Last week, we said goodbye to President Barack Obama, and soon we will say goodbye to Obamacare.
Eight years ago, when the tumultuous health care reform journey began, we could not have imagined the roller coaster ride it would take. The Affordable Care Act (aka Obamacare) passing without a single Republican vote, surviving the Supreme Court ruling by the vote of a Republican-appointed judge, a disastrous rollout of healthcare.gov, thriving for four years with the reelection of Obama, and now its inevitable repeal with Donald Trump’s election.
So it may help to look back on what Obamacare is and where it has been successful and where it has failed for Americans.
We need health care reform because our health care system in America is broken. Much like a stool with three broken legs, too many of us have high costs, low quality and difficult access.
Cost is our ability to pay for health services as an individual or a nation. Quality is providing good care to make our lives better. Access is our ability to have health insurance and find a doctor.
The prime goals of ACA were to improve access and quality by getting more people insured. To do this, the ACA put in place the following strategies:
Mandates: The most disliked part of the ACA was that it forced all Americans to buy health insurance, just as we have to buy car insurance, so as to have a healthy pool of people in the insurance mix. If we didn’t buy insurance, we have to pay a penalty.
Exchanges: This was a new marketplace to buy health insurance. Originally an idea of the conservative Heritage Foundation, it was adopted by the Democrats, and then shunned by the Republicans.
Preexisting conditions/lifetime coverage: Before the ACA, insurance companies could deny insurance to a patient with HIV or diabetes or stop coverage during a cancer treatment.
80:20 plan: Insurance companies had to spend 80 percent of the premiums for patient care or return the money.
Subsidies: Families who earn on average up to $80,000 and wanted to buy insurance would receive financial help from the government.
Coverage up to age 26: Young adults could stay on their parents’ plan until age 26.
Medicaid expansion: States, if they chose, could expand their Medicaid program for low-income people, with the help of significant additional federal funding.
Taxes on the rich: Those earning over $200,000 had to pay extra 0.9 percent on Medicare taxes and a 3.8 percent tax on investment income. This helped keep the Medicare Trust Fund solvent.
Fees on insurance companies and pharmaceuticals: They had to pay $10 billion to $20 billion in additional fees each year. This helped pay for the subsidies for working families to buy insurance.
While the 2,700-page law had many other provisions, these had the greatest impact. According to a new poll, voters are deeply divided over the law, but only 20 percent support the Republican strategy of trying to repeal it quickly without a replacement.
Over the decade, one wonders why Obamacare was so disliked by half of the country.
In part, the Republicans branded the health care law as all that was wrong with our healthcare system. And in part the ACA failed to do what most Americans wanted — that is, reduce the cost of healthcare.
Today, I believe, Americans and American businesses would sacrifice quality and even access (fewer people insured or less coverage for all) if only the premiums, the deductible, the drug prices and out-of-pocket health expenses cost would be lower or at the least kept from rising astronomically.
It is unclear what the replacement of ACA will be, but the pendulum needs to turn to cost containment with the hope of retaining much of the improved access and quality that Obamacare brought in. I believe, without a doubt, that a Trumpcare or a Ryancare will have the same fate as Obamacare, if they do not address health care costs.
So as Republicans in Congress and the White House work to redesign our health care system, it is important to know what an ideal health care system would look like, one that strives for low cost, high quality and easy access.
But from where we are today, most will be willing to sacrifice quality and access to make healthcare more affordable; ironically, this is what the Affordable Care Act was not able to do.
Source : Commercial Appeal