Obamacare, or the Affordable Care Act (ACA), was a controversial bill. Even now, a decade after the bill’s passage, many conservatives still hope to overturn Obamacare. Why was the bill so divisive? Did the negative effects predicted by the political right come to pass?
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Effects on Hospitals and Clinics
For some healthcare facilities, the ACA provided a steady source of funding. Instead of scrambling for donations, clinics and hospitals that serve low-income patients could instead help their community enroll in the expanded Medicaid coverage. By offering health insurance to more people, Obamacare increased the government funds available for community-based healthcare facilities. On the other hand, Medicaid offers famously low reimbursement rates to providers, putting financial pressure on some hospitals that were already operating on a razor-thin budget and forcing hospital administrators to raise prices for middle-income patients to compensate.
The Individual Mandate
The purpose of health insurance is to spread the cost of care across a large pool of participants with diverse ages and backgrounds. In an ideal system, many people pay premiums, the health insurance company takes a small piece of the pie for administering the system and a small subsection of enrollees needs large amounts of care due to bad luck or bad choices. In reality, many healthy people either don’t want or can’t afford to enroll in health insurance programs. This creates a problem for the health insurance company. If only sick people enroll in health insurance, the insurance company may need to pay more for care than it collects in premiums. The ACA addressed this issue with the individual mandate, which required all Americans to purchase health insurance or pay a tax penalty.
Rising Healthcare Costs
The Affordable Care Act was supposed to lower the overall cost of healthcare. However, as many conservatives predicted, healthcare costs continue to increase. According to Investopedia, some consumers have seen increasingly expensive healthcare premiums, with prices varying wildly by state. Of course, liberals could argue that premiums would have increased even more without the ACA, although it’s hard to prove or disprove that position.
Increased Government Reliance
One key conservative argument against Obamacare was opposition to increasing the role of the federal government. Conservatives often argue for reducing or eliminating “entitlement programs” like Social Security, Medicare, and Medicaid and instead allowing the free market to offer solutions. The passage of the ACA expanded Medicaid, a healthcare program for people with low income, and now even conservative voters are hesitant to roll back this form of government assistance, as the BBC captured in a visit to coal country in Appalachia. Whether this change is a positive outcome or another disaster of Obamacare is a matter of perspective.
The next generation of healthcare leaders, public health officials and nurse administrators will have plenty to do to improve healthcare in the United States. The Affordable Care Act started off as a transformative idea, but after months of political negotiating, it ended up as a much more modest bill than originally intended. While Obamacare did not fix all of the problems it set out to solve, it was also not the absolute disaster that many conservatives predicted it would be.