Why Did Americans Need the Affordable Care Act?
March 2015 will mark the fifth anniversary of Obamacare, and nearly five years later politicians continue to debate the new healthcare law’s relevance and importance. Despite the fact that millions of people now have access to real, affordable and quality healthcare, the subject of national healthcare reform continues to cause debate in the media. Did we even need healthcare reform? Is America better off now that the ACA has taken effect? You may even be asking these and other similar questions yourself.
The reality is that healthcare reform was necessary for several major reasons. The Affordable Care Act not only made it feasible for people to buy better health insurance policies, but it also forced insurers to stop playing games with the American public. For the past few decades, insurance companies have charged more for premiums while providing fewer benefits. Medical providers, too, share some of the responsibility for driving up costs while Americans continued to get sicker. Below, we’ll discuss the need for healthcare reform and how Obamacare changes the game for good.
New Medical Techniques
Innovation sometimes leads to unpleasant side effects, and this was the case in the 1980s. The technology that doctors use today is relatively new in the grand scheme of medical history. Prior to the 1980s, treatments were relatively non-invasive. When patients died or suffered long-term effects from surgeries, family members usually accepted the result as a limitation of medical science. After all, doctors can only do so much. The 1980s saw a shift in this mentality due to medical innovation and the need to treat serious conditions like aggressive cancers, terminal illnesses and AIDS. Suddenly, doctors became miracle workers with magic solutions to the ills of the world.
Of course, doctors have long been revered for their ability to see things that others don’t, but doctors in the 1980s began experimenting with new drugs and surgical procedures that boosted public confidence and awe in their skills. Not only were medical professionals treating long-standing issues, but they were also eliminating the death sentence of certain medical conditions. In other words, people didn’t necessarily have to die from invasive surgeries or aggressive treatment plans. People started looking to doctors for quick fixes and easy solutions to problems, and for a long time this method worked. Sick people got healthy, and people started living longer.
The Bubble Bursts
As we said, innovation often leads to side effects. In the medical world, side effects can be deadly. New drugs that had been relatively untested started backfiring. Surgical procedures didn’t always work, and patients started dying from treatment plans that lacked the benefit of extensive study. Add to these issues the fact that people started losing faith in medical professionals. Instead of accepting the limitations of medical science, family members of deceased patients shifted the blame to the doctors who had been trying to help. Surgeons and other medical professionals found themselves in courtrooms across the country defending their practices – and losing.
Medical malpractice lawsuits spiked. With the increase in lawsuits came an increase in medical malpractice insurance. Doctors needed greater protection against angry or dissatisfied patients and their loved ones. Before long, the cost of extra insurance translated into higher fees for patients everywhere. A trip to the doctor cost much more than it ever had, and by the late 1990s the country was headed in the frightening direction of high-cost medical care and reduced benefits. Average people couldn’t afford the premiums or the treatments. Something had to give.
The Strain on the System
Before Obamacare became law, 40 to 50 million people lacked a basic health insurance plan. However, even the people who had insurance weren’t always happy with their plans. Medical care costs a fortune and has for years, but cost alone isn’t the only issue with health insurance. Underlying problems like obesity and preventable diseases have put serious strains on the American healthcare industry. People seek out surgeries that might be avoided with proper preventative care, and doctors continue to treat patients’ symptoms rather than their fundamental problems. The next few sections will highlight some of the other reasons why healthcare reform is so essential.
It’s easy to blame one entity for all of the problems that led to healthcare reform, but lawsuits alone didn’t crash the American healthcare system. Insurance companies share the blame and the responsibility for unrest among patients. For example, under old regulations men and women paid different amounts for healthcare coverage. Women, in fact, paid more for the same basic treatments and care that men received. Their coverage also cost more in premiums. In an era where men and women have equal voting rights and share equal rights in society, it’s unfathomable that women should pay more for comparable healthcare than men.
Women weren’t the only ones suffering from unfair policies. People with pre-existing conditions had an even harder time finding health insurance because insurers refused to offer them coverage or charged them exorbitant premium prices. Keep in mind that insurers might determine that even very old injuries count as a pre-existing condition. In some extreme cases, expectant mothers might also be considered to have the “pre-existing condition” of pregnancy. Insurance companies used any means to deny people coverage or drop their coverage unexpectedly. About half of the population lives with a pre-existing condition, so you can see how these people had trouble finding coverage.
In an editorial piece published by the New York Times in 2009, President Obama noted that one insurance company “would not cover illnesses related to [a woman’s] internal organs because of an accident she had when she was 5 years old.” He also mentions the story of a man whose chemotherapy was halted by his insurer because he had an unknown gallstone issue. The man later died because his treatments ceased. Seeing only the bottom line, many insurance companies forgot about the humans they were supposed to be protecting.
There were other administrative issues that healthcare reform sought to address. Application errors could prevent someone from receiving coverage. Insurance companies could simply halt coverage whenever they chose, and patients were lucky to receive notice. In fact, dropping coverage unexpectedly was a popular method for discriminating against patients, and there was nothing a patient could do to appeal the decision.
In an effort to reduce the amount they had to pay for claims, insurers also placed annual and lifetime caps on payouts. In theory, this makes sense from a business perspective. But the reality is that some people need extensive and costly medical care for the duration of their lives. Lifetime limits make healthcare unaffordable for people who really need long-term care. Likewise, annual limits prevent many people from seeking lifesaving medical care because they’re concerned about reaching their maximum payouts.
Medical Providers and ER Care
Insurance companies want to make a profit, which is an understandable goal for a business. Unfortunately for beneficiaries, insurers don’t always focus on the community they service. The same can be said of certain medical providers but to a lesser extent. Doctors, surgeons and other medical care providers aren’t exempt from some of the blame.
Higher Fees for Lower Quality Care
Running like a well-oiled machine, hospitals and providers often see patients as numbers rather than people. The guidelines for pay rates and appointment times offer insight into the way medical professionals operate. For example, a 10-minute consultation with your primary care physician can be billed at $220. With insurance, you might only pay your $15 co-pay for that consultation, but the doctor will get the full amount one way or another.
Non-charitable hospitals also need to make a profit, and the need to make a profit can cloud judgment and lead to substandard care. Note that not all doctors operate on the profit philosophy, but established medical professionals soon realize that they can boost their practices by charging more and providing less. Efficient, assembly line doctor’s visits might work for people with relatively minor issues, but people who feel rushed at their appointments may fail to mention serious concerns. There’s greater room for error when doctors think only in dollar signs.
Even the people who received care under the old guidelines may not have received the actual treatments they need. It probably doesn’t surprise you that prescription drug use is on the rise. Someone who sees her doctor for headaches might be prescribed beta blockers to treat the symptoms. What would happen if that patient were to be prescribed alternative treatments such as exercise and other lifestyle changes? Natural remedies don’t cure everything, but they can help prevent more serious issues from developing. Again, not every doctor takes a cookie-cutter approach to medical care, but many of the more successful practitioners have lost sight of treating underlying issues and instead opt for quick fixes like prescription drugs.
One of the ACA’s goals is to bring more valuable medical care to underserved, lower income communities. Over the next few years, medical professionals may even be offered special incentives to develop strategies for providing medical care to people living in low-income areas. The problem is that families with very low incomes don’t get adequate preventative care because the cost is so prohibitive. When you have to choose between feeding your family and getting a cold taken care of, you’re going to choose food over medicine. This should not be a choice that a modern American family has to make regardless of income level.
The other problem with healthcare when it comes to low-income families and individuals is that many times these people will turn to the emergency room as their primary source of care. Even if people can’t afford to pay for treatments, ERs can’t turn away patients by federal law. Someone has to pick up the tab for these costs, and those costs usually translate into higher costs for other patients who can pay.
The Cost of Insurance
We’ve discussed how expensive insurance has been since the 1980s, but we haven’t given hard numbers because insurance costs vary depending on factors like age, taxpayer status, income and medical condition. Employer-sponsored healthcare also throws a wrench into calculations since employers that offer coverage often pay a portion of the tab. Before the ACA became law, self-employed individuals and people with pre-existing conditions had a hard time finding affordable coverage. And even though self-employed workers gain tax benefits from having healthcare coverage, the reward was often not worth the investment to many people. There’s something to be said about the mentality when it comes to healthcare costs. For many people, buying health insurance just isn’t worth it when they consider the benefits.
What happens if people refuse to get insurance? Some people argue that there’s no need for healthy people to buy insurance that they won’t use. Young people in particular assume invincibility and opt to forgo the monthly cost of health insurance premiums. Despite the fact that we’re all susceptible to accidents and injuries, some people insist on living without health insurance to save a couple hundred dollars each month. This would be a fine approach if it weren’t for the fact that emergency rooms are crowded with people who also felt that they didn’t need insurance. Insurers and medical providers aren’t the only entities that need to take responsibility for the state of American healthcare. Some of the blame falls on individuals as well.
What Insurance Really Protects
Insurance doesn’t just allow you to see your doctor when you have a fever or need to discuss poor sleeping habits. Like auto or home insurance, healthcare coverage protects you in the event of devastating emergencies. Before Obamacare became law, millions of people didn’t even have the option to buy health insurance if they wanted it. And while many millions of families had healthcare coverage, their insurance didn’t pay for everything they needed to protect their families. Conservatives in particular like to argue that people should be given a choice about their coverage. In reality, the healthcare system we had limited choice by preventing sick people from getting well.
Let’s take the case of vaccines. This hotly debated topic right now isn’t a debate for certain portions of the population. Underserved communities and people living in poverty don’t always have access to vaccines for basic medical conditions like measles and polio. One of the arguments in support of vaccinating your children centers on the idea that vaccinating your kids helps prevent diseases from spreading in low-income communities. The same can be argued for healthcare. By making healthcare more accessible to people who don’t earn enough to pay for it, we help protect more people in the long run.
Aside from making health insurance affordable for millions of people, Obamacare also helps push the country toward true healthcare reform. Some people like to point out all of the flaws in the new law. Court cases crop up all the time on various technicalities, and that’s to be expected in a country that’s pretty evenly divided on the political spectrum. However, new laws always require tweaking to get them right, and Obamacare offers a good place to start. Already, people have discovered the benefit of lower premiums and easier access to medical care. In this section, we’ll talk about some of the major improvements that the ACA has made to the healthcare system in America.
Earlier, we mentioned that women had to pay more for healthcare under the old regulations. Obamacare changed this practice so that men and women now pay the same amount for comparable medical care and insurance. This should help a lot of women receive the healthcare they need to prevent serious conditions like heart disease and reproductive issues. The new law also makes it possible for people with pre-existing conditions to buy health insurance, and the rates won’t be exorbitant. Insurers can’t deny coverage to people with pre-existing conditions no matter the situation. No longer will people who deal with issues like Crohn’s disease or diabetes have to spend a fortune treating their symptoms.
Bolstering Consumer Rights
With the health insurance exchanges and federal subsidies, millions of people nationwide now have access to affordable healthcare for the first time in decades. There’s never been a system like the Marketplace. Using the state-run exchanges or federal site, people can compare plans side by side to determine which option suits their needs. The demand for greater clarity and transparency has made it possible for people to know what they’re buying before they buy it. Plus, people now have the ability to apply directly for federal assistance via subsidies. These subsidies make health insurance attainable for an unprecedented number of U.S. citizens.
Access and affordability aren’t the only benefits that consumers gain under the Affordable Care Act. New health insurance plans now offer at least ten essential benefits: ambulatory or outpatient care, emergency care, hospital services, lab testing, maternity care, mental health services, pediatric care, prescription medications, preventative care and rehabilitative treatment including related equipment. No matter the type of plan you buy, your insurance coverage includes these benefits. In addition, you now have the right to appeal your insurer’s decision to drop or modify your coverage, and you’re protected against arbitrary decisions. Obamacare restores a variety of rights to the American people.
Keeping Insurers Accountable
Under the ACA, insurers now have to follow the “80/20” rule: Insurance companies can only spend up to 20 percent of their revenue on overhead or administrative costs. The remaining 80 percent must be spent on paying claims and providing service for beneficiaries. If your insurance company fails to meet this requirement, then it has to refund its beneficiaries for the difference. Obamacare seeks to hold insurers accountable for their spending, and the 80/20 rule puts a safeguard in place to make sure that companies uphold their end of the bargain. As a consumer, this is great news for you because you can expect your insurance company to start putting their customers ahead of their bottom lines.
Improving Individual Health
Easier access to preventative care will help people get the treatments they need to avoid more serious and more costly illnesses. For example, one of the ten essential benefits includes yearly screenings for breast and colon cancer. These two major forms of cancer in particular turn deadly quickly, and preventative screenings could help people detect cancer early so that they get the care they need. People will also have access to nutritional information in restaurants as a result of Obamacare, which could help us all make better decisions when we’re eating out. Obamacare is all about improving individual health and the health of our country as a whole.
The healthier people get, the fewer trips to the doctor they have to make. Healthy people may still face medical problems, but a lot of modern American health issues could be prevented or lessened with proper preventative care. As a result, healthcare spending nationwide will go down. President Obama wanted to address not only health insurance but the longevity of medical care as well. By eliminating unnecessary treatments and educating people on how to take control over their health issues, we can improve the healthcare industry while trimming the fat of excessive, wasteful spending.
Where Does Reform Take Us?
We hope that this article clears some things up when it comes to healthcare reform in America. Even people who disagree with Obamacare agree that the healthcare system in this country needed change. Where do we go from here? That’s the question that lawmakers, politicians and citizens will continue to ask in the coming decade. As the ACA rolls out changes gradually, more people will take advantage of the programs designed to improve access to and affordability of healthcare. Undoubtedly, legal challenges to the ACA will help shape the law so that it accurately reflects the pulse of the nation while keeping its primary goals intact. The future of American healthcare depends on constant evaluation and nationwide participation.