Essay Example on Healthcare in US: Before 1950s & Reforms

In the history of the United States, the healthcare sector has always been a subject of conversation, especially in such significant topics as premium cost, healthcare insurance, accessible healthcare for underserved and disadvantaged populations, Medicaid services and Medicare, and reforms in the sector. Before the 1950s, political representatives in the country desired that there should be universal health insurance coverage under the federal government (Manchikanti et al. 112). Subsequently, many political leaders and presents attempted to introduce universal healthcare without success. However, decades later, the Patient Protection and Affordable Care Act (ACA) was passed into law on March 23, 2010 (Manchikanti et al. 112). The new legislation led to the creation of healthcare insurance for all American citizens. ACA aimed to solve the problem in the medical insurance system and promote the benefit of health coverage by extending Medicaid to low-income people as well as providing Marketplace subsidies for those living below the poverty level (Manchikanti et al. 135). Since its launch, ACA has provided critical medical support to many Americans who would have otherwise not afforded the healthcare product and service. Some people, however, believe that the scheme is negatively affecting the economy, at both the state and federal budgets, as well as every citizen (Manchikanti et al. 135). Despite the health benefits associated with ACA, the system has experienced several challenges that are negatively affecting its efficiency.

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One of the challenges facing that faced by ACA right from its launch is political resistance. The enactment of ACA by Congress ended a political debate that had lasted for close to a century. As soon as the Act was passed, ACA began facing significant attacks on its legality and legitimacy in the form of repeated legal challenges and efforts some politicians to defund or repeal "Obamacare" (Buck 98). The foundation of this resistance was a massive political opinion that claimed that the passage of the Act in Congress was undemocratic and one-sided, characterized by inadequate consideration, debate, and compromise. The central claim against the ACA is that the bill was pushed using a legislative process where the Democratic majority party voted for it, despite the objection by the minority party. They further supported their claim by arguing that the bill was crafted behind closed doors by the Democratic leadership by taking advantage of the overwhelming party majorities (Buck 106). The replacement of the Democratic government with the Republican government under President Trump allowed the Republicans to repeal the Act. The repeal has significantly reduced the effectiveness of Obamacare by removing some of its key features that reduced the health insurance premium cost.

The first repeal on the Obamacare Act, under the new administration, was the elimination of individual mandate requirement. According to the clause on the individual mandate, all residents of the country were required to have health insurance or pay the penalty (Buck 105). The goal of the clause was to lower the premium for ACA policies by encouraging the healthier individual to seek health insurance cover. The impact of the repeal had a significant impact on the amount of premium paid for insurance cover. Immediately after reducing the penalty to zero, it caused the insurance premiums to rise. Besides, it opened an avenue for an attack against the Act in court. In 2012, the court had upheld ACA as constitutional because the penalty was a tax and that Congress has the power to create tax (Manchikanti et al. xx). The removal of penalties by the Trump administration, therefore, meant that the entire ACA is unconstitutional (Singer, et al. 5). With these constitutional legalities against Obamacare, many people are not willing to pay for the insurance cover, especially those who healthy, thus reducing the amount of financial pool that can reduce premium prices.

The second legal challenge that ACA faced is the expansion of Medicaid. Under Medicaid expansion policy, the federal government gave financial assistance to states that expanded Medicaid eligibility to include all low-income adults who are neither in school or working. The plan became quite popular, thus attracting 37 states and Washington to enroll for Medicaid expansion, and by 2018 election, Utah, Nebraska, and Idaho had voted to join (Manchikanti et al. 112). However, under the Trump administration, all beneficiaries of Medicaid must prove that they either working or schooling. The impact of this repeal had a disastrous effect on the number of people who are eligible for healthcare insurance (Skinner and Chandra 4). The majority of people who got health insurance after the passage of ACA got coverage because they were eligible to enroll in Medicaid.

The Obama administration had initially introduced cost-sharing reduction subsidies to insurers to help them keep the premiums down for everybody to be eligible. In 2017, the Trump administration stopped paying those subsidies (Shvedova 25). The new government, however, saw the initiative as a waste of money since the insurers took the money to enrich themselves instead of helping people. The latest move to stop remitting the money to insurers had an unexpected and strange impact on the new insurance market established by the ACA. The Act had put the insurers in a bind, where they were supposed to give low-income people insurance at a subsidized premium (Shvedova 26). Since the federal government is longer reimbursing the insurers, then they stop offering a premium to poor people at a subsidized premium.

The major challenge facing ACA, however, has been the anemic enrollment for people seeking health insurance through the system. In 2015, there were 18 million Americans who were eligible to buy health insurance from the state and marketplace who did not purchase it (Healthcare.gov). The main goal of ACA was to enroll as many people as possible, regardless of their financial status. The failure by the ACA to register such a large number of potential people is an indication that the program is failing to achieve its goal. Right from the beginning, the marketplace was unable to attract young adults, Hispanics, and young adults. The federal funding meant for the advertisement to enroll people dried up before all people in the country had purchased the cover. The trend of low enrollment has continued to increase all across up to 2020. By the end of November 2019, the registration in the first three weeks of open enrollment showed that there was a decline in the number of people purchasing the insurance in the year compared to the same time in the previous year by 51,956 (Healthcare.gov). The condition is even worst in 2020. The enrollment of 2020 is below those of 2019, despite the increase in the number of insurers by 20 competing and 4% reduction in premiums (Healthcare.gov). The continuous decline in enrollment for ACA has been the major challenge facing the sustainability of the program. Despite efforts made to increase the number of health insured individuals in the country, the number of those without insurance tend to grow. For example, in 2018, the number of people lacking health coverage was two million more than those in 2017 (Healthcare.gov).

The reason for the decline in the number of insured in 2020, is because of federal government cuts on sign-ups and outreach programs. These reductions in funds meant that fewer people are aware that the decline for taking the 2020 insurance cover was 5th December 2019 (Healthcare.gov). Besides, there was an assumption that the premium for coverage was more expensive if a person qualified for subsidies. Increasing awareness activities about the program can only reserve the impacts of these assumptions. However, comparing the Obama administration and that of Trump, the new government has reduced the program's advertisement and outreach budget by 90% from $100 million, while for the enrollment assistance it has cut the funding by 80% to only $10 million from the previous government (Healthcare.gov). The correlation between the decline in enrollment and a lack of support from the federal government is an indication that the future of the ACA mainly relies on the political goodwill of the country. The conflicting views between the Republican and Democratic politicians about ACA determine the effectiveness of the program. During the Obama administration, ACA enjoyed overwhelming support from the government. However, when Republicans took office, the programs suffered several setbacks that hindered the plan from achieving its initial goal providing universal insurance coverage to all Americans.

From the above discussion, it is evident that the ACA is experiencing several challenges. Most of these challenges are, however, intertwined and are primarily attributed to the political atmosphere of the country. These challenges are mainly the political resistance based on party politics that have led to the repeal of the program, thus eliminating some of its essential features. The elimination of individual mandate requirement has been a significant blow to the legality of the program. Besides, the failure by the new administration to support provide funds for Medicaid expansion cost-sharing subsidies and sign up and outreach programs had significantly undermined ACA. These challenges have collectively led to an increase in premium paid for health insurance, lack of awareness among the people, and an overall improvement in the number of insured people.

Works Cited

Buck, Isaac. "The Affordable Care Act and the Chronic Challenge of Cost Control." U. St. Thomas J.L. & Pub, vol. 11, no. 2, 2017, pp. 97-106, heinonline.org/hol-cgi-bin/get_pdf.cgi?handle=hein.journals/tjlpp11ion=10.

Healthcare.gov. "Patient Protection and Affordable Care Act." HealthCare.gov, 2020, www.healthcare.gov/glossary/patient-protection-and-affordable-care-act/. Accessed March 20. 2020.

Manchikanti, Laxmaiah, et al. "A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?" Health Policy Review, vol. 20, no. 1, 2017, pp. 111-138, www.ncbi.nlm.nih.gov/pubmed/28339427.

Shvedova, Nadezhda. "Trampcare vs. Obamacare: The First Round?" Russia and America in the 21st Century, vol. 3, no. 2, 2017, pp. 24-45, doi:10.18254/S207054760005620-9.

Singer, Phillip, et al. "Higher Education and Medicaid Spending: Analysis of State Budgetary Trade-offs and the Affordable Care Act." Higher Education Policy, vol. 4, no. 1, pp. 1-23, link.springer.com/article/10.1057/s41307-019-00164-y.

Skinner, Jonathan, and Amitabh Chandra. "The Past and Future of the Affordable Care Act." JAMA, vol. 316, no. 5, Aug. 2016, pp. 497-499, doi:10.1001/jama.2016.10158.