Urban Affairs issue: Healthcare (Obama Care repeal)
Problem
Obamacare or Afford Care Act (ACA) is a health policy in U.S which was passed on March 2010 for the purpose of providing Americans with essential health services, affordable and quality health insurance. President Barack Obama focused on provision of quality care and health insurance coverage regardless of race, ethnicity and disability, and ensured the prevention of chronic diseases (Stack, 2016). However, ACA is a controversial issue in that the Republicans have created the agenda on repealing the ACA and they have created a slogan ‘Repeal and Replace’ (Stack, 2016). The big problem with the Republican is that they do not have an alternative while majority of American people argue that there should be no repealing without replacement. The problem with ACA arises since opponents argue the law on ACA is a ‘job killer’ and imposes high costs on business. Private businesses do not benefit from the insurance coverage and indeed, they view it as an unwarranted intrusion. Other problem is that since ACA is constitutional, states were forced to modify the programs on Medicaid and the federal government was required to add more funding to the State to enable them increase the number of people entitled to receive Medicaid (Stack, 2016). However, the court rules out the States may cease to provide Medicaid expansion and this is an indication that poor people were enforced to engage in private insurance. Insurance companies are experiencing a challenge in that fewer Americans are signing up and this is an indication that insurances costs are high and this continues to discourage people from participating. ACA subsidies are few and failure to sign in raises higher fines and discourages middle-income American from enrolling in plans (Stack, 2016). Other problem with ACA is that premiums and government subsidies will increase but the subsidies are not provided to Medicaid members.
The history of Obamacare helps us understand why it has failed. ACA is a debatable issue in political arena and in 2009 when the debate on legislation was high, Republicans were unified to resist and Democratic were unified to support it. In the Supreme Court, the law was changed through Medicaid expansion to cover the disabled and the poor people. The coverage expansion was also aimed to include the middle and lower workers (Stack, 2016. However, in 2014, health insurance exchanges become a heavy burden to insurers. The debate on ACA started back in 20th century when Americans presidents Theodore and Clinton showed their effort in implementing health insurance program though they failed. Medicaid was enacted in 1960s by President Lyndon for the purpose of providing health insurance to the old and disabled Americans (Stack, 2016. Children and families health insurance was also passed in 1997. In 2003, Medicaid programs were expanded to include the drug coverage. The major problem as to why America lacks a single payer system is due to capitalism. The latter is associated with government intrusion and both have contributed to problem of ACA.
Issues
Majority of Americans are involved in the intense national debate since they believe that the Obamacare is irreparably flawed. Opponents offer arguable points that ACA has contributed to several negative issues such as high cost for business and families, high taxation on middle-class and excessive spending on health care, unanticipated consequences among many other issues which will be discussed in the paper (Lichtenstein, 2017). The partisan process was successive in the creation of ACA and majority supported the law. However, survey data showed that after the enactment of the law, 39% favored the ACA while 49.3% were opponents. The issue raised was that even though the healthcare is affordable, majority of family pay 35% for healthcare. Individuals and business are experiencing the challenges of higher health care costs. Even though premiums have increased, individuals are not protected by previous coverage (Lichtenstein, 2017). ACA’s administration pose challenges to families and individuals and many of the problems are as a result of increasing costs of quality care, financing and more. Even though the ACA’s administration promised Medicaid expansion and additional enrollees, the expansion of Medicaid is still a substandard. The functionality of the main provisions present some issues in that initially, the ACA had ambitious agenda but the approaches used in solving problems have been ineffective. Problems arose in 2013 when the federal government introduced health insurance exchanges websites and this revealed operational problems and managerial failure. For example, there were managerial failures which were related with ineffective leadership, poor decision making and poor project tasks (Lichtenstein, 2017). The federal websites lacked effective management and as result, there was a flawed arrangement based on dealing coverage exclusion, there were high health insurance costs and the overall process of insurance subsidies was complex. The ACA is flawed in that the subsidy programs are not administrated effectively since enrolment on subsidy is measured by eligibility, income, family size and residency. Problems have been encountered by low-income enrollees in that there is inconsistence of data and fraud. In addition, there are unprecedented mandates in that in 2014, American cities were forced to sign in and purchase health coverage but the Obama administration was reluctant and showed exemptions and delays. Due to multiplying exemptions and failure of the administration to delay penalty provisions, out of 30million uninsured, 90% were not fined (Lichtenstein, 2017). In discussing the issue, it is important to understand that ACA is the root cause of centralized power which affects the efficiency and effectiveness of federal government. The problem with centralized power as related with economy is that it will be difficult to poses requisite knowledge which also makes it difficult to gain cost and quality. The key point which everyone should get from issues contributed by ACA is that families and business are negatively impacted in that the high insurance costs are a heavy burden to them. Despite the fact that president promised premiums increase by 10% 13%, there was a premium rate shock in 2014 (Lichtenstein, 2017). The latter led to the out-of pocket costs which are made by premiums and deductibles. For example, low cost premium plan moves together with higher deductibles and in this case, low middle-income workers are constrained when it comes to insurance choice.
Ponnuru (2017) asserts that repealing is ‘a risky Obamacare strategy’. For seven years now, Republic has not gained the power to repeal and replace the Obamacare. It is true to say that they have the power to repeal because huge support is coming from White House and house of Congress but they lack a strategic approach of making the repeal. The reason why there are some constraints in changing the Obamacare is that almost all Republic supports the end of ACA and they argue with philosophical and practical points of view. The same people fear that the end of ACA will negatively impact them since they will lose the health coverage. There is also a conflict between the republics since they do not agree on ‘replacement system’ (Ponnuru, 2017). Some argue on implementing catastrophic-insurance policies while others argue on implementing existing government policy or add free market policy. It is important to understand that repealing Obamacare will contribute to disastrous effects. Many will be uninsured according to an estimation which showed that repealing will make 24.0 million to uninsured and 19.4% in the whole population will be uninsured in 2021(Ponnuru, 2017). If ACA will be repealed, Medicaid enrollment will decrease. Since the enactment of ACA, 52.6 million are covered by Medicaid and Health Insurance Program for children and if the enrollment continues, 69.3million will be enrolled by 2021. However, repealing will only enroll 14.5 million. A big effect will be on Insurance Coverage since enactment will increase the Uninsured. Economic Policy Institute sates that repealing will affect spending and taxes which will be approximately $109billiuon federal spending cuts and $70billion taxes in 2019(Ponnuru, 2017). Both tax cuts and spending cuts will lead to economic damage where job growth will fall by 1.2 million in 2019. Other point to note is that repealing will affect the purchasing power of working people, and this is an indication that local economy will be affected since people will spend less. Decrease in spending will reduce job growth and about 20million people will lose health insurance (Ponnuru, 2017).
The Issue on Obamacare repeal has been addressed and the main solution which has been offered is related with ‘if ACA should be repealed, then there should be a replacement (GARLAND, 2017). However, failure to replace will be a big challenge to the American people. Furthermore, repeal and replace is not an effective method and it is irresponsible in that it will worsen the health care system. If repeal is done without replacement, there will be uncertainty and Republican must understand that insurance companies and Health Insurance Marketplace will increase the prices. In addressing the issue, the perception that has been used is that individuals and families should be allowed to make decision through a patient-centered system but ACA denies this system since it is strongly fixed on federal government system (GARLAND, 2017). The best solutions have been offered regarding the patient-centered system and to achieve the latter, Obamacare repeal should be implementing in order to allow people have personal ownership and gain free-market innovation. In addressing this issue, it has been found that the ACA is unaffordable and unworkable and so repeal will allow Americans control their health insurance and gain tax relief (GARLAND, 2017). However, the solutions offered in addressing the issue are not implemented since Republicans are in dilemma as they have not set healthy care structure. Current, the issue is on ‘repeal and delay’ and this is another serious issue which will lead to new problems.
Solutions
First, it is important to understand that Obamacare is rooted from federal power which raises dependence on government, federal micromanagement and tax hikes. In repealing and replacement, individuals are interested with a better system which is able to provide reliable coverage and quality care. However, even though majority focus on repealing, this strategy is not enough since it does not include serious reforms and the few reforms will not address the financing health. The solutions are identifying the root cause of problem and fix (Hathi & Kocher, 2017).This is because; the health-care system is effective in terms of medical innovation and majority of American people access advanced care which is supported by insurance arrangements. However, rising cost is a big challenge where government’s revenue is spent on economy rather than on health care and this has contributed to deficits and debts. Tax exclusion has also resulted to employer-purchased insurance which has hindered not only consumer market coverage but also cost and value. Now, the solution is developing an insurance reform through developing a ‘defined contribution’ (Hathi & Kocher, 2017). The latter means that assessing the financial health care system will be a key element in creating a market-based approach and allow consumers be cost-conscious. The government should also provide ‘premium support’ which allows consumers to have personal responsibility and individual mandate. To address the pre-existing condition, the federal government should promote individual insurance which will allow individuals to have affordable options. Reform should also correlate with States partnership (Hathi & Kocher, 2017). Under ACA, States embrace federally managed system which allows them to create new programs such as insurance exchange where they pose extra costs. The reform should encourage partnership and allow States adhere to national policy and unite in creating policy innovation, insurance-market reform and safety-net programs. Other reform should be related with employer-sponsored plans and address issues which have been brought by federal tax policy such as higher costs of health care, lack of secure coverage and transparency in financing, discrimination and favoritism. To address this, there should standard tax credit which provides choice for coverage (Hathi & Kocher, 2017). This approach will also develop consumer control and allow them to have control in the health-care marketplace. Finally, reform should be done on Medicaid since it does not provide high-quality coverage. Medicaid has also resulted to lack of quality health care especially the lower-income people. To address this, individuals should be provided with private health-insurances and this will enable them access quality care (Hathi & Kocher, 2017).
Recommendation
Thus, the best approach is to fix some weaknesses in the health care system and the big challenge to consider is the rising costs (DRUM, 2017). Majorities are unable to pay insurance and government is experiencing challenges due to high budgets. The Medicare is flawed due to its inefficiency and overuse and its effect on economy. Tax exclusion is another problem especially on workers’ taxable income, and this later affects the consumer market. Generally, the big problem which needs to be fixed rather than repealing is cost explosion. In other words, there should be ‘insurance reform’ and this reform will cover all the uninsured, will address the issue of costs explosion and address the insurance coverage on pre-existing conditions (DRUM, 2017). Note that cost-cutting innovations will lead to new structure of health system and there will be strong financial incentives and highly competitive market place, thereby increase productivity and quality of care. The role of public administration on this reform is to make effective decisions based on provision of quality services. For example, on the issue of controlling cost, professionals of healthcare administration will create health programs and develop strategic planning of government services. It is their role and accountability to bring a systematic improvement on financial, access and quality (DRUM, 2017).
Reference
Stack, S. J. (2016). Health Care Reform in the United States: Past, Present and Future Challenges. World
Medical Journal, 62(4), 153-157.
Hathi, S., & Kocher, B. (2017). The Right Way to Reform Health Care. Foreign Affairs, 96(4), 17-25.
PONNURU, R. (2017). A Risky Obamacare Strategy. National Review, 69(2), 16-18.
DRUM, K. (2017). Here's How to Save Obamacare. Mother Jones, 42(1), 19-21.
GARLAND, S. B. (2017). The Impact on Medicare of ACA Repeal. Kiplinger's Retirement Report, 24(3), 14-
15.
Lichtenstein, N. (2017). Who Killed Obamacare?. Dissent (00123846), 64(2), 121-129.
