The Affordable Care Act is the United States’ first national health care system. Repealing it would revert the health care system back to a guiding principle of profits over people. President Trump understands this concept yet continues to push forward with the repeal effort for what amounts to nothing more than a mere political victory. President Trump, people’s lives are more important than political victories. Smart and caring politics are means to the ends: a pathway to ensure that every American has access to affordable and great health care.
Healthcare in the United States started to rapidly evolve from household care to medical facilities and hospitals at the turn of the 20th century. In response to this changing society and economy, progressive reformers sought to bring the government into the health care system to lower costs and provide “sickness” insurance. However, this campaign failed. In the absence of national health care, private health insurance started to enter the health care market. Although benefits increased because of private insurance, many people were not covered. So, Lyndon Johnson enacted federally funded Medicaid and Medicare to bring coverage to more people. However, in turn, health care prices spiked sharply. Then in the 1970s, the Nixon administration countered this liberal spending and government intervention with inflationary controls and gave authority back to private insurance. This back and forth is a microcosm of the history of United States’ health care system. The health care system has risen and fallen with economic booms and busts and political liberalism and conservatism. This instability has far reaching consequences for consumers including skyrocketing prices and lack of coverage across the United States.
In total, the people that benefit the most are the poor and the sick because Medicaid expansion covers more people for cheaper. Moreover, new requirements in quality such as essential benefits, preventative care and addressing preexisting conditions improve the coverage itself. The people that benefit the least are the middleclass businesses and individuals. For example, large businesses (50 employees or more) are mandated to provide insurance for their employees, however smaller businesses (less than 50 employees) aren’t mandated. So, businesses that consist of slightly more than 50 employees must pay for their employee’s coverage, but don’t qualify for tax credits as the smaller businesses do. The situation is similar for middle class individuals where they qualify for subsidies in marketplaces but these subsidies don’t account for increases in premiums. Furthermore, high earning individuals and businesses see their taxes increase the most while their tax reductions are eliminated.
As a person under the age of 26, I am one of the individuals who benefits from the entitlements given by the ACA by being allowed coverage under my parent’s insurance plan. When the ACA was enacted, our premium decreased from $500 to $250 because my parents’ income qualified for the ACA marketplace subsidies. However, our premium rose from $250 in 2010 to $700 in 2016 due to their recovering income and ACA problems. In 2016, my mom bought an insurance plan from her new employer where the new premium increased to $950. Due to the ACA requirements, this employer sponsored plan allows myself, 20 years of age, to remain insured until I am 26. Another important point is that the doctor given to us by the ACA was about 30 minutes from our house. Although after a quick call to the administration, we were given our original doctor back. I point this out because for many, losing their preferred doctor has been a significant issue.
There are other problems within ACA marketplaces and Medicaid expansion that causes the ACA to fail in some places. But fortunately there are solutions. First, require insurance companies to participate in rural areas or areas that aren’t necessarily the most profitable to increase competition and therefore drive down prices. Second, enforce antitrust laws so health care actors (insurance companies, hospitals, etc.) can’t consolidate services and create monopolies with marketplaces. Furthermore, marketplaces must aggressively recruit and pursue young and healthy individuals to buy insurance with targeted marketing and special deals. By increasing the pool, this would ultimately reduce premiums for all consumers.
Regarding Medicaid expansion, some states chose to opt out of the expansion. These states must reconsider this decision so that more people can attain coverage. Additionally, not opting into the expansion hurts other areas of the health care system because this forces more sick and elderly people into the marketplace pool instead of the Medicaid pool. Failing to bring young and healthy people into the marketplace pools has been one of the biggest challenges of the ACA, but one that is solvable with well-placed and well executed fixes.