Since the Patient Protection and Affordable Care Act, otherwise known as Obamacare, was signed into law March 23, 2010, the American public has endured a nearly endless and often vicious debate at every level of society. Even after the law was debated in Congress, signed into law by the president and upheld by the Supreme Court, the Republican-controlled House of Representatives has voted more than 40 times to repeal or defund the bill. Last week, the unrelenting effort of House Republicans to link the passage of the federal budget to a one-year delay of the ACA led to the first government shutdown in 17 years.
Politics aside, confusion and misinformation about the law persists. Recent polls indicate that 44 percent of Americans are still uncertain about the status of the law and that only about a third are actively seeking more information about it. In a less-than-scientific experiment, Jimmy Kimmel recently sent his staff out to ask everyday Americans how they felt about Obamacare vs. the ACA (hint: They’re exactly the same). The way that people attack Obamacare but laud the ACA in the sketch speaks to the polarized environment in which we live. As consumers begin to more directly experience the ACA’s benefits and consumer protections, we hope the conversation will become more constructive, honest and informed.
Similar to the way our country believes it is the right of every child to get an education, the ACA provides a framework for advancing a culture of coverage in which having quality, affordable insurance will be the norm for everyone. To achieve such a goal, health insurance needs to be accessible and affordable.
Under the ACA, health insurance plans can no longer deny coverage based on pre-existing conditions or charge a premium that effectively prices you out of the market. In return for a more accessible system, all U.S. citizens and permanent residents must purchase insurance, if affordable, or pay a fine. This is known as the individual mandate.
The mandate, however, affects only a small part of the population, because 86 percent of Americans have insurance and thus satisfy its requirement. Although controversial, this is a necessary mechanism that balances the number of healthy and sick people in the insurance pool. This ensures costs are spread out over a larger group and results in more affordable care for everyone.
While many of us already have insurance, nearly 47 million Americans are uninsured. Many are low-income, working individuals and families whose employer does not offer insurance or who do not qualify for public insurance programs such as Medicaid. For states such as California that authorize the ACA’s Medicaid expansion, millions will become newly eligible for the program, depending on annual income.
If you do not qualify for Medicaid, you may be able to receive advance tax credits that defray the cost of premiums for private health coverage in the new insurance marketplaces known as exchanges. The exchanges, which opened enrollment last week, facilitate improved health, better care quality and reduced costs by granting access to health coverage regardless of employment status and fostering competition among health plans. A simplified enrollment process and shopping tools are available at healthcare.gov. We strongly encourage everybody to visit the site and explore the options.
Expanded coverage options are also good for the economy. Uninsured Americans experience worse access to care and receive less primary and preventive care. Having a more regular source of care holds significant promise for lower health care costs due to early intervention for chronic conditions. For those in the workplace, the coverage options could reduce sick days and job-lock, in which employees feel forced to stay at a job simply because they have access to benefits. This will allow individuals to pursue entrepreneurship and increase their productivity in more fulfilling opportunities.
Comprehensive health care reform has eluded this country for nearly three-quarters of a century. The ACA is far from perfect, but it is a step in the right direction. At the very least, the law has decidedly shifted the way everybody, from policy wonks to the average citizen, thinks about the health care system. The ACA is a work in progress, one that will surely see successes and shortcomings.
This is a historic and exciting time, fraught with challenge and promise. Rather than reverting to the status quo, a more constructive dialogue should move toward improving and building upon the ACA. As Abraham Lincoln once said, “The best thing about the future is that it comes one day at a time.”
Keith Nevitt and Vishaal Pegany are graduate students in the joint Master of Public Policy and Master of Public Health program at UC Berkeley.