Abstract
President Obama’s significant effort and legislative policy, the ‘Patient Protection and Affordable Care Act’ of 2010, brings in control over the whole of U.S health care system. This act was signed into law by President Obama in March of 2010 and its major provisions went into effect on the 1st of January 2014. There have been significant changes that went into this policy before it was brought into effect and there will be many more changes in the years to come.
In this article we look into the genesis and the future of Obamacare Act and what goes into the core principles of the act.
Core Principles of the Act:
“Everyone should have some security when it comes to their health care”, Obama at the time of signing.
Commonly named Obamacare, the Affordable Care Act will be providing insurance to more than 30 million of uninsured people, by providing Medicaid as well as federal subsidies to the lower and middle income Americans who can buy private coverage.
Obama’s part and role in the advent of the Affordable Care Act
The concept which was proposed by President Obama was not new and had been tried by several democratic presidents before him, but unsuccessfully. They had all tried to create a nationwide insurance system for almost 75 years. President Obama pointed out at the time of signing in 2010, that there had been ‘generations of Americans’ who had put up a valiant struggle to ensure something similar was implemented’. As a presidential candidate Obama proposed what was seen as the ‘largest middle-class tax cut for healthcare in history’. This turned out to be a foundation of his presidential campaign.
Essence of Obamacare in a nutshell
● Essence of Obamacare can be seen as a three-legged stool of regulation and subsidies.
● It can be said to be a community rating that ensures that insurers make the same policy available to every citizen irrespective of health status as well as a mandate which insists that everyone purchase insurance. By this regulation and subsidy, healthy people are not allowed to keep from getting insured and subsidies are provided to those with lower incomes.
Origin or Genesis of Obamacare
Obamacare is said to have had its roots in the original “Heritage Plan of 1989” which is said to have had all these features.
Today, Heritage tries very hard to deny the obvious i.e. picking at the differences between what was in its tenets and ideals and what it used to advocate, as against what the democrats passed – making the differences seem like a big deal – while in reality it is not. It was all disinformation and importantly the features of the ACA and its mandate are all ideas the Republicans used to support.
We take a closer look at the history of the Individual Health Insurance Mandate of 1989 – 2010
The Republican Origins of Democratic Health Care Provision
Considered to have had its origin in 1989, the individual health insurance mandate took shape at the conservative Heritage Foundation. The Republicans had earlier introduced health care bills twice in succession which also had an individual health insurance mandate but paradoxically the very same advocates of those bills are seen to oppose the current mandate of Obamacare. These republicans include Orrin Hatch, Christopher Bond, and Robert Bennet etc. Democrats and republicans also introduced a bi-partisan bill.
Chronological Order of Events
In the past - Obama Opposing a mandate in 2008
● Strangely, Barack Obama opposed a similar mandate in Feb of 2008 and said that his views on the subject were divergent from those of Hillary Clinton.
● He, at that time, stated that both he and Hillary Clinton had the aspiration to care for the health of all Americans, but that there was a small difference in their approach to the mandate.
● He said, that Hillary Clinton’s directive, that every citizen buy healthcare and insurance was not in his framework. He thought that such a mandate would be difficult since people were not averse to buying healthcare but could not afford to buy it.
● So Barack Obama then ascertained that he was focussing on lowering healthcare costs and he stated then that, that was the ‘modest difference’.
● This was his argument and stance way back in 2008, when he was contesting the elections.
Constitution of the PPACA in 2010
● By the year 2010, the Patient Protection and Affordable Care Act (PPACA) as it is known today aka “Obamacare”, was passed in both the House and the Senate without any Republican votes.
● On March 23rd 2010, President Obama signed the act with the individual mandate and brought it into law.
● On January 5th 2011 the Republicans in the US House of Representatives brought in an act (The Repealing – the Job-Killing Health Care Law Act (HR 2) to repeal the PPACA.
● Their argument was that the health insurance mandate was unconstitutional.
● The hurdle in implementing the PPACA was cleared when the Supreme Court upheld the provisions of the health care law in June of 2012.
● The National Federation of Independent Business and Twenty-six states had filed suit in the federal court challenging the healthcare mandate opposing the law that individuals carry insurance or pay penalties and also the expansion of Medicaid.
● The Supreme Court finally ruled that states could not be forced into co-operating with the Medicaid expansion, leaving all other provisions intact.
● During the first year of President Obama’s tenure in office, came the political action, in the year 2009.
● On July 14th 2009, the House of Democrats brought in a 1000 page plan for revamping the health care system. The debate around this raged through the summer and beyond.
● There were those like John Boehner, who was a House leader, who charged that the PPACA would force millions of Americans out of their private health insurance into a government-run plan.
● On the 9th of September 2009, when President Obama addressed critics in a joint session of Congress, he mentioned the words of Sen. Ted Kennedy, who has died a few weeks prior and had battled for healthcare reform throughout his career. According to Sen. Ted Kennedy Healthcare reform was a ‘moral issue’ which addressed the ‘Fundamental principles of social justice’.
● President Barack Obama mentioned in the house that the law would not apply to illegal immigrants and this was implemented when the reform plan, introduced a week later, prohibited participation by those residing ‘unlawfully’ in the U.S.
● When the Senate Bill was amended and approved by the House in March of 2010, the republicans voted against it.
● Addressing all the concerns expressed nationwide, the Act pointed out that “the act or the bill does not force anyone to change their existing insurance”. It was stated clearly that the act avowed a ‘new, transparent and competitive insurance marketplace’.
● When Obama was re-elected in November of 2016, it ensured the Act becoming a reality.
What does the Affordable Care Act entail?
● The Patient Protection and Affordable Care Act of 2010 consists of Affordable Health Care for America Act, the Patient Protection Act, the health care sections of Health Care and Education Reconciliation Act and the Student Aid and Fiscal Responsibility Act.
● It includes amendments to other laws such as Food, Drug and Cosmetics Act and the Health and Public Services Act.
● Since implementation of the law there have been a few additions and deletions which we shall try to update.
Future of Obamacare and how it will affect Doctor’s incomes
● As Obamacare moved towards making key implementations a reality the massive law is creating change by affective physician incomes in many ways.
● In Jan of 2014, the Affordable Care Act (ACA) carried out the greatest insurance coverage expansion since 1965 and brought in historic change in the way insurers operate. This change affected doctors and the manner in which they earned and there were many such changes implemented.
More Covered Services:
● With the new law coming into force a few major impediments to insurance coverage have been removed and will also ensure a few extra services that your payers may not have covered for you earlier.
● Jeffrey Cain MD, President of the American Academy of Family Physicians (AAFP) says that these reforms will help physicians because those of the patients having insurance and access to primary care have better health outcomes.
● In 2011 and 2012 the ACA mandated that insurers covered 63 different preventive services without the need for out-of-pocket payment to be made by the patients.
● These included treatment of blood pressure and mammography screenings, immunizations of many varieties, screening for autism, child hood behaviour screening and a few controversial areas such as access to contraception.
● The physician practices will be reimbursed for these services without the hassle of having to collect money from the patients.
● Since January of 2014, individual and group plans have had to cover services such as ‘essential health benefits’ which include mental health services, maternity care, medications, rehabilitation, and chronic disease management.
● In this case also the insurers will have to pay the physicians and other providers for the services rendered.