(This article was last updated on October 30, 2015)
Obamacare Pros and Cons - Has Anything Changed?
Even though the Patient Protection And Affordable Care Act (ACA), which is also commonly known as Obamacare, has been passed into law, there are those who are against the Act. They want the Act repealed or changed. These people pay millions of dollars on ads and internet campaigns to turn Americans against the Act. They use “facts” that are stretched beyond recognition, so that Americans will turn against the Act. In the midst of all this anti-ACA campaigning, there must be a voice of reason. There must be a voice that will straightforwardly, without bias, point out the advantages as well as the disadvantages of the ACA. This is that straightforward voice. These are the pros and cons of the ACA.
It would be a mistake to not tell the millions of Americans who don’t understand anything that’s going on what the arguments against the ACA are. How can Americans make an informed decision without knowing all the data? To that end, the beginning of this explanation of the pros and cons of the ACA will include what both proponents of the Act as well as its detractors have to say. When we move on to the pros and cons, Americans will better understand how to weigh its benefits and disadvantages in relation to their own needs and lives.
What Proponents of the ACA Say
The original projections stated that there were 45 million people in the United States that need insurance. Undocumented uninsured people were estimated at 11 million. When the ACA was enacted and when the deadline was reached, the coverage goals exceeded the original goals. When the deadline closed, healthcare spending was noticeably down. By the end of the President’s term, the hope is that there will be only a small portion of people who will still be uninsured.
A Washington Post article celebrates the fact that even in states that refused to set up exchanges or expand Medicaid, sign-ups happened and other reports, including the Congressional Budget Office's projections, show that the numbers for the 2015 and 2016 Open Enrollment Period are set to increase greatly. The Post agrees that the ACA is working. In between all the finger pointing and aspersions being cast, the verdict is that more uninsured are expected to sign up for the ACA in the next enrollment term.
This is what the press had to say about the ACA, but what do other people say about the ACA? Research organization, The Rand Corporation, finds that dissent over the ACA is declining steadily. California’s Sterling Health Administration discusses in its blog the price of an HSA, or health savings account. ACA’s health savings accounts might be hard to detect on the website, but they are there, and they are priced at less than before the ACA was born.
Some Of The Pros Of Obamacare
With all that said, here are the pros of the ACA. As with anything, there are different facets and circumstances to be considered. With the ACA, there are health benefits as well as financial benefits. Keep in mind that the ACA is not an insurance company or specific type of policy, but is rather a regulation on what insurance companies may and must offer to people and at reasonable prices.
Significant Health Advantages Thanks To The Affordable Care Act
Ambulatory Patient Services
This is when folks walk into the doctor’s office, explain the problem, get a prescription or otherwise treat the problem and leave. Most all health insurance policies cover this.
Many policies cover drugs only as a separate subject. People have a choice of Generic Drugs or Brand Name Drugs, and they have a choice of a Copay. With ACA, plans will offer at least one drug in each class of drugs described in U. S. Pharmacopeia.
Already covered under most all plans, under ACA emergency room care cannot be denied even if the hospital is out of network.
Mental Health Services
This is not covered under most insurance plans. Under ACA, however, it is. People may pay a small fee, and in a few states, therapy visits may be limited to a few times per year.
Folks who have to be hospitalized will pay 20 percent, if they’ve already paid their deductible. This is what bankrupts people. Hospital costs include not just doctors, but testing, drugs, treatments as well as room and board. That adds up to more than most Americans can pay.
Car accidents, sporting accidents and other various types of injury can result in people needing to learn how to walk, talk and move around again. That’s during and after pain management and physical therapy. Often such sufferers need walkers, canes, wheelchairs, knee and back braces and so forth. Most insurance plans cover these.
Prevention and Wellness
The idea behind this innovation is to get people to see their doctors to gain advice and information before they get sick. This could include nutritional information, physical exercise information and lifestyle information in addition to the usual flu shots and other preventive measures like PAP smears, prostate tests and children’s wellness measures.
Labs Maternity And Newborn Care
Folks can be charged for tests and scans for diagnostic purposes. These range from $20 per test to 30 percent of the cost of an MRI.
Maternity And Newborn Care
Not covered under most insurance plans, the ACA decided that prenatal care was a preventive thing. Birth and newborn care were not usually covered. They are now. This will be a load off the shoulders of most new parents.
These are the ten essential points covered in the ACA. Insurance policies must meet these ten points. However, there are other health advantages to the ACA.
- If you have asthma, diabetes or another Pre-existing Condition, you cannot be denied health insurance.
- If you get sick, your health insurance can’t drop you.
- Women have access to breastfeeding support and supplies
- Women have access to domestic violence support
- Women have access to testing for gestational diabetes
- Women have access to DNA tests for high risk of HPV
- Women have access to testing and support for sexually transmitted infections like HIV
- Women have access to contraceptive methods and support
- Women have access to wellness visits
- Women not in the American mainstream such as lesbian-bisexual-transgender women and women of color will have greater access to health care insurance and community health centers
- Women with children under 19 with a pre-existing condition may not be denied coverage
- Young adults reaching the age of 26 may apply for coverage with the same insurance company as a stop-gap measure upon reaching age 26
- Young adults may also apply during open enrollment, a special enrollment of which insurance companies are mandated to inform young adults
- Young adults will be offered the same benefit package they had on their parents’ policy
- Young adults who are not married, not in school and not dependents on their parents’ tax returns must be covered
- Children have access to preventive care, hospitalization, tests and treatments as well as vision and dental care
Financial Advantages Thanks To Obamacare
- Women may not be charged more for the same coverage men get
- Women may not pay higher a Premium just because they are women
- Loopholes in the law have been closed, allowing America’s seniors to afford their medications
- Small business owners are getting tax credits, so they can provide employees with insurance
- Those at or below the poverty level, both individuals and families, will pay next to nothing for insurance premiums
- Out-of-Pocket Costs are severely capped
- Seniors will save on medication costs, as well as gain free preventive screenings
- Medicare spending has already been severely cut
- Tax credits may be paid at the time of purchase or at tax time, depending on the individual’s circumstances
Some of the Cons of Obamacare
Some people do not like change and particularly do not like the fact that the federal government is now telling them that they need to pay for something else - health insurance. There are a number of other cons to the ACA, which are listed below.
- If young people, ages 18-34, do not sign up for insurance the entire system will fail. The ACA relies on the young people to pay into the pot of premiums because they are less likely to take out of that pot to pay for claims because, quite simply, they are sick less often then their older counterparts.
- Now that insurance companies must now cover people no matter what, they may have to raise their rates slightly to the new risks they are taking on and typically avoided or dropped before the ACA was passed.
- Companies with more than 50 full-time employees must provide adequate health coverage to their employees. This may mean more money out of the company’s pocket, less full-time employees, or increased premiums costs coming out of the employee’s paychecks. Although there already many organizations both large and small that have actually found cost savings as a result of forcing their employees to shop for coverage in the general marketplace.
- Some companies are choosing not to hire new employees at all or to only hire on a part-time basis to avoid the insurance requirement.
- Pharmaceutical companies are being taxed to close the Donut Hole in Medicare and some detractors suspect that his will cause drug prices to increase for consumers.
- In order to conform to the ACA’s requirements, some insurance companies will be forced to cancel certain plans that their customers already had and liked.
The ACA requires an independent panel of people to review the Medicare program and figure out ways to make it more sustainable financially. The Act also requires that funds be cut from Medicare Advantage (Medicare Part C plans), which may force many insurance companies to discontinue those plans from the market.
Do the Pros of the ACA Outweigh the Cons?
There may never be a consensus as to whether the pros of Obamacare outweigh the cons of the program; however, there are plenty of opinions on the subject. The Journal of the American Medical Association published an article in November 2013, a portion of which states that up until that point, the ACA was a welcome thing. A study done by the Heritage Foundation, however, found the burden on the dreadfully understaffed medical community when the ACA covered 30 million people would be nearly unbearable once the entire population of uninsured people entered the market. That included the medical community and the patients. However there is even more recent speculation that much of the non-life threatening emergency services that are often what keep people waiting for hours in the emergency room of their local hospital, much of that will be handed by urgent care centers. In fact a number of new urgent care businesses are popping up across the nation. A great resource for information on urgent care centers can be found at the UrgentCare.com urgent care locations tool that they provide free of charge.
The opinions of young people, most of whom may feel secure in the fact that they will be covered after all, think well of the ACA. Other folks don’t.
The press has their opinion as well. NBC News thinks that entrepreneurs will benefit from ACA. The Huffington Post reports a mixed bag, meaning that some say the ACA is working and some say the opposite. Forbes, meanwhile, thinks that even though the ACA is a good idea, it will hit business, especially small businesses, hard.
Seniors stand to gain significant savings from the ACA. National Public Radio, or NPR, offers very plain answers to most questions of interest to seniors. Townhall.com, on the other hand, thinks the ACA is a disaster for seniors.
There is significant evidence that the ACA is working right now, but there is worry for the coming ten years over which the ACA stretches when certain portions of the bill will come due. The evidence comes from all walks of life, from financial centers to research entities and from the medical community to the people they treat. Keep in mind that the Act has only just been set in motion and it will most certainly have its share of bugs that will need to get worked out.
Let us not forget as well, that the ACA has ten years in which to work out those bumps and bugs from all pertinent points of view. Americans who have no idea what is going on may now make a better-informed decision as to health care insurance, based on their own circumstances and needs, that really is what the ACA is all about.
We hope that this straightforward voice of reason helps cut through the thousands of words to give Americans a clearer view of the ACA and its advantages and disadvantages.