I was born, raised and live in the U.K. I am 24 years old. I remember, on the face of things, Obamacare being a step forward for the shenanigans which is the U.S. healthcare system. But, I often see posts stating it failed. Someone please explain 🙂
I hold our NHS in high regard. I cannot imagine a healthcare system which can leave people who have worked, paid taxes for 30 years+ and are all round good citizens in financial ruins. What exactly is Obamacare and why do people say it failed?
In: Other
A law that:
Federally subsidized private health insurance.
Protected sick people from losing insurance.
Fined people for not having insurance.
Failed to cap market costs.
People got health insurance, people used health insurance, health insurance charged more and more making it unaffordable.
It was a mandate that tried to socialize the insurance industry. It was meant to make everything cheaper and make it easier to get insurance if you have pre-existing conditions but there were a few issues, the most important of which as the fact that the way you paid was via an increased tax rate, and there were some issues opting out. A lot of Americans don’t much like taxes going up, so it kind of turned into a shitshow. Eventually Republicans gutted the system and it became kind of useless.
I can’t explain it but I just remember my already impoverished family have to pay fines endlessly when I was a kid because we couldn’t afford health insurance for me.
So that is at least one way it failed. Made some of the poor even poorer.
It’s a huge complicated mess of a bill, with huge compromises that some people hated just for doing anything at all.
It expanded Medicaid by giving states money to give Medicaid to more people. Some states just outright refused to do it, even though they were being given the money which was money their residents had already paid taxes on. Some states did expand Medicaid, the residents liked it, and they still reversed it. Some never expanded it at all.
But even with expanding Medicaid, people who made too much money to qualify (a lot of people) were left with choosing private options on the exchanges that ObamaCare created. One complaint has been that premiums have gone up. That is true. What is also true is that premiums have gone up more slowly than they had been going up before ObamaCare.
It made a horrible, balkanized system a bit better. For the people who got Medicaid, it made things a lot better, except a lot of doctors don’t take Medicaid (the government doesn’t force doctors to accept it).
My premium is 1300 a MONTH for a shitty plan. That is the main issue. I am only mid 30s. It was 500 before Obamacare with a much better deductible.
It allows kids to stay on parent’s insurance until they are 26. Even if it did nothing else, I would be eternally grateful. It also forces insurance companies to spent a minimum percentage of premium income on care for insured people (instead of shareholder or other profit)
It’s a giant blow job to the insurance companies, essentially, though it does have a few good things peppered in for us regular folk.
Pre existing conditions being covered is one. Maximum out of pocket limits is another. A standard expectation of care across insurance plans, as well.
But really, it just forced Americans to buy into a very broken system, and there have been some unintended consequences. Deductibles have gone up (the amount we have to pay before insurance really kicks in), as have co-pays (what we have to pay when going to the doctor, emergency, etc just to be seen) and premiums (the amount we pay monthly just to have the honor of being insured), but honestly, that had already been a huge problem for years and part of why this happened.
Personally, this year, I am incredibly thankful for Obamacare. I had to have surgery, and spent time at two separate hospitals. My bills are north of $125,00, but thanks to the maximum out of pocket provision, I “only” owe 7-9k (not entirely clear yet) where pre ACA (Affordable Care Act, or Obamacare as it’s also known as), it’d be a *much higher* percentage of that $125,000….
ETA: there’s also what is called in network and out of network, and the in network maximum for an individual this year is $7150, while the out of network maximum is around $14,000. This is why I owe between 7-9k. $7150 is due to the first hospital for in network services, but some of the doctors and a couple of the tests were “out of network” meaning they don’t have an agreement with my insurance company and aren’t part of the “network.” I have little or no say about this…
There are also many treatments that are considered experimental or unproven, which insurance can just refuse to pay for. The instances of people ending up with hundreds of thousands of dollars of medical debt are lower today than pre ACA, but they are hardly entirely gone. Your insurance may also just refuse to pay for certain treatments, forcing out of pocket expenses.
The ACA was a step forward in some ways, but still forcing us to work within a very broken for profit system that can and often does bankrupt people, deny treatments, be unaffordable from the get go, etc.
For example, I pay ~$200 a month for my health insurance. The family plan at my company, though, for employee, spouse, and children, is about $1100 a month, one full paycheck for many of the staff….
Others have already covered the major components of the program, so I’ll focus on the question “why do people say it failed”.
This is kind of loaded question because it depends on your definition of success. In terms of reducing the uninsured rate it was a great success: it got us to a 90% insured rate which is the highest it’s ever been in history. It also established protection for pre-existing conditions and allowed young people to stay on their parents’ plan until age 26 which are both hugely positive accomplishments. I will also add this was the first major change to the US healthcare system after *decades* of attempts, so just the fact that anything got passed is honestly a success.
Now where did it go wrong? For one thing it didn’t really improve healthcare quality; it mostly focused on getting more people covered. For another it didn’t quite go as far as people liked – it got the uninsured rate to historic lows but not to 0%, and it didn’t help to stop the ballooning prices.
Why did it fall short? Largely due to politics. Democrats had to make major concessions just to get something passed. I don’t really think it’s fair to call that a failure because it’s better to make some progress than no progress. One of the concessions was the removal of the public option. That part was critical for driving down cost. Basically the idea is if everyone is required to get insurance, and there’s an affordable government option, then private companies would have to lower their prices in order to stay competitive. It’s really too bad that this part had to get removed, and if we could get it passed it would really go a long way.
Regulations, most of which has nothing to do with healthcare and instead just massive growth of government and bureaucracy, that removed rights and choice, and set a precedent that to be alive means a bureaucracy can force you to buy a service otherwise you’ll be punished, and was supposed to fix all the bad things in healthcare (that were primarily created originally by the same people and ideology saying they’ll solve the problems now)…
And now they continue to say it is bad and they want more power and money.
It was an attempt to get as close as possible to the universal health care system you enjoy in the UK, while operating within the constraints of the existing US health care industry.
The major challenge was that the US health care industry is huge and powerful.
Even if corporate lobbying weren’t a factor, disrupting the careers of tens of millions of healthcare workers would be political suicide. So Obamacare kept the private health care companies and insurance companies intact.
The core of the Obamacare compromise was this: first, everyone was *required* to have health insurance, or they have to pay a penalty. Lower income people would get money for care from the government, which would expand Medicare (our government-funded, privately-delivered health care program). Middle- and high-income people would have to buy insurance from private insurers, at government-negotiated prices, and the insurers wouldn’t be allowed to turn anyone away.
So the hospitals get more paying customers, but have more cost controls on their services. The insurance companies get a guaranteed pool of healthy customers to offset the more expensive ones they’re now required to cover, and everybody gets health care, either from the government or at a (hopefully) fair price out of pocket. Everybody wins, nobody loses their job.
The program fell apart in two ways. First, the plan relied on expanding Medicare to cover people in lower-middle incomes who couldn’t afford private policies, but Medicare is operated by federal grants to individual states, and many Republican states refused to expand coverage. It was hundreds of billions of dollars of free money, and they turned it down in order to sabotage the plan.
Second, the Republicans argued that *requiring every American to buy something* was unconstitutional, but the Supreme Court argued that the penalty for not buying it was a reasonable exercise of the government’s power to tax.
So the Republicans in Congress set the penalty to zero. Now the requirement to buy health care is arguably *not* a tax so the government can’t do it. And if people aren’t required to buy insurance, healthy people will not buy insurance. This means insurance companies will have to charge more to cover the sick people that remain, and eventually *nobody* will be able to afford private insurance. Only way to solve that is to get rid of the requirement to cover everyone…. and now we’re right back where we started.
In the end, I think both sides of American politics now agree that the effort to nationalize health care “by the back door”, without disrupting existing industries, was a failure. It was a clever balancing act, but it turned out to be a house of cards. Most agree that our choices are either some sort of full nationally-funded system, or the status quo.
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