In March of 2010, the Patient Protection and Affordable Health Care Act – also known as PPACA or Obamacare – was signed into law by president Obama and set to be fully implemented as of 2016. The idea is not to provide free medical care for everyone at the expense of government funds coming from tax revenues, but rather to ensure that everyone is insured and that those who cannot afford insurance are also guaranteed insurance without being financially penalized. Although the key elements of the PPACA are to help provide universal medical coverage, the act inadvertently causes financial problems for others including the government. Many amendments have been made to the PPACA in order to be more appealing, but the overall debate seems to end in the repeal and replacement of Obamacare with the American Health Care Act, also known as AHCA or Trumpcare.
Introduction of the PPACA and Universal Health Care
History
Healthcare become a major concern in the U.S. around 1965 with the introduction of Medicare and Medicaid during the presidency of Lyndon B. Johnson (CMS, 2018). Originally healthcare was mostly concerned with covering hospital and supplemental medical insurance for senior citizens under Medicare and partial medical coverage for the poor paid for by the government through Medicaid. Throughout the years, medical coverage has expanded, and insurance has become a major issue for many political debates (Ginsberg, et. al., 2017). The biggest debate concerns the ethicality and practicality of universal healthcare in the U.S.: Obamacare (PPACA) vs. Trumpcare (AHCA).
Key Components of the PPACA
PPACA outlines a universal medical system that makes medical insurance mandatory for all U.S. citizens in which “an individual mandate…requires every American to buy health insurance and maintain that coverage year-round” (EHealth, 2018) or else one can choose to pay a penalty tax to avoid purchasing insurance. For many countries, like Canada, Germany, and most other European countries, universal healthcare has been implemented for many years. The PPACA takes some inspiration from these existing programs, especially with its focus on providing medical services to the poor who may not have the means to purchase insurance. Premium insurance dollars under the PPACA “requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement,” (FFCMH, 2010) thus investing premium dollars in medicine instead of in corporate paychecks. These premium rates are also reduced by prohibiting annual and lifetime benefit dollar limits. Tax revenue is used to help close the gap between what the poor can afford and what they need, especially in pharmaceuticals and other more expensive treatments and checkups. In essence, tax revenue is the support for Medicaid and Medicare in the case that the federal government provides payment for medical expenses of the poor through tax-funded federal programs. Obamacare also ensures that children can remain on their parent’s medical insurance and that individuals with pre-existing conditions cannot be denied medical insurance. Prevention programs for illness and disease for all ages and providing improved medical care for elderly outside of hospital care are two main factors that play into Obamacare other than providing better medical coverage for the poor.
Health Care Debate
Supporting Points
Those in favor of the PPACA recognize that universal healthcare is an important step forward in the modernization of medicine. The idea that there are U.S. citizens who cannot afford medical care is a major influence on the creation of Obamacare and expanding Medicaid, but the PPACA also provides better medical coverage for all Americans regardless of financial status. Many supporters claim that Obamacare slows the rise of healthcare costs, provides coverage for individuals with pre-existing medical conditions, and lowers the overall cost of medical care for everyone especially by reducing the “doughnut hole” (Amadeo, 2018) gap in pharmaceuticals and investing more premium dollars back into medicine instead of pay raises (EHealth, 2018). The main argument for Obamacare is that it creates a more affordable path for the average American to obtain health insurance while still allowing non-average citizens benefit from the system through either free Medicaid for the poor or by paying a tax to opt out of having insurance.
Opposing Points
Opponents of the PPACA also recognize the advantages of universal healthcare under Obamacare, but they also argue that it will need finances from taxes in order to support the government providing for so many new medical benefits. Income taxes will rise in order to pay for federal spending on Medicaid and Medicare; prices of pharmaceuticals will increase for those without insurance or without the right insurance since companies will begin to raise prices due to their financial losses through the elimination of the “doughnut hole” gap (Amadeo, 2018); penalty taxes will be implemented and people will choose to pay the penalty instead of insurance since they do not feel as though they need insurance. Those who pay the penalty tax – approximately “19 million people have opted-out of Obamacare, either by paying the uninsured tax (6.5 million) or by filing a hardship exemption (12.7 million)” (EHealth, 2018) – are not insured, which goes directly against the impetus of Obamacare. Most arguments against the PPACA come from a financial concern for the medical economy and those already invested in insurance. With free medicine available, some may choose to take advantage of the system’s altruistic aspects thus flooding the fragile medical economy with federal dollars and raising taxes to accommodate for those taking advantage of the system. Obamacare also removes the existing medical coverage provided by employers, businesses, unions, etc. which forces those working to find a new source of insurance that may or may not have the benefits they need. Since companies can buy insurance packages at lower prices and afford better benefits for their workers, when this is removed, many workers are forced to move to insurances without the same benefits since they may not be able to afford the same insurance that the company provided prior to the PPACA. The main argument against Obamacare is definitely that it will reduce the number of people with adequate insurance and raise taxes drastically, leaving many middle-class Americans in danger of poverty since they are not poor enough for Medicaid and not wealthy enough to afford insurance and taxes.
Introduction of the AHCA and Current Health Care
Recently, the American Health Care Act was passed in anticipation of the repeal of the PPACA. In the AHCA, also known as Trumpcare, health insurance is not a requirement, there is no penalty for not having insurance, tax credits for insurance are accessible for more people with higher incomes (single – US$75,000; married – US$150,000), and gives states more power in determining how Medicaid and Medicare will be implemented and extended throughout the state instead of being mandated at a federal level (EHealth, 2018). Many conservative and republican affiliates are in favor of the AHCA, or a more feasible approach to medical care, while more liberals and democrats are in favor of the PPACA, or a universal healthcare system that provides for everyone. The argument still continues into current politics and is unavoidable even in everyday life; while a socialist medical system sounds great for poorer, millennial, and elderly Americans, a less inclusive system sounds much more appealing for middle-class working Americans, especially with families.
Conclusion
Comparing the Patient Protection and Affordable Health Care Act to the American Health Care Act is a bit difficult since the two programs are not all that different from each other. Overall, the impetus of achieving health care for everyone in the U.S. is common ground for both programs, but federal involvement and benefit programs differ. Neither plan fully embraces and represents truly universal medical coverage since they both focus mainly on increasing the number of people with health insurance. Although neither plan offers free medical coverage for all citizens, both emphasize the importance of providing medical coverage for those who cannot afford to pay for health insurance. The Patient Protection and Affordable Health Care Act was designed to pay for anyone who could not afford medical care regardless of their financial background, but ultimately punished the middle-class working Americans since they were neither too poor nor too rich to afford health insurance according to the PPACA program. The American Health Care Act is designed to better accommodate middle-class Americans, but it has less federal funds allocated for poorer individuals and families who cannot afford health insurance. Although both health care programs are designed to increase the number of insured people in the U.S. neither is perfect, but neither is truly expected to be so. Both plans try to appease the demands of different subpopulations in the U.S.: PPACA appeases the poor, while AHCA appeases the middle-class. Conclusively, the U.S. will have to accept the fact that the AHCA was signed into place to take action in 2018, but there are always improvements being made as time moves forward. If one really wishes to change the health care standard in the U.S., s/he can by spreading the word about those wishes.
Personally, I do not have much say in today’s medical system, but as someone who does have health insurance through my parents, I am grateful that the U.S. has quality health insurance available and does not use a more socialist approach to health care. After experiencing socialized universal medical care in Germany, the U.S. is far better when it comes to wait time, service, and overall care, so the overarching program is a good approach to medical care, but there should be a greater focus on providing health care for those who cannot afford it as well as a focus on health care quality. The best program would be one in which the U.S. quality of health care would not be sacrificed when more federal involvement occurred in favor of the providing health care for the poor.