What is Healthcare Reform and why do we Need It?

Many Americans are uninsured or underinsured due to unaffordable insurance options. The ACA will help many currently uninsured individuals gain health coverage by providing coverage options across the income spectrum for low and moderate-income people (The Henry J. Kaiser Family Foundation, 2018). The Affordable Care Act is not a health insurance plan but has 3 main objectives: (1) to reform the private insurance market—especially for individuals and small-group purchasers, (2) to expand Medicaid to the working poor with income up to 133% of the federal poverty level, and (3) to change the way that medical decisions are made (Silvers J. B. 2013). Our healthcare system has been neglected for a long time, but the ACA has helped shed some light on problems that have been swept under the rug.

How did we in the U.S. end up with the most expensive and inefficient health care system? The push for universal healthcare began a long time before President Obama enacted The Affordable Care Act. Healthcare was relatively inexpensive but with the increase in technology, the cost in care started to rise. Health care economists estimate that 40–50% of annual cost increases can be traced to new technologies or the intensified use of old ones (The Hastings Center, 2018). As people started to be less willing to pay for the tests ordered, a decline in care started. Most people would avoid going to the doctor until they had no other choice. In turn, patients would seek treatment when they were very ill. Waiting till the last minute, lead to a vicious cycle that incurred more costs.

For the working class, most insurance is cheaper if purchased through the employer instead of purchasing insurance on their own. Although those plans are not practical for most employees, most of the time it is what is the best option/price for the company. The premium paid by employers for their group policies is typically increased every year based on the previous year’s healthcare costs of the employee group. With group health insurance, the risk is spread over the company -- the number of employees you're covering (Merhar, 2018).

The Affordable Care Act has substantially decreased the number of uninsured Americans and improved access to health care, though insurance affordability and disparities by geography, race/ethnicity, and income persist. These are some of the findings revealed in nearly 100 studies, dating back to 2010, pertaining to the ACA in a new research paper (AJMC, 2018). 1-3 million uninsured young adults gained coverage under the ACA. The gains in coverage are especially pronounced for men, unmarried individuals, and nonstudents.

A major goal of the Affordable Care Act (ACA) is to increase access to healthcare, particularly for those who are uninsured, underinsured, or without stable healthcare insurance. The ACA has reduced the size of the uninsured population, and in 2016, close to 13 million Americans enrolled in a health plan through the federal or state-operated healthcare exchanges (AJMC, 2018). However, there has been significant debate as to whether the ACA has achieved its goals of improving access and decreasing costs and whether it should continue in its current form. Most empirical studies since implementation of the ACA’s healthcare exchanges in 2014 have focused on the number of uninsured Americans within the United States and by state or examined care trends at the population level. The impact of insurance obtained through healthcare exchanges on access and costs of care at the individual level is largely unknown (AJMC, 2018).

Insurance companies are not the only reason why health care is so expensive. Many do not realize what all falls into this wide category. Pharmaceutical companies, pharmacies, doctors, hospitals, and insurance companies all want to be paid for services and they all fall under the umbrella of insurance.

There are 5 different features of the law that have been important to improving Americans’ health and financial security. The Affordable Care Act protects people with pre-existing conditions from being denied health insurance. The ACA gave everyone a lifelong guarantee that health insurers cannot, under any circumstances, discriminate against them based on pre-existing health conditions. This includes cancer, diabetes, and high blood pressure. (Families USA, 2018)

Thanks to the ACA, young people are currently guaranteed coverage on their parents’ health plans until they are 26, whether their parents purchase their health coverage on their own or receive it through a job. Young adults are eligible even if they are married or if they live in a different state than their parents. (Families USA, 2018)

One of the most important provisions of the Affordable Care Act is the expansion of health coverage to low-income families through the Medicaid program. Before the ACA, most states did not give health coverage to adults without children, no matter how poor they were. And most states only covered parents if they had extremely low incomes. (Families USA, 2018)

The ACA required that most health plans cover preventive care—like cancer screenings, vaccines, birth control, blood pressure tests and more—at no additional cost. Repeal of the ACA threatens the access to preventive care of nearly 138 million people with private health coverage (including nearly 29 million children) and 55 million seniors on Medicare. Nearly 56 million women will lose the guarantee of free preventive services, including contraception coverage. Under the ACA, women have saved an average of $255 per year on oral contraceptives. (Families USA, 2018)

Thanks to the Affordable Care Act, millions more people have coverage for mental health and substance use disorder services. Coverage of these services is now a required benefit in plans sold to individuals, families, and small businesses. Before the ACA people enrolled in private plans often found they did not have coverage for the services they needed, 34 percent did not have any coverage for substance use disorder services. The ACA required, for the first time, that small employer and individual market plans treat mental health care as equal to general medical care. Coverage for mental health and substance use disorder is considered part of the ACA’s “essential health benefits,” bringing parity protections to consumers. (Families USA, 2018)

The purpose of the Affordable Care Act is to help make insurance affordable to those who are uninsured. The Affordable Care Act is not a health insurance plan, but its goal is to expand insurance coverage and to increase access to care. The ACA required that most health plans cover preventive care. The ACA gave everyone a lifelong guarantee that health insurers cannot, under any circumstances, discriminate against them based on pre-existing health conditions. Our healthcare system has been neglected for a long time, but the ACA has helped shed some light on problems that have been swept under the rug.

References:

1. AJMC. (2018). Improvements in Access and Care Through the Affordable Care Act. [online] Available at: https://www.ajmc.com/journals/issue/2017/2017-vol23-n3/improvements-in-access-and-care-through-the-affordable-care-act [Accessed 17 Dec. 2018].
2. University of Miami. (2016, August 30). Affordable Care Act has improved access to health care, but disparities persist: The Affordable Care Act has substantially decreased the number of uninsured Americans. ScienceDaily. Retrieved December 16, 2018 from www.sciencedaily.com/releases/2016/08/160830130828.htm
3. Families USA. (2018). 5 Ways the Affordable Care Act is Helping Real People. [online] Available at: https://familiesusa.org/5-ways-affordable-care-act-helping-real-people [Accessed 17 Dec. 2018].
4. The Henry J. Kaiser Family Foundation. (2018). How Will the Uninsured Fare Under the Affordable Care Act? [online] Available at: https://www.kff.org/health-reform/fact-sheet/how-will-the-uninsured-fare-under-the-affordable-care-act/ [Accessed 22 Dec. 2018].
5. Silvers J. B. (2013). The Affordable Care Act: objectives and likely results in an imperfect world. Annals of family medicine, 11(5), 402-5.
6. Merhar, C. (2018). Why Individual Health Insurance is More Affordable Than Group Health Insurance. [online] Peoplekeep.com. Available at: https://www.peoplekeep.com/blog/bid/322844/why-individual-health-insurance-is-more-affordable-than-group-health-insurance [Accessed 22 Dec. 2018].

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