Approved in 2010 and reaffirmed by popular acclamation through Barack Obama’s November 2012 reelection, I am puzzled by the persistent Republican attempts to sabotage the implementation of the Affordable Care Act – aka Obamacare— through backdoor tactics culminating in the current government shut down.
“A faction of House Republicans is refusing to approve the US budget unless funding to implement Obamacare is removed … More worrisome, it could lead the US government to start defaulting on its debts by mid-October” according to global health expert Gina Lagomarsino.
Why would Republicans go to these lengths to undermine a policy initiative that only seeks to grant universal health coverage to all Americans? What continues to motivate them after initially opposing its passage into law, after unsuccessfully challenging its constitutionality in the Supreme Court in 2012, after voting 42 times to repeal it, and now this!
So entrenched is the Republican opposition that even amidst ongoing attempts to negotiate a compromise out of the ongoing government shutdown crisis, Senate Minority leader Mitch McConnell has clearly indicated that the fight over health care is far from over, adding, “This law is ravaging our economy, killing jobs, driving up premiums and driving people off the coverage they have, and like, in droves”
So what are the current deficits of the US healthcare system that Obamacare hopes to address?
Firstly at 18% of GDP (Gross Domestic Product), the US healthcare system is seen as overly expensive. Secondly, over 50 million Americans totally 16% of the population do not currently have access to health insurance. While those over 65 years are covered by government under Medicare, Americans less than 65 years whose employers are unable to purchase insurance for them may struggle to personally purchase insurance on account of high premiums. Premiums become crippling if the person seeking insurance have an existing health condition. Thirdly, insurance companies are currently allowed to deny coverage or charge significantly higher premiums to people with already existing health problems in an attempt to address adverse selection. Finally, the “near poor” virtually get no help from government. While very low income Americans may qualify for and be covered by state and federal government-funded Medicaid, people with incomes slightly above the lowest are left out despite also being unable to purchase their own insurance in some cases. This is especially so if their employer’s are unable to pay or they themselves have an underlying health condition.
How does Obamacare propose to address the above conundrum?
First of all, the Affordable Care law has made illegal the ability of insurance companies to deny coverage and to charge increased premiums to people with preexisting health conditions. This implies that without having to pay extra premiums, even if people choose to purchase insurance at the point of ill health, there would be no incentive for healthy people to buy insurance thereby making the insurance companies attract a lot of so called high risk clients who will end up financially endangering the insurance companies. To counter this, the Affordable Care Act makes it mandatory for all Americans to buy insurance effective January 2014 or pay a tax penalty. Since the very poor may not be able to afford the premiums, Obamacare provides subsidies for households with incomes up to four times the poverty level.
Obamacare is thus summarized as follows: all Americans to get insured or pay tax penalty, insurers prevented from denying coverage or overcharging sick people and provision of subsidies for the lowest income population.
To a large extent, opposition to Obamacare is mainly rooted in ideology, namely that Obamacare ushers us into the era of big government “taking over.” Republicans argue that individuals should be responsible and not overly reliant on government. Of most interest is the angle where the requirement for each citizen to buy insurance is seen as an infringement of individual liberties. Further, although economic models used by the US Congress predict no serious escalation of costs, there are those not necessarily beholden to ideology who believe that Obamacare will worsen healthcare costs.
More interestingly, Obamacare proposes an integrated care approach that aims at addressing quality and cost concerns simultaneously. As explained by Gina Lagomarsino, “the new law encourages the development of Accountable Care Organizations (ACOs), integrated private delivery organizations that offer a full range of care from primary care to hospitalizations. ACOs are accountable for the quality, appropriateness and efficiency of care for an assigned population of patients, and can share any cost-savings with the payor. The hope is that this new organization and payment model will encourage integrated, well-coordinated care and reduce medical cost-inflation because providers will do better financially if they focus on quality rather than increased volume of services.”
In Ghana, with politicians across the divide securing consensus on a national health insurance scheme driving towards universal coverage, and with private health insurance schemes still at very nascent stages, we are unlikely to get locked into this crippling ideological morass. Possible areas of focus for us will be to evolve interventions for increasing registration into the scheme, while taking urgent steps to address the worrying issue of declining active membership and finally, addressing concerns on quality of care.
As for Obamacare, I believe it is timely and necessary with right motivations. After all, onipa nua ni nipa! I encourage President Obama to stay focused and not allow his political agenda and health reforms to be derailed by these Republicans who similarly sabotaged President Clinton’s health care reforms in 1994.