Category: Obamacare

Pros of Obamacare: Preventive Care

One of the key objectives set by the Affordable Care Act was the promotion and support of preventive healthcare. Today, preventive medicine is recognized as the most sustainable approach as regular checkups and timely measures avert an aggravation or a serious health emergency. Among the advantages of preventive healthcare is increasing the lifespan of citizens and helping them enjoy an active life. Extended insurance coverage means that patients can prevent an acute condition from turning into a chronic one as well as having to take care of large medical bills or bankruptcy. For those who already suffer from a chronic condition, treatment has been made easier by the promulgation of the Affordable Care Act.

The National Conference of State Legislatures (2014) writes that since 2014, citizens are entitled to 63 distinct preventive services that must be covered without an additional payment on the person’s part, co-insurance, or a deductible. Some of the examples of such services include colorectal Cancer screening for adults over 50, type 2 diabetes screening for adults with hypertension, and diet counseling for adults at risk for developing a chronic condition. As seen from the examples, the ACA encourages the early diagnosis of quite serious diseases to avoid future hospitalization and increased healthcare expenses.

A day in a hospital may cost from $2,000 to $20,000, and many citizens are unprepared for dealing with a bill this large. They may not be aware of exactly what is the maximum implied by their current insurance plan. If patients are unable to cover the bills, they can file bankruptcy, to which the hospital responds by declaring a loss and passing the bill to someone else. Between 2010 and 2016, Obamacare decreased the number of bankruptcy filings from 1.5 million to 780,000.

Cons of Obamacare: Distribution of Resources

One of the greatest issues that occur when devising a healthcare strategy is the distribution of resources. Among other goals, Obamacare sought to be a universal policy that would keep the number of uninsured citizens down and offer advantages to each demographic. Today, the Affordable Care Act is often criticized for not exactly reaching young people. As of now, millennials constitute less than 30% of all the people enrolled in Medicare and Medicaid, which, of course, is far from ideal. The Centers for Medicare & Medicaid Services report that the total of all consumers under the age of 30-35 was 8,746,642 with an average premium of $621.

Furthermore, for the last four years since its peak in 2016, the enrollment rate has been on a steady decrease. Such unpopularity of the healthcare policy with the millennials may be indicative of several problems inherent to its stipulations and realization.

First and foremost, Obamacare might have still not be able to resolve one of the biggest problems with the American healthcare system: its affordability. Moore (2018) writes that in 2017, the average deductible for individuals whose employers provided them with medical insurance was $1,221, which is significant compared to $303 in 2006. Besides, extending coverage for all enrollees means more taxes for everyone else – the fact that may also be making the millennials especially wary of the legislation. Lastly, Obamacare did not help mitigate the health insurance market instability that frightens many younger Americans and impedes their decision-making.

Response to “Pros of Obamacare: Preventive Care”

Preventive care is indeed a reasonable approach to medicine that spares millions of people suffering and undesirable expenses down the line. It is true that regular checkups instead of neglecting a condition may avert critical amounts of money in medical bills. Yet, this effect might be mitigated by other not-so-obvious expenses that are well indicative of the fact that Obamacare might not have lived up to its initial ambitions.

Firstly, preventive care was supposed to lead to decreased use of emergency room services whose cost was also diminished as part of the new policy. The opposite happened: Nikpay et al. (2017) suggest that after the promulgation of the Affordable Care Act, Oregon and Massachusetts started to visit emergency rooms more often. People do not always choose to go to the emergency room because they cannot afford an actual appointment: they do so because it is more convenient.

Another aspect of the Affordable Care Act that might be rather dubious is its promotion of workplace wellness programs. Jones, Molitor, and Reif (2019) explain that this part of the policy was supposed to be non-discriminatory and rewarding to those employees that make healthy choices and show better health outcomes. In reality, however, according to the researchers, the realization of the plan proved to be punitive and unfair toward unhealthy employees. They were not receiving financial incentives and had to bear greater costs, despite often being from underprivileged socioeconomic backgrounds. In summation, the cost efficiency of preventive services covered by medical insurance plans might as well be nothing more than a myth that both politicians and citizens choose to believe in.

Response to “Cons of Obamacare: Distribution of Resources”

The fact that Obamacare is not exactly popular with the younger generation may not be reflective of its inherent faultiness. First and foremost, young people might be reluctant to enroll in the program because they do not see exactly how it could provide any value to them. One look at the list of preventive care services can demonstrate that many of the conditions that Obamacare helps to diagnose early on are age-related. Since it is senior citizens that are more susceptible to such conditions as hypertension, heart failure, and colon cancer, young people may not see these services as necessary.

As for affordability, it would not be correct to compare and contrast expenses in 2006 and 2017 because they do not take into account many factors such as inflation and average income growth. Another reasonable note on the affordability of Obamacare would be that the millennials themselves are making life choices that deprive them of the opportunity to become financially stable early in life. More young people than ever enroll in college programs and graduate with an average debt as large as $37,000 (Friedman, 2020). Sociologists describe the phenomenon of the “Odyssey years” that describe a significant gap between college graduation and maturation.

The new generation tends to search for themselves, make career transitions, and gain new experiences before settling down. These decisions may postpone financial growth and prevent individuals from spending money on healthcare.

Lastly, the low enrolment rate may be explained by the poor medical literacy of the new generation. TransUnion (2017) Healthcare Millennial study shows that more than half (57%) of millennials have a very faint idea of basic healthcare out-of-pocket expenses as well as co-insurance, co-pays, and deductibles. 40% do not understand how medical insurance works and what benefits they are entitled to. In summation, better literacy and awareness might change the situation and make Obamacare more attractive for this demographic cohort.

References

Centers for Medicare & Medicaid Services. (2018). Health insurance exchanges 2018 open enrollment period final report. Web.

Friedman, Z. (2020). Student loan debt statistics in 2020: A record $1.6 trillion. Web.

Jones, D., Molitor, D., & Reif, J. (2019). What do workplace wellness programs do? Evidence from the Illinois workplace wellness study. The Quarterly Journal of Economics, 134(4), 1747-1791.

Moore, S. (2018). 8 reasons to still hate Obamacare. Web.

National Conference of State Legislatures. (2014). Preventive services covered under the Affordable Care Act. Web.

Nikpay, S., Freedman, S., Levy, H., & Buchmueller, T. (2017). Effect of the Affordable Care Act Medicaid expansion on emergency department visits: Evidence from state-level emergency department databases. Annals of Emergency Medicine, 70(2), 215-225.

TransUnion. (2017). Lack of knowledge and changing healthcare landscape impacting millennial payments. Web.

The major overhaul that has remained controversial is the Obamacare that aims to spearhead the provision of affordable healthcare to all. Since the 1960s, the healthcare system has not received such changes, and the inception of Obamacare caused a stir-up everywhere. Headlines all over the United States have highlighted the controversies arising from the endorsed Affordable Care Act (ACA) by President Barack Obama in 2010. Despite the fact that this new law has faced uncountable challenges and strong unpopularity, it continues to achieve its objectives, largely due to the associated sanctions and penalties. People are not fully conversant with the ACA; hence, there are always emerging issues leading to unending court cases as individuals, businesses, and the marketplace try to unearth feasible implementation mechanisms of the ACA. This paper is a discussion of the controversies surrounding the ACA, and thereafter determines its efficacy in the current healthcare set-up.

In accordance with Reisman (2015), this paper argues that the new Affordable Care Act is beneficial, but it is also highly controversial resulting in the dissatisfaction of the people. In addition, the influence of politics and poor publicity has taken a toll on its receivership by the people; thus, the implementation of this act has received mixed reactions. Despite the many controversies surrounding the implementation of the ACA, the underlying rationale is noble and workable if minor adjustments are made. The mandates and penalties associated with this act make it unfavorable for most employers because their profits are bound to reduce at the expense of increasing the insured rate. In addition, employers are worried about recruitment and retention of employees as the future Cadillac tax poses a threat to employers with high value health benefit plans that supersede a specific predetermined amount (Galvin 2016). This action cannot be perceived positively because the same congress advocates for payment of high premiums in order for the insurance to intervene.

The ACA was meant to increase health insurance coverage by around 15% via extending the insurance service to individuals who have no access to this service; precisely, “individuals not covered by the US health programmes for the poor and the elderly and those who have not received coverage from their employers” (Why is Obamacare so controversial? 2014, par. 3). Whereas this is a good thing, the manner in which this is implemented is not succinct because some people complain of restricted access to healthcare as insurance companies insist on meeting a certain deductible before it can intervene; yet, as long as the healthcare insurance plan meets the requirements of the law, it is not clear as to why the insurance would fail to intervene under such circumstances (Jan 2015). According to Reisman (2015), the ACA has surpassed expectations by reducing the number of individuals without insurance significantly: almost 17 million more Americans have benefited from this new law. Statistics indicate that there has been a remarkable dip in the uninsured rate: 6% since 2013 at 11.9% in the first quarter of 2015. This rate has been regarded as the lowest in history since Gallup began tracking this phenomenon in 2008 as shown in the figure below:

Thus, despite the opposition that is based on selfish interest, the new but controversial healthcare system by president Obama is a good thing for America. These controversies are bound to be resolved amicably.

The ACA increases the insured rate through federal subsidies, expansion of the Medicaid program in various states, and use of parental policies to cover children till they reach 26years of age. Also, the ACA regulations oppose the termination of policies for individuals with pre-existing conditions the minute they get sick. Whereas the Obamacare seems to expand accessibility to affordable health care, controversies about its accessibility in federally-run marketplaces versus state-based marketplaces is evident due to variation in the kind of marketplace prevailing in each state as shown by the figure below.

The administration within a state might act as the impediment to the successful implementation of the ACA because a look at the table below, which has been adapted from Manchikanti et al. (2011), indicates the commitment of the federal government to aid in offsetting the insurance premiums but managing to access quality healthcare. Hence, it is all a matter of sheer politics that tend to thwart the prudent and noble intentions underlying the ACA.

It is only now in the recent decade that Americans are content with the healthcare system due to reduced medical bills and financial barriers to accessing healthcare services due to the introduction the Patient Protection and ACA (Blumenthal, Abrams, & Nuzum 2015). However, before this realization, embarking on the ACA was not received with the expected enthusiasm. Usually, people are resistant to change without taking the time to review this change. In an article by Appleby (2014) in the Washington Post, an uproar over policy cancellations were eminent and brought about a political firestorm for Barrack Obama as these cancellations counter-indicated his promise on retaining current insurance policies if individuals were content with them. On a different spectrum, the issue of compliance to already laid-down health law’s standards emerged, which has resulted in numerous inconveniencing cancellations. Different states have handled this matter differently; whereas some have given a year’s span for discontinuation, others have an extended duration till 2017.

Individual plans have been at a greater disadvantage in comparison to those provided by small businesses (Appleby 2014). In a study conducted by Antwi, Moriya, and Simon (2012), it was revealed that an upsurge in extended parental coverage to older children above 19 years regardless of their studentship was associated with reduced marginal costs and increased marginal gains. On the flipside, a substantial percentage of young adults remain uninsured even though the parents have insurance policies. Most of the research studies have looked at the rate of the insured versus that of the uninsured as success indicators for the ACA. Solely focusing on the rate of individuals that are insured can misguide an individual in reference to the success of the ACA as other domains that influence the success of the ACA receive little attention.

Apparently, most individuals and small businesses preferred to renew old policies if provided with an option because they were deemed to be relatively cheaper. Yet, in comparison to the old scheme, the new scheme has more coverage options because it includes maternity and prescription coverage. In addition, it puts a limit to the consumer costs due to the provision of government subsidies. In addition, the new scheme nullifies the earlier provision that allowed access to insurance policies based on an individual’s health. Whereas the ACA is increasing the insured rate, physicians are opting out of the system as La Couture (2014) indicates. Apparently, the ACA promotes quality health care at relatively low costs, but at the expense of the doctors. Due to the high competition for low reimbursement rates, even the private insurers now have a lower reimbursement rate than Medicare, which is deemed the standard. Subsequently, doctors are required to work more now that the number of insured patients is high. However, attending to more patients is considered futile in the light of the already high volume of patients (Fodeman 2016; Page 2013).

Earlier on, this paper indicates that governments are obliged to offset the deductibles and out-of-pocket payments through subsidies. Rosenbaum (2011) and Sommers et al. (2013) indicate improved access to healthcare and reduced delays in getting treatment under the ACA. On a different based on a case of the Andersons described later, the mechanism under which these subsidies prevail are not clear as narrated by Jan (2015). Despite paying a monthly deductible of $875 every month, they were required to pay an additional deductible of $7,000 for the insurance to offset their medical bill. Hence, the actual effect of the ACA in relation to access of healthcare while evaluating the relationship between deductibles, associated copayments, and amount insured in case of a health crisis need to be determined. The study by Sommers et al. (2013), the case study of the Andersons and La Couture’s (2014) article are indications of the prevailing controversies revolving around the ACA. Another study by Galvin (2016) indicates that high deductible plans are the most effective plans for employers, insurers and individuals. On a different note, Jan (2015) shows that these high deductible plans limit access to healthcare for all individuals contrary to the objectives of the ACA. La Couture (2014) indicates that some low-income individuals may be enrolled in the high deductible plans and end up not paying the required premiums; hence, not reimbursement to the healthcare provider. Another study by Wherry and Miller (2016) indicates the positive effects of the Patient and Protection ACA in relation to increased insurance coverage, improved quality of health due to more interventions for chronic ailments, and escalated levels in utilization of health. Therefore, if this act is working in some states, it is likely that the issues in other states can equally be resolved with better integration efforts and commitment.

Discussion and Conclusion

Five years is quite a short time to exhaustively determine the effects of the new Obamacare under the ACA. The high rates of insured people tend to shroud the reality behind the ACA based on the subjective views of various individuals and institutions. The increased numbers of individuals enrolling for the ACA policy stemmed from the enthusiasm that came along with hope for improved access to healthcare services as was the case with the Andersons until reality dawned on them (Jan 2015). Despite the high deductibles, healthcare still remains unaffordable due to increased out-of-pockets healthcare costs as indicated by the case of the Andersons. On a different note, the arguments presented herein indicate that the controversies surrounding the ACA are based on misconceived perceptions and misinterpretations of the ACA act.

There is the issue of misconceived benefits of the old scheme as opposed to the new scheme, but in reality, the new scheme is more comprehensive and more beneficial because of the provision of government subsidies. In a bid to ensure provision of quality health care, the new scheme has increased coverage options at affordable premiums considering the stipulated and accepted policy package. Better quality is associated with extra costs; hence, the reinforcement of the minimum essential coverage, which is deemed expensive to some individuals. The Internal Revenue Service articulately presents the definition of a marketplace in reference to provision of subsidies. On the contrary, the ACA is succinct on the provision of subsidies to state-based marketplaces only. Hence, the emergence of issues surrounding the same, such as in the King v. Burwell court case (Musumeci 2015). This controversy has not been holistically resolved in all states, but solutions from other states and federal governments are being imported to solve similar controversies in other states and promote the success of the ACA.

Evidently, consumer confusion is apparent because the ACA is not articulate on its provisions. There is need for educating the public through community meetings, workplace seminars and educational talks on the ACA and how it operates. People cannot see the positive side of the ACA because they might have been used to living in mediocrity that they cannot see the benefits of this new scheme. This ACA promotes quality in the sense that there will be reduced Medicare Readmissions, which means that healthcare workers are required to ensure that they provide optimal healthcare to avoid associated penalties. Subsequently, they will enjoy the full reimbursement amount. More conclusive research is required to examine the effects of the ACA from various perspectives other than increased insurance coverage.

References

Antwi, YA, Moriya, AS, & Simon, K 2012, “Effects of federal policy to insure young adults: Evidence from the 2010 affordable care act dependent coverage mandate” Working Paper 18200. National Bureau of Economic Research, Cambridge, MA.

Appleby, J 2014, “Insurers poised to cancel health plans that don’t comply with Affordable Care Act”, The Washington Post, Web.

Blumenthal, D, Abrams, M & Nuzum, R 2015, “The Affordable Care Act at 5 years”, The New England Journal of Medicine, vol. 372, pp. 2451-2458.

Fodeman, J 2016, The new health law: Bad for doctors, awful for patients, Web.

Galvin, R 2016, “How employers are responding to the ACA”, The New England Journal of Medicine, vol. 374, pp. 604-606.

Jan, T 2015, Critics say high deductibles make insurance unaffordable, Web.

La Couture, B 2014, Health care providers are opting-out of Obamacare, Web.

Manchikanti, L, Caraway, D, Parr, AT, Fellows, B & Hirsch, JA 2011, “Patient Protection and Affordable Care Act of 2010: Reforming the health care reform for the new decade”, Pain Physician, vol. 14, pp. e35-e67.

Musumeci, M 2015, Are premium subsidies available in states with a Federally-run marketplace? A guide to the supreme court argument in King v. Burwell, Web.

Page, L 2013, 8 ways that the ACA is affecting doctors’ incomes, Web.

Reisman, M 2015, “The Affordable Care Act, Five Years Later: Policies, Progress, and Politics”, Pharmacy and Therapeutics, vol. 40, no. 9, pp. 575–600.

Rosenbaum, S 2011, “The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice”, Public Health Reports, vol. 126, no. 1, pp.130–135.

Sommers, BG, Buchmueller, T, Decker, SL, Carey, C & Kronick, R 2013, “The Affordable Care Act has led to significant gains in health insurance and access to care for young adults”, Health Affairs, vol. 32, no. 1, pp. 165-174.

Wherry, LR & Miller, S 2016, “Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid expansions: A quasi-experimental study”, Annals of Internal Medicine, Web.

Why is Obamacare so controversial? 2014, BBC News, Web.