Political Science
12/10/13
100 Years of Health Care Reform: Obamacare Bringing Us into the Future
In 2008 when presidential candidate Barack Obama was platforming for universal healthcare for the United Sates, most people thought that it was a revolutionary idea, and liked the way it sounded. Who wouldn’t want affordable universal health care? But what many people did/do not know is that Obama’s platform was not revolutionary at all. In fact there had been many presidents before Barack Obama who had fought for some sort of universal health care. Now hat eager democratic candidate of 2008 has entered into his second term as president of the United Sates, and as his platform promised, he has been able to pass a bill that gives every American citizen affordable health care. This bill is called the Affordable Care Act; though many people know it now as Obamacare. What is interesting about Obamacare is that although it was widely praised by the American public before it was passed, it is now getting many mixed reviews. But to really be able to make a decision about whether or not you are for or against the new bill, you must understand the Affordable Care Act or ACA fully; its history, and its meaning. Private and public health insurance has not always been a part of American medicine. In fact the very first prepaid health care coverage was not established until 1929, when Baylor Hospital in Dallas, Texas developed the Baylor Plan which helped a local teachers union with hospital costs. The Baylor Plan is the predecessor of what is now Blue Cross, a private insurance company. President Franklin Delano Roosevelt and his progressive movement had been fighting for national healthcare sense WWI, but when the Great Depression hit the United States, FDR shifted his attention to establishing unemployment insurance and social security benefits. During this time, FDR creates the Committee on Economic Security to address the issues of the nation, including that of medical care and insurance. But once the Social Security Act is passed in 1934, healthcare is overlooked. The American Medical Association ends up strongly opposing FDR’s plan for national health insurance, because they believed that the program would increase bureaucracy, limit doctor’s freedom, and it would interfere with the doctor-patient relationship. It wasn’t until 1944 when FDR maked a state of the Union address that outlines an “economic bill of rights” that includes the right to good health. After the address, businesses began to offer healthcare benefits during WWII as they needed to have some leverage in competing for workers. The employer-based system that started during WWII is in many ways the same today as it was then. The second president to propose national healthcare was Harry Truman who proposes universal mandatory coverage with more hospitals, doctors and nurses, but again is shot down by the American Medical Association. This time the AMA says that Truman’s plan is labeled “socialized medicine”, and the plan gets shot down before it can really begin. It’s not until twenty years later in 1965 that national healthcare see’s any kind of success. President Lyndon Johnson signs into law the most impactful health reform of the century with the beginning of Medicare and Medicaid. For the first time in American history, there is government run healthcare. Medicare covers persons 65 and older, and Medicaid helps cover persons who are poor and disabled. A few years after the introduction of Medicare and Medicaid, insurance costs end up skyrocketing due to the millions of Americans who are now insured. President Richard Nixon tries to stop the rapidly increasing spike in insurance costs by signing into law the Health Maintenance Organization Act -- HMO -- which are prepaid, managed-care group plans, but due to the Watergate Scandal, further cost cutting action is stopped for several decades. In the 1980’s even though insurance prices have increased, America sees a shift towards private insurance, and by 1987 only 13% of the American Population is uninsured. In 1992 first lady Hillary Rodham Clinton works with her husband to develop a plan for universal healthcare coverage. The plan requires all businesses to cover the health care costs of their workers and mandates everyone to have insurance. Again, this idea is overthrown by medical lobbyists and never sees a vote. Over the next 13 years very little changed in health insurance, besides the growing price. But in 2006 a revolutionary moment happens in American History for healthcare reform. Massachusetts passes a law to guarantee health care coverage to nearly all of the state’s residents. This plan works through a program of shared responsibility between the government, employers, and individuals. By 2008 Massachusetts’s uninsured rate is cut in half, and is so successful that Vermont passes a healthcare bill of their own.
Now bringing it all back to the present day; Obama’s ACA is really nothing that we haven’t seen before in American History. In fact we have seen it many other times, and has been proposed by many other presidents in the past. So what made the ACA different than all the failed bills of the past? There are quite a few different answers to that question, but it mainly had to do with Obama’s personal background with fighting health insurance companies on behalf of his dying mother; the fact that Massachusetts has seen success in state wide health coverage; and because health insurance costs are more than ever out of control. Fewer and fewer people are able to afford insurance through private plans, or even plans provided through their employers, and more and more people are being denied private insurance due to preexisting conditions. For the first time in American history there was a perfect storm as to why we need to have our government step in and create universal healthcare, and Obama had the wining plan.
After years of fighting for Universal Health Coverage, newly elected President Obama addresses Congress about his ACA plan in February 2009. On November 7, 2009, the ACA is passed by the House of Representatives by a 220-215 vote and is moved on to the Senate for final passage. On December 24, 2009 the Senate passes the bill on a vote of 60-39. For the first time in American History, national universal healthcare coverage is now a part of the American future. On March 23, 2010 the ACA was signed into law by President Obama, and from that moment, healthcare began to change forever.
Under the ACA there are a number of changes in the healthcare reform that will span out over ten years. Below is a timeline of those changed that have already happened and will continue to happen until 2020. * As of January 2010: * Small businesses were able to count 35% of the money spent on employee health insurance as a tax deduction. * Medicare Part D coverage rises $500 for each person. * In June 2010: * Temporary high-risk pools are created to cover those with pre-existing conditions. * Rebates of $250 start going out to seniors who have reached the Medicare Part D coverage gap. * In September 2010: * It becomes illegal for insurance companies to cancel coverage after signing up. * Certain types of preventative care start having no deductibles. * Persons under the age of 26 can be dependents on their parent’s insurance plans. * Lifetime limits on insurance benefits are banned. * In 2011: * Medicare Advantage is restructured to cut costs, which will result in cutbacks in benefits for those enrolled. * Brand-name drugs are discounted by 50% for those on Medicare Part D. * Individual States can begin expanding their Medicaid coverage to include those who are made eligible for benefits by the new ACA law. * In 2013: * Maximum contribution to a FSA is $2,500 per year and is tied to inflation. * Medical deductions rise from 7.5% to 10% of adjusted gross income per individuals and families. * Medicare tax goes up for individuals earning more than $200,000 and married couples earning $250,000 per year. * In October 2013: * The State-based insurance exchanges open in some states. This exchange is online at healthcare.gov and there will be four standard levels of coverage based on income level for individuals and families. * In 2014: * All states that have opted into the exchange will have plans available on the exchange; currently there are 48 states that have opted in. * Tax credits will be issued to help the uninsured earning from 100-400% of the federal poverty line in order to buy insurance. * Medicaid will cover children, parents and childless adults not under Medicare who earn up to 133% of the poverty line. * Employees who get insurance through their employers can opt to receive a voucher for the buying insurance on the exchange instead. * Businesses with more than 50 employees are required to provide health insurance to employees or they will have to pay steep fines. * By April 1, 2014: * Tax penalties will be issued for any citizen still without insurance, and will increase each year that person stays uninsured. * By 2017: * Any business with more than 100 employees can shop for health insurance on state exchanges. * In 2018: * An excise tax begins on health plans that cost more than $27,500 per family, and $10,200 for individuals. * By 2020: * There will be drug maker discounts and government subsidies for brand-name drugs or all Medicare recipients.
There are some other points about Obamacare that everyone should know. Such as: The ACA is not a mandate. Anyone who wants to opt out of buying insurance can, but they will have to pay a fine for each year they don’t have insurance. The first year’s fee starts in 2014 and is $95 or 1% of income per US citizen. Each year those fees increase, and by 2016 can be up to $2,085 or 2.5 percent of a family’s income. The incentive for this is that people will opt into buying affordable health insurance or even signing up for free Medicare health insurance if they qualify, instead of paying an increasing fee. Also, people who are already insured need to do nothing, they are able to stay with the insurance they have, if they wish. And, no one will have to pay over 9.5% of their annual income to buy insurance. Since the 1970’s the inflation of health insurance has skyrocketed so high that most people cannot afford to buy into it, and because of the highly inflated insurance prices, medical costs are and have been the number one reason for bankruptcies in the United States for the past 30 years. That 9.5% cap for insurance cost will force insurance companies to offer lower cost insurance to everyone, and allow health insurance to be feasible on any budget. Lastly, no insurance company can deny you coverage because of age and/or preexisting conditions. Now literally everyone can get the same healthcare no matter what medical challenges you face. ACA brings insurance down to an even playing field.
The way the exchange works is that there will be four levels of plans available based on your income level. These plans are titled Bronze 60, Enhanced Silver 70, Gold 80, and Platinum 90. Each plan has a number of companies that will support that particular plan, and you will be able to choose from all those various companies once you decide on which plan is right for you. All of the companies that opt into the exchange have to qualify by covering a basic 10 piece umbrella that is stated in the ACA law, while falling into the outlined price set by the government. Those ten things are called the “essential health benefits,” and they include: * Ambulatory patient services (outpatient care you get without being admitted to a hospital). * Emergency services. * Hospitalization (such as surgery). * Maternity and newborn care (care before and after your baby is born). * Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy). * Prescription drugs. * Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills). * Laboratory services. * Preventive and wellness services and chronic disease management. * Pediatric services.
So while services such as these listed above may have not been a part of certain insurance plans in the past, they all must cover at least these 10 essential benefits by law. Also, there will be a government subsidy for individuals and families who make under a certain amount. The amount of the subsidy will be based on how much you make annually. Those persons who purchase insurance through the exchange and fall within 133-150% of the national poverty level will receive government subsidies that will lower their monthly premium costs to 3-4% of their income. These subsidies also span up to individuals making $45,960, and families of four making $94,200. And although these subsides will help with premium costs, under the new ACA law no individual or family will have to pay more than 9.5% of their annual income on health insurance when purchased through the exchange. Although the ACA law seems to be a positive step in the right direction for America and especially American citizens struggling in a bad economy, there is still a lot of opposition, and an ongoing fight from the Republican Party to stop the ACA all together. While many Americans loved the idea of affordable and universal healthcare, now that it is in the works, and is now in the hands of the people to decide on coverage, many of those people who were for it in the beginning have changed their minds. The reasons why the majority of people are opposing the ACA is because they either don’t want to spend more money -- which is only affecting those who make over $200,000 per year, or are uninsured and by federal level can afford it without government subsidies. Or people who don’t want the government telling them how to live their lives. Many people believe that our government is too big already and the thought of big brother telling us how to live, is almost a crime in their eyes. Another reason is because they are business owners who have not offered health coverage to their employees in the past and now have to make that expense by law. Some others who are opposing the ACA are a part of the Nation’s richest 1%, and they oppose the fact that they will end up paying higher taxes to help cover Medicare and Medicaid, and are worried about the outcome of their investments in insurance and medical companies. There is another opposing side that is coming from some doctors and medical caregivers who are worried about the way Medicaid and Medical billing will affect how they get paid and how their current patients will be affected with the changes.
But of all of these negative voices, the positive outcomes of the ACA in progress highly out way the bad. With anything new, there are always a few glitches, and those glitches are normally human related. Once Americans just accept that this law will help us all in the long run, the less people will focus on the negative and move with the flow of change and progress. So in conclusion, “Obamacare”, the Affordable Care Act, Health Care Reform -- whatever you want to call it -- may be an idea from the past, but it is now a part of America’s future, and a mentally and physically healthy country is rich and powerful country. I don’t think anyone can argue with that!

Work Cited
“Health Reform”. Whitehouse.gov. Web. 06 Dec. 2013
Healthcare.gov. U.S. Department of Health and Human Services. Web. 06 Dec. 2013
“Minimum Coverage Provision.”APHA.org. Web 06 Dec. 2013
“Eight Decades of Healthcare.” hhnmag.com. Healthcare Forum, Inc. Web. 06 Dec. 2013