The goal of this post series is to educate and outline the healthcare system and the current debates surrounding accessibility to healthcare and health insurance. While I am not an expert in this field, I will hyperlink reliable sources that can offer further information about the topics at hand. Please leave your political stances, charged/accusatory/emotional comments, or closed mind at the entry to the site and approach these topics with an understanding that health care will never be a topic of uniform opinion. Regardless of the direction our country takes in regards to it’s own healthcare system in the next few years, there will always be some who are dissatisfied with the changes, and there will always be people with opinions different from your own. Here, I hope to shed light on the basics of the healthcare system with the goal of forming a ground of mutual understanding. Not everyone has to agree, but we should all be well informed.
Last week we discussed the various structures of healthcare systems around the world. I provided a basic outline of the American system, as well. However, it is widely known that this system underwent numerous changes in 2010 with the implementation of the Affordable Care Act. Now, the ACA may undergo some more changes or, perhaps, be dismantled by the Trump administration. Today, I will outline the changes created to the US healthcare system by the ACA and the continued changes we might see in the future.
In March 2010, the Affordable Care Act was signed into law, effectively changing the direction and composition of American healthcare. This act came about due to the high cost and poor coverage of the healthcare system in place at the time. At the time, more than 60% of bankruptcy claims were due to healthcare related costs, and almost 15 million people in the country lacked healthcare insurance coverage. The concern at the time was that this created a health disparity in which millions of people lacked reasonable access to medical care simply due to cost. The system was divided so that those who were fortunate enough to afford care or the costs of insurance could access healthcare, and those who were enrolled in government plans, such as Medicare, Medicaid and CHIP could access care. This left a margin of people in between these two groups that could not afford insurance coverage from private insurance companies but were not eligible for coverage through a federal program. An additional concern for private insurance companies was that it left gaps in coverage, so someone may be able to afford some appointments or circumstances, but not others. Spotty coverage (or lack thereof) leads to people neglecting their health because of cost. The ACA’s aim was to reduce these problems by creating a system that provided universal coverage, hopefully providing an effective solution to improving America’s health.
So, what changes did the ACA make to the previous system? First and foremost, it requires all Americans to have insurance coverage. To help make healthcare insurance an affordable, subsidies and other financial breaks were used. Additionally, the number of businesses offering insurance coverage to employees was increased by requiring all declared businesses with more than 50 employees to offer insurance plans. Another previous concern was that many Americans that lacked coverage were because they could not obtain coverage secondary to pre-existing health conditions that allowed existing companies to deny their applications. Thus, ACA made it illegal for health insurance companies to deny coverage to people with pre-existing conditions.
The Affordable Care Act did not go through implementation and successive practice without challenges and changes. Before its passage, the largest concern was that a universal system would lead to increased taxes or create financial burdens for families that were happy with the existing system. Dissatisfaction continued after the ACA’s implementation. The plan required insurance plans to provide coverage for birth control, a controversial issue for businesses and conservatives that wanted to refuse mandatory coverage to birth control on the grounds of personal beliefs or business reputation. Other changes that were made to the ACA include extending the age of dependent coverage to 26 years old, extension of coverage to people with pre-existing health issues, including children, extension and changes to coverage for early retirees, and new policies for preventative care. The implementation has not gone smoothly. A few challenges include: healthcare.gov experiences technical difficulties, concerns about distribution of insurance subsities were heard in the Supreme Court.
While this program has undergone many changes since its initiation, nothing compares to President Trump’s plan to redesign, or even repeal the act all together in order to replace the existing system with a new structure. We will cover insurance plans and the proposed changes by the Trump administration in the next edition of “So, What is Healthcare?”