College Papers

The is “an organized healthcare system that provides

The Patient Protection
and Affordable Care Act (PPACA), often called Obamacare, is a United States
federal statute enacted by the 11th United States Congress and signed into law
by President Barack Obama on March 23, 2010 (Patient Protection).  The
Patient Protection and Affordable Care Act is universal healthcare.  Universal healthcare is “an organized
healthcare system that provides healthcare benefits to all person in a specified
region” (Staff, Investopedia). Democratic Party Platform stated, “Democrats
have been fighting to secure universal health care for the American people for
generations, and we are proud to be the party that passed Medicare, Medicaid,
and the Affordable Care Act” (Health Care). 
Democrats over the decades have been fighting for the idea that everyone
should have security in health care (Health Care).  Its other purpose was to make health
insurance more affordable for individuals (Affordable).  “Expand the
Medicaid program to cover all adults with income below 138% of the federal
poverty level and support innovative medical care delivery methods designed to
lower the costs of the health care generally” (Affordable).  There
have been many issues with this act for many years.  Now that Donald Trump
has become president Obamacare might be repealed.  Should Obamacare be
repealed and replaced because of the many issues involving it?

A
study done in 2013 by Carnegie Mellon University found that 86 percent of Americans
between 25 and 64 did not understand Obamacare (Neporent, Liz).  ABC NEWS
clarified that it works “by offering consumers discounts on
government-sponsored health insurance plans”.  PPACA has changed the other
insurance companies’ rules.  In the past when customers had diabetes or
another pre-existing medical condition they could be turned down for insurance,
or the cost of coverage would rise (Neporent, Liz).  “Now you can’t be
turned down for any reason, and the hope is that costs will be contained” (Neporent,
Liz).  There is also talk that if you do not buy insurance you are
penalized.  “But any American who meets certain income-based criteria must
now, by law, have insurance, Medicare or Medicaid or pay a penalty that will be
leveled when you file your tax return” (Neporent, Liz).

            The cost of Obamacare depends on five factors: your age,
income, family size, location, and the type of plan you (Amadeo, Kimberly).  This is because they provide subsidies, which
is a financial assistance that helps people pay for something, for
middle-income individuals, families, and small businesses (Amadeo, Kimberly).  The first factor would be the plan
chosen.  Obamacare has four health
insurance plans called bronze, silver, gold, and platinum.  Bronze has 60
percent coverage, lowest premium, high deductible, and no cost-sharing
subsidies (Vore, Amy De).  Silver has 70 percent coverage, 2nd lowest
premium, separate medical and Rx deductibles, and cost-sharing subsidies (Vore,
Amy De).  Gold has an 80 percent coverage, higher premium, no deductible,
and no cost-sharing subsidies (Vore, Amy De).  Platinum is the highest
premium out of all of them with a 90 percent coverage, no deductible, and no
cost-sharing subsidies (Vore, Amy De).  They all offer the same ten health
benefits.  These benefits are preventive
and wellness visits, maternity and newborn care, mental and behavioral health
treatment, services, lab tests, pediatric care, prescription drugs, outpatient care,
hospitalization, and emergency room services (Amadeo, Kimberly).  Secondly, age can influence the cost.  Insurance companies are allowed to charge
older people with higher premiums.  However,
they cannot charge more than three times the premium of the cost for younger
people Amadeo, Kimberly). The second most important category cost is determined
by is where people live.  Some cities
have higher health insurance than others. 
Finally, the most important categories are income and family size.  If they were to make 400 percent or less of
the federal poverty level then they would receive a subsidy (Amadeo, Kimberly).  Now that we know how they determine the cost
what are some of the pros that have changed the way we look at it.

            There are many pros that people do
not consider.  Because of Obamacare, more
Americans have health insurance.  Sixteen
million Americans acquired health insurance coverage in the first five years of
the PPACA (The Pros).  Before PPACA, insurance companies set limits
on the amount of money they could spend (The
Pros).  Now insurance companies can
no longer pre-set a dollar limit on the coverage they provide their
customers.  Some more pros would be more
screenings are covered and lower prescription drug costs (The Pros). Fifteen billion dollars were saved on prescription drugs
within the first five years of Obamacare (The
Pros).

Even
though Obamacare seems to be a great thing it does come with its issues.
 Aaron Bandler from Daily Wire wrote 11 Biggest Problems With Obamacare.
 He first said that deductibles are increasing.  They are set to increase
17 percent for silver plans and 6 percent for bronze (Bandler, Aaron).
 The ones that do not qualify for the subsidies will be increased by 21
percent (Bandler, Aaron).  One issue he pointed out said, “There are a
lack of insurance options under Obamacare.  Seven states have only one
insurer providing insurance through Obamacare due to the fact that major
insurers like Blue Cross Blue Shield, United Healthcare and Aetna are all
leaving the exchanges because of unsustainability.  As a result, there has
been less competition throughout the Obamacare exchanges, contributing to the
rise of premiums and deductibles and less consumer choice” (Bandler, Aaron).
 So, one of the reasons that deductibles are going up is because of the
lack of insurance options.  Another issue is Obamacare’s Medicaid has
become a burden to the states.  The cost has grown 49 percent higher
(Bandler, Aaron).  This is due to the enrollment numbers for Medicaid.
 It was expected that only 5.5 million people would sign up but actually,
11.5 million signed up in 24 states (Bandler, Aaron).  The editors of
Investor’s Business Daily wrote, “States that expanded Medicaid will either
have to boost health costs, raise taxes or cut spending to cover this Obamacare
‘freebie'” (Bandler, Aaron).  This leaves States to be left with higher
Medicaid bills since the federal government will not pay as much for it.
 This leading to a drain on state budgets (Bandler, Aaron).  

            The Medicaid expansion has caused many issues.  One
is that it is resulting in a higher wait time in emergency rooms (Bandler,
Aaron).  Many doctors are not accepting Medicaid because of the program’s
bureaucracy for less than satisfactory compensation (Bandler, Aaron).
 This causes patients to go to the emergency room to obtain a doctor.
 It has also resulted in a shortage of primary doctors.  “Doctors
have struggled to keep up with higher demand as 81 percent of physicians
surveyed by The Physicians Foundation in 2012 were “over-extended or at full
capacity” in terms of their ability to seek new patients- a real problem when
new doctors are not entering the field” (Bandler, Aaron).  Forty-six
percent of doctors have rated Obamacare as a “D” or an “F”. 

            There is a huge issue that can only be stopped by this
year.  “Obamacare’s Independent Advisory Board
(IPAB), more popularly known as the “death panels,” is still on the books”
(Bandler, Aaron).  Independent Payment
Advisory Board was created to help reduce Medicare costs outside the influence
of political processes and pressures (Independent
Payment).  “People seem to have
forgotten about IPAB. The House of Representatives actually passed a bill to
repeal it in 2015, but it is still law and could go into effect, creating a
15-member panel of experts that rations Medicare through price controls and
determining the type of care that Medicare pays for.  Whatever IPAB recommends becomes law if Congress
cannot garner a two-thirds majority vote to override it.  Even worse, none of IPAB’s 15-member panel
can be fired by the president, and if the appointments are never made, then the
Department of Health and Human Services assumes the panel’s power – an alarming
centralization of power.  There is only a
brief window in 2017 when IPAB can be replaced, and if it’s not, then in 2020
the panels edicts will be law, even if Congress attempts to overrides them”
(Bandler, Aaron). 

            Democrats and Republicans have different stances on
healthcare policies.  Democrats support universal
healthcare and strongly support of involvement in healthcare (Democrat vs
Republican).  While Republicans believe
private companies can provide healthcare services more efficiently than
government-run (Democrat vs Republican). 
This explains why Republicans want to repeal and Democrats want to
keep.  Democrats think that the
involvement of the government in healthcare is great which is what Obamacare
is. 

            On January 20, 2017, Donald Trump was sworn into office.
 Trump is known to be very outspoken and speaks his mind.  During his
campaigning and before even being sworn into office he has always spoken out
about disliking Obamacare.  During his 2015 announcement speech to become
president he said, “We have a disaster called the big lie:   Obamacare.  Yesterday, it came out that
costs are going for people up 29, 39, 49 and even 55 percent, and deductibles
are through the roof.  You have to be hit by a tractor, literally, to use
it, because the deductibles are so high, it’s virtually useless.  It is a
disaster.  And remember the $5 billion website?  $5 billion we spent
on a website, and to this day it doesn’t work.  I have so many websites, I
have them all over the place.  I hire people, they do a website” (Thomas,
Lauren).  Also, he talked about PPACA during his campaign trail in 2016.
 Trump said, “One thing we have to do: Repeal and replace the disaster
known as Obamacare.  It’s destroying our country.  It’s destroying
our businesses. You take a look at the kind of numbers that will cost us in the
year 2017, it is a disaster.  It’s probably going to die of its own
weight.  But Obamacare has to go.  The premiums are going up 60, 90,
80 percent.  Bad health care at the most expensive price.  We have to
repeal and replace Obamacare” (Thomas, Lauren).

 New York Times analyzed new data that was
provided by the McKinsey Center for U.S. Health System Reform on weather or not
President Trump is correct about Obamacare premiums (Park, Haeyoun).  McKinsey says that he was right because the
median rise in premiums for bronze plans was 18 percent (Park, Haeyoun).  However, he was also wrong because “About
half of Americans who buy their own health insurance qualify for subsidies that
insulate them from the price increases. 
The subsidies are designed to increase if premiums rise.  For those customers, the cost of the
lowest-price silver plan may actually go down compared with this year in a
majority of counties” (Park, Haeyoun). 
New York Times believe he is partly to blame for these causes.  Their evidence was that Trump has tried to
end certain subsidies to insurers. 
Subsidies to insurers allowed them to give out discounts to low-income
consumers (Park, Haeyoun).  For them to
make up the lost funding they must increase the price of their plans.  Now that he has become president he is trying
to repeal and replace Obamacare yet again. 
One unexpected twist is that there are now some places that have the
gold plan less expensive than silver. 
Some of these places would be Kansas, Wyoming, Pennsylvania, and most of
Texas.

His
first attempt was called The Restoring Americans’ Healthcare Freedom Reconciliation
Act of 2015 (Restoring Americans’).  The bill, however, was passed by Congress on
January 8, 2016, but was later vetoed by Barack Obama on January 8, 2016 (Restoring Americans’). If passed it
would have repealed the federal budget, such as the premium tax credits and the
Medicaid expansion.  It would have also
suspended federal funding for planned parenthood for a year.  It is also known that if it was enacted the
changes would have gone into effect in 2018 (Restoring Americans’).  On
February 28, 2017, Trump gave congress five principles for Obamacare
replacement (Mangan, Dan).  His goal is to expand
choice, increase access, lower costs, and provide better healthcare
(Mangan, Dan).  Trump’s five key outlines to replace Obamacare included
first, “ensuring people with pre-existing health condition are guaranteed
“access” to health insurance, “and that we have a stable transition for
Americans currently enrolled in the health-care exchanged” (Mangan, Dan).
 Secondly, “Giving people who buy their own health coverage tax credits
and expanded health savings accounts to help pay for their coverage, as well as
flexibility about the design of their plans” (Mangan, Dan).  Thirdly,
“Give states “the resources and flexibility” in their Medicaid programs “to
make sure no one is left out” (Mangan, Dan).  Fourthly, “Legal reforms to
protect doctors and patients “from unnecessary costs” that drive up insurance
costs, and to bring down the price of high-cost drugs” (Mangan, Dan).
 Finally, “Creating a national insurance marketplace that allows insurers
to sell health plans across state lines” (Mangan, Dan). 

On
December 1, 2017, Republicans approved the repeal of Obamacare’s individual
mandate.  This is a huge step toward
ending the unpopular part of the health-care law (Sullivan, Peter).  Senator John Barrasso said, “Families ought
to be able to make decisions about what they want to buy and what works for
them – not the government.  I believe if
people don’t want to buy the Obamacare insurance, they shouldn’t have to pay a
tax penalty to the IRS” (Sullivan, Peter). 
During the voting, no democrat voted for the GOP tax bills (Sullivan,
Peter).  It was not Senate Finance
Committees original plan to repeal the mandate but President Trump and Senate
conservatives made a public push for its inclusion. Trump is eager to return to
the repeal and replace push now that the final tax bill passes.  In late October Trump tweeted, “We will
Repeal & Replace and have great Healthcare soon after Tax Cuts” (Sullivan,
Peter).  Also, Senator John Kennedy
believes that the mandate repeal puts the repeal and replacement a step closer.

 Its seem to be very unclear what the repeal of
the mandate will do to Obamacare.  The
Hill stated, “Many experts and health-care groups warn that repeal will
destabilize Obamacare markets, leading to premium increases or insurers simply
dropping out of certain areas.  Without a
financial penalty under the mandate for lacking health coverage, there is less
incentive for healthy people to sign up and balance out the costs of the sick”
(Sullivan, Peter).   The Congressional Budget Office found that
repealing this mandate saves $300 billion over ten years in subsidies that
would have originally been spent on consumers (Sullivan, Peter).  They also estimate that 13 million fewer
Americans will have health insurance over the next decade and premiums will
rise 10 percent (Sullivan, Peter).  Newsweek
stated, “If the mandate repeal does make it to the final bill, political
analysts have warned it could hit red states that voted for Donald Trump in
2016 hardest” (Porter, Tom). Many states only have one health insurance plan,
and residents could have zero healthcare options if insurers refuse to sell in
the market without a mandate.  LA Times
investigation showed that Alaska, Iowa, Missouri, Nebraska, Nevada, and Wyoming
would be the states at risk (Porter, Tom). 
However, the bill still has to pass the GOP- controlled House of
Representatives, whose tax reform bill does not include the mandate’s
repeal. 

If
the bill is pulled Republicans are planning a bi-partisan bill to secure
insurance markets (Porter, Tom).  Bipartisan
is the agreement or cooperation of two political parties that usually oppose
each other’s policies.  This could lead
to a conflict with anti-Obamacare GOP hardliners (Porter, Tom).  Many people have collaborated with one
another to create a bipartisan bill. 
Republican Senator Lamar Alexander and Democratic Senator Patty Murray
co-authored one which if passed, “would restore billions of dollars in subsidies
that health insurers use to reduce out-of-pocket costs for low income
Americans” said Newsweek (Porter, Tom).  A
second co-authored bill, by Maine Republican Susan Collins and Democratic
Senator Bill Nelson, would create a $4.5 billion fund to reimburse insurers for
covering health care for the sickest patients (Porter, Tom).  A health economist at the Kaiser Family
Foundation named Larry Levitt said, “Neither of these bills would do anything
to offset the increase in uninsured resulting from a mandate repeal.  The marketplaces would limp along without a
mandate but its probably not a stable place” (Porter, Tom).

            In conclusion, Obamacare should be
repealed and replaced.  This reason for
this is because there are more issues than there are pros.  One of the issues is that there is a lack of
insurance options.  Because of the lack
of insurance options, the less competition between them.  This leads to the rise in premiums and deductibles.  Also because of the Medicaid expansion,
states will have to raise taxes, boost health cost, or cut spending to cover the
costs of this so-called freebie.  Another
huge problem is Obamacare’s Independent Advisory Board also known as death
panels.  Just the nickname gives away how
bad it could be if not repealed.  The
15-panel members have to much power and control.  Even Congress cannot override them and they
can not be fired.  Donald Trump the
former president of the United States has even spoken out about his dislike of
Obamacare.  He has also given his reasons
for the disliking of it.  Trump likes to
talk about in his speeches about how deductibles and premiums are rising.  The repeal of the mandate is even proof that
we are one step closer to fully pushing the repeal of Obamacare.  His first attempt almost was a success but
Barack Obama vetoed the bill.  Which I
think is pretty unfair since he was the one who created it in the first
place.  Of course, he is going to veto a
bill that would ruin his act that he put hours into creating.  On the other hand, now that Barack Obama is
out of office and Donald Trump has taken his spot as President I believe there
is a good chance that this repeal of a mandate will be put into place.  It has already been approved by the
Republicans but it still has to pass GOP-controlled House of
Representatives.  This repeal shows that
we are one step closer to having it completely gone.  The new replacement bill that Donald Trump
has put together is to expand choice, increase access, lower costs, and provide
better healthcare.  This is much better than
Obamacare because they didn’t have many choices, high costs over the years, and
has overall never been a great healthcare.