000 people who bought health insurance on the state’s exchange last year received tax credits, which averaged about $524 a month. People who don’t qualify for subsidies, however, are paying top dollar.
The Metamorphosis of Obama’s Affordable Care Act
The law has changed in many ways since it was signed a decade ago. In 2017, congressional Republicans failed to garner enough votes to repeal the law, but the Trump administration and Congress have made other changes. One of the biggest was when Congress erased the penalty people had to pay for being uninsured, a change that took effect last year.
The number of people without insurance has again been climbing, since 2017, but it is unclear whether that is because the penalty is gone, insurance is expensive, the Trump administration cut back on advertising and outreach surrounding the exchanges, or other factors.
The law will face another major test later this year when the U.S. Supreme Court considers whether the mandate to buy insurance, and in turn, the law, is still constitutional without the penalty. Going by the debate around the law, it is more likely the court will strike down parts of the law rather than do away with it entirely. In the case it is struck down, it would be kind of unimaginably disruptive.
However, if the law is upheld, supporters acknowledge there will be more work to be undertaken, such as addressing the high costs of prescription drugs. Much as it has been a matter of serious considerations, the cost of drugs is very high in the United States. It forms one of the biggest chunks of healthcare cost, the poor are worst hit, especially those with an underlying condition.
The supporters of the law seem to have as top of their priority list the need to expand insurance coverage and arguably missed a chance to clamp down on the ever-rising health care costs. Whereas this is what many people desire, it is often easier said than done.
The US Congress might get a chance to make these improvements, and even with high chances of breakthrough especially if a Democrat is elected to the White House in the forthcoming elections. The people who lack insurance, and have their hopes dimmed if the law is done away with form a solid support base for these moves. They really want the law to remain, and be strengthened. The people who depend on exchanged to afford a cover for their health needs have in recent times been mobilizing others to support Obamacare and see it strengthened.
Even with the myriad of challenges the law faces, what remains indisputable is that everyone deserves to be covered, regardless of the economic situation they are in. Health touches on every individual. That may explain why the Affordable Care Act has been impactful, especially among those who were previously uncovered. The point is, the ACA may not have been the perfect solution to healthcare coverage for Americans, but undeniably, it has made the necessary steps in bringing everyone on board in addressing the issue of escalating costs of healthcare.
Coronavirus Underscores the Need for Affordable Universal Health Coverage
There are several practical ways to take the next steps toward universal health coverage (UHC). None perfect. All perhaps better than Obamacare. Americans do not want their health or their ability to pay for it to be a matter of political gymnastics in Washington.
What all people are asking for is not to have to worry about the ability to take care of themselves if they get sick and more essentially, how affordable it will be to stay healthy. On this tenth Obamacare anniversary, the chilling reminder of why this needs to extend to all rings deep. Health knows no class or economic situation. Everyone deserves the best there can be.
As COVID-19 continues to spread, many people are scared they or their loved ones will fall ill. Those fears are especially acute for those who don’t have health insurance — some of whom lack coverage because they can’t afford plans sold on the Affordable Care Act exchange.