The Affordable Care Act, commonly known as Obamacare, is a middle-of-the-road approach which allows people to have freedom in how they receive medical care, but enough regulation to ensure that basic care is always available. Prior to Obamacare, coverage was cheaper for many consumers, but coverage was much less comprehensive (Census). In the current healthcare debate, Republicans are proposing a plan that would remove federal funding for family planning, remove federal protections for pre-existing conditions, and allow the sale of “bare-bones” healthcare plans (Washington Post).
Allowing this plan to come to fruition would have adverse effects on the U.S. healthcare system. Democratic plans, farther to the “Left”, such as Medicare for all, would result in major federal budget shortages, which would prove detrimental to the U.S. economy as a whole (Blahous). Prior to the Affordable Care Act, there was little consistency among healthcare plans, leading to a great deal of confusion for many consumers. Obamacare needs to remain in place as it has helped to boost competition in providers, has made care less expensive, and has made coverage more widespread compared to the previous system that was in place.
Although there are many critics from the left and the right, the ACA has proven to be viable and a strong healthcare solution. According to the Congressional Budget Office, the ACA has reduced the federal deficit by $143 Billion between 2010-2019 (Elmendorf, 1). This is shown in the following table. This table essentially shows how the budget deficit is being affected by provisions in the Affordable Care Act. It shows how the federal deficit is affected by insurance coverage in billions of dollars, year-by-year. According to the chart, the deficit will have only increased by $788 billion from 2010 to 2019, compared to the estimated $1.1 trillion per year that Medicare For All would add to the deficit (Blahous).
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Source: Elmendorf, Douglas W. “Manager’s Amendment to Reconciliation Proposal.” Congressional Budget Office, 20 Mar. 2010
Healthcare has become affordable for the 33 million people who previously had no coverage. In fact, in 2017, 91.5% of U.S. citizens had health insurance (Barnett). That is compared to the only 83.8% in 2009, just before Obamacare was enacted (Mendes). This has occurred partly as a result of catching illnesses early on before they became serious. This is due to preventative healthcare provisions in the Affordable Care Act; essentially catching diseases before they become expensive. The ACA also has negotiated savings on Medicare services.
Next, the Affordable Care Act resulted in a series of cost-saving negotiations with various entities. First, several areas of Medicare payments were negotiated down, including the payments to healthcare providers, fee schedules for hospitals, and payments to drug companies. Drug companies are being charged higher fees and taxing high-income families on healthcare has added $210 billion. In addition, insurance companies paid an added tax on high-end health insurance plans. High-income families were also taxed in additional ways. For example, couples who made more than $250,000 paid additional taxes on investments and paid higher Medicare taxes on their income. Another area of increased funding came from large employers who had to pay a tax of $2000 per worker per year. Taxing employers more has added $65 billion in income for the government (Elmendorf, 2).
Medicare for all would damage the U.S. economy significantly. It would add $27.7 trillion to medical spending between 2019 and 2028. Additionally, just the financing for the proposal would cost $24.7 trillion between 2017 and 2026 (Thorpe) This would increase the national debt tremendously. Spending this amount on healthcare would be an obscene waste of money, it would be incredibly harmful to the U.S. economy, and likely impact many federal services. Although free health insurance for all Americans does sound like an ideal plan, where does the money to afford this come from? Well, according to Emory University professor Kenneth Thorpe, the majority of the money funded would come from a 40 % tax increase on families earning more than $250,000. Essentially, just because these families are earning more money, they would be subject to unequal treatment from the government. This would be very unfair to many people who need this income to support their family. Although it may seem like that amount of money provides a cushion which essentially means that it wouldn’t hurt them, it would be an unjust way to fund a system that would still cost the federal government money every year and increase in cost each year in place.
The system of Medicare For All could also make the quality of hospitals degrade. Since every person would be part of the same provider, lines would likely get even longer and the standard of care could decrease. If just the government is controlling healthcare for all Americans, it would be a massive expense and would hurt not just wealthier people and businesses, but also the U.S. economy and the general standard of care in all medical facilities. Ultimately, this plan would likely cause problems for all involved and completely collapse. Also, it would cause problems for those on Medicaid, ” Overall spending will increase for the federal government since payment rates to providers would increase among those formerly covered by Medicaid.
Medicaid pays providers approximately 88 percent of costs so spending on behalf of former Medicaid patients would rise by $210 billion over ten years (Thorpe).” In general, although it looks like rates may decrease, the cost of healthcare will go up as a whole under the single-payer Medicare for All Plan. It would single out certain groups and force them to pay much higher taxes while others below a threshold wouldn’t have to worry at all about these higher rates. Even though it’s a popular plan, you can’t just offload a giant debt onto people who take home more money. This would cause a major instability in the U.S. tax system.
The Republican healthcare plan is a proposal that would be a step backward, even though it maintains some of Obamacare’s provisions. States would no longer mandate that insurers charge people the same rate, whether sick or healthy. It also does not require insurers to cover basic healthcare needs, such as maternity care and prescription drug coverage (Washington Post). Similarly, people with preexisting conditions are not guaranteed coverage. Next, there are no tax credits for low-income people; that was a fundamental part of Obamacare. Instead, older people would receive credits to help purchase insurance. Furthermore, funding sources that assist in paying for Obamacare would be repealed, including taxes on high-cost insurance, medical devices, and even taxes on indoor tanning salons would be repealed. Medicaid expansion would slow down and stop. It is estimated that 24 million people who are currently insured would lose their coverage from this plan (Sojo).
This takes us back to the situation in which many uninsured people end up getting very sick and needing expensive emergency room and hospital care. Currently, this problem has been reduced by Obamacare. However, in the Republican plan, preventive care, which has been shown to be cost-effective would no longer be mandated in health insurance plans. The Balance reports that insurers would be able to charge older Americans 5 times as much as young people for the same care (The Balance). The proposal also allows the sale of bare-bones policies. Bare-bones policies are healthcare insurance policies in name only. Such policies might only cover one night of hospitalization and have no provision for maternity care, mental health care, or medications.
Consumers don’t often read the fine print and have no idea that the policies won’t cover them in these situations, such as if they are diagnosed with cancer (Consumer Reports). This cost would then be offloaded to either the government or the patient. Consumer Reports reported in 2009 that 14,000 people a day were losing employer-based health insurance and purchasing plans with “ coverage so riddled with loopholes, limits, exclusions, and gotchas that it won’t come close to covering their expenses if they fall seriously ill(Qtd. In Washington Post).” This could become the case again if we were to institute the current Republican plan. In summary, the Republican plan is simply a rollback of consumer protections without a plan to replace them.
The Affordable Care Act represents a moderate middle course in providing quality and relatively affordable health insurance to most Americans while providing individual choice and freedom from severe government controls. The step forward of the ACA resulted in increases in both quality and breadth of healthcare services in addition to relieving anxiety to the insured. Insured persons no longer need to worry about going into debt because of serious health problems. Further, improvements in preventive healthcare led to savings overall, especially when paired with cost controls negotiated on those covered by Medicare. The alternatively proposed single payer (Medicare for All) plan would result in greatly increased costs overall while offering few additional benefits and decreasing freedom in choice of doctors and potential quality of care decreases. At the other end of the spectrum, the proposed Republican plan is a rollback to a time when fewer people were covered, simple health problems that were untreated became serious medical conditions, and greedy insurers profited off of the suffering of unsuspecting consumers. Healthcare is a unique issue in which thorough but careful government controls are necessary, but individual freedom of choice for patients is also important. The ACA represents a middle ground that offers freedom of choice, with safety and support guaranteed by government regulations.
Works Cited
- Abutaleb, Yasmeen. “Just the Facts: A Look Inside the Republican Health Care Plan.” Sojourners, 5 May 2017,
- Amadeo, Kimberly. “Who Really Pays for Obamacare?” The Balance Berchick, Edward R, and Jessica C Barnett. “Health Insurance Coverage in the United States: 2016.” Census, 25 July 2018
- Bernstein, Lenny, and Paige Winnfield Cunningham. “’Bare Bones’ Insurance Policies Really Only Work for People Who Are Healthy.” The Washington Post, WP Company, 15 July 2017
- Blahous, Charles. “The Costs of a National Single-Payer Healthcare System.” Mercatus Center Elmendorf, Douglas W. “Manager’s Amendment to Reconciliation Proposal.” Congressional Budget Office, 20 Mar. 2010
- Mendes, Elizabeth. “More Americans Went Uninsured in 2009 Than in 2008.” Gallup.com, Gallup, 8 Jan. 2010
- Thorpe, Kenneth. “An Analysis of Senator Sanders Single Payer Plan.” Emory University, 27 Jan. 2016.
