Barack Obama, former US president, created a law whose objective was to allow more people to have access to health insurance, in a change that came to be known as Obamacare.
Patient care has always been a secondary action of the US government. Dependent on health insurance, the citizens of that country saw the situation change from 2010 onwards. With the creation of the Affordable Care Act (ACA), or Affordable Care Act.
A 2018 government report saw 11.8 million Americans re-enroll in health insurance and 27% were new users.
It was about 400,000 fewer people than in 2017 — a lower number than expected. A Gallup poll earlier this year showed that 55% of Americans care “quite a lot” about access, healthcare and patient care — the fifth year in a row that healthcare has topped the list of problems.
Gallup also reported that the rate of uninsured adults dropped to a record 10.9% in 2016. But it has since risen to 12.3% after the Trump administration.
What is PPACA (Patient Protection and Affordable Care Act)
The PPACA (Patient Protection and Affordable Care Act), also called simply the ACA (Affordable Care Act/Affordable Care Act), became known as Obamacare. This is due to the fact that it was implemented in 2010 by then US President Barack Obama, with the aim of making a broad health reform, focused on patient care.
Obamacare’s principle was to ensure that all Americans had access to health insurance. This is because in the United States there is no national service as in Brazil through the SUS (Sistema Único de Saúde). And according to surveys at the time of its implementation, 15% of the population did not have any health insurance coverage.
This hole in the system was due to the fact that in addition to not having health plans in the companies they worked or for individuals, they were also not covered by government health plans. In the United States, the poorest are covered by Medicaid and the oldest are covered by Medicare.
Through the Affordable Care Act, all people residing in the United States are now required to purchase a type of health insurance. That is, those who do not have insurance pay a fine that started out as 1% of income. Then rising to 2% and from 2016 onwards it rose to 2.5%.
With Obamacare, people who lived in the hole of lack of coverage by a health plan would now rely on state subsidies when buying their insurance on marketplaces, as is the case with healthcare.go v. With this, it was expected to reduce the individual market of insurance companies, in which only citizens with money could bear the costs of health insurance, marginalizing the others.
Obamacare Access Rules
But in addition to allowing more people access to insurers, Obamacare also messed with the rules of access. One of the examples is that, if the person previously had a pre-existing disease, they could have their request denied access to the health plan. Having to pay astronomical amounts at the hospital if I needed care. With the Affordable Care Act, no one else can be discriminated against.
In addition, the law allowed children up to the age of 26 to be included in their parents’ health plans. Significantly reducing insurers’ expenses by bringing younger and, in theory, healthier people into the system.
And who doesn’t have financial conditions?
For poor people, or people over 65 years old, the US Federal Government has two programs maintained with government resources. These are called Medicare and Medicaid.
Medicare is a social insurance program created in 1966. It is funded by the Federal Government, and provides medical care and care to patients over 65 years of age who have contributed to the payment of health taxes during their working years. The system also serves people with disabilities or conditions that prevent them from working, as well as terminally ill people.
Medicare is divided into four different types of services that not all beneficiaries are entitled to:
- A – Hospital Insurance: Covers hospital admissions, care in specialized nursing centers, palliative care and some health care at home.
- B – Medical Insurance: Covers medical services, outpatient care, supplies and preventive health services.
- C – Medicare Advantage Plan: These are health plans within Medicare offered by a private company to its employees, including the benefits of parts A and B. In this case, the company pays for the services and has tax reductions or exemptions as compensation.
- D – Prescription Drug Coverage: Plans are offered by private health care companies or Medicare-approved insurance companies. They cover the purchase of prescription drugs.
In turn, Medicaid is a health program that serves people of any age and with extremely limited financial resources. Unlike Medicare, which is funded by US welfare, Medicaid is funded by the federal government in conjunction with state governments. In this model, governments reimburse hospitals and doctors who provide treatment to people who cannot afford their own medical expenses.
In this model, certain groups of people benefit. Such as low-income families and children who already receive supplemental security income from the state government.
Why is Trump against Obamacare?
On the same day that President Donald Trump took office — January 20, 2017 — he signed an executive order instructing administration officials to “waiver, defer, or grant exemptions” from implementing parts of the Affordable Care Act, while Congress was preparing to repeal and replace President Barack Obama’s signature health law.
However, years later Trump still has not managed to eliminate Obamacare, but continues to criticize it openly whenever possible. In 2018, congressional Republicans managed to repeal the requirement that people buy health insurance or pay a tax penalty.
As early as December 2018, a federal judge in Texas ruled that the repeal of this “essential” part of the law meant that the entirety of Obamacare is unconstitutional. Even so, the law remains in effect when an appeal is addressed to the US Supreme Court.
As a way of fighting Obamacare, Trump has allowed small businesses to offer Americans cheaper, less comprehensive policies, called Association Health Plans (AHPs), that last just one year. Because AHPs are short-term, companies may charge higher premiums or deny coverage based on medical history. And on pre-existing conditions, which Obamacare made illegal for long-term plans.
These restricted plans are intended to care for the youngest, healthiest patient, but some AHPs may not cover basics such as prescription drugs or maternity care. But in March 2019, a federal judge in Washington DC blocked AHPs based on the fact that they are “clearly an endgame” of patient protections in the ACA.
Influence on elections
In the midst of the American presidential elections, the topic of the Affordable Care Act is on the rise. Recently, Democratic presidential candidate Joe Biden, vice president when President Barack Obama secured his most important national achievement, released a statement.
This fall, Donald Trump will be trying to get the Supreme Court to overturn Obamacare, stripping 30 million Americans of health insurance, ending protections for 100 million more with pre-existing conditions, destroying families and costing a million jobs. I will fight to end the Donald Trump administration.”
The harsh criticism met with an almost non-existent Republican reaction, even though President Donald Trump has made abolishing the law a priority. He only said he would preserve some of the program’s most popular provisions — such as guaranteed coverage for pre-existing conditions — but did not come up with a plan.
As you can see, the future of patient care through a truly inclusive US health policy has been guiding the current US political campaign. But one thing is certain: Obamacare will change.