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Obamacare: the Main Features and Characteristics

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The Patient Protection and Affordable Care Act (PPACA), often called Obamacare, is a United States federal statute enacted by the 11th United States Congress and signed into law by President Barack Obama on March 23, 2010 (Patient Protection). The Patient Protection and Affordable Care Act is universal healthcare. Universal healthcare is “an organized healthcare system that provides healthcare benefits to all persons in a specified region” (Staff, Investopedia). Democratic Party Platform stated, “Democrats have been fighting to secure universal health care for the American people for generations, and we are proud to be the party that passed Medicare, Medicaid, and the Affordable Care Act” (Health Care). Democrats over the decades have been fighting for the idea that everyone should have security in health care (Health Care). Its other purpose was to make health insurance more affordable for individuals (Affordable). “Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level and support innovative medical care delivery methods designed to lower the costs of the health care generally” (Affordable). There have been many issues with this act for many years. Now that Donald Trump has become president Obamacare might be repealed. Should Obamacare be repealed and replaced because of the many issues involving it?

A study done in 2013 by Carnegie Mellon University found that 86 percent of Americans between 25 and 64 did not understand Obamacare (Neporent, Liz). ABC NEWS clarified that it works “by offering consumers discounts on government-sponsored health insurance plans”. PPACA has changed the other insurance companies’ rules. In the past when customers had diabetes or another pre-existing medical condition they could be turned down for insurance, or the cost of coverage would rise (Neporent, Liz). “Now you can’t be turned down for any reason, and the hope is that costs will be contained” (Neporent, Liz). There is also talk that if you do not buy the insurance you are penalized. “But any American who meets certain income-based criteria must now, by law, have insurance, Medicare or Medicaid or pay a penalty that will be leveled when you file your tax return” (Neporent, Liz).

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The cost of Obamacare depends on five factors: your age, income, family size, location, and the type of plan you (Amadeo, Kimberly). This is because they provide subsidies, which is financial assistance that helps people pay for something, for middle-income individuals, families, and small businesses (Amadeo, Kimberly). The first factor would be the plan chosen. Obamacare has four health insurance plans called bronze, silver, gold, and platinum. Bronze has 60 percent coverage, lowest premium, high deductible, and no cost-sharing subsidies (Vore, Amy De). Silver has 70 percent coverage, 2nd lowest premium, separate medical and Rx deductibles, and cost-sharing subsidies (Vore, Amy De). Gold has an 80 percent coverage, higher premium, no deductible, and no cost-sharing subsidies (Vore, Amy De). Platinum is the highest premium out of all of them with a 90 percent coverage, no deductible, and no cost-sharing subsidies (Vore, Amy De). They all offer the same ten health

benefits. These benefits are preventive and wellness visits, maternity and newborn care, mental and behavioral health treatment, services, lab tests, pediatric care, prescription drugs, outpatient care, hospitalization, and emergency room services (Amadeo, Kimberly). Secondly, age can influence cost. Insurance companies are allowed to charge older people with higher premiums. However, they cannot charge more than three times the premium of the cost for younger people Amadeo, Kimberly). The second most important category cost is determined by is where people live. Some cities have higher health insurance than others. Finally, the most important categories are income and family size. If they were to make 400 percent or less of the federal poverty level then they would receive a subsidy (Amadeo, Kimberly). Now that we know how they determine the cost what are some of the pros that have changed the way we look at it.

There are many pros that people do not consider. Because of Obamacare, more Americans have health insurance. Sixteen million Americans acquired health insurance coverage in the first five years of the PPACA (The Pros). Before PPACA, insurance companies set limits on the amount of money they could spend (The

Pros). Now insurance companies can no longer pre-set a dollar limit on the coverage they provide their customers. Some more pros would be more screenings are covered and lower prescription drug costs (The Pros). Fifteen billion dollars were saved on prescription drugs (The Pros).

Even though Obamacare seems to be a great thing it does come with its issues. Aaron Bandler from Daily Wire wrote 11 Biggest Problems With Obamacare.

He first said that deductibles are increasing. They are set to increase 17 percent for silver plans and 6 percent for bronze (Bandler, Aaron). The ones that do not qualify for the subsidies will be increased by 21 percent (Bandler, Aaron). One issue he pointed out said, “There is a lack of insurance options under Obamacare. Seven states have only one insurer providing insurance through Obamacare due to the fact that major insurers like Blue Cross Blue Shield, United Healthcare, and Aetna are all leaving the exchanges because of unsustainability. As a result, there has been less competition throughout the Obamacare exchanges, contributing to the rise of premiums and deductibles and less consumer choice” (Bandler, Aaron). So, one of the reasons that deductibles are going up is because of the lack of insurance options. Another issue is Obamacare’s Medicaid has become a burden to the states. The cost has grown 49 percent higher (Bandler, Aaron). This is due to the enrollment numbers for Medicaid. It was expected that only 5.5 million people would sign up but actually, 11.5 million signed up in 24 states (Bandler, Aaron). The editors of Investor’s Business Daily wrote, “States that expanded Medicaid will either have to boost health costs, raise taxes or cut spending to cover this Obamacare

‘freebie”‘ (Bandler, Aaron). This leaves States to be left with higher Medicaid bills since the federal government will not pay as much for it. This leading to a drain on state budgets (Bandler, Aaron).

Medicaid expansion has caused many issues. One is that it is resulting in higher wait times in emergency rooms (Bandler, Aaron). Many doctors are not accepting Medicaid because of the program’s bureaucracy for less than satisfactory compensation (Bandler, Aaron). This causes patients to go to the emergency room to obtain a doctor. It has also resulted in a shortage of primary doctors. “Doctors have struggled to keep up with higher demand as 81 percent of physicians surveyed by The Physicians Foundation in 2012 were “over-extended or at full capacity” in terms of their ability to seek new patients – a real problem when new doctors are not entering the field” (Bandler, Aaron). Forty-six percent of doctors have rated Obamacare as a “D” or an “F”.

There is a huge issue that can only be stopped by this year. “Obamacare’s Independent Advisory Board (IPAB), more popularly known as the “death panels,” is still on the books” (Bandler, Aaron). Independent Payment Advisory Board was created to help reduce Medicare costs outside the influence of political processes and pressures (Independent Payment). “People seem to have forgotten about IPAB. The House of Representatives actually passed a bill to repeal it in 2015, but it is still the law and could go into effect, creating a 15-member panel of experts that rations Medicare through price controls and determining the type of care that Medicare pays for. Whatever IPAB recommends becomes law if Congress cannot garner a two-thirds majority vote to override it. Even worse, none of IPAB’s 15-member panel

can be fired by the president, and if the appointments are never made, then the Department of Health and Human Services assumes the panel’s power – an alarming

centralization of power. There is only a brief window in 2017 when IPAB can be replaced, and if it’s not, then in 2020 the panels edicts will be law, even if Congress attempts to override them” (Bandler, Aaron).

Democrats and Republicans have different stances on healthcare policies. Democrats support universal healthcare and strongly support involvement in healthcare (Democrat vs Republican). While Republicans believe private companies can provide healthcare services more efficiently than government-run (Democrat vs Republican). This explains why Republicans want to repeal and Democrats want to keep. Democrats think that the involvement of the government in healthcare is great which is what Obamacare is.

On January 20, 2017, Donald Trump was sworn into office. Trump is known to be very outspoken and speaks his mind. During his campaigning and before even being sworn into office he has always spoken out about disliking Obamacare. During his 2015 announcement speech to become president he said, “We have a disaster called the big lie: Obamacare. Yesterday, it came out that costs are going for people up 29, 39, 49 and even 55 percent, and deductibles are through the roof. You have to be hit by a tractor, literally, to use it, because the deductibles are so high, it’s virtually useless. It is a disaster. And remember the $5 billion websites? $5 billion we spent on a website, and to this day it doesn’t work. I have so many websites, I have them all over the place. I hire people, they do a website” (Thomas, Lauren). Also, he talked about PPACA during his campaign trail in 2016. Trump said, “One thing we have to do: Repeal and replace the disaster known as Obamacare. It’s destroying our country. It’s destroying our businesses. You take a look at the kind of numbers that will cost us in the year 2017, it is a disaster. It’s probably going to die of its own

weight. But Obamacare has to go. The premiums are going up 60, 90, 80 percent. Bad health care at the most expensive price. We have to repeal and replace Obamacare” (Thomas, Lauren).

New York Times analyzed new data that was provided by the McKinsey Center for U.S. Health System Reform on whether or not President Trump is correct about Obamacare premiums (Park, Haeyoun). McKinsey says that he was right because the median rise in premiums for bronze plans was 18 percent (Park, Haeyoun). However, he was also wrong because “About half of Americans who buy their own health insurance qualify for subsidies that insulate them from the price increases.

The subsidies are designed to increase if premiums rise. For those customers, the cost of the lowest-price silver plan may actually go down compared with this year in a majority of counties” (Park, Haeyoun). New York Times believes he is partly to blame for these causes. Their evidence was that Trump has tried to end certain subsidies to insurers. Subsidies to insurers allowed them to give out discounts to low-income consumers (Park, Haeyoun). For them to make up the lost funding they must increase the price of their plans. Now that he has become president he is trying to repeal and replace Obamacare yet again. One unexpected twist is that there are now some places that have the gold plan less expensive than silver. Some of these places would be Kansas, Wyoming, Pennsylvania, and most of Texas.

His first attempt was called The Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015 (Restoring Americans’). The bill, however, was passed by Congress on January 8, 2016, but was later vetoed by Barack Obama on January 8, 2016 (Restoring Americans’). If passed it would have repealed the federal budget, such as the premium tax credits and the Medicaid expansion. It would have also suspended federal funding for planned parenthood for a year. It is also known that if it was enacted the changes would have gone into effect in 2018 (Restoring Americans). On February 28, 2017, Trump gave congress five principles for Obamacare

replacement (Mangan, Dan). His goal is to expand choice, increase access, lower costs, and provide better healthcare (Mangan, Dan). Trump’s five key outlines to replace Obamacare included first, “ensuring people with a pre-existing health condition are guaranteed “access” to health insurance, “and that we have a stable transition for Americans currently enrolled in the health-care exchanged” (Mangan, Dan). Secondly, “Giving people who buy their own health coverage tax credits

and expanded health savings accounts to help pay for their coverage, as well as flexibility about the design of their plans” (Mangan, Dan). Thirdly, “Give states “the resources and flexibility” in their Medicaid programs “to make sure no one is left out” (Mangan, Dan). Fourthly, “Legal reforms to protect doctors and patients “from unnecessary costs” that drive up insurance costs, and to bring down the price of high-cost drugs” (Mangan, Dan). Finally, “Creating a national insurance marketplace that allows insurers to sell health plans across state lines” (Mangan, Dan).

On December 1, 2017, Republicans approved the repeal of Obamacare’s individual mandate. This is a huge step toward ending the unpopular part of the health-care law (Sullivan, Peter). Senator John Barrasso said, “Families ought to be able to make decisions about what they want to buy and what works for them – not the government. I believe if people don’t want to buy Obamacare insurance, they shouldn’t have to pay a tax penalty to the IRS” (Sullivan, Peter). During the voting, no democrat voted for the GOP tax bills (Sullivan, Peter). It was not Senate Finance Committees original plan to repeal the mandate but President Trump and Senate

conservatives made a public push for its inclusion. Trump is eager to return to the repeal and replace push now that the final tax bill passes. In late October Trump tweeted, “We will Repeal & Replace and have great Healthcare soon after Tax Cuts” (Sullivan, Peter). Also, Senator John Kennedy believes that the mandate repeal puts the repeal and replacement a step closer.

It seems to be very unclear what the repeal of the mandate will do to Obamacare. The Hill stated, “Many experts and health-care groups warn that repeal will destabilize Obamacare markets, leading to premium increases or insurers simply dropping out of certain areas. Without a financial penalty under the mandate for lacking health coverage, there is less incentive for healthy people to sign up and balance out the costs of the sick” (Sullivan, Peter). The Congressional Budget Office found that repealing this mandate saves $300 billion over ten years in subsidies that would have originally been spent on consumers (Sullivan, Peter). They also estimate that 13 million fewer Americans will have health insurance over the next decade and premiums will rise 10 percent (Sullivan, Peter). Newsweek stated, “If the mandate repeal does make it to the final bill, political analysts have warned it could hit red states that voted for Donald Trump in 2016 hardest” (Porter, Tom). Many states only have one health insurance plan, and residents could have zero healthcare options if insurers refuse to sell in the market without a mandate. LA Times

investigation showed that Alaska, Iowa, Missouri, Nebraska, Nevada, and Wyoming would be the states at risk (Porter, Tom). However, the bill still has to pass the GOP- controlled House of Representatives, whose tax reform bill does not include the mandate’s repeal.

If the bill is pulled Republicans are planning a bi-partisan bill to secure insurance markets (Porter, Tom). Bipartisan is the agreement or cooperation of two political parties that usually oppose each other’s policies. This could lead to a conflict with anti-Obamacare GOP hardliners (Porter, Tom). Many people have collaborated with one another to create a bipartisan bill. Republican Senator Lamar Alexander and Democratic Senator Patty Murray co-authored one which if passed, “would restore billions of dollars in subsidies that health insurers use to reduce out-of-pocket costs for low-income Americans” said Newsweek (Porter, Tom). A second co-authored bill, by Maine Republican Susan Collins and Democratic Senator Bill Nelson, would create a $4.5 billion fund to reimburse insurers for covering health care for the sickest patients (Porter, Tom). A health economist at the Kaiser Family Foundation named Larry Levitt said, “Neither of these bills would do anything to offset the increase in uninsured resulting from mandate repeal. The marketplaces would limp along without a mandate but its probably not a stable place” (Porter, Tom).

In conclusion, Obamacare should be repealed and replaced. This reason for this is because there are more issues than there are pros. One of the issues is that there is a lack of insurance options. Because of the lack of insurance options, the less competition between them. This leads to a rise in premiums and deductibles. Also because of the Medicaid expansion, states will have to raise taxes, boost health costs, or cut spending to cover the costs of this so-called freebie. Another huge problem is Obamacare’s Independent Advisory Board also known as the death panels. Just the nickname gives away how bad it could be if not repealed. The 15-panel members have to much power and control. Even Congress cannot override them and they can not be fired. Donald Trump the former president of the United States has even spoken out about his dislike of Obamacare. He has also given his reasons for the disliking of it. Trump likes to talk about in his speeches about how deductibles and premiums are rising. The repeal of the mandate is even proof that we are one step closer to fully pushing the repeal of Obamacare. His first attempt almost was a success but Barack Obama vetoed the bill. Which I think is pretty unfair since he was the one who created it in the first place. Of course, he is going to veto a

bill that would ruin his act that he put hours into creating. On the other hand, now that Barack Obama is out of the office and Donald Trump has taken his spot as President I believe there is a good chance that this repeal of a mandate will be put into place. It has already been approved by the Republicans but it still has to pass the GOP-controlled House of Representatives. This repeal shows that we are one step closer to having it completely gone. The new replacement bill that Donald Trump has put together is to expand choice, increase access, lower costs, and provide better healthcare. This is much better than Obamacare because they didn’t have many choices, high costs over the years, and has overall never been great healthcare.

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