Patient Protection and Affordable Care Act

Patient Protection and Affordable Care Act (Obamacare) are a set of health insurance and industry reforms that aim to expand access to health insurance and change the way the federal government pays doctors. The expansion of people with insurance can be attributed to three main provisions in the law – The expansion of Medicaid, the creation of insurance exchanges and the individual mandate (Kliff, 2017). While Obamacare relies on insurance companies and federal government, single - payer healthcare relies on government (single payer) and covers the cost of essential healthcare for all residents through publicly funded taxes.

The first provision under Obamacare is the expansion of Medicaid, a federal program that provides health care coverage to low income Americans. Before the expansion of Medicaid, residents of states such as Massachusetts and New York qualified for Medicaid based on income, household size, disability, family status and other factors. However, after the expansion of Medicaid in these states, residents can quality based on income level alone. If their income level is below 133% of the federal poverty level, they are eligible (HealthCare.gov). The second provision under Obamacare is the creation of health insurance marketplaces or health exchanges through which people can purchase and choose from a range of government – regulated and standardized health care plans. Before Obamacare, health insurance companies could deny coverage or charge higher prices for people with pre – existing conditions.

However, under Obamacare, one’s health, medical history and gender can’t affect their premiums. Insurance companies are only allowed to account five factors while setting premiums which are Age, Location, Tobacco use, Individual vs family enrollment and Plan Category (HealthCare.gov). The third and the most controversial provision under Obamacare is the individual mandate that requires most Americans to purchase health insurance coverage. The individual mandate would provide health care to all sections of society, irrespective of their race, color and class, thus hugely benefitting the oppressed sections. This provision forces healthy people (who wouldn’t purchase insurance) to sign up in order to keep the premiums low. However, people who can’t find an affordable plan or have religious reasons for not buying health insurance are exempted from the individual mandate. One of the aims of Obamacare is to tether doctors’ payments, at least partially, to patient outcomes, rewarding doctors who practice better medicine with higher payments.

Despite having various benefits, Obamacare has some evident loopholes in it. First, residents of states such as Alabama and Mississippi (without Medicaid expansion) with incomes below the federal poverty level are severely affected since they don’t qualify for either Medicaid or health insurance savings program (HealthCare.gov). Also, Insurers are fleeing the health insurance marketplaces because Medicaid Expansion have made it more expensive for insurers in non – expansive states since they have to cover for poor people who tend to be sicker than rich people. For instance, in Alabama, Blue Cross Blue Shield being the only insurer participating in the exchange is spending $1.20 for every $1 collected in premiums (Khazan, 2017). As a result, new taxes on medical device and pharmaceutical sales were created to pay for ACA. Moreover, if an individual remains uninsured, under the individual mandate provision, he/she is asked to pay penalties which rise every year if they are still uninsured (Kliff, 2017). While Obamacare implemented individual mandate provision to reduce the premiums by encouraging healthy people to join, covering people with pre – existing conditions have caused the premiums to rise exponentially.

On the other hand, policies such as single payer healthcare requires the federal government (single payer) to cover the costs of essential healthcare for all residents with costs financed by publicly funded taxes. Single payer system aims to provide universal health care, thereby, reducing the number of uninsured people. In a single payer government - run system, government would negotiate with doctors, hospitals and pharmacies, thus, reducing price per service and bringing health care costs down (Kurtzleben,2017). Such unified system would ensure high quality health care as the quality of care would have to be high enough to be acceptable to all residents.

While single payer healthcare plan of free health care with no copays and deductibles seems cost effective, government would have to increase taxes to provide funding for everyone. This tax increase could exceed the money spend on copays, deductibles and health insurance plans, thus making it cost intensive. Moreover, a single payer plan doesn’t imply no copays or deductibles. For instance, Canada’s single payer system does not include coverage for dental and vision care alongside several prescription drugs. One of the largest single payer systems, England’s National Health Services charges a $12 copay for drugs prescribed outside hospital setting. Therefore, single payer doesn’t guarantee free health care (Kliff,2015).

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