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ObamaCare, Patient Protection and the Affordable Care Act, ACA – Yes, They’re All the Same Thing

By Anna Bailey

Early in 2016, the U.S. Department of Health and Human Services released a new report that an estimated 20 million people became insured under the 2010 federal statute called the Affordable Care Act (ACA), which was put in place by President Obama. In the coming weeks , Congress intends to take steps towards repealing ACA without proposing a replacement. With the historic all time low number of uninsured and the GOPs rush to repeal it, I think it’s important that we understand exactly what the Affordable Care Act is.

The Affordable Care Act is actually two separate pieces of legislation: Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010. Obama’s intention with creating the Act was to expand Medicaid coverage to low income Americans, create an online health insurance marketplace, let young Americans stay on their parents’ health insurance until age 26, and to put in place a mandate that requires everyone to purchase health insurance.

In a New England Journal of Medicine article, President Obama wrote, “Republican congressional leaders say they will repeal the ACA early this year, with a promise to replace it in subsequent legislation — which, if patterned after House Speaker Paul Ryan’s ideas, would be partly paid for by capping Medicare and Medicaid spending. They have yet to hold a hearing on it or produce a cost analysis — let alone engage in the more than a year of public debate that preceded passage of the ACA.” The debate, according to the GOP, will occur after ACA has been repealed: a repeal first, replace later approach which is, simply said by President Obama, irresponsible.

No one believes ACA is perfect – it needs work, but it is simply a skeleton to build upon. Challenges like “a lack of choice in some health insurance markets, premiums that remain unaffordable for some families, and high prescription-drug costs” can be changed by improvements, such as “allowing Medicare to negotiate drug prices that could both reduce seniors’ spending and give private payers greater leverage.” But generally, ACA enrollees are happy with their health insurance. The Commonwealth Fund, a private nonpartisan foundation that supports independent research, found that 82% of Medicaid and marketplace enrollees are “very satisfied” or “somewhat satisfied” with their plans, meaning that most enrollees were able to “find a doctor who accepts their plan and were able to see a doctor within 14 days of signing up.” Of course, this does not mean that enrollees are without frustration. Another survey from the Kaiser Family Foundation found that half of all enrollees aren’t happy with their deductible. Every month for the last seven years, the Kaiser Family Foundation has run a survey where they ask if Americans have favorable or unfavorable opinions about ACA and they’ve found that very little has changed in the public’s opinion — a nearly-even number of people who want to expand the law and those who want to repeal it entirely.

The problem is that ACA is very expensive. The nonpartisan Congressional Budget Office estimated that the ACA will cost about $1.34 trillion  over the next decade; currently the national deficit is well over $19 trillion, so taxpayers are rightfully concerned with the massive costs. Since ACA costs a fortune, the amount will be distributed through taxpayer support, which means that, as a taxpayer, you are responsible for a portion of the trillion or so dollars required to fund ACA. The bill is lengthy and almost unreadable to untrained eyes and many members of Congress haven’t even read the bill in its entirety, so it’s difficult for constituents to believe Congress has a right to impose a law on the public if they haven’t  read it nor understand it.

We do know, however, that a repeal would leave 30 million Americans without coverage and 52 million people with pre-existing conditions will face more risks under a Republican plan – prior to the Affordable Care Act, 27% of Americans would have been denied coverage due to their pre-existing conditions like cancer, being HIV positive, and acne. This isn’t to say that a Republican backed plan would again deny those people, but instead they would allow insurers to charge sick people more if they did not maintain “continuous coverage,” while currently the ACA prohibits charging sicker people higher premiums. Under ACA, the only factors insurers can take into account are where someone lives, how old they are and if they smoke.

The Obama Administration had hoped one-third of the marketplace enrollees would be between the ages of 18 and 34, but it’s only about a fourth – which is where Republicans are hoping to succeed. Republicans would invite younger Americans to the marketplace by allowing insurers to charge them significant lower premiums than the Affordable Care Act allows, so if this happened younger people would see their premiums go down, while older people would see their premium go up – some win and some lose.

No matter your stance on politics, no matter your political leanings, it’s clear that this is a train we cannot stop. If you think the Affordable Care Act should be improved instead of replaced, call your local representative, let your voice be heard. Your voice matters when it comes to your health.

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