Before Obamacare, the United States stood out from the rest of the developed world in terms of providing accessible medical care for the public but not in a positive note. Most of the developed nations around the world had some form of universal health care like the National Health Service (NHS) of the UK. However, the US had none of that. Being one of the richest nations in the world, the lack of healthcare benefits for its citizens was quite alarming.
Other developed countries adopted compulsory insurance plans for its citizens that are subsidized by the government – the UK’s NHS being an example.
Another glaring aspect of US health coverage before Obamacare was that the US government spent a whole lot more on health care for every person compared to other countries offering free, universal health care.
Also, the US ranked high when it came to public spending on health care. A report by the Organization for Economic Cooperation and Development said that “The overall level of health spending in the United States is so high that public (i.e. government) spending on health per capita is still greater than in all other OECD counties, except Norway and Netherlands.”
Health care costs were clearly issues that needed to be addressed and that was one of the aims for the development of the Affordable Care Act (ACA) as Obamacare is commonly known.
But is the ACA a true universal health care plan?
What Is Universal Health Care?
Universal health care is a system of providing health care and financial protection for all citizens of a certain country. A step towards a national health insurance scheme was made as far back as 1883 in Germany. The Sickness Insurance Law was founded to provide insurance for low-wage workers and was funded by taking a portion of workers’ wages. Other countries soon followed suit but weren’t really true universal programs.
It was after the events of the Second World War that universal health care systems were set up all over the world. The NHS of the UK was launched in July 5, 1948. The Nordic countries soon followed, then it was adapted in Japan and Canada (but through stages).
Countries in southern and western Europe started introducing universal coverage between the 1970s and 2000s. Asian countries also adopted universal care from the late 80s to 2000s.
Several countries in Latin America, the Caribbean, Africa and the Asia-Pacific region also took steps to introduce universal health care programs after the 90s.
A universal health care program is also funded in various ways. For example, majority of European schemes get financing through a combination of public and private contributions. Other types of funding models include the following.
- compulsory insurance
- single payer
- tax-based financing
- social health insurance
- private insurance
- community-based health insurance
Obamacare or more formally, the Patient Protection and Affordable Care Act – a group of health insurance and industry reforms passed by Congress – was signed by President Barack Obama in March 23, 2010. It’s aim: to make health insurance coverage accessible to more citizens.
It’s been a few years since the program was officially implemented and it did result in an increase of insured citizens. In fact, federal budget forecasters believe that 25 million people will get health coverage through Obamacare in the next couple of years. In addition, around 17 million now have insurance since the expansion in 2014.
The ACA aims to increase health care coverage for citizens through the following methods.
- The expansion of Medicaid, a federal program offering health coverage to Americans who earn low incomes.
- The creation of insurance exchanges, which are websites where citizens can look around for coverage.
- The individual mandate, which is the requirement that all Americans (with a couple of exemptions like being part of a religious organization that doesn’t support this kind of health care coverage) get covered or pay a penalty.
One of the great things about the ACA is that even those with pre-existing conditions can apply for coverage – something that was terribly hard to do in the past.
Obamacare as Universal Health Care: Arguments and Support
In a commentary for The Baltimore Sun, Max Romano argues that Obamacare is not universal health care. He says that “If we really want universal health care, we need a public system that actually includes all people, such as extending Medicare to all Americans. Obamacare’s individual mandate to buy health insurance does not reach everyone because many uninsured individuals will not ‘buy-in’ to an expensive and overly complex insurance system.” Even after criticizing the ACA, Romano does point out that it didn’t get everything wrong as “It has made health insurance for individuals cheaper and better.” But while Romano argues that the ACA has done some things to fix the health insurance market, it doesn’t take into account those who have not included insurance in their budget before. In short, yes, Obamacare will get Americans – million of them – insured but millions more will still be left without coverage.
Originally, Obamacare was envisioned as requiring every state to expand their Medicaid programs. However, a June 2012 ruling by the Supreme Court changed that. The court believed that such a requirement would be so taxing on each state. So, they decided that every state have the choice on whether or not they would expand their Medicaid program.
As of September 2014, 27 states have adopted Medicaid expansion, Pennsylvania being the latest. However, that still leaves a lot of people uninsured given that more than 10 states have chosen not to expand Medicaid.
One of the most glaring aspects of the ACA is that those living below the poverty line are basically helpless. People living in such conditions cannot apply for subsidized private insurance, and of course, they may be short on resources to get affordable coverage. Additionally, they are the group legislators didn’t include in subsidies because they believed that they would be covered by Medicaid. As such, there’s this huge gap where those who really can’t afford subsidies so they can buy insurance are left uncovered.
The Bottom Line
It’s not hard to argue that Obamacare has indeed helped more citizens get health insurance. But while those numbers prove good, the fact that millions are still not getting covered cannot be ignored. A truly universal health care system is one that benefits the helpless.